Alcohol and seizures

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2. Alcohol and seizures
(Seizures – Medical Causes and management)
Dr Pratyush Chaudhuri

4. Introduction
•Alcohol abuse is the commonest cause of adult onset
seizures.
•82% of trauma and about 73% of adult onset seizure in my
practice.
•Terminology: Alcohol Related Seizure (ARS)

5. History
•First recorded by Hippocrates 400BC
•1852- Huss described – Rum fits
•Victor & Adams – first systemic study and clinical
data publication about withdrawal syndromes.

6. Pathogenesis of seizure related to drinking alcohol
•Complex biochemical mechanism.
•Alcohol is a general anaesthetic with anti-convulsant
properties.
•Causes change in membrane properties and may be
responsible for alteration in membrane receptors.

8. •Alcohol specifically potentiates the post
synaptic effect of γ-aminobuteric acid (GABA).
•Modulation of G proteins
•Modulation of calcium channel

9. Differential diagnosis
Differential diagnosis of seizures in alcohol dependant patient.
1. Withdrawal from alcohol
2. Withdrawal from drugs (benzodiazapines, barbiturates and narcotics)
3. Exacerbation of idiopathic or post traumatic epilepsy
4. Acute overdose
(alcohol, amphetamine , cocain, anticholinergics, phenothiazines, tricyclics and isoniazide)
5. Metabolic disorders ( Hypoglycemia, hyponatremia, hypomagnesemia & hypocalcemia)
6. CNS disorder
Acute head trauma, infection (meningitis, encephalitis and brain abscess), stroke
7. Noncompliance with anticonvulsant medication

11. Partial or complete withdrawal of alcohol
•Major cause
•GTC type
•About 7 – 48 hrs after cessation of alcohol
consumption.
•Possibly by alteration GABA receptor sensitivity

12. Alcohol as central nervous system toxin.
3.Direct epileptogenic effect.
5.Risk is higher for non drinker consuming > 12g alcohol.
Supported by the finding that hemodialysis helps alcoholic
patients with seizures.

14. Metabolic disorder
•Alkalosis: hyperventilation with resultant
respiratory alkalosis
Hyper-excitability of the CNS
Lowering of seizure threshold ( possible
due to lowering of ionised sr calcium)

15. •Hypo-Magnesemia: suggested as a cause.
•No strong evidence
•Studies failed to show measurable low
magnesium in blood.

16. Hypoglycemia
•Several factors contribute
3.Depletion of liver glycogen
4.Decreased nutrition support
5.Decreased cortisol level
6.Sepsis and hypothermia.
•Systematic studies – no correlation (lacking significant
corelation between the blood sugar level and seizures)

17. Acute intoxication or poisoning
2.Ingestion of other drugs – may ppt a seizure.
3.Medication for co-morbid disease like INH,
antidepressant (tricyclics) and anti-psychotics
(phenothiazines)
5.Withdrawal from GABA receptor analogues
6.Other drugs

19. Pre-existing epilepsy
•Stimulant effect (systematic data prove that this is least likely)
•Withdrawal phenomenon
•Non-compliance to anti-convulsant
•Alteration of absorption of drug
•Enhancement of anti-epiletic drug metabolism

20. •Structural abnormality
2.Increased incidence of CVA, hemorrhagic stroke and SAH.
3.Alcohol causes cerebral vaso-spasm
4.Micro infarction due to increased platelet and erythrocyte
aggregation.
5.Change in coagulation and platelet aggregation.
6.Head trauma
7.Cerebral atrophy

21. management
•Objectives
3.Treatment of convulsions and associated symptoms
of withdrawal
4.Identification and treatment of coexisting structural
and/or toxic-metabolic causes of seizure.

22. Initial assessment
•ABC
•IV access and primary management as done for most patients
of epilepsy
•Check blood sugar level
•Get information about what medicines is the patient
presently taking.
•12 lead ECG – identify intra-ventricular conduction delays and
heart block- primary emergency.
•Patient should receive 100mg thiamine along with dextrose
infusion + 2 gm of magnesium sulphate.

24. •Laboratory
•Routine physician profile
•Toxin profile if suspected (alcohol amphetamine, cocaine,
marijuana, phencyclidine)
•If on anticonvulsants- may consider doing
drug levels.

25. •Diagnostic examination
•X Ray Chest & cervical spine.
•CT scan brain
•EEG

26. Management
•Benzodiazpines
Lorazepam is the drug of choice:
Because of
•Minimal depressant action on respiration and circulation
•Shorter half life
•No active metabolites
•Prolonged period of action
•Half life not affected by liver or renal dysfunction.

28. Barbiturates (phenobarbitone)
•Good for control of seizures
•Narrow therapeutic index
•Known to increase hepatic enzyme activity.

29. Anti-epileptic drugs
•Patients wit ARS without coexisting structural abnormalities
or pre-existing epilepsy do not require anticonvulsant
therapy.

30. •Patient with new onset seizure should be
admitted to the hospital in the setting of
chronic alcohol abuse

32. That’s it !