Alcohol and Seizures: Understanding the Relationship Between Alcohol Withdrawal and Seizures
Chronic, heavy alcohol use causes significant changes in the brain. There are two brain chemicals that are particularly affected by alcohol: the inhibitory neurotransmitter GABA and the receptor for the excitatory neurotransmitter NMDA. Alcohol increases the effects of GABA, meaning that there is less activity in the brain, and also reduces the functionality of the NMDA receptor, which leads to even less brain activity. Over time, the entire brain becomes adapted to this reduced level of activity and depends on alcohol to maintain it.
If alcohol use is stopped suddenly, hyperexcitability manifests as anxiety, tremors, insomnia, profuse sweating and hyperthermia, all of which are characteristic symptoms of alcohol withdrawal. If the persistent alcohol-induced inhibition was strong enough, the brains rebound during withdrawal can be so dramatic that seizures occur.
Quick Facts About Alcohol and Seizures
Despite the debilitating effects of alcohol on the brain and body, alcohol is among the most commonly used substances in America.
An estimated 15.1 million adults meet the criteria for alcohol use disorder and alcohol is associated with approximately 88,000 preventable deaths every year. Alcohol use rapidly causes tolerance, dependence and addiction, which are all consequences of altered brain chemistry. Once those changes take place, alcohol cessation causes withdrawal symptoms as the brain tries to reestablish itself. Alcohol withdrawal symptoms may include seizures.
Does Alcohol Cause Epilepsy?
Alcohol does not cause epilepsy, although alcohol withdrawal can cause seizures. The Epilepsy Foundation defines epilepsy as, “…a chronic disorder, the hallmark of which is recurrent, unprovoked seizures.” Because alcohol-induced seizures are provoked, they do not strictly meet the definition of epilepsy.
Seizures that are a consequence of alcohol withdrawal are distinct from epileptic seizures. A recent study was conducted to characterize alcohol-related seizures and epileptic seizures. There are substantial differences in brain activity between people who had experienced alcohol-related or epileptic seizures 72 hours prior to testing. These findings suggest that alcohol-related seizures are physiologically distinct from epileptic seizures.
One case where alcohol may lead to epilepsy is chronic, heavy alcohol abuse among people who have gone through several episodes of withdrawal that caused seizures. In these people, the risk for spontaneous (unrelated to alcohol) seizures is increased. However, whether the pathology underlying this seizure disorder is the same as that of epileptic seizure disorders is unclear.
Does Alcohol Trigger Seizures?
Alcohol is a central nervous system (CNS) depressant, meaning that it reduces brain activity. Seizures are the result of brain hyperexcitability. Thus, alcohol itself does not trigger seizures, but withdrawal can cause a state of brain hyperexcitability that may cause seizures.
Alcohol Withdrawal and Seizures
The primary cause of alcohol-related seizures is usually not the alcohol itself, but the absence of alcohol in someone with severe alcohol dependence who suddenly stops drinking. In this case, the brain has become accustomed to a state where alcohol persistently inhibits excitation of brain cells. When alcohol is suddenly removed, the regions of the brain may become so active that spontaneous seizures result. Alcohol withdrawal seizures generally occur within 6 to 48 hours of discontinuation.
Symptoms of Alcohol Withdrawal and Seizures
Alcohol withdrawal is associated with uncomfortable and dangerous symptoms. Symptom severity correlates with the amount, frequency and duration of alcohol use. Symptoms include tremors, anxiety, insomnia, sweating, and nausea or vomiting. Even without seizure activity withdrawal can be deadly. Severe withdrawal can cause a heart attack or delirium tremens (a state of mental confusion and delirium).
Seizures that are caused by alcohol withdrawal are “generalized tonic-clonic seizures”, sometimes known as grand mal seizures. Tonic-clonic seizures are characterized by two phases: The first “tonic” phase, where muscles become stiff and the body is rigid, followed by the clonic phase, which features the convulsive behavior that is generally associated with a seizure. Tonic-clonic seizures that last for more than five minutes are considered to be status epilepticus.
Alcohol withdrawal can be dangerous, even lethal. Some statistics suggest that in cases of severe, untreated withdrawal, the mortality rate is as high as 37%. Seizures can be dangerous too: When a tonic-clonic seizure begins, the person experiencing it generally loses consciousness and falls over. Someone falling in an unsafe place or falling and hitting their head is dangerous. If the seizure progresses to status epilepticus, it is a true medical emergency.
People in status epilepticus are treated with artificial respiration, IV fluids and may be put into a medically-induced coma to stop seizure activity. “Sudden unexpected death in epilepsy” (SUDEP) is the unexplained death of an otherwise healthy person who has a seizure. Although people suffering from severe alcohol withdrawal may not be considered to be healthy, SUDEP is a risk for them.
Alcohol is addictive and setbacks among people in alcohol recovery is common. The most effective treatment options are generally medically supervised detox and residential rehab, which can provide physical and psychological treatment to maximize the likelihood of long term sobriety. In early recovery, especially if seizures are a concern, clients may be given medications to mitigate the severity of symptoms and reduce the likelihood of seizures.
Contact the Orlando Recovery Center to speak with a representative about how professional addiction treatment can help address an alcohol use disorder. You deserve a healthier future, call today.
Rogawski, Michael A. “Update on the Neurobiology of Alcohol Withdrawal Seizures.” Epilepsy Currents, November 2005. Accessed August 18, 2019.
National Institute on Alcohol Abuse and Alcoholism. “Alcohol Facts and Statistics.” August 2018. Accessed August 18, 2019.
The Epilepsy Foundation. “What is Epilepsy?” January 2014. Accessed August 18, 2019.
Bråthen, Geir; et al. “Alcohol-related seizures.” European Handbook of Neurological Management, 2011. Accessed August 18, 2019.
Rahman, Abdul; Paul, Manju. “Delirium Tremens (DT).” NCBI StatPearls, updated November 2018. Accessed August 18, 2019.
Kiriakopoulos, Elaine. “Tonic-Clonic Seizures.” Epilepsy.com, March 2017. Accessed August 24, 2019.
Schachter, Steven C. “Status Epilepticus.” Epilepsy.com, March 2014. Accessed August 24, 2019.
SUDEP Institute. “SUDEP.” Epilepsy.com, June 2019. Accessed August 24, 2019.
Scorza, Carla A, et al. “Alcohol consumption and sudden unexpected death in epilepsy: experimental approach.” Arquivos de Neuro-Psiquiatria, December 2009. Accessed August 24, 2019.