Alcohol - related epilepsy


  • Up to 30% of patients presenting to this ED with seizures will have alcohol-related seizure.
  • Withdrawal seizures are the leading cause of acute symptomatic seizures in adults.
  • Alcohol withdrawal seizures often occur 6 - 8 hours after cessation of alcohol use.
  • Seizures later than 24 hours after alcohol cessation are NOT alcohol-related but are usually due to a (treatable) structural lesion.
  • Chronic alcohol consumption causes adaptation and down-regulation of the GABA receptors (GABA-energic benzodiazepines are very effective in treatment) and up-regulation of the NMDA receptors (Ca++). Abrupt withdrawal causes hyperexcitability of NMDA neurons, sudden influx of calcium and results in withdrawal seizure.
  • Alcohol-related seizures are strongly dose-related - the risk of seizure is proportional to consumption.
  • "Kindling" i.e. repeated alcohol stimulation and withdrawal lowers the threshold for fitting, is believed to contribute to many alcohol related seizures.


Similar approach to other causes of fitting. Patients may be unco-operative and difficult but try to get a relatively accurate history, most importantly why did they stop drinking. You must assume that a pathological ("treatable") process has prompted the patient to stop drinking.

Alcohol-related seizures are usually generalised, occurring without warning shortly after alcohol cessation. See background). One quarter of such fits may be of focal onset.

Assess for

  • Hypoglycaemia, Infection, Structural Intracranial Lesion (classically SDH), Haemorrhagic stroke
  • Hepatic failure, Peritonitis, GI bleed, Arrhythmia, Trauma, Include a neurological exam  - focal signs, eye signs or meningism.
  • Lab studies include glucose, U&E, toxic screen, Ca++, Mg++, Septic screen including CXR, ? antiepileptic levels / alcohol levels ? LP

ALL alcoholics with a first fit should have an urgent CT head.


  • A B C (position, suction, oxygen).
  • Don't Ever Forget Glucose.
  • Short duration fits may not need immediate treatment.
  • Lorazepam (1 - 2mg IV) is used for the termination and prophylaxis of alcohol withdrawal seizures.
  • All patients should have a multivitamin infusion irrespective of disposal.
  • Conventional anti-epileptics have NO place in the treatment or prophylaxis of alcohol related seizures.
  • Prophylaxis of rum fits consists of chlordiazepoxide (librium).

Document by Dr Íomhar O' Sullivan 20/02/2004. Reviewed by Dr ÍOS 27/02/2005, 08/01/2007. Last review Dr Chris Luke 15/02/2010,Dr ÍOS 11/09/14.