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01-12-2003 | Therapy In Practice

Seizures in Alcohol-Dependent Patients

Epidemiology, Pathophysiology and Management

Authors: Dr Matti Hillbom, Ilkka Pieninkeroinen, Maurizio Leone

Published in: CNS Drugs | Issue 14/2003

Abstract

The relationship between alcohol and seizures is complex and multifaceted. The prevalence of epilepsy in alcohol-dependent patients of western industrialised countries may be at least triple that in the general population, whereas the prevalence of alcoholism is only slightly higher in patients with epilepsy than in the general population.

The seizure threshold is raised by alcohol drinking and declines on cessation of drinking. As a result, during withdrawal from alcohol, usually 6–8 hours after the cessation of drinking, seizures may occur. Alcohol acts on the brain through several mechanisms that influence seizure threshold. These include effects on calcium and chloride flux through the ion-gated glutamate NMDA and GABA receptors. During prolonged intoxication, the CNS adapts to the effects of alcohol, resulting in tolerance; however, these adaptive effects seem to be transient, disappearing after alcohol intake is stopped. Although the relationship of seizures to alcohol use is likely to be dose dependent and causal, the available clinical data do not suggest that alcohol use results in seizure genesis. However, a genetic predisposition to alcohol withdrawal seizures is possible. Other seizures in alcohol-dependent individuals may be due to concurrent metabolic, toxic, infectious, traumatic, neoplastic and cerebrovascular diseases and are frequently partial-onset seizures. Alcohol abuse is a major precipitant of status epilepticus (9–25% of cases), which may even be the first-ever seizure type.

Prompt treatment of alcohol withdrawal seizures is recommended to prevent status epilepticus. During the detoxification process, primary and secondary preventative measures can be taken. A meta-analysis of controlled trials for the primary prevention of alcohol withdrawal seizures demonstrated a highly significant risk reduction for seizures with benzodiazepines and antiepileptic drugs and an increased risk with antipsychotics. A meta-analysis of randomised, placebocontrolled trials for the secondary prevention of seizures after alcohol withdrawal showed lorazepam to be effective, whereas phenytoin was ineffective. Because withdrawal seizures do not recur if the patient remains abstinent, long-term administration of antiepileptic drugs is unnecessary in abstinent patients. The first seizure not related to alcohol withdrawal should not result in permanent drug treatment in an alcohol-dependent patient, because of poor compliance and the high likelihood of remission. The treatment of alcohol dependence is more important and should be prioritised before the prevention of further seizures.

Yamane H, Katoh N. Alcoholic epilepsy: a definition and a description of other convulsions related to alcoholism. Eur Neurol 1981; 20: 17–24PubMedCrossRef

Hauser WA, Ng SKC, Brust JCM. Alcohol, seizures, and epilepsy. Epilepsia 1988; 29Suppl. 2: S66–78PubMedCrossRef

Lloyd G. Hippocratic writings. Middlesex: Penguin Books, 1978

Lennox WG. Alcohol and epilepsy. Q J Stud Alcohol 1941; 2: 1–7

Huss M. Alcoholismus chronicus eller chronisk alkoholssjukdom: ett bidrag till dyskrasiernas kannedom, enligt egen och andras erfarenhet. Stockholm: Johan Beckman, 1849

Victor M, Brausch C. The role of abstinence in the genesis of alcoholic epilepsy. Epilepsia 1967; 8: 1–20PubMedCrossRef

Earnest MP, Yarnell PR. Seizure admissions to a city hospital: the role of alcohol. Epilepsia 1976; 17: 387–93PubMedCrossRef

Hillbom M. Occurrence of cerebral seizures provoked by alcohol abuse. Epilepsia 1980; 21: 459–66PubMedCrossRef

Kramholz A, Grufferman S, Orr ST, et al. Seizures and seizure care in an emergency department. Epilepsia 1989; 30: 175–81CrossRef

10.

Pilke A, Partinen M, Kovanen J. Status epilepticus and alcohol abuse: an analysis of 82 status epilepticus admissions. Acta Neurol Scand 1984; 70: 443–50PubMedCrossRef

11.

Lowenstein DH, Alldredge BK. Status epilepticus at an urban public hospital in the 1980s. Neurology 1993; 43: 483–8PubMedCrossRef

12.

Leppik IE, Jacobs MP, Loewenson RB, et al. Alcohol and status epilepticus. In: Porter RJ, Mattson RH, Cramer JA, et al., editors. Alcohol and seizures: basic mechanisms and clinical concepts. Philadelphia (PA): FA Davis Company, 1990: 216–21

13.

Tomson T. Mortality in epilepsy. J Neurol 2000; 247: 15–21PubMedCrossRef

14.

Lhatoo SD, Johnson AL, Goodridge DM, et al. Mortality in epilepsy in the first 11 to 14 years after diagnosis: multivariate analysis of a long-term, prospective, population-based cohort. Ann Neurol 2001; 49: 336–44PubMedCrossRef

15.

Pieninkeroinen IP, Telakivi TM, Hillbom ME. Outcome in subjects with alcohol-provoked seizures. Alcohol Clin Exp Res 1992; 16: 955–9PubMedCrossRef

16.

Alldredge BK, Lowenstein DH. Status epilepticus related to alcohol abuse. Epilepsia 1993; 34: 1033–7PubMedCrossRef

17.

Bråthen G, Brodtkorb E, Helde G, et al. The diversity of seizures related to alcohol use: a study of consecutive patients. Eur J Neurol 1999; 6: 697–703PubMedCrossRef

18.

Bråthen G. The classification and clinical diagnosis of alcoholrelated seizures [dissertation]. Trondheim: Norwegian University of Science and Technology, 2001

19.

Ng SKC, Hauser WA, Brust JCM, et al. Alcohol consumption and withdrawal in new-onset seizures. N Engl J Med 1988; 319: 666–73PubMedCrossRef

20.

Leone M, Bottacchi E, Beghi E, et al. Alcohol use is a risk factor for a first generalized tonic-clonic seizure: the ALC.E. (Alcohol and Epilepsy) Study Group. Neurology 1997; 48: 614–20PubMedCrossRef

21.

Chan AW. Alcoholism and epilepsy. Epilepsia 1985; 26: 323–33PubMedCrossRef

22.

Hauser WA, Annegers JF, Kurland LT. Prevalence of epilepsy in Rochester, Minnesota: 1940–1980. Epilepsia 1991; 32: 429–45PubMedCrossRef

23.

Forsgren L. Prevalence of epilepsy in adults in northern Sweden. Epilepsia 1992; 33: 450–8PubMedCrossRef

24.

Granieri E, Rosati G, Tola R, et al. A descriptive study of epilepsy in the district of Copparo, Italy, 1964–1978. Epilepsia 1983; 24: 502–14PubMedCrossRef

25.

Bråthen G, Brodtkorb E, Sand T, et al. Weekday distribution of alcohol consumption in Norway: influence on the occurrence of epileptic seizures and stroke? Eur J Neurol 2000; 7: 413–21PubMedCrossRef

26.

Tartara A, Manni R, Mazzella G. Epileptic seizures and alcoholism: clinical and pathogenetic aspects. Acta Neurol Belg 1983; 83: 88–94PubMed

27.

Wolfe SM, Victor M. The relationship of hypomagnesemia and alkalosis to alcohol withdrawal symptoms. Ann N Y Acad Sci 1969; 162: 973–84PubMedCrossRef

28.

Hillbom ME. Alcohol withdrawal seizures and binge versus chronic drinking. In: Porter RJ, Mattson RH, Cramer JA, et al., editors. Alcohol and seizures: basic mechanisms and clinical concepts. Philadelphia (PA): FA Davis Company, 1990: 206–15

29.

Gross MM, Lewis E, Best S, et al. Quantitative changes of signs and symptoms associated with acute alcohol withdrawal: incidence, severity and circadian effects in experimental studies of alcoholism. Adv Exp Med Biol 1979; 59: 615–31

30.

Goldstein DB. Relationship of alcohol dose to intensity of withdrawal signs in mice. J Pharmacol Exp Ther 1972; 180: 203–15PubMed

31.

Majchrowicz E. Induction of physical dependence upon ethanol and the associated behavioral changes in rats. Psychopharmacologia 1975; 43: 245–54PubMedCrossRef

32.

Majchrowicz E, Hunt WA. Temporal relationship of the induction of tolerance and physical dependence after continuous intoxication with maximum tolerable doses of ethanol in rats. Psychopharmacology 1976; 50: 107–12PubMedCrossRef

33.

Goldstein DB, Chin JH. Interaction of ethanol with biological membrane. Fed Proc 1981; 40: 1073–6

34.

Goldstein DB. Pharmacology of alcohol. New York: Oxford University Press, 1983

35.

Nestoros JN. Ethanol specifically potentiates GABA-mediated neurotransmission in feline cerebral cortex. Science 1980; 209: 708–10PubMedCrossRef

36.

Linnoila M, Mefford I, Nutt D, et al. Alcohol withdrawal and noradrenergic function. Ann Intern Med 1987; 107: 875–9PubMed

37.

Sanna E, Serra M, Cossu A, et al. Chronic ethanol intoxication induces differential effects on GABA and NMDA receptor function in the rat brain. Alcohol Clin Exp Res 1993; 17: 115–23PubMedCrossRef

38.

Tsai G, Gastfriend DR, Coyle JT. The glutamatergic basis of human alcoholism. Am J Psychiatry 1995; 152: 332–40PubMed

39.

Carboni S, Isola R, Gessa GL, et al. Ethanol prevents the glutamate release induced by N-methyl-D-aspartate in the rat striatum. Neurosci Lett 1993; 152: 133–6PubMedCrossRef

40.

Nie Z, Yuan X, Madamba SG, et al. Ethanol decreases glutamatergic synaptic transmission in rat nucleus accumbens in vitro: naloxone reversal. J Pharmacol Exp Ther 1993; 266: 1705–12PubMed

41.

Lovinger DM, White G, Weight FF. Ethanol inhibits NMDA-activated ion current in hippocampal neurons. Science 1989; 243: 1721–4PubMedCrossRef

42.

Iorio KR, Reinlib L, Tabakoff B, et al. Chronic exposure of cerebellar granule cells to ethanol results in increased Nmethyl-D-aspartate receptor function. Mol Pharmacol 1992; 41: 1142–8PubMed

43.

Trevisan L, Fitzgerald LW, Brose N, et al. Chronic ingestion of ethanol up-regulates NMDAR1 receptor subunit immunoreactivity in rat hippocampus. J Neurochem 1994; 62: 1635–8PubMedCrossRef

44.

Engberg G, Hajos M. Ethanol attenuates the response of locus coeruleus neurons to excitatory amino acid agonists in vivo. Naunyn Schmiedebergs Arch Pharmacol 1992; 345: 222–6PubMedCrossRef

45.

Tan CY, Weaver DF. Molecular pathogenesis of alcohol withdrawal seizures: the modified lipid-protein interaction mechanism. Seizure 1997; 6: 255–74PubMedCrossRef

46.

Porter RJ, Mattson RH, Cramer JA, et al., editors. Alcohol and seizures: basic mechanisms and clinical concepts. Philadelphia (PA): FA Davis Company, 1990

47.

Okubo T, Harada S. Polymorphism of the neuropeptide Y gene: an association study with alcohol withdrawal. Alcohol Clin Exp Res 2001; 25(6 Suppl.): 59S–62SPubMedCrossRef

48.

Sander T, Harms H, Podschus J, et al. Allelic association of a dopamine transporter gene polymorphism in alcohol dependence with withdrawal seizures or delirium. Biol Psychiatry 1997; 41: 299–304PubMedCrossRef

49.

Schaumann BA, Annegers JF, Johnson SB, et al. Family history of seizures in posttraumatic and alcohol-associated seizure disorders. Epilepsia 1994; 35: 48–52PubMedCrossRef

50.

Valverius P, Crabbe JC, Hoffman PL, et al. NMDA receptors in mice bred to be prone or resistant to ethanol withdrawal seizures. Eur J Pharmacol 1990; 184: 185–9PubMedCrossRef

51.

Kosobud AE, Crabbe JC. Sensitivity to N-methyl-D-aspartic acid-induced convulsions is genetically associated with resistance to ethanol withdrawal seizures. Brain Res 1993; 610: 176–9PubMedCrossRef

52.

Sand T, Bråthen G, Michler R, et al. Clinical utility of EEG in alcohol-related seizures. Acta Neurol Scand 2002; 105: 18–24PubMedCrossRef

53.

Skullerud K, Andersen SN, Lundevall J. Cerebral lesions and causes of death in male alcoholics: a forensic autopsy study. Int J Legal Med 1991; 104: 209–13PubMedCrossRef

54.

Mattson RH, Fay ML, Sturman JK, et al. The effect of various patterns of alcohol use on seizures in patients with epilepsy. In: Porter RJ, Mattson RH, Cramer JA, et al., editors. Alcohol and seizures: basic mechanisms and clinical concepts. Philadelphia (PA): FA Davis Company, 1990: 233–40

55.

Pedersen SB, Petersen KA. Juvenile myoclonic epilepsy: clinical and EEG features. Acta Neurol Scand 1998; 97: 160–3PubMedCrossRef

56.

Genton P, Guerrin R. Antimyoclonic effect of alcohol in progressive myoclonic epilepsy. Neurology 1990; 40: 1412–6PubMedCrossRef

57.

Bartolomei F, Azulay J-P, Barrié M, et al. Myoclonic alcoholic epilepsy. Epilepsia 1996; 37: 406–9PubMedCrossRef

58.

Jain S, Tamer SK, Hiran S. Beneficial effect of alcohol in hereditary cerebellar ataxia with myoclonus (progressive myoclonic ataxia): report of two siblings. Mov Disord 1996; 11: 751–2PubMedCrossRef

59.

Hsiao MC, Liu CY, Yang YY, et al. Progressive myoclonic epilepsies syndrome (Ramsay Hunt syndrome) with mental disorder: report of two cases. Psychiatry Clin Neurosci 1999; 53: 575–8PubMedCrossRef

60.

Aminoff MJ, Simon RP. Status epilepticus: causes, clinical features and consequences in 98 patients. Am J Med 1980; 69: 657–66PubMedCrossRef

61.

Passera S, Rocchi R, Rossi S, et al. Seizures after spontaneous supratentorial intracerebral hemorrhage. Epilepsia 2002; 43: 1175–80CrossRef

62.

Earnest MP, Feldman H, Marx JA, et al. Intracranial lesions shown by CT scans in 259 cases of first alcohol-related seizures. Neurology 1988; 38: 1561–5PubMedCrossRef

63.

Powers RD. Serum chemistry abnormalities in adult patients with seizure. Ann Emerg Med 1985; 14: 416–20PubMedCrossRef

64.

Earnest MP. Seizures. Neurol Clin 1993; 11: 563–75PubMed

65.

Alldredge BK, Lowenstein DH, Simon RP. Seizures associated with recreational drug abuse. Neurology 1989; 39: 1037–9PubMedCrossRef

66.

Koppel BS, Samkoff L, Daras M. Relation of cocaine use to seizures and epilepsy. Epilepsia 1996; 37: 875–8PubMedCrossRef

67.

Moak DH, Anton RF. Alcohol-related seizures and the kindling effect of repeated detoxifications: the influence of cocaine. Alcohol Alcohol 1996; 31: 135–43PubMed

68.

Spivey WH. Flumazenil and seizures: analysis of 43 cases. Clin Ther 1992; 14: 292–305PubMed

69.

Hillbom ME, Hjelm-Jäger M. Should alcohol withdrawal seizures be treated with anti-epileptic drugs? Acta Neurol Scand 1984; 69: 39–42PubMedCrossRef

70.

Cassano PA, Koepsell TD, Farwell JR. Risk of febrile seizures in childhood in relation to prenatal maternal cigarette smoking and alcohol intake. Am J Epidemiol 1990; 132: 462–73PubMed

71.

Avdaloff W. Alcoholism, seizures and cerebral atrophy. Adv Biol Psychiatry 1979; 3: 20–32

72.

Sullivan EV, Marsh L, Mathalon DH, et al.Relationship between alcohol withdrawal seizures and temporal lobe white matter volume deficits. Alcohol Clin Exp Res 1996; 20: 348–54PubMedCrossRef

73.

Dam AM, Fuglsang-Frederiksen A, Svarre-Olsen U, et al. Late onset epilepsy: etiologies, types of seizure, and value of clinical investigation, EEG and computerized tomography scan. Epilepsia 1985; 26: 227–31PubMedCrossRef

74.

Hesdorffer DC, Logroscino G, Cascino G, et al.Risk of unprovoked seizure after acute symptomatic seizure: effect of status epilepticus. Ann Neurol 1998; 44: 908–12PubMedCrossRef

75.

Ballenger JC, Post RM. Kindling as a model for alcohol withdrawal syndrome. Br J Psychiatry 1978; 133: 1–14PubMedCrossRef

76.

Pinel JPJ. Alcohol withdrawal seizures: implications of kindling. Pharmacol Biochem Behav 1980; 13Suppl. 1: 225–31PubMedCrossRef

77.

Mucha RF, Pinel JPJ. Increased susceptibility to kindled seizures in rats following a single injection of alcohol. J Stud Alcohol 1979; 40: 258–71PubMed

78.

Clemmesen L, Hemmingsen R. Physical dependence on ethanol during multiple intoxication and withdrawal episodes in the rat: evidence of a potentiation. Acta Pharmacol Toxicol (Copenh) 1984; 55: 345–50CrossRef

79.

Becker HC, Hale RL. Repeated episodes of ethanol withdrawal potentiate the severity of subsequent withdrawal seizures: an animal model of alcohol withdrawal “kindling”. Alcohol Clin Exp Res 1993; 17: 94–8PubMedCrossRef

80.

Becker HC, Diaz-Granados JL, Weathersby RT. Repeated ethanol withdrawal experience increases the severity and duration of subsequent withdrawal seizures in mice. Alcohol 1997; 14: 319–26PubMedCrossRef

81.

Becker HC, Diaz-Granados JL, Hale RL. Exacerbation of ethanol withdrawal seizures in mice with a history of multiple withdrawal experience. Pharmacol Biochem Behav 1997; 1-2: 179–83CrossRef

82.

Brown ME, Anton RF, Malcolm R, et al. Alcohol detoxification and withdrawal seizures: clinical support for a kindling hypothesis. Biol Psychiatry 1988; 23: 507–14PubMedCrossRef

83.

Lechtenberg R, Worner TM. Seizure risk with recurrent alcohol detoxification. Arch Neurol 1990; 47: 535–8PubMedCrossRef

84.

Worner TM. Relative kindling effect of readmissions in alcoholics. Alcohol Alcohol 1996; 31: 375–80PubMed

85.

Wojnar M, Bizon Z, Wasilewski D. Assessment of the role of kindling in the pathogenesis of alcohol withdrawal seizures and delirium tremens. Alcohol Clin Exp Res 1999; 23: 204–8PubMedCrossRef

86.

Veatch LM, Gonzalez LP. Repeated ethanol withdrawal delays development of focal seizures in hippocampal kindling. Alcohol Clin Exp Res 1999; 23: 1145–50PubMed

87.

Claassen CA, Adinoff B. Alcohol withdrawal syndrome: guidelines for management. CNS Drugs 1999; 12: 279–91CrossRef

88.

Mayo-Smith MF. Pharmacological management of alcohol withdrawal: a meta-analysis and evidence-based practice guideline: American Society of Addiction Medicine Working Group on Pharmacological Management of Alcohol Withdrawal. JAMA 1997; 278: 144–51PubMedCrossRef

89.

Gordon E, Devinsky O. Alcohol and marijuana: effects of epilepsy and use by patients with epilepsy. Epilepsia 2001; 42: 1266–72PubMedCrossRef

90.

Alldredge BK, Lowenstein DH, Simon RP. Placebo-controlled trial of intravenous diphenylhydantoin for short-term treatment of alcohol withdrawal seizures. Am J Med 1989; 87: 645–8PubMedCrossRef

91.

Chance JF. Emergency department treatment of alcohol withdrawal seizures with phenytoin. Ann Emerg Med 1991; 20: 520–2PubMedCrossRef

92.

Rathlev NK, D’Onofrio G, Fish SS,et al. The lack of efficacy of phenytoin in the prevention of recurrent alcohol-related seizures. Ann Emerg Med 1994; 23: 513–8PubMedCrossRef

93.

D’Onofrio G, Rathlev NK, Ulrich AS, et al. Lorazepam for the prevention of recurrent seizures related to alcohol. N Engl J Med 1999; 340: 915–9PubMedCrossRef

94.

Sereny G, Kalant H. Comparative clinical evaluation of chlordiazepoxide and promazine in treatment of alcohol withdrawal syndrome. BMJ 1965; 1: 92–7PubMedCrossRef

95.

Chambers JF, Schultz JD. Double-blind study of three drugs in the treatment of acute alcoholic states. Q J Stud Alcohol 1965; 26: 10–8PubMed

96.

Golbert TM, Sanz CJ, Rose HD, et al. Comparative evaluation of treatments of alcohol withdrawal syndromes. JAMA 1967; 10: 99–102CrossRef

97.

Kaim SC, Klett CJ, Rothfeld B. Treatment of the acute alcohol withdrawal state: a comparison of four drugs. Am J Psychiatry 1969; 125: 1640–6PubMed

98.

Rothstein E. Prevention of alcohol withdrawal seizures: the roles of diphenylhydantoin and chlordiazepoxide. Am J Psychiatry 1973; 130: 1381–2PubMed

99.

Sampliner R, Iber FL. Diphenylhydantoin control of alcohol withdrawal seizures: results of a controlled study. JAMA 1974; 4: 1430–2CrossRef

100.

Lambie DG, Johnson RH, Vijayasenan ME, et al. Sodium valproate in the treatment of the alcohol withdrawal syndrome. Aust N Z J Psychiatry 1980; 14: 213–5PubMedCrossRef

101.

Zilm DH, Jacob MS, MacLeod SM, et al.Propranolol and chlordiazepoxide effects on cardiac arrhythmias during alcohol withdrawal. Alcohol Clin Exp Res 1980; 4: 400–5PubMedCrossRef

102.

Sellers EM, Naranjo CA, Harrison M, et al. Diazepam loading: simplified treatment of alcohol withdrawal. Clin Pharmacol Ther 1983; 34: 822–6PubMedCrossRef

103.

Solomon J, Rouck LA, Hoepke HH. Double-blind comparison of lorazepam and chlordiazepoxide in the treatment of the acute alcohol abstinence syndrome. Clin Ther 1983; 6: 52–8PubMed

104.

Flygenring J, Hansen J, Holst B, et al. Treatment of alcohol withdrawal symptoms in hospitalized patients: a randomized, double-blind comparison of carbamazepine and barbital. Acta Psychiatr Scand 1984; 69: 398–408PubMedCrossRef

105.

Wilson A, Vulcano BA. Double-blind trial of alprazolam and chlordiazepoxide in the management of the acute ethanol withdrawal syndrome. Alcohol Clin Exp Res 1985; 9: 23–7PubMedCrossRef

106.

Cushman Jr P, Forbes R, Lerner W, et al. Alcohol withdrawal syndromes: clinical management with lofexidine. Alcohol Clin Exp Res 1985; 9: 103–8PubMedCrossRef

107.

Ritson B, Chick J. Comparison of two benzodiazepines in the treatment of alcohol withdrawal: effects on symptoms and cognitive recovery. Drug Alcohol Depend 1986; 18: 329–34PubMedCrossRef

108.

Hillbom M, Tokola R, Kuusela V, et al. Prevention of alcohol withdrawal seizures with carbamazepine and valproic acid. Alcohol 1989; 6: 223–6PubMedCrossRef

109.

Robinson BJ, Robinson GM, Maling TJ, et al. Is clonidine useful in the treatment of alcohol withdrawal? Alcohol Clin Exp Res 1989; 13: 95–8PubMedCrossRef

110.

Stanhope JM, Curry KH. The use of carbamazepine in chlormethiazole-modified withdrawal from alcohol. Aust Drug Alcohol Rev 1989; 8: 5–8CrossRef

111.

Baumgartner GR, Rowen RC. Transdermal clonidine versus chlordiazepoxide in alcohol withdrawal: a randomized, controlled clinical trial. South Med J 1991; 84: 312–21PubMedCrossRef

112.

Bailly D, Servant D, Blandin N, et al. Effects of beta-blocking drugs in alcohol withdrawal: a double-blind comparative study with propranolol and diazepam. Biomed Pharmacother 1992; 46: 419–24PubMedCrossRef

113.

Saitz R, Mayo-Smith MF, Roberts MS, et al. Individualized treatment for alcohol withdrawal: a randomized double-blind controlled trial. JAMA 1994; 272: 519–23PubMedCrossRef

114.

Rosenthal RN, Perkel C, Singh P, et al. A pilot open randomized trial of valproate and phenobarbital in the treatment of acute alcohol withdrawal. Am J Addict 1998; 7: 189–97PubMed

115.

Nimmerrichter AA, Walter H, Gutierrez-Lobos KE, et al. Double-blind controlled trial of γ-hydroxybutyrate and chlormethiazole in the treatment of alcohol withdrawal. Alcohol Alcohol 2002; 37: 67–73PubMed

116.

Mayo-Smith MF, Bernard D. Late-onset seizures in alcohol withdrawal. Alcohol Clin Exp Res 1995; 19: 656–9PubMedCrossRef

117.

Kraemer KL, Conigliaro J, Saitz R. Managing alcohol withdrawal in the elderly. Drugs Aging 1999; 14: 409–25PubMedCrossRef

118.

Young GP, Dailey RH. Treatment of alcohol withdrawal seizures with intravenous phenobarbital. In: Porter RJ, Mattson RH, Cramer JA, et al., editor. Alcohol and seizures: basic mechanisms and clinical concepts. Philadelphia (PA): FA Davis Company, 1990: 298–303

119.

Morgan MY. The management of alcohol withdrawal using chlormethiazole. Alcohol Alcohol 1995; 30: 771–4PubMed

120.

Shaw GK. Detoxification: the use of benzodiazepines. Alcohol Alcohol 1995; 30: 765–70PubMed

121.

Hillbom ME. Alcohol withdrawal seizures: alternatives for treatment and prevention. Nord Psykiatr Tidsskr 1987; 41Suppl. 17: 45–7CrossRef

122.

Malcolm R, Myrick H, Brady KT, et al. Update on anticonvulsants for the treatment of alcohol withdrawal. Am J Addict 2001; 10: 16–23PubMed

123.

Naranjo CA, Sellers EM, Chater K, et al. Nonpharmacologic intervention in acute alcohol withdrawal. Clin Parmacol Ther 1983; 34: 214–9CrossRef

124.

Booth BM, Blow FC. The kindling hypothesis: further evidence from a US nation study of alcoholic men. Alcohol Alcohol 1993; 28: 593–8PubMed

125.

Beerman B, Bolwig T, Borg S, et al. Workshop om farmakologisk behandling vid alkoholism: abstinens och aversionsbehandling. Uppsala: Information från Socialstyrelsens Läkemedelsavdelning, 1984: 8

126.

Schumacher L, Pruitt II JN, Phillips M. Identifying patients “at risk” for alcohol withdrawal syndrome and a treatment protocol. J Neurosci Nurs 2000; 32: 158–63PubMedCrossRef

127.

Jaeger TM, Lohr RH, Pankratz VS. Symptom-triggered therapy for alcohol withdrawal syndrome in medical inpatients. Mayo Clin Proc 2001; 76: 695–701PubMedCrossRef

128.

Dudek H, Michno T, Michalski J, et al. Late posttraumatic epilepsy in patients with an alcoholic problem treated surgically for posttraumatic chronic subdural hematomas. Rocz Akad Med Bialymst 1999; 44: 119–27PubMed

129.

Spies CD, Dubisz N, Neumann T, et al. Therapy of alcohol withdrawal syndrome in intensive care unit patients following trauma: results of a prospective, randomised trial. Crit Care Med 1996; 24: 414–22PubMedCrossRef

130.

MacDonald BK, Johnson AL, Goodridge DM, et al. Factors predicting prognosis of epilepsy after presentation with seizures. Ann Neurol 2000; 48: 833–41PubMedCrossRef

131.

Thorbecke R. Patients with epilepsy who discontinue treatment. Epilepsy Res Suppl 1988; 1: 119–24

132.

Ulrichsen J, Bech B, Allerup P, et al. Diazepam prevents progression of kindled alcohol withdrawal behaviour. Psychopharmacology 1995; 121: 451–60PubMedCrossRef

133.

Bienkowski P, Krzascik P, Koros E, et al. Effects of a novel uncompetitive NMDA receptor antagonist, MRZ 2/579 on ethanol self-administration and ethanol withdrawal seizures in the rat. Eur J Pharmacol 2001; 413: 81–9PubMedCrossRef

134.

Kotlinska J. NMDA antagonists inhibit the development of ethanol dependence in rats. Pol J Pharmacol 2001; 53: 47–50PubMed

135.

Rathlev NK, Ulrich A, Shieh TC, et al. Etiology and weekly occurrence of alcohol-related seizures. Acad Emerg Med 2002; 9: 824–8PubMedCrossRef

136.

Commission on Epidemiology and Prognosis, International League Against Epilepsy. Guidelines for epidemiologic studies on epilepsy. Epilepsia 1993; 34: 592–6CrossRef

137.

Berg AT, Shinnar S. The risk of seizure recurrence following a first unprovoked seizure: a quantitative review. Neurology 1991; 41: 965–72PubMedCrossRef

138.

Musicco M, Beghi E, Solari A, et al. Treatment of first tonicclonic seizure does not improve the prognosis of epilepsy: First Seizure Trial Group (FIRST Group). Neurology 1997; 49: 991–8PubMedCrossRef

139.

Newsom JA. Withdrawal seizures in an in-patient alcoholism program. In: Galanter M, editor. Currents in alcoholism, treatment and rehabilitation and epidemiology. New York: Grune & Stratton, 1979: 6, 11–4

140.

Hoppener RJ. The effect of social alcohol use on seizures in patients with epilepsy. In: Porter RJ, Mattson RH, Cramer JA et al., editors. Alcohol and seizures: basic mechanisms and clinical concepts. ladelphia (PA): FA Davis Company 1990: 222–32

141.

Hoppener RJ, Kuyer A, van der Lugt PJM. Epilepsy and alcohol: the influence of social alcohol intake on seizures and treatment in epilepsy. Epilepsia 1983; 24: 459–71PubMedCrossRef

142.

Heckmatt J, Shaikh AA, Swash M, et al. Seizure induction by alcohol in patients with epilepsy experience in two hospital clinics. J R Soc Med 1990; 83: 6–9PubMed

143.

Bauer J, Saher MS, Burr W, et al. Precipitating factors and therapeutic outcome in epilepsy with generalized tonic-clonic seizures. Acta Neurol Scand 2000; 102: 205–8PubMedCrossRef

Title: Seizures in Alcohol-Dependent Patients
Epidemiology, Pathophysiology and Management
Authors: Dr Matti Hillbom
Ilkka Pieninkeroinen
Maurizio Leone
Publication date: 01-12-2003
Publisher: Springer International Publishing
Published in: CNS Drugs / Issue 14/2003
Print ISSN: 1172-7047
Electronic ISSN: 1179-1934
DOI: https://doi.org/10.2165/00023210-200317140-00002

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Seizures in Alcohol-Dependent Patients

Epidemiology, Pathophysiology and Management

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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