Epilepsy, seizures and alcohol use

Although alcohol-related seizures have been recognized since antiquity, their pathophysiological mechanisms, classification and treatment options remain unsettled. The best-described entity is the alcohol withdrawal seizure, usually occurring within 48 hours after cessation of drinking, during which the seizure threshold is reduced. However, alcohol use can trigger seizures unrelated to withdrawal, impair seizure control in epilepsy, and has the potential to induce epilepsy. Approximately a third of patients being hospitalized for acute seizures have overused alcohol prior to the seizure. The diagnosis is clinical, and rests on a thorough medical history. A structured interview supported by the Alcohol Use Disorders Identification Test (AUDIT), or the CAGE questions, provides a reliable measure of drinking habits. Carbohydrate-deficient transferrin (CDT) is the best biomarker for alcohol abuse available, and may provide a good supplement to the clinical investigation. Management of the acute seizure does not differ from seizures with other etiologies. After a withdrawal seizure, prophylactic medication should be restricted to the first few days, and in co-existing epilepsy and alcohol abuse, antiepileptic drugs (AEDs) should be used with caution. Little evidence supports the necessity for well-controlled epilepsy patients to abstain totally from alcohol.