Seizures in alcohol withdrawal syndrome

Abstract

Alcohol withdrawal syndrome develops in individuals with alcohol dependence who discontinue or reduce alcohol intake after long-term or binge drinking. Withdrawal symptoms usually occur 6–8 hours after the last alcohol consumption and peak between 24–72 hours. Typical manifestations include tremor, nausea, vomiting, insomnia, agitation, and excess sweating. Complicated withdrawal syndrome may manifest with seizures (including cluster seizures), status epilepticus, acute psychosis and delirium, when hallucinations are accompanied by disorientation in time, place and situation. About 10–15% of patients develop complicated withdrawal syndrome. The seizures in alcohol withdrawal syndrome are triggered in the brain stem and have a mechanism other than that of classic epileptic seizures. Benzodiazepines, which are more effective than other classes of anticonvulsants (they primarily reduce the frequency of convulsions in the first two days after alcohol discontinuation and significantly reduce the risk of death), are the gold standard for the treatment of alcohol withdrawal syndrome. The Clinical Institute of Withdrawal Assessment for Alcohol Scale (CIWA-Ar) is a helpful tool for making decisions on treatment initiation or discontinuation. It should be noted that chronic use of benzodiazepines in the secondary prevention of alcohol withdrawal seizures is not recommended due to the addictive potential of these agents and a more severe course of alcohol withdrawal seizures with benzodiazepine co-dependence.