Seizures in Alcohol-Dependent Patients

Epidemiology, Pathophysiology and Management

Abstract

The relationship between alcohol and seizures is complex and multifaceted. The prevalence of epilepsy in alcohol-dependent patients of western industrialised countries may be at least triple that in the general population, whereas the prevalence of alcoholism is only slightly higher in patients with epilepsy than in the general population.

The seizure threshold is raised by alcohol drinking and declines on cessation of drinking. As a result, during withdrawal from alcohol, usually 6–8 hours after the cessation of drinking, seizures may occur. Alcohol acts on the brain through several mechanisms that influence seizure threshold. These include effects on calcium and chloride flux through the ion-gated glutamate NMDA and GABA receptors. During prolonged intoxication, the CNS adapts to the effects of alcohol, resulting in tolerance; however, these adaptive effects seem to be transient, disappearing after alcohol intake is stopped. Although the relationship of seizures to alcohol use is likely to be dose dependent and causal, the available clinical data do not suggest that alcohol use results in seizure genesis. However, a genetic predisposition to alcohol withdrawal seizures is possible. Other seizures in alcohol-dependent individuals may be due to concurrent metabolic, toxic, infectious, traumatic, neoplastic and cerebrovascular diseases and are frequently partial-onset seizures. Alcohol abuse is a major precipitant of status epilepticus (9–25% of cases), which may even be the first-ever seizure type.

Prompt treatment of alcohol withdrawal seizures is recommended to prevent status epilepticus. During the detoxification process, primary and secondary preventative measures can be taken. A meta-analysis of controlled trials for the primary prevention of alcohol withdrawal seizures demonstrated a highly significant risk reduction for seizures with benzodiazepines and antiepileptic drugs and an increased risk with antipsychotics. A meta-analysis of randomised, placebocontrolled trials for the secondary prevention of seizures after alcohol withdrawal showed lorazepam to be effective, whereas phenytoin was ineffective. Because withdrawal seizures do not recur if the patient remains abstinent, long-term administration of antiepileptic drugs is unnecessary in abstinent patients. The first seizure not related to alcohol withdrawal should not result in permanent drug treatment in an alcohol-dependent patient, because of poor compliance and the high likelihood of remission. The treatment of alcohol dependence is more important and should be prioritised before the prevention of further seizures.

This is a preview of subscription content, access via your institution.

Table I
Table II
Table III
Table IV
Table V

References

  1. 1.

    Yamane H, Katoh N. Alcoholic epilepsy: a definition and a description of other convulsions related to alcoholism. Eur Neurol 1981; 20: 17–24

    PubMed  CAS  Article  Google Scholar 

  2. 2.

    Hauser WA, Ng SKC, Brust JCM. Alcohol, seizures, and epilepsy. Epilepsia 1988; 29Suppl. 2: S66–78

    PubMed  CAS  Article  Google Scholar 

  3. 3.

    Lloyd G. Hippocratic writings. Middlesex: Penguin Books, 1978

    Google Scholar 

  4. 4.

    Lennox WG. Alcohol and epilepsy. Q J Stud Alcohol 1941; 2: 1–7

    CAS  Google Scholar 

  5. 5.

    Huss M. Alcoholismus chronicus eller chronisk alkoholssjukdom: ett bidrag till dyskrasiernas kannedom, enligt egen och andras erfarenhet. Stockholm: Johan Beckman, 1849

    Google Scholar 

  6. 6.

    Victor M, Brausch C. The role of abstinence in the genesis of alcoholic epilepsy. Epilepsia 1967; 8: 1–20

    PubMed  CAS  Article  Google Scholar 

  7. 7.

    Earnest MP, Yarnell PR. Seizure admissions to a city hospital: the role of alcohol. Epilepsia 1976; 17: 387–93

    PubMed  CAS  Article  Google Scholar 

  8. 8.

    Hillbom M. Occurrence of cerebral seizures provoked by alcohol abuse. Epilepsia 1980; 21: 459–66

    PubMed  CAS  Article  Google Scholar 

  9. 9.

    Kramholz A, Grufferman S, Orr ST, et al. Seizures and seizure care in an emergency department. Epilepsia 1989; 30: 175–81

    Article  Google Scholar 

  10. 10.

    Pilke A, Partinen M, Kovanen J. Status epilepticus and alcohol abuse: an analysis of 82 status epilepticus admissions. Acta Neurol Scand 1984; 70: 443–50

    PubMed  CAS  Article  Google Scholar 

  11. 11.

    Lowenstein DH, Alldredge BK. Status epilepticus at an urban public hospital in the 1980s. Neurology 1993; 43: 483–8

    PubMed  CAS  Article  Google Scholar 

  12. 12.

    Leppik IE, Jacobs MP, Loewenson RB, et al. Alcohol and status epilepticus. In: Porter RJ, Mattson RH, Cramer JA, et al., editors. Alcohol and seizures: basic mechanisms and clinical concepts. Philadelphia (PA): FA Davis Company, 1990: 216–21

    Google Scholar 

  13. 13.

    Tomson T. Mortality in epilepsy. J Neurol 2000; 247: 15–21

    PubMed  CAS  Article  Google Scholar 

  14. 14.

    Lhatoo SD, Johnson AL, Goodridge DM, et al. Mortality in epilepsy in the first 11 to 14 years after diagnosis: multivariate analysis of a long-term, prospective, population-based cohort. Ann Neurol 2001; 49: 336–44

    PubMed  CAS  Article  Google Scholar 

  15. 15.

    Pieninkeroinen IP, Telakivi TM, Hillbom ME. Outcome in subjects with alcohol-provoked seizures. Alcohol Clin Exp Res 1992; 16: 955–9

    PubMed  CAS  Article  Google Scholar 

  16. 16.

    Alldredge BK, Lowenstein DH. Status epilepticus related to alcohol abuse. Epilepsia 1993; 34: 1033–7

    PubMed  CAS  Article  Google Scholar 

  17. 17.

    Bråthen G, Brodtkorb E, Helde G, et al. The diversity of seizures related to alcohol use: a study of consecutive patients. Eur J Neurol 1999; 6: 697–703

    PubMed  Article  Google Scholar 

  18. 18.

    Bråthen G. The classification and clinical diagnosis of alcoholrelated seizures [dissertation]. Trondheim: Norwegian University of Science and Technology, 2001

    Google Scholar 

  19. 19.

    Ng SKC, Hauser WA, Brust JCM, et al. Alcohol consumption and withdrawal in new-onset seizures. N Engl J Med 1988; 319: 666–73

    PubMed  CAS  Article  Google Scholar 

  20. 20.

    Leone M, Bottacchi E, Beghi E, et al. Alcohol use is a risk factor for a first generalized tonic-clonic seizure: the ALC.E. (Alcohol and Epilepsy) Study Group. Neurology 1997; 48: 614–20

    PubMed  CAS  Article  Google Scholar 

  21. 21.

    Chan AW. Alcoholism and epilepsy. Epilepsia 1985; 26: 323–33

    PubMed  CAS  Article  Google Scholar 

  22. 22.

    Hauser WA, Annegers JF, Kurland LT. Prevalence of epilepsy in Rochester, Minnesota: 1940–1980. Epilepsia 1991; 32: 429–45

    PubMed  CAS  Article  Google Scholar 

  23. 23.

    Forsgren L. Prevalence of epilepsy in adults in northern Sweden. Epilepsia 1992; 33: 450–8

    PubMed  CAS  Article  Google Scholar 

  24. 24.

    Granieri E, Rosati G, Tola R, et al. A descriptive study of epilepsy in the district of Copparo, Italy, 1964–1978. Epilepsia 1983; 24: 502–14

    PubMed  CAS  Article  Google Scholar 

  25. 25.

    Bråthen G, Brodtkorb E, Sand T, et al. Weekday distribution of alcohol consumption in Norway: influence on the occurrence of epileptic seizures and stroke? Eur J Neurol 2000; 7: 413–21

    PubMed  Article  Google Scholar 

  26. 26.

    Tartara A, Manni R, Mazzella G. Epileptic seizures and alcoholism: clinical and pathogenetic aspects. Acta Neurol Belg 1983; 83: 88–94

    PubMed  CAS  Google Scholar 

  27. 27.

    Wolfe SM, Victor M. The relationship of hypomagnesemia and alkalosis to alcohol withdrawal symptoms. Ann N Y Acad Sci 1969; 162: 973–84

    PubMed  CAS  Article  Google Scholar 

  28. 28.

    Hillbom ME. Alcohol withdrawal seizures and binge versus chronic drinking. In: Porter RJ, Mattson RH, Cramer JA, et al., editors. Alcohol and seizures: basic mechanisms and clinical concepts. Philadelphia (PA): FA Davis Company, 1990: 206–15

    Google Scholar 

  29. 29.

    Gross MM, Lewis E, Best S, et al. Quantitative changes of signs and symptoms associated with acute alcohol withdrawal: incidence, severity and circadian effects in experimental studies of alcoholism. Adv Exp Med Biol 1979; 59: 615–31

    Google Scholar 

  30. 30.

    Goldstein DB. Relationship of alcohol dose to intensity of withdrawal signs in mice. J Pharmacol Exp Ther 1972; 180: 203–15

    PubMed  CAS  Google Scholar 

  31. 31.

    Majchrowicz E. Induction of physical dependence upon ethanol and the associated behavioral changes in rats. Psychopharmacologia 1975; 43: 245–54

    PubMed  CAS  Article  Google Scholar 

  32. 32.

    Majchrowicz E, Hunt WA. Temporal relationship of the induction of tolerance and physical dependence after continuous intoxication with maximum tolerable doses of ethanol in rats. Psychopharmacology 1976; 50: 107–12

    PubMed  CAS  Article  Google Scholar 

  33. 33.

    Goldstein DB, Chin JH. Interaction of ethanol with biological membrane. Fed Proc 1981; 40: 1073–6

    Google Scholar 

  34. 34.

    Goldstein DB. Pharmacology of alcohol. New York: Oxford University Press, 1983

    Google Scholar 

  35. 35.

    Nestoros JN. Ethanol specifically potentiates GABA-mediated neurotransmission in feline cerebral cortex. Science 1980; 209: 708–10

    PubMed  CAS  Article  Google Scholar 

  36. 36.

    Linnoila M, Mefford I, Nutt D, et al. Alcohol withdrawal and noradrenergic function. Ann Intern Med 1987; 107: 875–9

    PubMed  CAS  Google Scholar 

  37. 37.

    Sanna E, Serra M, Cossu A, et al. Chronic ethanol intoxication induces differential effects on GABA and NMDA receptor function in the rat brain. Alcohol Clin Exp Res 1993; 17: 115–23

    PubMed  CAS  Article  Google Scholar 

  38. 38.

    Tsai G, Gastfriend DR, Coyle JT. The glutamatergic basis of human alcoholism. Am J Psychiatry 1995; 152: 332–40

    PubMed  CAS  Google Scholar 

  39. 39.

    Carboni S, Isola R, Gessa GL, et al. Ethanol prevents the glutamate release induced by N-methyl-D-aspartate in the rat striatum. Neurosci Lett 1993; 152: 133–6

    PubMed  CAS  Article  Google Scholar 

  40. 40.

    Nie Z, Yuan X, Madamba SG, et al. Ethanol decreases glutamatergic synaptic transmission in rat nucleus accumbens in vitro: naloxone reversal. J Pharmacol Exp Ther 1993; 266: 1705–12

    PubMed  CAS  Google Scholar 

  41. 41.

    Lovinger DM, White G, Weight FF. Ethanol inhibits NMDA-activated ion current in hippocampal neurons. Science 1989; 243: 1721–4

    PubMed  CAS  Article  Google Scholar 

  42. 42.

    Iorio KR, Reinlib L, Tabakoff B, et al. Chronic exposure of cerebellar granule cells to ethanol results in increased Nmethyl-D-aspartate receptor function. Mol Pharmacol 1992; 41: 1142–8

    PubMed  CAS  Google Scholar 

  43. 43.

    Trevisan L, Fitzgerald LW, Brose N, et al. Chronic ingestion of ethanol up-regulates NMDAR1 receptor subunit immunoreactivity in rat hippocampus. J Neurochem 1994; 62: 1635–8

    PubMed  CAS  Article  Google Scholar 

  44. 44.

    Engberg G, Hajos M. Ethanol attenuates the response of locus coeruleus neurons to excitatory amino acid agonists in vivo. Naunyn Schmiedebergs Arch Pharmacol 1992; 345: 222–6

    PubMed  CAS  Article  Google Scholar 

  45. 45.

    Tan CY, Weaver DF. Molecular pathogenesis of alcohol withdrawal seizures: the modified lipid-protein interaction mechanism. Seizure 1997; 6: 255–74

    PubMed  CAS  Article  Google Scholar 

  46. 46.

    Porter RJ, Mattson RH, Cramer JA, et al., editors. Alcohol and seizures: basic mechanisms and clinical concepts. Philadelphia (PA): FA Davis Company, 1990

    Google Scholar 

  47. 47.

    Okubo T, Harada S. Polymorphism of the neuropeptide Y gene: an association study with alcohol withdrawal. Alcohol Clin Exp Res 2001; 25(6 Suppl.): 59S–62S

    PubMed  CAS  Article  Google Scholar 

  48. 48.

    Sander T, Harms H, Podschus J, et al. Allelic association of a dopamine transporter gene polymorphism in alcohol dependence with withdrawal seizures or delirium. Biol Psychiatry 1997; 41: 299–304

    PubMed  CAS  Article  Google Scholar 

  49. 49.

    Schaumann BA, Annegers JF, Johnson SB, et al. Family history of seizures in posttraumatic and alcohol-associated seizure disorders. Epilepsia 1994; 35: 48–52

    PubMed  CAS  Article  Google Scholar 

  50. 50.

    Valverius P, Crabbe JC, Hoffman PL, et al. NMDA receptors in mice bred to be prone or resistant to ethanol withdrawal seizures. Eur J Pharmacol 1990; 184: 185–9

    PubMed  CAS  Article  Google Scholar 

  51. 51.

    Kosobud AE, Crabbe JC. Sensitivity to N-methyl-D-aspartic acid-induced convulsions is genetically associated with resistance to ethanol withdrawal seizures. Brain Res 1993; 610: 176–9

    PubMed  CAS  Article  Google Scholar 

  52. 52.

    Sand T, Bråthen G, Michler R, et al. Clinical utility of EEG in alcohol-related seizures. Acta Neurol Scand 2002; 105: 18–24

    PubMed  CAS  Article  Google Scholar 

  53. 53.

    Skullerud K, Andersen SN, Lundevall J. Cerebral lesions and causes of death in male alcoholics: a forensic autopsy study. Int J Legal Med 1991; 104: 209–13

    PubMed  CAS  Article  Google Scholar 

  54. 54.

    Mattson RH, Fay ML, Sturman JK, et al. The effect of various patterns of alcohol use on seizures in patients with epilepsy. In: Porter RJ, Mattson RH, Cramer JA, et al., editors. Alcohol and seizures: basic mechanisms and clinical concepts. Philadelphia (PA): FA Davis Company, 1990: 233–40

    Google Scholar 

  55. 55.

    Pedersen SB, Petersen KA. Juvenile myoclonic epilepsy: clinical and EEG features. Acta Neurol Scand 1998; 97: 160–3

    PubMed  CAS  Article  Google Scholar 

  56. 56.

    Genton P, Guerrin R. Antimyoclonic effect of alcohol in progressive myoclonic epilepsy. Neurology 1990; 40: 1412–6

    PubMed  CAS  Article  Google Scholar 

  57. 57.

    Bartolomei F, Azulay J-P, Barrié M, et al. Myoclonic alcoholic epilepsy. Epilepsia 1996; 37: 406–9

    PubMed  CAS  Article  Google Scholar 

  58. 58.

    Jain S, Tamer SK, Hiran S. Beneficial effect of alcohol in hereditary cerebellar ataxia with myoclonus (progressive myoclonic ataxia): report of two siblings. Mov Disord 1996; 11: 751–2

    PubMed  CAS  Article  Google Scholar 

  59. 59.

    Hsiao MC, Liu CY, Yang YY, et al. Progressive myoclonic epilepsies syndrome (Ramsay Hunt syndrome) with mental disorder: report of two cases. Psychiatry Clin Neurosci 1999; 53: 575–8

    PubMed  CAS  Article  Google Scholar 

  60. 60.

    Aminoff MJ, Simon RP. Status epilepticus: causes, clinical features and consequences in 98 patients. Am J Med 1980; 69: 657–66

    PubMed  CAS  Article  Google Scholar 

  61. 61.

    Passera S, Rocchi R, Rossi S, et al. Seizures after spontaneous supratentorial intracerebral hemorrhage. Epilepsia 2002; 43: 1175–80

    Article  Google Scholar 

  62. 62.

    Earnest MP, Feldman H, Marx JA, et al. Intracranial lesions shown by CT scans in 259 cases of first alcohol-related seizures. Neurology 1988; 38: 1561–5

    PubMed  CAS  Article  Google Scholar 

  63. 63.

    Powers RD. Serum chemistry abnormalities in adult patients with seizure. Ann Emerg Med 1985; 14: 416–20

    PubMed  CAS  Article  Google Scholar 

  64. 64.

    Earnest MP. Seizures. Neurol Clin 1993; 11: 563–75

    PubMed  CAS  Google Scholar 

  65. 65.

    Alldredge BK, Lowenstein DH, Simon RP. Seizures associated with recreational drug abuse. Neurology 1989; 39: 1037–9

    PubMed  CAS  Article  Google Scholar 

  66. 66.

    Koppel BS, Samkoff L, Daras M. Relation of cocaine use to seizures and epilepsy. Epilepsia 1996; 37: 875–8

    PubMed  CAS  Article  Google Scholar 

  67. 67.

    Moak DH, Anton RF. Alcohol-related seizures and the kindling effect of repeated detoxifications: the influence of cocaine. Alcohol Alcohol 1996; 31: 135–43

    PubMed  CAS  Google Scholar 

  68. 68.

    Spivey WH. Flumazenil and seizures: analysis of 43 cases. Clin Ther 1992; 14: 292–305

    PubMed  CAS  Google Scholar 

  69. 69.

    Hillbom ME, Hjelm-Jäger M. Should alcohol withdrawal seizures be treated with anti-epileptic drugs? Acta Neurol Scand 1984; 69: 39–42

    PubMed  CAS  Article  Google Scholar 

  70. 70.

    Cassano PA, Koepsell TD, Farwell JR. Risk of febrile seizures in childhood in relation to prenatal maternal cigarette smoking and alcohol intake. Am J Epidemiol 1990; 132: 462–73

    PubMed  CAS  Google Scholar 

  71. 71.

    Avdaloff W. Alcoholism, seizures and cerebral atrophy. Adv Biol Psychiatry 1979; 3: 20–32

    Google Scholar 

  72. 72.

    Sullivan EV, Marsh L, Mathalon DH, et al.Relationship between alcohol withdrawal seizures and temporal lobe white matter volume deficits. Alcohol Clin Exp Res 1996; 20: 348–54

    PubMed  CAS  Article  Google Scholar 

  73. 73.

    Dam AM, Fuglsang-Frederiksen A, Svarre-Olsen U, et al. Late onset epilepsy: etiologies, types of seizure, and value of clinical investigation, EEG and computerized tomography scan. Epilepsia 1985; 26: 227–31

    PubMed  CAS  Article  Google Scholar 

  74. 74.

    Hesdorffer DC, Logroscino G, Cascino G, et al.Risk of unprovoked seizure after acute symptomatic seizure: effect of status epilepticus. Ann Neurol 1998; 44: 908–12

    PubMed  CAS  Article  Google Scholar 

  75. 75.

    Ballenger JC, Post RM. Kindling as a model for alcohol withdrawal syndrome. Br J Psychiatry 1978; 133: 1–14

    PubMed  CAS  Article  Google Scholar 

  76. 76.

    Pinel JPJ. Alcohol withdrawal seizures: implications of kindling. Pharmacol Biochem Behav 1980; 13Suppl. 1: 225–31

    PubMed  Article  Google Scholar 

  77. 77.

    Mucha RF, Pinel JPJ. Increased susceptibility to kindled seizures in rats following a single injection of alcohol. J Stud Alcohol 1979; 40: 258–71

    PubMed  CAS  Google Scholar 

  78. 78.

    Clemmesen L, Hemmingsen R. Physical dependence on ethanol during multiple intoxication and withdrawal episodes in the rat: evidence of a potentiation. Acta Pharmacol Toxicol (Copenh) 1984; 55: 345–50

    CAS  Article  Google Scholar 

  79. 79.

    Becker HC, Hale RL. Repeated episodes of ethanol withdrawal potentiate the severity of subsequent withdrawal seizures: an animal model of alcohol withdrawal “kindling”. Alcohol Clin Exp Res 1993; 17: 94–8

    PubMed  CAS  Article  Google Scholar 

  80. 80.

    Becker HC, Diaz-Granados JL, Weathersby RT. Repeated ethanol withdrawal experience increases the severity and duration of subsequent withdrawal seizures in mice. Alcohol 1997; 14: 319–26

    PubMed  CAS  Article  Google Scholar 

  81. 81.

    Becker HC, Diaz-Granados JL, Hale RL. Exacerbation of ethanol withdrawal seizures in mice with a history of multiple withdrawal experience. Pharmacol Biochem Behav 1997; 1-2: 179–83

    Article  Google Scholar 

  82. 82.

    Brown ME, Anton RF, Malcolm R, et al. Alcohol detoxification and withdrawal seizures: clinical support for a kindling hypothesis. Biol Psychiatry 1988; 23: 507–14

    PubMed  CAS  Article  Google Scholar 

  83. 83.

    Lechtenberg R, Worner TM. Seizure risk with recurrent alcohol detoxification. Arch Neurol 1990; 47: 535–8

    PubMed  CAS  Article  Google Scholar 

  84. 84.

    Worner TM. Relative kindling effect of readmissions in alcoholics. Alcohol Alcohol 1996; 31: 375–80

    PubMed  CAS  Google Scholar 

  85. 85.

    Wojnar M, Bizon Z, Wasilewski D. Assessment of the role of kindling in the pathogenesis of alcohol withdrawal seizures and delirium tremens. Alcohol Clin Exp Res 1999; 23: 204–8

    PubMed  CAS  Article  Google Scholar 

  86. 86.

    Veatch LM, Gonzalez LP. Repeated ethanol withdrawal delays development of focal seizures in hippocampal kindling. Alcohol Clin Exp Res 1999; 23: 1145–50

    PubMed  CAS  Google Scholar 

  87. 87.

    Claassen CA, Adinoff B. Alcohol withdrawal syndrome: guidelines for management. CNS Drugs 1999; 12: 279–91

    CAS  Article  Google Scholar 

  88. 88.

    Mayo-Smith MF. Pharmacological management of alcohol withdrawal: a meta-analysis and evidence-based practice guideline: American Society of Addiction Medicine Working Group on Pharmacological Management of Alcohol Withdrawal. JAMA 1997; 278: 144–51

    PubMed  CAS  Article  Google Scholar 

  89. 89.

    Gordon E, Devinsky O. Alcohol and marijuana: effects of epilepsy and use by patients with epilepsy. Epilepsia 2001; 42: 1266–72

    PubMed  CAS  Article  Google Scholar 

  90. 90.

    Alldredge BK, Lowenstein DH, Simon RP. Placebo-controlled trial of intravenous diphenylhydantoin for short-term treatment of alcohol withdrawal seizures. Am J Med 1989; 87: 645–8

    PubMed  CAS  Article  Google Scholar 

  91. 91.

    Chance JF. Emergency department treatment of alcohol withdrawal seizures with phenytoin. Ann Emerg Med 1991; 20: 520–2

    PubMed  CAS  Article  Google Scholar 

  92. 92.

    Rathlev NK, D’Onofrio G, Fish SS,et al. The lack of efficacy of phenytoin in the prevention of recurrent alcohol-related seizures. Ann Emerg Med 1994; 23: 513–8

    PubMed  CAS  Article  Google Scholar 

  93. 93.

    D’Onofrio G, Rathlev NK, Ulrich AS, et al. Lorazepam for the prevention of recurrent seizures related to alcohol. N Engl J Med 1999; 340: 915–9

    PubMed  Article  Google Scholar 

  94. 94.

    Sereny G, Kalant H. Comparative clinical evaluation of chlordiazepoxide and promazine in treatment of alcohol withdrawal syndrome. BMJ 1965; 1: 92–7

    PubMed  CAS  Article  Google Scholar 

  95. 95.

    Chambers JF, Schultz JD. Double-blind study of three drugs in the treatment of acute alcoholic states. Q J Stud Alcohol 1965; 26: 10–8

    PubMed  CAS  Google Scholar 

  96. 96.

    Golbert TM, Sanz CJ, Rose HD, et al. Comparative evaluation of treatments of alcohol withdrawal syndromes. JAMA 1967; 10: 99–102

    Article  Google Scholar 

  97. 97.

    Kaim SC, Klett CJ, Rothfeld B. Treatment of the acute alcohol withdrawal state: a comparison of four drugs. Am J Psychiatry 1969; 125: 1640–6

    PubMed  CAS  Google Scholar 

  98. 98.

    Rothstein E. Prevention of alcohol withdrawal seizures: the roles of diphenylhydantoin and chlordiazepoxide. Am J Psychiatry 1973; 130: 1381–2

    PubMed  CAS  Google Scholar 

  99. 99.

    Sampliner R, Iber FL. Diphenylhydantoin control of alcohol withdrawal seizures: results of a controlled study. JAMA 1974; 4: 1430–2

    Article  Google Scholar 

  100. 100.

    Lambie DG, Johnson RH, Vijayasenan ME, et al. Sodium valproate in the treatment of the alcohol withdrawal syndrome. Aust N Z J Psychiatry 1980; 14: 213–5

    PubMed  CAS  Article  Google Scholar 

  101. 101.

    Zilm DH, Jacob MS, MacLeod SM, et al.Propranolol and chlordiazepoxide effects on cardiac arrhythmias during alcohol withdrawal. Alcohol Clin Exp Res 1980; 4: 400–5

    PubMed  CAS  Article  Google Scholar 

  102. 102.

    Sellers EM, Naranjo CA, Harrison M, et al. Diazepam loading: simplified treatment of alcohol withdrawal. Clin Pharmacol Ther 1983; 34: 822–6

    PubMed  CAS  Article  Google Scholar 

  103. 103.

    Solomon J, Rouck LA, Hoepke HH. Double-blind comparison of lorazepam and chlordiazepoxide in the treatment of the acute alcohol abstinence syndrome. Clin Ther 1983; 6: 52–8

    PubMed  CAS  Google Scholar 

  104. 104.

    Flygenring J, Hansen J, Holst B, et al. Treatment of alcohol withdrawal symptoms in hospitalized patients: a randomized, double-blind comparison of carbamazepine and barbital. Acta Psychiatr Scand 1984; 69: 398–408

    PubMed  CAS  Article  Google Scholar 

  105. 105.

    Wilson A, Vulcano BA. Double-blind trial of alprazolam and chlordiazepoxide in the management of the acute ethanol withdrawal syndrome. Alcohol Clin Exp Res 1985; 9: 23–7

    PubMed  CAS  Article  Google Scholar 

  106. 106.

    Cushman Jr P, Forbes R, Lerner W, et al. Alcohol withdrawal syndromes: clinical management with lofexidine. Alcohol Clin Exp Res 1985; 9: 103–8

    PubMed  Article  Google Scholar 

  107. 107.

    Ritson B, Chick J. Comparison of two benzodiazepines in the treatment of alcohol withdrawal: effects on symptoms and cognitive recovery. Drug Alcohol Depend 1986; 18: 329–34

    PubMed  CAS  Article  Google Scholar 

  108. 108.

    Hillbom M, Tokola R, Kuusela V, et al. Prevention of alcohol withdrawal seizures with carbamazepine and valproic acid. Alcohol 1989; 6: 223–6

    PubMed  CAS  Article  Google Scholar 

  109. 109.

    Robinson BJ, Robinson GM, Maling TJ, et al. Is clonidine useful in the treatment of alcohol withdrawal? Alcohol Clin Exp Res 1989; 13: 95–8

    PubMed  CAS  Article  Google Scholar 

  110. 110.

    Stanhope JM, Curry KH. The use of carbamazepine in chlormethiazole-modified withdrawal from alcohol. Aust Drug Alcohol Rev 1989; 8: 5–8

    Article  Google Scholar 

  111. 111.

    Baumgartner GR, Rowen RC. Transdermal clonidine versus chlordiazepoxide in alcohol withdrawal: a randomized, controlled clinical trial. South Med J 1991; 84: 312–21

    PubMed  CAS  Article  Google Scholar 

  112. 112.

    Bailly D, Servant D, Blandin N, et al. Effects of beta-blocking drugs in alcohol withdrawal: a double-blind comparative study with propranolol and diazepam. Biomed Pharmacother 1992; 46: 419–24

    PubMed  CAS  Article  Google Scholar 

  113. 113.

    Saitz R, Mayo-Smith MF, Roberts MS, et al. Individualized treatment for alcohol withdrawal: a randomized double-blind controlled trial. JAMA 1994; 272: 519–23

    PubMed  CAS  Article  Google Scholar 

  114. 114.

    Rosenthal RN, Perkel C, Singh P, et al. A pilot open randomized trial of valproate and phenobarbital in the treatment of acute alcohol withdrawal. Am J Addict 1998; 7: 189–97

    PubMed  CAS  Google Scholar 

  115. 115.

    Nimmerrichter AA, Walter H, Gutierrez-Lobos KE, et al. Double-blind controlled trial of γ-hydroxybutyrate and chlormethiazole in the treatment of alcohol withdrawal. Alcohol Alcohol 2002; 37: 67–73

    PubMed  CAS  Google Scholar 

  116. 116.

    Mayo-Smith MF, Bernard D. Late-onset seizures in alcohol withdrawal. Alcohol Clin Exp Res 1995; 19: 656–9

    PubMed  CAS  Article  Google Scholar 

  117. 117.

    Kraemer KL, Conigliaro J, Saitz R. Managing alcohol withdrawal in the elderly. Drugs Aging 1999; 14: 409–25

    PubMed  CAS  Article  Google Scholar 

  118. 118.

    Young GP, Dailey RH. Treatment of alcohol withdrawal seizures with intravenous phenobarbital. In: Porter RJ, Mattson RH, Cramer JA, et al., editor. Alcohol and seizures: basic mechanisms and clinical concepts. Philadelphia (PA): FA Davis Company, 1990: 298–303

    Google Scholar 

  119. 119.

    Morgan MY. The management of alcohol withdrawal using chlormethiazole. Alcohol Alcohol 1995; 30: 771–4

    PubMed  CAS  Google Scholar 

  120. 120.

    Shaw GK. Detoxification: the use of benzodiazepines. Alcohol Alcohol 1995; 30: 765–70

    PubMed  CAS  Google Scholar 

  121. 121.

    Hillbom ME. Alcohol withdrawal seizures: alternatives for treatment and prevention. Nord Psykiatr Tidsskr 1987; 41Suppl. 17: 45–7

    Article  Google Scholar 

  122. 122.

    Malcolm R, Myrick H, Brady KT, et al. Update on anticonvulsants for the treatment of alcohol withdrawal. Am J Addict 2001; 10: 16–23

    PubMed  Google Scholar 

  123. 123.

    Naranjo CA, Sellers EM, Chater K, et al. Nonpharmacologic intervention in acute alcohol withdrawal. Clin Parmacol Ther 1983; 34: 214–9

    CAS  Article  Google Scholar 

  124. 124.

    Booth BM, Blow FC. The kindling hypothesis: further evidence from a US nation study of alcoholic men. Alcohol Alcohol 1993; 28: 593–8

    PubMed  CAS  Google Scholar 

  125. 125.

    Beerman B, Bolwig T, Borg S, et al. Workshop om farmakologisk behandling vid alkoholism: abstinens och aversionsbehandling. Uppsala: Information från Socialstyrelsens Läkemedelsavdelning, 1984: 8

    Google Scholar 

  126. 126.

    Schumacher L, Pruitt II JN, Phillips M. Identifying patients “at risk” for alcohol withdrawal syndrome and a treatment protocol. J Neurosci Nurs 2000; 32: 158–63

    PubMed  CAS  Article  Google Scholar 

  127. 127.

    Jaeger TM, Lohr RH, Pankratz VS. Symptom-triggered therapy for alcohol withdrawal syndrome in medical inpatients. Mayo Clin Proc 2001; 76: 695–701

    PubMed  CAS  Article  Google Scholar 

  128. 128.

    Dudek H, Michno T, Michalski J, et al. Late posttraumatic epilepsy in patients with an alcoholic problem treated surgically for posttraumatic chronic subdural hematomas. Rocz Akad Med Bialymst 1999; 44: 119–27

    PubMed  CAS  Google Scholar 

  129. 129.

    Spies CD, Dubisz N, Neumann T, et al. Therapy of alcohol withdrawal syndrome in intensive care unit patients following trauma: results of a prospective, randomised trial. Crit Care Med 1996; 24: 414–22

    PubMed  CAS  Article  Google Scholar 

  130. 130.

    MacDonald BK, Johnson AL, Goodridge DM, et al. Factors predicting prognosis of epilepsy after presentation with seizures. Ann Neurol 2000; 48: 833–41

    PubMed  CAS  Article  Google Scholar 

  131. 131.

    Thorbecke R. Patients with epilepsy who discontinue treatment. Epilepsy Res Suppl 1988; 1: 119–24

    CAS  Google Scholar 

  132. 132.

    Ulrichsen J, Bech B, Allerup P, et al. Diazepam prevents progression of kindled alcohol withdrawal behaviour. Psychopharmacology 1995; 121: 451–60

    PubMed  CAS  Article  Google Scholar 

  133. 133.

    Bienkowski P, Krzascik P, Koros E, et al. Effects of a novel uncompetitive NMDA receptor antagonist, MRZ 2/579 on ethanol self-administration and ethanol withdrawal seizures in the rat. Eur J Pharmacol 2001; 413: 81–9

    PubMed  CAS  Article  Google Scholar 

  134. 134.

    Kotlinska J. NMDA antagonists inhibit the development of ethanol dependence in rats. Pol J Pharmacol 2001; 53: 47–50

    PubMed  CAS  Google Scholar 

  135. 135.

    Rathlev NK, Ulrich A, Shieh TC, et al. Etiology and weekly occurrence of alcohol-related seizures. Acad Emerg Med 2002; 9: 824–8

    PubMed  Article  Google Scholar 

  136. 136.

    Commission on Epidemiology and Prognosis, International League Against Epilepsy. Guidelines for epidemiologic studies on epilepsy. Epilepsia 1993; 34: 592–6

    Article  Google Scholar 

  137. 137.

    Berg AT, Shinnar S. The risk of seizure recurrence following a first unprovoked seizure: a quantitative review. Neurology 1991; 41: 965–72

    PubMed  CAS  Article  Google Scholar 

  138. 138.

    Musicco M, Beghi E, Solari A, et al. Treatment of first tonicclonic seizure does not improve the prognosis of epilepsy: First Seizure Trial Group (FIRST Group). Neurology 1997; 49: 991–8

    PubMed  CAS  Article  Google Scholar 

  139. 139.

    Newsom JA. Withdrawal seizures in an in-patient alcoholism program. In: Galanter M, editor. Currents in alcoholism, treatment and rehabilitation and epidemiology. New York: Grune & Stratton, 1979: 6, 11–4

    Google Scholar 

  140. 140.

    Hoppener RJ. The effect of social alcohol use on seizures in patients with epilepsy. In: Porter RJ, Mattson RH, Cramer JA et al., editors. Alcohol and seizures: basic mechanisms and clinical concepts. ladelphia (PA): FA Davis Company 1990: 222–32

    Google Scholar 

  141. 141.

    Hoppener RJ, Kuyer A, van der Lugt PJM. Epilepsy and alcohol: the influence of social alcohol intake on seizures and treatment in epilepsy. Epilepsia 1983; 24: 459–71

    PubMed  CAS  Article  Google Scholar 

  142. 142.

    Heckmatt J, Shaikh AA, Swash M, et al. Seizure induction by alcohol in patients with epilepsy experience in two hospital clinics. J R Soc Med 1990; 83: 6–9

    PubMed  CAS  Google Scholar 

  143. 143.

    Bauer J, Saher MS, Burr W, et al. Precipitating factors and therapeutic outcome in epilepsy with generalized tonic-clonic seizures. Acta Neurol Scand 2000; 102: 205–8

    PubMed  CAS  Article  Google Scholar 

Download references

Acknowledgements

No sources of funding were used to assist in the preparation of this manuscript. The authors have no conflicts of interest that are directly relevant to the content of this manuscript.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Dr Matti Hillbom.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Hillbom, M., Pieninkeroinen, I. & Leone, M. Seizures in Alcohol-Dependent Patients. CNS Drugs 17, 1013–1030 (2003). https://doi.org/10.2165/00023210-200317140-00002

Download citation

Keywords

  • Status Epilepticus
  • Alcohol Withdrawal
  • Alcohol Withdrawal Syndrome
  • Juvenile Myoclonic Epilepsy
  • Acute Seizure