Alcohol-Related Seizures
Section snippets
Alcohol withdrawal seizures
Chronic alcohol consumption affects central α-adrenergic and β-adrenergic receptors, the inhibitory neurotransmitter γ-aminobutyric acid, and dopamine turnover. The hallmark of alcohol withdrawal is CNS excitation with increased levels of cerebrospinal fluid (CSF) and plasma and urinary catecholamine.6, 7 The withdrawal syndrome develops 6 to 24 hours after the reduction of ethanol intake and usually lasts for 2 to 7 days. The alcohol withdrawal state ranges from mild withdrawal with insomnia
New-Onset ARS
Patients with new-onset ARS must be thoroughly evaluated, including alcoholic patients who claim to have had seizures in the past but for whom no documentation of previous seizures or of an appropriate workup is available. Possibility of metabolic disorders, toxin ingestion, infection, and structural abnormalities is ruled out by history, physical examination, and laboratory testing, including the estimation of levels of electrolytes, serum urea nitrogen, creatinine, glucose and computed
New-Onset Partial Seizure
Partial (focal) seizures are reported to account for up to 24% of ARS. Conversely, studies have shown that 17% to 21% of patients with partial ARS have structural lesions (hematomas, tumors, or vascular abnormalities).17 These primary causes of partial ARS, such as prior head trauma, may be missed in the history taking. As a result, an emergent CT scan is indicated to evaluate new-onset partial seizures.
The patient with a documented history of focal ARS, who has been previously evaluated does
Management
Historically, up to one-third of patients with AWS progressed to delirium tremens because of inadequate treatment. Currently, this proportion has decreased to less than 5% with early aggressive benzodiazepine therapy.18
An intravenous line of normal saline should be established. If the patient has an altered mental status, administration of thiamine, magnesium, dextrose, and naloxone should be considered. Empirical glucose bolus dosing should not be prescribed if a prompt and accurate
Phenytoin/anticonvulsant conundrum
Phenytoin has no significant benefit over placebo in preventing recurrence of AWS.1, 37 Considering the risks of phenytoin and no demonstrated benefit in the setting of AWS, it is not indicated for the treatment of AWS. The sudden withdrawal of phenytoin administration may induce the convulsive effects of alcohol withdrawal. Withdrawal seizures may occur in epileptic patients withdrawn from phenytoin treatment. In patients with status epilepticus, alcohol and noncompliance with anticonvulsant
Future directions
In this age of computerized medicine, it will soon be possible to have a complete medical history on even the most obtunded ED patient. This advancement will go a long way in helping the emergency physician determine if the alcohol-related seizure is an isolated event or a recurrent problem. It will help determine if the patient an epileptic whose presentation is complicated by alcohol or if alcohol is the sole problem. This kind of comprehensive history should help reduce the cost of emergency
Summary
Alcohol kills the person who consumes it and it kills unintended victims by the acts of inebriated persons. Whatever medical, traumatic, psychological, or social problem brings an alcoholic patient to the ED, the underlying problem is alcoholism and the ultimate goal is abstinence. Most municipalities have either an Alcoholics Anonymous chapter or a treatment center for anyone who desires help with alcohol. In small communities, clergy or social workers can usually arrange rehabilitation
Acknowledgments
The authors wish to thank Alisha Miles and Laurie Hodgen for their research on this project.
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Cited by (18)
Alcohol dependence and physical comorbidity: Increased prevalence but reduced relevance of individual comorbidities for hospital-based mortality during a 12.5-year observation period in general hospital admissions in urban North-West England
2015, European PsychiatryCitation Excerpt :Furthermore, this AD sample was highly loaded with neurological and circulatory diseases. The high OR of epilepsy in individuals with AD compared to controls points to a complex interaction between alcohol withdrawal seizures and other causes of epileptic seizures in individuals with AD [2,7,30,33,52,53]. Herewith consistent, the prevalences of cerebrovascular disease, ischemic stroke, and non-specific dementia were increased in individuals with AD compared to controls.
Molecular and neurologic responses to chronic alcohol use
2014, Handbook of Clinical NeurologyCitation Excerpt :However, in more severe cases, individuals may need to be withdrawn from alcohol under medical supervision (Hall and Zador, 1997). Alcohol abuse accounts for 20–40% of all new-onset seizures seen in emergency departments, particularly in male patients between 30 and 60 years of age (Tardy et al., 1995; McMicken and Liss, 2011). Additionally, another large clinical study showed that alcohol use was one of the four leading etiologies for status epilepticus (Lowenstein and Alldredge, 1993).
DISORDERS OF THE CENTRAL NERVOUS SYSTEM
2022, Karch's Drug Abuse Handbook: Third EditionAcute symptomatic epileptic seizures due to internal diseases and noxious agents
2021, Zeitschrift fur Epileptologie