alcohol withdrawal seizure

Clinical manifestations

• seizures occur in 10% of patients in alcohol withdrawal
• onset generally 6-48 hours after alcohol cessation
• frequently occur in binge drinkers (average duration of alcoholic binge is 2 weeks)
• usually generalized tonic-clonic (grand mal) seizure
• no prodome
• loss of consciousness is common
• multiple seizures in 60%
  • generally <5
  • occur relatively close together, generally within 6 hour period
• alcohol withdrawal seizures are a single event; multiple seizures should prompt workup of a different etiology

Laboratory

• normal baseline EEG

Management

• supportive care
  • 100 mg of thiamine IM
  • D5 1/2NS with 1 g of Mg+2 & 20 meq KCl @ 250 mL/hr
  • MVI, folate
  • MgSO4, 10 g over 24 hours
• pharmacologic agents
  • benzodiazepines
    • lorazepam or oxazepam if liver disease
    • diazepam
    • midazolam
  • phenytoin loading & long term therapy is not necessary
  • barbiturates not recommended
    • abuse potential
    • narrow therapeutic index
    • barbiturate withdrawal is associated with seizures
  • butyrophenones:
    • haloperidol
    • droperidol
    • no intrinsic anti-seizure activity
    • may be synergistic with benzodiazepines
  • phenothiazines are contraindicated
    • induce hypertension
    • lower seizure threshold
    • disrupt central temperature regulation
• status epilepticus (5% of alcohol-related seizures)

More general terms

• seizure; epileptic seizure
• alcohol withdrawal syndrome

Additional terms

• status epilepticus