While people can safely enjoy moderate amounts of alcohol without becoming addicted, those who drink heavily may develop a tolerance for alcohol and eventually become dependent on it. In some cases, heavy alcohol use can lead to a clinical condition called an alcohol use disorder.

One symptom of an alcohol use disorder, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), is withdrawal. This happens when a person stops drinking and experiences uncomfortable symptoms such as sleep problems, nausea, and tremors as alcohol leaves the body. In some cases, alcohol withdrawal can lead to seizures, but not everyone who undergoes withdrawal will have a seizure.

Prevalence of Alcohol Withdrawal Seizures

While not everyone who experiences alcohol withdrawal will suffer from seizures, a 2015 report in the journal Drugs indicates that about one-tenth of patients undergoing withdrawal will have a seizure. Seizures from alcohol withdrawal typically begin one to two days after a person has his or her last alcoholic beverage, and they are usually tonic-clonic seizures.

Also called grand mal seizures, this type of seizure involves muscle stiffening as well as twitching and jerking motions, according to Johns Hopkins Medicine. A person suffering a tonic-clonic or grand mal seizure will become unconscious and may have difficulty breathing.

Seizures and Stages in the Alcohol Withdrawal Process

To better understand the development of alcohol withdrawal seizures, it is helpful to learn about the various stages of alcohol withdrawal. According to the report in Drugs, initial withdrawal symptoms, which begin six to 12 hours after a person stops drinking, are relatively mild and include elevated blood pressure and heart rate, sweating, tremors, and nausea/vomiting. Following these symptoms, a patient may develop visual, auditory, and tactile hallucinations 12 hours to one day after giving up drinking.

When do alcohol withdrawal seizures begin?

It is in the third stage of alcohol withdrawal that seizures begin, one to two days after the patient consumes his or her last alcoholic beverage. In severe cases, a patient may develop a potentially fatal condition called delirium tremens, which typically appears three to four days after the last alcoholic drink. This condition involves psychosis, hallucinations, dangerously high blood pressure, elevated body temperature, more seizures, and in some cases, coma. Per the authors of the report in Drugs, one-third of patients with delirium tremens are simply suffering from a worsening of initial withdrawal seizures.

Fortunately, while research shows that as many as half of patients with alcohol use disorders develop withdrawal when they stop drinking, most symptoms are mild and fade away on their own without medical treatment. That being said, a patient who progresses to seizures should seek medical care, especially since these seizures can be an early sign of delirium tremens.

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Who is at Risk for Alcohol Withdrawal Seizures?

As indicated previously, not everyone who undergoes alcohol withdrawal will experience seizures, as only 10 percent of patients suffer an alcohol withdrawal seizure while detoxing. While a relatively large portion of people do not have a seizure, certain risk factors can make someone more likely to experience seizures. For example, experts report that withdrawal symptoms are more severe among people with previous cases of alcohol withdrawal, due to a process called kindling, in which the nervous system becomes extremely overactive from repeated withdrawal. Someone who has a long history of alcohol abuse and who repeatedly undergoes withdrawal may therefore be more likely to suffer from a seizure when giving up drinking.

According to a 2006 publication of The Journal of Emergency Medicine, there are additional risk factors for alcohol withdrawal seizures. These include brain lesions, having an epilepsy diagnosis, and the use of other substances. Another report, included in a 2012 edition of Biological Psychiatry, found that older age and cigarette smoking were linked to alcohol withdrawal seizures.

What Causes Seizures during Alcohol Withdrawal?

Certain risk factors explain who is more likely to have a withdrawal seizure, but neuroscience indicates why these seizures occur. According to scientists writing for the professional journal Drugs, alcohol consumption slows the activity of the nervous system by increasing the effects of a brain chemical called GABA, which has a relaxing effect, while at the same time decreasing the actions of glutamate, which excites the nervous system.

Over time, the nervous system adapts to these changes, resulting in tolerance. When a person stops drinking, it becomes unbalanced, resulting in alcohol withdrawal symptoms. With repeated withdrawal, the nervous system becomes especially sensitive, which is why someone who undergoes multiple rounds of alcohol withdrawal is more likely to experience seizures.

Treating Alcohol Withdrawal Seizures

Someone who experiences an alcohol withdrawal seizure is in need of medical treatment, especially given the fact that seizures can progress to delirium tremens, which can be life-threatening without prompt treatment. Since seizures represent a more severe form of alcohol withdrawal, those who experience them should be treated in a hospital setting.

According to experts writing for a 2003 publication of CNS Drugs, a type of prescription drug called benzodiazepines prevents seizure development. They are also the gold standard for treating withdrawal seizures, according to experts from the Post Graduate Institute of Medical Education and Research and the ESIC Medical College and Hospital in India. A patient who receives treatment for withdrawal seizures can expect to receive benzodiazepine medications.

One important fact to consider is that patients who have an initial withdrawal seizure are at risk for having additional seizures. Experts therefore recommend that patients who have a seizure receive immediate treatment with benzodiazepines to prevent further seizures and complications. A specific type of benzodiazepine called diazepam is typically the drug of choice for treating seizures. Furthermore, if a patient seems to be progressing to delirium tremens, doctors may use a combination of diazepam and a drug called clomethiazole to treat seizures.

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Life After an Alcohol Withdrawal Seizure

Once a patient receives treatment for withdrawal seizures to prevent complications or progression to delirium tremens, it is important that he or she receive treatment for the underlying alcohol abuse. This treatment may include support groups like Alcoholics Anonymous, or individual counseling, such as cognitive behavioral therapy, where people can learn coping skills and develop the tools to prevent relapse.

Depending on the severity of a person’s alcohol abuse, treatment may occur on an inpatient or outpatient basis. Those who have a safe place to live, as well as support in the community, may be successful in outpatient treatment for alcohol abuse. On the other hand, someone who has a more severe addiction or who has undergone multiple rounds of alcohol withdrawal may fare better in an inpatient or residential treatment program.

Regardless of the treatment setting chosen after receiving medical care for alcohol withdrawal seizures, it is important to remember that detoxing from alcohol and receiving care for seizures is just the first step in achieving sobriety. Alcohol abuse may not always result in serious side effects like alcohol withdrawal seizures, but the reality is that those who abuse alcohol can experience seizures, which can be fatal if untreated. In addition, some research shows that alcohol abuse can cause permanent nerve damage, leading to alcohol-related seizures, even when a person isn’t in a state of withdrawal. For some people, these seizures may be an impetus that motivates them to begin treatment and embark upon a journey toward an alcohol-free lifestyle.

Are you or a loved one experiencing alcohol withdrawal symptoms? We can help! Pines Recovery Life Detox, one of Florida’s premiere drug and alcohol detox facilities, specializes in medical treatment of alcohol withdrawal. Contact us today with questions or verify insurance to confirm coverage.