Does Alcohol Withdrawal Cause Seizures?
Does alcohol withdrawal cause seizures?
A withdrawal seizure usually arrives on the second day, without warning, to someone who thought they were getting through the worst of it.
A withdrawal seizure usually arrives on the second day, without warning, to someone who thought they were getting through the worst of it. Heavy drinking builds tolerance, and tolerance turns into dependence. At that point it becomes 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. Withdrawal can lead to seizures. Not everyone who goes through withdrawal has one.
How common they are
Not everyone in alcohol withdrawal has a seizure. About one in ten people going through withdrawal will have one. They usually begin one to two days after the last drink, and they are usually tonic-clonic seizures.
Also called grand mal seizures. The muscles stiffen, then twitch and jerk. Someone having a tonic-clonic seizure loses consciousness and may have trouble breathing.
Where seizures fall in the stages
Seizures make more sense once you know the stages of alcohol withdrawal. The initial withdrawal symptoms, which begin six to 12 hours after a person stops drinking, are relatively mild: raised blood pressure and heart rate, sweating, tremors, nausea, vomiting. After those, hallucinations can follow, visual or auditory or tactile, 12 hours to one day after the last drink.
When do alcohol withdrawal seizures begin?
Seizures begin in the third stage of alcohol withdrawal , one to two days after the last drink. In severe cases a patient develops delirium tremens, which can be fatal and which typically appears three to four days after the last drink. DTs bring psychosis, hallucinations, dangerously high blood pressure, a raised body temperature, more seizures, and sometimes coma. For about a third of patients with delirium tremens, it is the initial withdrawal seizures getting worse.
As many as half of people with an alcohol use disorder go into withdrawal when they stop drinking, and most of those symptoms are mild and pass on their own without medical treatment. A patient who progresses to seizures needs medical care, because a seizure can be an early sign of delirium tremens.
Who is at risk
About 10 percent of patients have a seizure while detoxing, so most people do not. Some things make it more likely. Withdrawal is more severe in people who have been through it before, because of a process called kindling, where the nervous system becomes more and more overactive with each round of withdrawal. A long history of drinking and repeated withdrawals raises the odds of a seizure the next time.
There are other risk factors for alcohol withdrawal seizures: brain lesions, an epilepsy diagnosis, the use of other substances. Older age and cigarette smoking are also linked to alcohol withdrawal seizures.
What causes the seizures
Risk factors say who. The neuroscience says why. Alcohol slows the nervous system down. It increases the effect of a brain chemical called GABA, which relaxes you, and it decreases the action of glutamate, which excites the nervous system.
Over time the nervous system adapts, and that adaptation is tolerance. Stop drinking and the balance goes, which is what withdrawal symptoms are. Each round of withdrawal leaves the system more sensitive, which is why people who have detoxed several times are the ones most likely to seize.
Treating a withdrawal seizure
Anyone who has an alcohol withdrawal seizure needs medical treatment, because seizures can progress to delirium tremens, which can be life-threatening without prompt treatment. A seizure means the withdrawal is severe, and severe withdrawal belongs in a hospital.
Benzodiazepines, a class of prescription drug, prevent seizures from developing, and they are the standard treatment once a seizure has happened. A patient treated for withdrawal seizures should expect benzodiazepines.
A first seizure puts a patient at risk of more. That is why treatment with benzodiazepines starts immediately, to stop further seizures and the complications that come with them. The specific benzodiazepine usually chosen is diazepam . If a patient looks to be progressing to delirium tremens, doctors may combine diazepam with a drug called clomethiazole to treat seizures.
After the seizure
Once the seizure is treated and the risk of delirium tremens has passed, the drinking underneath it still needs treating. That can include support groups like Alcoholics Anonymous, or individual counseling, such as cognitive behavioral therapy, where people learn coping skills and the tools to prevent relapse.
How severe the misuse is decides the setting. Someone with a safe place to live and support around them can do well in outpatient treatment for alcohol misuse. Someone with a more severe addiction, or several rounds of withdrawal behind them, usually does better in an inpatient or residential treatment program.
Whichever setting is chosen after medical care for withdrawal seizures, remember that detoxing from alcohol and getting care for the seizures is only the first step toward sobriety. Alcohol misuse does not always cause serious side effects like alcohol withdrawal seizures. People who misuse alcohol can have them, and an untreated seizure can be fatal. Alcohol misuse can also cause permanent nerve damage, which brings on alcohol-related seizures even when a person is not in withdrawal. For some people a seizure is what finally pushes them into treatment and toward a life free of alcohol.
Are you or someone you love going through alcohol withdrawal? Pines Recovery Life provides medical treatment for alcohol withdrawal. Contact us today with questions or verify insurance to confirm coverage.
Sources and additional resources
- httpss://www.sciencedirect.com/science/article/abs/pii/S0736467906003192
- httpss://link.springer.com/article/10.1007/s00702-012-0825-8
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Frequently Asked Questions
Can alcohol withdrawal cause seizures?
Yes. Alcohol withdrawal seizures occur in roughly 5 to 10% of people in moderate-to-severe alcohol withdrawal who are not medically managed. They typically appear 12 to 48 hours after the last drink.
When do alcohol withdrawal seizures happen?
Most often 12 to 48 hours after the last drink, though they can happen earlier in patients with prior withdrawal seizures or severe long-term dependence. They are often grand mal (generalized tonic-clonic) seizures.
Are alcohol withdrawal seizures dangerous?
Yes. They can cause head injury or aspiration, and rarely sudden death. They also predict progression to delirium tremens. Anyone who has had a prior withdrawal seizure is at much higher risk for another.
How are alcohol withdrawal seizures prevented?
Long-acting benzodiazepines (chlordiazepoxide, diazepam, lorazepam) given on a symptom-triggered or scheduled basis. Started early and dosed adequately, they prevent seizures in nearly all patients.
Who is at highest risk for withdrawal seizures?
People with daily heavy drinking for several months or more, prior withdrawal seizures, prior DTs, age over 30, dehydration, electrolyte imbalance, and co-occurring sedative or benzodiazepine use.
Should I detox at home if I am at risk?
No. Anyone at risk for withdrawal seizures should detox under medical supervision. Pines provides 24/7 physician-supervised detox with continuous monitoring and immediate access to seizure-prevention medications. Call (855) 981-8935.
