Neuroscience Clerkship

 
 

 

CHARACTERIZATION OF ALCOHOL WITHDRAWAL SEIZURES
Of the many causes of seizures, alcohol withdrawal is one of the most common. Many times, alcohol withdrawal seizures first present after a patient is admitted to the hospital for another reason. In this case, the patient is suddenly taken away from their alcohol. Many times, the family is not aware of the patient’s alcohol intake and the patient themselves may deny excessive alcohol intake
 
Alcohol withdrawal seizures are characterized by the following:
 
•     Patients typically must have abused alcohol on a daily basis for at least three months or have consumed large quantities for at least a week.
 
• Often, patients have other symptoms and signs of withdrawal (anxiety, paresthesias, tremor, chills, sweats, fevers, palpitations, insomnia, etc.).
 
• Seizures are usually the brief, generalized, tonic-clonic type, without an aura.
 
• 50% of the time, the seizure is a single event. When multiple seizures are present, they tend to occur in short bursts (so-called "rum fits") of 1-3 seizures with a short post-ictal period.
 
• They typically occur 6-48 hours after the last drink taken, and are almost exclusively seen within seven days of the last drink.
 
• Incidence peaks 24 hours following the most recent ingestion.
 
• Most seizures terminate spontaneously but are easily treated by benzodiazepine administration.

Please note:


Alcohol withdrawal seizures are not the same as delirium tremens (DTs), which is a life-threatening condition. DTs usually begins 48-96 hours after cessation of alcohol (later than alcohol withdrawal seizures). DTs involve profound confusion, hallucinations, and severe autonomic nervous system overactivity. Significant dehydration is possible because of intense diaphoresis, hyperventilation, and restricted oral intake.

Also keep in mind that alcoholics may have seizures from other etiologies, among them head trauma, Wernicke's encephalopathy, and infection (the latter from a compromised immune system).