Understand Alcohol Withdrawal Seizure Treatment & Prevention

What is Alcohol Withdrawal?

Although excessive alcohol consumption is detrimental to your health, suddenly stopping chronic alcohol use can pose severe risks. Alcohol withdrawal syndrome is a condition that causes physical and mental side effects when the body doesn’t get alcohol.

These withdrawal symptoms can range from mild to severe. Among the severe symptoms are seizures and delirium tremens (DTs).

What Triggers Alcohol Withdrawal?

After long-term alcohol abuse, your brain will become more dependent on alcohol to produce feelings of relaxation. When you suddenly stop drinking, the imbalance in your nervous system causes alcohol withdrawal symptoms.^1,2

Alcohol is a depressant that calms the nervous system by affecting glutamate and gamma-aminobutyric acid (GABA). Both of these neurotransmitters play a role in managing brain activity and relaxation.

Usually, glutamate and GABA are in balance, allowing the brain to function normally. However, alcohol stimulates GABA activity, causing relaxation. An imbalance in your nervous system can result in alcohol withdrawal when you suddenly stop drinking.

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What to Expect During Alcohol Withdrawal 

Alcohol withdrawal symptoms can range from mild to severe. If left untreated, severe alcohol withdrawal symptoms can be potentially life-threatening.

Alcohol withdrawal syndrome is made up of four stages based on severity:^3,4

Stage 1: Minor Withdrawal Symptoms

The following mild withdrawal symptoms may develop within 6 to 12 hours after the last drink: 

• Anxiety
• Tremors (like shaky hands)
• Headache
• Gastrointestinal upset (like vomiting and nausea)
• Insomnia
• Sweating
• Increased heart rate
• Increased body temperature or fever

Stage 2: Alcoholic Hallucinosis

Hallucinations may happen 12 to 24 hours after the last drink. The minor symptoms from stage 1 can also become severe and life-threatening if not treated.

Stage 3: Alcohol Withdrawal Seizures

The onset of seizures or “rum fits” occurs during this stage. Seizures happen in about 10% of people undergoing alcohol withdrawal. Seizures typically start 24 to 48 hours after a person’s last drink.⁴

Although alcohol rarely causes seizures, alcohol’s relaxing effect is removed during withdrawal. As a result, the brain becomes hyperactive and prone to seizures.

Alcohol withdrawal seizures are of the tonic-clonic type. They involve muscle stiffening (tonic phase) and twitching or jerking (clonic phase). 

Stage 4: Delirium Tremens

Delirium tremens (DTs) usually occur 48 to 72 hours after the last drink. Symptoms include:^{1, 5}

• Fever 
• Sweating
• Nightmares
• Agitation
• Confusion
• Disorientation
• Visual and auditory hallucinations
• Seizures
• Cardiovascular and metabolic complications (like high blood pressure and increased heart rate)

DT is a severe withdrawal symptom that requires immediate medical attention. Reports suggest that people with delirium tremens have a 1 to 15% mortality rate.^6,7

Who is at Risk for Seizures From Withdrawal?

While alcohol withdrawal can lead to seizures, not everyone experiencing withdrawal will have them. Here are the risk factors that studies have linked to withdrawal seizures:^2,10,11

• Previous history of seizure and other withdrawal symptoms 

• Thrombocytopenia (low platelet count)
• Hypokalemia (low potassium level)
• Structural brain lesions

Previous withdrawal episodes appear to be the most reliable predictor of who is at risk for future withdrawal, with or without seizures.

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How to Diagnose Alcohol Withdrawal

The Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar) is used to identify withdrawal symptoms. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), an alcohol withdrawal syndrome diagnosis is made by observing the person. 

There must be at least two symptoms present:⁸

1. Nausea and vomiting 
2. Tremors 
3. Sweating 
4. Anxiety 
5. Agitation
6. Tactile disturbances (itching, pins and needles sensation, numbness) 
7. Auditory disturbances
8. Visual disturbances
9. Headache and fullness of head 
10. Orientation and clouding of the sensorium (the brain’s "seat of sensation”)

Each item is scored depending on the severity of symptoms. Items 1 to 9 are assigned 0 to 7 points. Item 10 is assigned 0 to 4 points. The highest score a person can get is 67 points.⁹

The total score is computed and used to classify the patient’s alcohol withdrawal condition:^2,4

• Less than 8: Mild symptoms that may not need medications
• 8 to 15: Moderate symptoms that may need medications to prevent the progression of symptoms
• Greater than 15: Severe symptoms with a high chance of seizures and delirium

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Types of Alcohol Withdrawal Syndrome

There are two types of alcohol withdrawal syndrome: acute alcohol withdrawal and post-acute alcohol withdrawal, otherwise known as protracted withdrawal. Both function differently and have distinct symptoms.¹⁶

Acute withdrawal happens almost immediately after you stop using alcohol. On the other hand, protracted withdrawal is a collection of lingering side effects after acute withdrawal.¹⁶

Unlike acute withdrawal, protracted withdrawal mainly has long-term mental side effects. Symptoms include:¹⁶

• Cognitive or memory problems
• Urges and cravings
• Irritability or hostility
• Sleep disturbances (insomnia or vivid dreams)
• Fatigue
• Lack of coordination
• Stress sensitivity
• Anxiety or panic
• Depression
• Lack of initiative
• Impaired ability to focus
• Mood swings

What to Do if Alcohol Withdrawal Causes Seizures

Treatment of alcohol withdrawal is usually based on the severity of withdrawal. A person may go to an outpatient setting for mild and moderate symptoms. This option is safe, effective, relatively cheap, and doesn’t disrupt their personal life. 

However, hospital treatment is needed for serious withdrawal cases. Doctors will need to monitor and manage your condition for any complications. They may also provide intravenous fluids to prevent dehydration and medication to ease your symptoms. 

People with the following conditions are top candidates for hospital or inpatient treatment:^{3, 5, 12}

• Severe withdrawal symptoms
• History of withdrawal seizures
• High risk of delirium tremens
• Acute illnesses
• Poorly controlled chronic medical conditions
• Suicidal thoughts and other serious psychiatric conditions
• Abnormal laboratory results
• Lack of a support network
• Use of other substances

How to Prevent Seizures When You Quit Drinking

The best way to prevent seizures and other withdrawal symptoms is to avoid regular and heavy alcohol use. However, there are ways to minimize the risk of symptoms and complications.² It can be done by:

• Medical detoxification
• Gradually reducing the person’s dependence on alcohol
• Substituting alcohol with approved medications

If you or someone you know has an alcohol use disorder, know that help is available. Speak with an addiction specialist today.

Alcohol Withdrawal Seizure Treatment 

Substance abuse treatment can vary depending on the severity of the addiction. People with severe withdrawal symptoms may need interventions that involve medications. 

However, not all treatment options for alcohol withdrawal are effective in managing seizures. The medications that are used in the management of alcohol withdrawal include:

Benzodiazepine

Benzodiazepines are the top choice for treating and preventing alcohol withdrawal in the U.S. They’re sedatives that help reduce seizures and prevent symptoms from becoming severe.^3,5,12,13,14

The commonly prescribed benzodiazepines are: 

• Chlordiazepoxide
• Lorazepam
• Alprazolam

Benzodiazepine can be combined with haloperidol, beta-blockers, clonidine, and phenytoin to treat withdrawal complications.¹⁵ Benzodiazepines carry an FDA warning because of their addictive properties. You should discuss this risk with your doctor and follow instructions carefully.

Carbamazepine

Carbamazepine is an anticonvulsant. It’s an alternative to benzodiazepines in the outpatient treatment of mild-to-moderate symptoms.¹⁵ It’s commonly prescribed in Europe.¹³

Chlormethiazole

Chlormethiazole (also called clomethiazole or heminevrin) enhances GABA activity. It can protect against withdrawal seizures. Like carbamazepine, it’s commonly prescribed in Europe.¹³

Valproate

Valproate (also known as valproic acid) reduces the incidence of seizures. It also prevents the progression of withdrawal symptoms.⁴ Like chlormethiazole and carbamazepine, it’s commonly prescribed in Europe.¹³

Neuroleptics

Neuroleptic agents (like haloperidol and phenothiazines) may reduce the severity of withdrawal symptoms. They may work with people with uncontrolled agitation. However, they’re less effective than benzodiazepines in treating seizures and delirium.³

Barbiturates

Combining benzodiazepines and certain barbiturates can increase the efficacy of benzodiazepines’ action.⁴

Propofol

One of the propofol’s effects is to stimulate GABA. This makes the drug useful for people with severe delirium tremens who respond poorly to benzodiazepines.⁴

Sodium Oxybate

Sodium oxybate is structurally similar to GABA. It’s approved in some European countries for alcohol withdrawal treatment. However, it’s not approved in other countries because of its addictive properties.⁴

Gabapentin

Gabapentin is another drug that’s structurally similar to GABA. It can be combined with other medications to treat partial seizures.^3,4

Baclofen 

Baclofen can reduce alcohol withdrawal symptoms by activating GABA receptors.^3,4

Supplements

Vitamins and minerals are given to replace essential nutrients that alcohol use has depleted. In particular, thiamine and folic acid are given to prevent a neurological disease called Wernicke’s encephalopathy.⁴ Additional supplements may address nutritional deficiencies once the withdrawal is gone.⁵

Summary

When chronic heavy drinkers suddenly stop drinking, they experience alcohol withdrawal symptoms. These are uncomfortable physical and mental side effects that can be potentially life-threatening.

It’s caused by an imbalance of two neurotransmitters known as GABA and glutamate. Alcohol withdrawal has four stages: minor withdrawal symptoms, hallucinations, withdrawal seizure, and delirium tremens.

Alcohol withdrawal syndrome is a medical emergency that requires immediate medical attention. Fortunately, treatment options and medications are used in alcohol withdrawal management.