The Link Between Epilepsy and Alcohol
Alcohol-related seizures and epilepsy are considered to be distinct disorders. According to The Epilepsy Foundation, epilepsy is defined as “a chronic disorder, the hallmark of which is recurrent, unprovoked seizures.” Since alcohol-induced seizures are provoked, they do not fit the definition of epilepsy. In cases where someone has undergone multiple episodes of withdrawal that have included seizures, the risk for developing a subsequent seizure disorder is increased. However, because the underlying pathologies are different, whether alcohol-related idiopathic (spontaneous) seizures and epileptic seizures should be considered the same disorder remains unclear.
A recent study evaluated the consequences of epileptic seizures and alcohol withdrawal-related seizures on the brain and found that they have distinct effects on brain activity 72 hours after the seizure. For example, measurements of brain activity show that people who have suffered alcohol withdrawal-associated seizures have relatively normal brain activity but also experience anxiety, tremors, high blood pressure and fever. Conversely, epileptic seizures are associated with abnormally reduced brain activity (“post-ictal slowing”) and do not experience low mood, anxiety, elevated blood pressure or fever.
- Epilepsy from alcohol withdrawal: Although cases of repeated, severe withdrawal that is associated with seizures may predispose someone to future idiopathic (spontaneous) seizures, because the pathophysiology associated with these seizures is thought to be different from true epileptic seizures, many medical professionals do not consider seizures that are a consequence of alcohol use to be epileptic.
- Epilepsy from alcohol abuse: Chronic alcohol abuse itself is not associated with epilepsy or seizures. The presence of alcohol actually reduces seizure risk, it is only when alcohol leaves the system that seizure risk increases. Notably, alcohol abuse must be chronic and severe in order to cause significant brain maladaptations that potentiate seizure activity.
- Epilepsy from alcohol poisoning: Although there is some evidence for acute alcohol poisoning causing seizures (most likely due to low blood sugar or significant changes in ion concentrations in the blood and brain), these seizures are distinct from epileptic seizures.
- Epilepsy medications and alcohol: Epileptics who take anti-epileptic drugs (AEDs) must drink alcohol with caution. AEDs can reduce tolerance to alcohol and alcohol can reduce AED efficiency. In addition, there is some risk of negative interactions between alcohol and epilepsy medicine.
Importantly, people with epilepsy are strongly advised to limit daily alcohol intake to a maximum of two drinks, and it is recommended that they be consumed slowly. Anyone with epilepsy is urged to discuss alcohol use with their doctor, especially if they are given a prescription for epilepsy medication. Binge drinking and chronic alcohol abuse are major risk factors for seizure activity.
Treating Epilepsy and Alcohol Addiction
A dual diagnosis treatment plan for epilepsy and alcohol addiction will vary depending on whether the epilepsy is newly diagnosed, what kind of epilepsy is diagnosed and the severity of the alcohol use disorder. In many cases, it may be necessary to get the substance abuse component of the dual diagnosis under control before starting medication to treat epilepsy. In this case, the first step will likely be an alcohol detox program followed by a residential rehab program that can oversee the implementation of anti-epileptic drugs.
The alcohol detox timeline and the specific protocol for alcohol withdrawal treatment will depend on the severity of withdrawal symptoms but can be expected to take one to two weeks for most cases. People with mild alcohol use disorders may be started on AEDs right away and begin an outpatient treatment program that will help them learn how to avoid triggers and deal with stressful situations in more constructive ways.
People who are diagnosed with alcohol-induced seizure disorders in conjunction with an alcohol use disorder are urged to participate in a residential rehab program that will maximize the likelihood of long-term sobriety. Oftentimes the most appropriate rehab program will be medical detox and a long-term residential stay followed by an intensive outpatient program that transitions into outpatient and aftercare programs. It is imperative for people who have suffered from alcohol-induced seizures to abstain from any alcohol use to reduce the risk of future seizures and development of spontaneous seizure disorders.
For people with epilepsy, alcohol use disorders can be particularly risky. If you or someone you love has epilepsy and is struggling with alcohol use, help is available. Contact The Recovery Village Ridgefield to learn how we can help get you on the path to recovery.
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.
Leach, John Paul; Mohanraj; Rajiv; Borland, William. “Alcohol and drugs in epilepsy: Pathophysiology, presentation, possibilities, and prevention.” Epilepsia, September 2012. Accessed August 18, 2019.
The Epilepsy Foundation. “Alcohol.” March 2014. Accessed August 18, 2019.
Hillbom, Matti; Pieninkeroinen, Ilkk; Leone, Maurizio. “Seizures in alcohol-dependent patients: Epidemiology, pathophysiology and management.” CNS Drugs, January 2013. Accessed August 18, 2019.
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