Alcohol-Related Seizures in the ICU

Abstract

Alcohol abuse is a common cause of seizures resulting in admission to the intensive care unit. The cause of the alcohol-related seizures (ARS) is usually abstinence in a chronic alcoholic, although some patients may still have detectable levels of alcohol in their blood. ARS generally occur between 7 and 48 h after abstinence. Approximately half of patients presenting with ARS will have recurrent seizures (usually two to four) within a vulnerable 6-h period following the initial ARS. Although patients with ARS rarely enter status epilepticus (SE), alcohol withdrawal is a common contributing factor in many cases of SE. Evaluation involves searching for a focal cause of the seizure as well as looking for comorbid conditions, including delirium tremens, that may complicate the management of chronic alcohol abusers. Treatment of ARS is similar to general management of alcohol withdrawal, with benzodiazepines being the mainstay of treatment. Treatment of alcohol-related SE is similar to that of other causes of SE. Phenytoin is not indicated for treatment of ARS unless the patient enters SE.Key WordsSeizurewithdrawalalcoholstatus epilepticusintensive careICUdelirium tremensantiepilepticphenytoin