Alcohol Withdrawal Seizures

The prevalence of alcohol use and abuse in the United States is increasing, and an estimated 15.1 million adults meet the criteria established for having alcohol use disorder. Consequently, potentially dangerous symptoms of alcohol withdrawal are increasingly more likely to occur when people reduce or eliminate alcohol use. Among the most dangerous withdrawal symptoms are seizures.

Alcohol withdrawal seizures are the result of substantial and persistent alcohol-induced changes in the brain. Two chemicals in the brain are particularly affected by excessive alcohol consumption: The inhibitory neurotransmitter GABA and the excitatory neurotransmitter NMDA. Alcohol enhances the effects of GABA, meaning that there is reduced activity in the brain, and inhibits the ability of the NMDA receptor to interact with NMDA, which leads to inhibition of brain activity. Chronic alcohol use disorders cause the brain to become adapted to this new state of inhibited activity.

Reasons for Seizures During Alcohol Withdrawal

Seizures that are associated with severe alcohol withdrawal syndrome are related to the persistent state of inhibition that the brain experiences during chronic, heavy alcohol consumption. If alcohol use is suddenly stopped, the “brake” that was inhibiting brain activity is no longer in place. Consequently, the brain quickly tries to restore GABA and NMDA receptor activity to normal levels by reducing the levels of GABA (resulting in less inhibition) and increasing the functionality of NMDA receptors (resulting in more excitation). The net result of the sudden decrease in inhibition and increase in excitation is a general state of hyperexcitability in the brain. This hyperexcitability underlies common withdrawal symptoms, including tremors, anxiety, nausea, insomnia and profuse sweating. If the degree of hyperexcitability is high enough, seizures can occur. Seizures are most likely to occur within 6 to 48 hours after the last drink.

Withdrawal-related seizures are “generalized tonic-clonic seizures,” often known as grand mal seizures. Tonic-clonic seizures include two phases: The first “tonic” phase features muscle stiffness and overall body rigidity, and the second “clonic” phase includes the convulsive behavior that is a stereotypical symptom of a seizure. While some seizures start on one side of the brain (focal seizures), generalized tonic-clonic seizures are the result of overall abnormal brain activity, which is consistent with the global effects of alcohol on the brain.

Alcohol Poisoning

Alcohol poisoning is a consequence of extreme binge drinking that causes toxic (poisonous) levels of alcohol in the blood. Acute alcohol overdose may be sufficient to trigger alcohol poisoning-induced seizure activity, although the precise cause and associated mechanisms remain unclear. Two mechanisms are likely candidates for alcohol poisoning and seizure activity: low blood sugar and ionic disturbances. Alcohol consumption is known to reduce levels of blood sugar. Low blood sugar may be a risk factor for seizures. In addition, heavy alcohol use can affect the levels of ions in blood circulation and in the brain, particularly calcium and magnesium. If these ions are significantly out of normal ranges, seizures may occur. However, seizures associated with acute alcohol poisoning are extremely uncommon and whether other risk factors (e.g., undiagnosed epilepsy) are involved remains unclear.

Delirium Tremens

Delirium tremens (DTs) is a symptom of severe alcohol withdrawal that affects 3% to 5% of people. Symptoms of DTs include confusion, delirium, confusion, nightmares and other mental disturbances. DTs generally appear approximately three days after withdrawal symptoms appear and may last for up to a week. Even in the absence of seizure activity, DTs can be lethal, with some estimates of the mortality rate of DTs in an untreated withdrawal being as high as 37%.

DTs and withdrawal-related seizures may co-occur, but they are consequences of different mechanistic disruptions and one may appear without the other. Most seizures occur within 6 to 48 hours after the last drink, so are they are typically present well ahead of the onset of DTs.

Preventing Alcohol-Induced Seizures During Withdrawal

The safest and most reliable way to overcome withdrawal and prevent seizures is to undergo medically assisted detox, ideally followed by a residential rehab program that can help prevent a setback in sobriety. It is important that alcohol detox is conducted under the supervision of medical professionals who can intervene in the case of complications. People who have experienced one episode of withdrawal seizures are at higher risk for future withdrawal-related seizures. 

Long-term prevention of alcohol-induced seizures is achieved by avoiding all alcohol, which may be easier said than done. Participation in a high-quality rehab program can maximize the odds of successful short- and long-term recovery and help prevent relapse.

Alcohol withdrawal is an uncomfortable experience and can often be dangerous. If you or a loved one is struggling with alcohol use, The Recovery Village at Palmer Lake can provide medically assisted detox, 24/7 access to experienced rehab professionals and, when appropriate, pharmacological interventions that can ease the challenges of withdrawal. Call us today to learn about our comprehensive rehab programs and how we can help you get your life back on track. 

World Health Organization. “Global status report on alcohol and health 2018: Executive summary.”  Geneva: World Health Organization, 2018. Accessed August 27, 2019.

National Institute on Alcohol Abuse and Alcoholism. “Alcohol Facts and Statistics.” August 2018. Accessed August 18, 2019.

Rogawski, Michael A. “Update on the Neurobiology of Alcohol Withdrawal Seizures.” Epilepsy Currents, November 2005. Accessed August 28, 2019.

Bayard, Max; et al. “Alcohol Withdrawal Syndrome.” American Family Physician, March 2004. Accessed August 18, 2019.

Kiriakopoulos, Elaine. “Tonic-Clonic Seizures.”, March 2017. Accessed August 24, 2019.

Nordqvist, Christian. “What to know about alcohol poisoning.” Medical News Today, December 2017. Accessed August 28, 2019.

Halawa, Imad; Zelano, Johan; Kumlien, Eva. “Hypoglycemia and risk of seizures: A retrospective cross-sectional study.” Seizure, February 2015. Accessed August 28, 2019.

Samokhvalov, Andriy V;  Irving, Hyacinth; Mohapatra, Satya;  Rehm, Jürgen. “Alcohol consumption, unprovoked seizures, and epilepsy: A systematic review and meta‐analysis.” Epilepsia, July 2010. Accessed August 28, 2019.

Schuckit, Marc A. “Recognition and Management of Withdrawal Delirium (Delirium Tremens).” The New England Journal of Medicine, November 2014. Accessed August 18, 2019.

Rahman, Abdul; Paul, Manju. “Delirium Tremens (DT).” NCBI StatPearls, November 2018. Accessed August 18, 2019.

Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.

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