Epilepsy and Alcohol: Triggers, Diagnosis & Treatment

Drinking alcohol can lead to complications for those with epilepsy. It’s important to talk with your doctor to reduce the risks of epilepsy and alcohol.

Someone with epilepsy should be particularly careful when using alcohol, only drinking if their doctor has okayed it and, even then, only in moderation. Using alcohol can make epilepsy worse in some situations and requires special considerations. 

Epilepsy and Alcohol: An Overview

Epilepsy is a brain disorder that causes repeated, unpredictable seizures. This condition can affect people of all ages, races and ethnic backgrounds. Alcohol is a depressant that suppresses activity in your brain. Using alcohol can actually reduce your seizure risk while you are intoxicated, but it artificially increases your seizure risk as it wears off. Alcohol also increases your risk of developing epilepsy and can interfere with epilepsy treatments. 

How Alcohol Affects Seizures and Epilepsy

Alcohol can lead to seizures even in those who do not have epilepsy. It can also increase the risks associated with epilepsy. There are several ways alcohol affects seizures and epilepsy:

• Heavy alcohol use increases the risk you will eventually develop epilepsy.
• Withdrawing from alcohol after using it frequently or binge drinking increases the chance an epileptic seizure will occur.
• Alcohol can interfere with epilepsy medications, increasing the risk of toxicity or decreasing their effectiveness.
• Drinking heavily can cause alcohol poisoning. This leads to conditions like low oxygen levels that can increase the risk of seizures.

It is important to note that some people with epilepsy may be able to drink light or moderate amounts of alcohol safely. It is vital, however, that they clear alcohol use with their doctor before changing their drinking habits or whenever their medications are changed.

Understanding Seizure Triggers

Seizures are often thought of as convulsions that randomly strike; however, convulsions are actually a symptom of seizures. Seizures themselves are a type of brain function change in which the neurons in your brain stop firing in the patterns they are supposed to and begin all firing together. This can cause convulsions, but it can also result in other symptoms.

Seizures are triggered when your brain meets a particular threshold of stimulation, often referred to as a “seizure threshold.” Certain medications and or stimulation can increase your seizure threshold (which decreases your likelihood of having a seizure) or decrease your seizure threshold (increasing the likelihood of a seizure). There are many different factors affecting your seizure threshold. Someone with epilepsy generally has a lower seizure threshold than the average person.

Binge Drinking and Seizure Risk

Binge drinking can significantly increase your risk of seizures, primarily by affecting your brain as it wears off. Alcohol increases your seizure threshold while it is in your bloodstream. As it wears off, however, your seizure threshold falls, often dropping lower than it was initially. Binge drinking increases the magnitude of this drop, increasing the likelihood that a seizure will occur.

Alcohol Withdrawal and Seizures

Alcohol-related seizures are most common during withdrawal. The same effect that can make the aftereffects of binge drinking cause a seizure also happens during withdrawal, but at a much larger scale. Alcohol withdrawal significantly lowers your seizure threshold, with the risk of seizures being highest at the peak of withdrawal. Withdrawal symptoms typically peak within 48–72 hours of your last drink.

Diagnosing Epilepsy and Alcohol Dependence

Epilepsy and alcohol dependence are both diagnosed using completely separate approaches. Epilepsy is primarily diagnosed based on your medical history, a physical and neurological examination, and diagnostic tests. Your doctor may use an electroencephalogram (EEG) to monitor electrical activity in the brain as well as specialized imaging, like MRI or CT scans.

Diagnosing alcohol dependence is done by observing whether withdrawal symptoms occur when you stop using alcohol. Healthcare professionals will often use assessment tools like the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) or the Alcohol Withdrawal Syndrome (AWS) scale to assess the presence and severity of withdrawal. It is important to note that alcohol dependence is different from alcohol addiction or alcohol use disorder (AUD). AUD is diagnosed separately, using a specific set of psychiatric criteria.

Identifying Seizure Types

There are many different types of seizures. If someone is having a seizure, the important thing is to know that a seizure is occurring, not to identify the specific seizure type. 

A seizure can be convulsions or uncontrollable movement of all or part of the body. A type of seizure called an absence seizure doesn’t cause movement — it just results in the person staring, remaining completely still and not being aware of what happened. A seizure should only last two minutes or less. A seizure that continues for more than five minutes indicates a dangerous condition called status epilepticus is present, which is a medical emergency.

Alcohol Use Disorder Screening

There are many different ways that healthcare providers screen for AUD. Commonly used tools include the AUDIT screen or the CAGE assessment. A diagnosis of AUD requires evaluation of whether you meet the criteria for the disease outlined in the Diagnostic and Statistical Manual, fifth edition, or DSM-V. This resource is published by the American Psychiatric Association and outlines the accepted definition of AUD.

Treatment Options for Epilepsy and Alcohol Dependence

Epilepsy is typically treated using medications that increase the brain’s seizure threshold. Surgery or neurological stimulators can be used in some situations to help prevent epileptic seizures.

Alcohol dependence is treated by stopping alcohol, then managing the withdrawal symptoms that occur until the brain readjusts to the absence of alcohol. This process, called detox, is typically done under medical supervision so that withdrawal symptoms can be quickly treated as they develop. Medical detox is absolutely essential if there is a risk of seizures during detox.

Medications for Seizures and Alcohol Addiction

There are several different types of medications used to help prevent or treat seizures in someone with alcohol addiction during an alcohol detox. These include:

• Benzodiazepines: This class of medications includes drugs like diazepam (Valium), lorazepam (Ativan) and chlordiazepoxide (Librium). They help reduce the severity of withdrawal symptoms, including seizures.
• Barbiturates: Phenobarbital is a barbiturate often used in the management of severe withdrawal symptoms, including seizures, when benzodiazepines are not effective or available. They may also be used to supplement benzodiazepines in some situations.
• Anticonvulsants: Some anticonvulsant medications, such as carbamazepine (Tegretol), gabapentin (Neurontin) and valproate (Depakote), may be used to help prevent seizures. They are less commonly used than benzodiazepines for this purpose but can be a helpful addition for those at high risk or with a history of epilepsy.
• Magnesium Sulfate: While not a seizure medication per se, magnesium sulfate can be administered to treat magnesium deficiency commonly seen in those with chronic alcohol use. Magnesium plays an important role in neuronal activity, and its deficiency can increase the risk of seizures.

Behavioral Therapy for Dual Diagnosis Treatment

Dual diagnosis complicates alcohol addiction treatment and requires specialized behavioral therapy. This condition occurs when someone has an addiction coupled with a mental illness. Epilepsy is not a mental illness, but mental illnesses can accompany alcohol addiction as well as epilepsy, complicating recovery.

Managing Epilepsy and Alcohol Dependence in Daily Life

Managing epilepsy requires following instructions given by your doctor and taking medications as prescribed. Someone at risk for epilepsy should avoid potential triggers that may cause a seizure and avoid activities that could be dangerous if a seizure occurred while they were engaged in it. Activities like driving, for example, should be avoided unless you are specifically cleared by your doctor.

Managing alcohol dependence requires undergoing a medically assisted detox. There is no other way to avoid alcohol dependence or to rid yourself of it once it has developed.

Coping Strategies for Seizure Triggers

Knowing that a seizure could occur at any time can be stressful. You should do what you can by following your doctor’s instructions and should not blame yourself if a seizure does occur. You can better cope by identifying what triggers cause seizures and avoiding them as best you can. 

Many people with epilepsy also have auras, a sensation like a taste, smell or vision change that precedes a seizure. Knowing your aura can help you recognize when you are about to have a seizure and notify those with you. Recognizing your aura can also help you take action to avoid dangerous situations, such as falls, during a seizure.

Sober Living Tips for Addiction Recovery

While sober living tips cannot replace the comprehensive strategies that professional rehab supplies, they may help support you in your addiction recovery journey.

• Establish a routine: Regular daily routines can provide structure and reduce uncertainty, which can help manage cravings and reduce anxiety.
• Practice self-care: Regular exercise, a balanced diet and sufficient sleep can enhance physical health and emotional well-being, making it easier to resist cravings.
• Avoid triggers: This may mean changing your social circle, avoiding certain places or even changing daily routines to avoid situations that could lead to relapse.
• Seek support: Support from friends, family and support groups can be very helpful. Consider joining a local or online recovery group.
• Keep busy: Find new hobbies or rediscover old ones. Staying active and engaged can help distract from cravings and provide a sense of achievement and purpose.
• Practice mindfulness and meditation: These can help manage stress, increase awareness of triggers and improve mental health.
• Celebrate milestones: Celebrate each day, week or month of sobriety. This can boost motivation and confidence.

Frequently Asked Questions

Can alcoholism cause seizures?

Heavy alcohol use can cause seizures. Coming down from alcohol after a night of drinking increases your risk of drinking, as does going through alcohol withdrawal after drinking for a prolonged period of time. Heavy alcohol use for prolonged periods of time can also increase your risk of developing epilepsy or your risk of head injuries that can lead to seizures. 

Can you drink alcohol while taking seizure medication?

You may be able to drink in moderation while taking seizure medication; however, you should always check with your doctor before trying this. Alcohol can definitely affect your seizure medicine, and these medications can make alcohol have a greater impact when you use it. It is never safe to combine seizure medicines and alcohol without first talking to your doctor.