Alcohol withdrawal seizures
Physical dependency on alcohol usually develops following a sustained period of daily heavy drinking. This results in the development of alcohol withdrawal symptoms, such as tremulousness (the shakes), sweating, In more severe cases withdrawal seizures (or fits) may occur. These usually occur alcohol intake, though can occur up to 2 weeks later.
Alcohol withdrawal seizures usually occur in severely dependant individuals when there is a sudden and significant reduction in their blood alcohol levels. Such rapid reductions in alcohol consumption may be precipitated factors such as ill health (and an inability to drink), financial constraints and rushed attempts to ‘self detox’.
Seizures are more likely in those with a previous history, especially if they have nutritional deficiencies due to prolonged poor diet. Metabolic disturbances due to hepatic (liver) and renal (kidney) functions may also increase the risk. Additional factors include infections (producing raised body temperature) and low blood sugar (related to inadequate diet).
Alcohol withdrawal seizures are similar to the grand seizures seen with epilepsy (also known as tonic-or generalised seizures). Experiencing a withdrawal seizure however does not necessarily mean that someone has epilepsy per se.
Seizures involve a loss of consciousness of several minutes, muscle contraction and rigidity (lasting 15 or 20 seconds), and then violent muscle contraction and relaxation lasting for 1 or 2 minutes. Other features include biting of the cheek or tongue, clenched teeth and incontinence. In some cases breathing difficulties occur and the skin may become cyanosed (blue in colour). Some seizures are preceded by a warning (or aura) sensation, such as characterised sounds or smells. After the seizure there may be a loss of memory, drowsiness, brief confusion and headache. Breathing usually returns to normal soon after the end of the seizure.
First aid during a seizure involves removing sharp/hard objects from the area; providing a cushion (etc) to protect the head; loosening clothing around the neck; positioning the head to prevent the tongue from obstructing the airway and observing for difficulties. Following the convulsion the person should be placed in the recovery position (i.e. laid on one side) to aid breathing and reduce the risk of asphyxiation. It is also important to provide reassurance and monitor the person until consciousness is regained.
It is inadvisable to restrain someone during a seizure, or to put anything in the person’s mouth or to force anything between his or her teeth. The person should not be moved unless they are in danger. Drinks should not be given until consciousness is fully regained.
Urgent medical attention is not always required following a withdrawal seizure, though may be needed if an injury occurs during the seizure.
Status epileptics (repeated/prolonged seizure) may cause a severe lack of oxygen to the brain and is an emergency situation requiring immediate medical attention.
To minimise the risk of a withdrawal seizure, alcohol consumption should be reduced gradually, or benzodiazepine medication, such as diazepam (valium) should be employed. Correcting metabolic disturbances and avoiding long periods without food may also prove useful.
Some long-term heavy drinkers may develop epilepsy proper and will be prone to seizures independently of alcohol withdrawal. If they continue to drink heavily their epilepsy may be exacerbated, especially if they fail to comply with their anti-convulsant medication, take a poor diet and lead an erratic lifestyle. In addition, the intoxicating effects of alcohol are increased by anti-convulsant medication, thereby increasing the risk of falls and other accidents.
