In this post I thought I shall discuss the effects of alcohol on the brain especially with respect to seizures. Many people drink socially , a drink or two after work is not only relaxing but also enjoyable. But who is an alcoholic or rather when does one have a drinking problem? We doctors use the CAGE criteria as a rather simple questionaire to determine if someone has a drinking problem.
“CAGE” where each letter has a question attached to it and the person has to answer yes or no. Let me elaborate a little.
C–stands for “cutting down”–have you ever felt the need to cut down on your drinking?
A–stands for “anger”—have you ever felt angry if someone has questioned your drinking habit?
G–stands for “guilt”—have you ever felt guilty about your drinking?
E– stands for “eyeopener”–have you ever taken a drink first thing in the morning?
If the person answers yes to these questions, he or she may have a drinking problem. What though is the effect of heavy alcohol drinking on the brain? Does it actually kill brain cells (neurons)? Does it lead to dementia? Can too many drinks cause a seizure?
Alcohol contrary to popular beliefs is a CNS depressant and not a stimulant. Alcohol is rather rapidly absorbed through the lining of the stomach and enters the blood stream from where it is carried to the brain. In the brain, it acts on the neurons and initially causes a loss of inhibition. You loosen up, your speech flows more smoothly and soon you become the life of the party. Well as you continue to drink, alcohol then starts depressing the central nervous system (CNS) . People usually fall asleep soon after consuming alcohol.
But let us get back to how chronic alcohol intake affects the CNS especially with respect to seizures.
I shall discuss this one by one.
Alcohol induced seizures
Heavy alcohol consumption can induce seizures. Alcohol induced seizures are of different types. One is what is commonly referred to as “rum fits”. Let me explain with an example. You are out with your friends celebrating a promotion. Your drink for the night is beer. Your normal “limit” is say 4 beers. But hey you are celebrating and so you end up binging. Before you know it you are on your 10th beer of the night. Right as you are having your 11th beer, your eyes roll up and you have a big generalized tonic-clonic convulsion (see my posts on epilepsy on my website http://braindiseases.info) . This kind of seizure which occurs at the height of binging is what has been referred to as a “rum” fit. I guess it was first described with respect to rum. Any of us can have a rum fit if we drink too much alcohol. You do not need to be an epileptic to have a rum fit, though I feel these kinds of seizures associated with alcohol binging are more common in patients who have an underlying seizure tendency. Thus if you are an epileptic you are more likely to have a rum fit if you overindulge in alcohol as regards to someone who does not have a seizure tendency. Hence I always advise my seizure patients to drink alcohol in moderation. You can drink and by all means enjoy your occasional drink but do not overindulge in this pleasure. Know when to say no and walk out of the bar.
Another type of seizure associated with alcohol is what is called “Alcohol Withdrawal Seizure”. Here the seizure occurs in a different scenario. Usually the person is one who is a chronic alcohol drinker, one who is dependent on alcohol and feels uneasy and restless if he does not drink everyday. Let us now assume he suddenly stops drinking for whatever reason. Maybe he runs out of money and cannot buy alcohol. Usually 24 to 48 hours after his last drink, this patient may have a generalized tonic clonic convulsion. As this seizure occurs in the setting of a withdrawal from alcohol, it is called alcohol withdrawal seizure. It is important that heavy and chronic alcohol drinkers keep this is mind and do suddenly stop drinking. If a person does decide to quit alcohol he should do it under medical supervision.
Now for the third setting in which seizures might occur with alcohol. Again we have a person who is an alcoholic (heavy and chronic alcohol user). Again for some reason he suddenly stops drinking. Uusally after 72 hours, he starts becoming delirious (confused), he has autonomic dysfunction and is tachycardic, sweating profusely, his blood pressure is up. Such a patient is said to be in what we refer to as “delirium tremens” (DT) . Patient who are in DT may have a flurry of seizures one after the other. DT is a life threatening condition and a patient may die if not treated in time. Usually patients are admitted to the intensive care unit of the hospital. We hydrate them aggressively, we give them medications to calm them down. Lorazepam (Ativan) or other benzodiazepines like chordiazepoxide (Librium) are given to prevent seizures and treat acute alcohol withdrawal.
Patients who have had a rum fit, an alcohol withdrawal seizure or even DT do not warrant long term treatment with an antiepileptic drug. These patients do not have epilepsy. If they abstain from drinking in the future it is more than likely that they may never have a seizure again in their lifetime. However there are a few patients whom we feel have a high risk for seizure recurrence, in such patients we may prescribe antiepileptic drug therapy for some time (the duration of the therapy varies depending upon the history, examination findings and the results of investigations like EEG and CT scan or MRI brain)
I have tried to give an overview of the kinds of seizures associated with alcohol intake. Like I stated earlier one need not be an epileptic to have seizures associated with alcohol intake. I try to explain this to my patients as follows. The brain has a threshold for the amount of alcohol it can tolerate. This threshold varies from person to person. If you drink above that threshold, the brain does not like it and one way it reacts is by having a seizure. This “threshold” is lower in patients who have an underlying seizure tendency. In these epileptic patients, a small amount of alcohol may induce a seizure. Also if you mix your drinks or combine alcohol consumption with other recreational drugs like cocaine you are creating the ideal grounds to have a seizure. Certain medicines like antibiotics also lower your seizure threshold and hence should not be used along with alcohol.
Patients with epilepsy should discuss about alcohol consumption with their doctors because at times we doctors do not initiate this discussion of our own. If you have seizures my advise to you would be to drink in moderation and not exceed your limits.
Nitin Sethi, MD
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My son has had 6 grand mal seizures in the past 3 years. He is now 25. After 2 seizures his license was removed and each time he almost went 1 year seizure free to reinstate his license he had another seizure. In the past 2 years he was almost alcohol free, but he drank after 1 year alcohol free and had a seizure which put him back on the waiting list. Now he has gone another full year without a seizure and no alcohol. Last night he drank 0% beer at a party and suffered a mild (30 second) seizure.
Is there something in beer that he may react to ? Do you have a direction to go with this?
Dear Peter,
thank you for writing in. It is likely that your son has an underlying seizure tendency (propensity to have seizures) and alcohol brings it out. There are a couple of things which I would advise you. One would be to have your son see a neurologist/ epileptologist. The doctor shall review his history and physical examination and then may order a few tests namely an EEG (brain-wave study) and a CT or MRI scan of the brain. The EEG shall help in characterizing what kind of seizure disorder your son has and shall also be of value in prognostication purposes. The CT or MRI scan shall aid in ruling out any underlying structural lesion in the brain.
Depending upon the results of the above tests, your son may warrant to be on some anti-seizure medication. Also since alcohol obviously brings out the seizures in his case, he should complete abstain from it. The rules with respect to driving vary from state to state. In New York state you have to be seizure free for 1 year (on medication) before you can drive. You can read more about the same on my website http://braindiseases.info.
Personal Regards,
Nitin Sethi, MD
Thanks for the reply. I am from Canada and am familiar with the driving restrictions here. I wanted to bring up in the history that my son had a minor seizure recently and NO alcohol was involved. The seizure was about one half of a minute and he experienced it after a late night with very little sleep. Does this fit your profile that he has a tendency toward seizures, but may have different triggers? It was suggested by one doctor that sllep depravation might cause a seizure also…what else would be considered a possible trigger?
Thank you so much
Peter
Thank you for writing back Peter. Patients who have an underlying seizure tendency, frequently have a seizure if they do not sleep well the night before. In fact sleep deprivation is frequently used to trigger a seizure when we monitor these patients in an inpatient video-EEG unit (epilepsy monitoring unit). We basically ask these patients to try to remain up the whole night. Lo and behold the next day, many of them have a seizure which we can then record on the EEG machine to help us characterize it.
There are many seizure triggers or rather events which lower the seizure theshold. Lack of sleep, alcohol, certain drugs (antibiotics like ciprofloxacin, certain anti-depressants), recreational drugs like cocaine all have been implicated in lowering the seizure threshold.
Personal Regards,
Nitin Sethi, MD
hi, i suffered my 2nd seizure in october last year. my first 1 was 6 years ago. i usually go out most w ends and suffered my seizure 4 days after the last night i was out. i was not sleeping very well that week and felt very confused the day before it happened.
am i likely to suffer more attacks if i carry on going out at w ends? i have read its alcoholics that get these attacks and i dont consider myself to be an alcoholic as i only go out at w ends when im not working. it has never happened to any of my friends and its all a bit hard to take in. i have had an mri scan and have my eeg on the 23rd. just looking for some help and advice if pos.
thanks.
Dear Colin,
thank you for writing in. It is possible you have an underlying seizure tendency which is brought out by your weekend drinking and late nights.
My advise would be to bring it to the attention of your doctor. He/she may want to refer you to see a neurologist.
Personal Regards,
Nitin Sethi, MD
My roomate came back last night at about 1am. I could tell she was drunk, but not anymore than usual when we go out. She was a little incoherent however, asking if she could urinate in our trash can. Throughout the night she was snoring like a bear, and I kept getting up to nudge her and put a pillow under her head, which usually works. Most times, she will wake up when I do this, but she did not. She had an 8:30 am class this morning and my friend came back frantically at 9am saying that my roomate had collapsed in class and had what she thought was a seizure. She is now at the hospital. I’m so shaken up! Most of the posts that are up have to do with people with alcoholism and seizures. My roomate is definately not an alcoholic, but she does binge on occasion. With no record of any previous seizures, I wonder what could have caused this? Thank you for your time
Dear Sarah,
thank you for writing in. Your room mate is indeed lucky to have a friend like you. While I cannot comment on her case in particular, my advise would be that she needs a basic work-up to determine the etiology of her episode (collapse, loss of consciousness and seizure like activity).
It is indeed likely that she may have had a seizure precipitated by excessive alcohol intake the night before. The money though lies in determining how likely she is to have a similar episode again in the near future and whether she needs to be on any medications.
Personal Regards,
Nitin Sethi, MD
I am wondering about if you could summerize some info on this disease i am tring to find tid bits of info for a report at school. Is drinking the only drug that causes seizure withdrawl syptoms and why is epilepsy so different from seizures induced by alcohol.
Dear Jessica,
thank you for writing in. There are many factors which can provoke a seizure, some internal and some external. Let me explain further. Patients who have a seizure disorder frequently experience seizures if they do not sleep well at night (in simple words, lack of sleep stresses out the brain), if they fail to take their seizure medication or more commonly miss a dose then too they can have seizures.
There are many drugs which lower the seizure threshold. Alcohol is a central nervous system depressant and too much alcohol intake (binge drinking) can provoke a seizure. This usually occurs in people who have an underlying seizure tendency ( meaning they have a seizure disorder and alcohol brings it out). That said and done anyone can have a seizure if he or she drinks way in excess (see my post on “rum” fits on my website http://braindiseases.info).
Other drugs of abuse such as cocaine and estacy also may provoke a seizure (especially when people mix drugs and take it with alcohol). Further there are some antibiotics and anti-depressants which may on occasion cause a seizure (in some people).
Epilepsy refers to a condition which is characterized by recurrent seizures (also referred to as a seizure disorder). On the other hand seizures induced by alcohol may not be recurrent (provided the person abstains from further alcohol intake).
Personal Regards,
Nitin Sethi, MD
My son is 21 and we determined about 18 months ago that he is an alcoholic.He is determined that he can quit on his own, he can’t. He refuses to get help. About 5 months ago we did convince him to go to a hospital for detox. Two days after being released he drank and fell down a full flight of steps and lay unconsious on the floor.
Since then he will drink for a few weeks then he will try to quit again, he will usually make it sober for about 2-7 days before he relapses. His age doesn’t help he is determined he can teach himself to be a social drinker like his friends. We keep telling him that will never happen he has to quit for good. Anyway he has expierenced every withdrwal symtom there is except hallucination [At least that I know of]. Yesterday he came to our house and was on the computor I heard strange noises. When I went into the room he fell off the chair. His body was flinching all over his eyes were really wierd, there was slobber coming out of his mouth, and he was totally
unaware of what was going on. He was all clammy with sweat and very pale. It lasted about 5-10 minutes before he even reconized me. [He said he had not drank in 3 days and appeared to be sober]. He does not remember anything except lifting his arm while sitting in the chair and then me waking him up[his eyes never closed,just were really weird looking like he wasn't in there]. He later told us that a few months ago he was working at his place and he woke up on the floor with his tool belt on and he did not know what happened. I am assuming that this was a DT seizure. Should we expect this to happen more often. And is there any warning. How bad of shape is he in? At the hospital they told us he was malnutricianed, dehydrated and had high blood pressure. We are also very concerned about his stomach and his throat. Any advice you can offer would be greatly appreciated. We are trying to convince him to get some help. Could the fall be any part of this?
Thankyou
Vicki
Dear Vicki,
I am sorry to hear that your family is passing through these difficult times. It is possible that your son is having alcohol withdrawal seizures (likely precipitated by his frequent unsuccessful attempts to give up alcohol). Sudden cessation of alcohol intake by a chronic alcoholic can precipitate alcohol withdrawal seizures and at times delirium tremens. I want to add that at times DTs can prove to be fatal and hence should not be taken likely. We think of them as medical emergencies and patients are frequently admitted to intensive care unit for close observation and monitoring. The fact that your son is malnourished and dehydrated also worries me.
I would make sure he gets good care and follow with his doctor on a regular basis.
Personal Regards,
Nitin Sethi, MD
Hello
My 48yr. old brother is an alcoholic and uses pot regularly currently. About 15 years ago he had seizures at work and wound up in the hospital and had had 2 more there. He was placed on anti seizure meds and quit drinking and doing drugs for several months. He was told the seizures were a result of the mix of drugs/alcohol he was doing. He has since stopped the meds (on the anti seizures meds for only a few months) and has been seizure free since then til last October. He had resumed the drinking and avoids the heavier drugs since the first seizures 15 years ago. He tried rehab 4 years ago for 2 months but that didn’t help and he had NO seizures at that time. In October while at work, he had another seizure. He had done no heavy drinking and had his usual beer that morning prior to working and seizuring. He had been without a drink for about 6 hours. The doctors have no idea what is wrong and tried to say it was a with drawl seizure but we think not. Currently we are awaiting the results of an MRI and found out he has an enlarged heart. He has started out patient counseling and given up alcohol (with no seizures so far). Is it still possible to have a seizure that is alcohol related in this case? Thanks
Dear Mary,
it is more than likely that alcohol is still playing a role in your brother’s intermittent seizures. Whether we label the seizure as alcohol withdrawal or something else, I feel is just playing with words.
It would be best that he abstains from alcohol completely. Whether he needs to be on long term anti-seizure medication shall be best decided by his doctor after reviewing his history and results of tests such as EEG and MRI.
Personal Regards,
Nitin Sethi, MD
Hi,
I have been drinking pretty regular for the last seven years. In the last few months I am noticing I have very bad anxiety the day after drinking. I am afraid I am going to have a seizure. I don’t drink every day but several times a week for sure. I have cut that down to twice a week, but I still have the bad panick the next day. My fear comes because my head feels weird the next day, my throat, tounge and sinus feel like they want to gag me on an off, an then I get spooked that that it is a seizure coming on and then I have a panick attack. I have never had a seizure though. Just trying to eliminate the fear and hoping you can help. When I drink its like 5 to 7 beers over the the course of 9PM to 2AM with maybe 1 or 2 shots in there. On a night like that I am pretty tipsy and the next day will feel like dog poo. Anywho by 1:30pm or later that next day is when my head starts feeling funky and brings on the panic of a seizure. Do you think I am a candidate of having a seizure? I hope not. My goal is to stop drinking all together. Just fighting through the social changes in implements. Thank you for your time and feedback.
Chris
Dear Chris,
Thank you for writing in. Anyone who drinks heavily is a candidate for a seizure, some more than others. If it makes you feel so sick the next day, it shall be a wise decision indeed to abstain. It is tough like you said but can be done and I would only encourage you in that endeavor.
Personal Regards,
Nitin Sethi, MD
Our 18 year old son most recently has been traveling in Southeast Asia with a few of his friends. By their own admission, they have been consuming large quantities of beer, rum and marijuana on an almost, if not daily, basis. Added to this by our son, was a half tab of ecstacy and a small quantity of opium (smoked). After a two month period, they were rafting down a river in Laos where at very frequent intervals they stopped at the river side bars and drank buckets of hard liquor. After the forth day of this, my son started to complain that he was feeling unwell. He decided not to participate one particular day, opting to stay at home in their bungalow. He started having a migraine like headache around dinner, that was followed by intense feelings of nausea resulting in copious amounts of vomitting by about midnight. At around 4:00am in the morning, his friends witnessed our son going through what was later diagnosed as a grand mal seizure. They managed to get him to the hospital that was five minutes away, where infront of a non English speaking Laotian doctor he suffered his second grand mal seizure. He remembers nothing of the first event, but remembers feeling what he described as an electrical storm raging between his head and the end of his spinal cord. The doctor gave him a shot of Diazepam and without any further testing sent him out of the hospital. On the medical notes, the doctor diagnosed him with Epilepsy. During the first event, he foamed at the mouth, his eyes rolled back and stayed fixed, his body shook with violent tremors and he was arching his back. He returned to his bungalow and slept for the rest of the day at which point we were contacted. I flew to Laos immediately and met him two days after the seizures. He looked dull and dopey. I was afraid to take him home immediately because of the long flights involved and instead chose to take him to quiet bungalow on the beach near a larger hospital in case of emergency. For two weeks I re-hydrated him with clean water, he ate good food and got plenty of rest. In that time I noticed a real improvement in the clearing of his eyes and in his general health overall. There wasn’t any alcohol and marijuana to be had so it was a cold turkey approach to those substances. He did not have any other episodes and only complained of very minor headaches for the first three days. We have returned home and his father and I have tried to explain to him about the dangers of returning to using the substances that he was. He feels that the episodes were “a one of” kind of thing and we are trying to educate him about the possibility that there might be some really good reasons for the seizures that he had. He seems to fit either profile; alcohol induced or alcohol withdrawl. We have heavily suggested that he resist any drinking or smoking of marijuana (or any other drugs for that matter) until he has undergone extensive testing to help determine what the root causes might be for these episodes. He is not responding in a positive way….and until I found your website, I didn’t know where else to research any of this. I would truly appreciate any insights you may have with regards to what all of this could mean. I will show him your response as one of many that we will solicit so that he can see the wisdom in the replies. You have a very straightforward way of responding and I believe he will come to see the rationality of abstaining from substance abuse once he receives an ‘outsiders’ opinion. Many thanks for any assistance you can give us.
Dear Trudessa,
thank you for writing in. I always feel parents love their children so much and would do anything for them. Your love and concern for your son’s health is apparent. I am what I am because of my parents love and I thank them for that.
Well I shall not mince words. Mixing alcohol with recreational drugs and especially binging is like playing with fire. Seizures are common when drugs and alcohol mix and at times can prove to be fatal. One can suffer a cardio-respiratory arrest (you stop breathing or your heart may stop). I see many people brought to the ER in this state after a night of partying which involved heavy alcohol use and drugs. Some suffer brain insult and are left in a vegetative state.
I paint the worse possible scenario, not to scare anyone just laying the facts on the table. My advise to your son would be to abstain from alcohol and drugs completely. Life is beautiful and he has too much to lose if he continues to drink and do drugs.
I wish him and you my very best.
Personal Regards,
Nitin Sethi, MD
Because your son traveled, I would be aware of any parasitic infestations that can lead to seizures. There is a pretty good list of them on humaworm.com.. I am not promoting the product, although it DOES work, I am merely pointing out that some developing countries have more worms/parasites than US and could potentially be causing ALL of his problems.. Here are some examples:
SCHISTOSOMIASIS – this infection comes from contaminated fresh water. Days after infection, itchy skin or a rash develops – after 1-2 months, fever, chills, cough and muscle aches set in. The body reacts to the eggs produced by these worms, not the worms themselves. The eggs can be found in the brain, spinal cord and can cause seizures, spinal cord inflammation and paralysis. The parasite can damage the liver, intestines, lungs and bladder.
BLOOD FLUKES – travel all over the human body and into all organs including the brain and spinal cord. They can cause seizures and they destroy red blood cells.
Dear Sarah,
thank you for writing in. Parasitic infestations of the brain are a frequent cause of seizures in young adults specially in the developing countries. With international travel becoming more and more common, we are now seeing many such patients here in the United States too.
Personal Regards,
Nitin Sethi, MD
Many thanks for your response Doctor….I do have one question though? In his everyday life here in our community the substance abuse (drinking and smoking pot) is not a daily event. Mostly it occurs during the weekend. During his trip abroad, he was also taking Doxicillin (? Antibiotic taken to ward off the effects of Malaria) at a rate of one pill a day. Could the antibiotic, along with the already mentioned alcohol and recreational drugs, have caused these two seizures? Is it at all likely that he may never again suffer a seizure if he was to continue in the mode that he does while at home? We totally agree with you that abstinence would be the most desired approach….but at 18 he seems to think he knows his body and himself better than any of us. My husband and I do not drink or do any kind of drug whatsoever…nor have we ever in all the years we have been raising our three children (24). The downside is this; in our community, it is a most accepted way to pass your recreational time with adults and children partying together. We often feel that it is time to move…but also realize that might not be the solution to this problem. Again….many thanks for any attention you can give these last questions of mine. And thank you for providing this forum…..it is a wonderful way to be of service to humanity.
Dear Trudessa,
you are very welcome. Some medicines and that includes antibiotics like ciprofloxacin (and other members of the quinolones group) may lower seizure threshold and precipitate a seizure in people who have an underlying predisposition to have a seizure.
It is possible that your son has an underlying seizure tendency and the mix of drinks, drugs and maybe antibiotics precipitated the convulsion.
It shall be indeed wise to abstain completely from alcohol as well as recreational drugs. The question whether he may have another seizure in the future can be best answered by his doctor after going over the results of some basic tests like an EEG (electroencephalogram–a test which looks at the brain waves).
Personal Regards,
Nitin Sethi, MD
Hi,
My Mom is about 55 and has been a pretty heavy drinker for the past 20 or more years, she drinks about two glasses of wine a day, binge drinking about once or twice a week, and her drinking was much heavier ten years ago. I don’t really know if she is an alcoholic but her drinking is defintely excessive, she has difficulty quiting and can only last about a month before drinking again, and is constantly ill with infections and many other things such as breast cancer, hernias, rheumatoid arthritis, IBS, high blood pressure, etc. About a year and a half ago, she had a seizure in the middle of the day, her first seizure ever. She says the doctors called it a “Grand Mal” seizure and diagnosed her with epilepsy and she has been taking Topomax ever since, I believe. I do not think she was drunk when the seizure happened, though I am not sure. I was wondering if her history of drinking could have caused the seizure and if her continued drinking puts her at a high risk for another seizure. Thanks so much.
Dear Pamela,
thank you for writing in. Yes both heavy alcohol consumption and sudden cessation (by a person who is an alcoholic and drinks heavily on a regular basis) can provoke a seizure. Alcohol lowers the seizure threshold especially in persons who have an underlying seizure disorder. So yes, your mother’s heavy drinking does put her at risk for another seizure. Have her see a neurologist, he or she shall be able to determine if your mother has an underlying seizure disorder or whether all her seizures are related to alcohol abuse.
Personal Regards,
Nitin Sethi, MD
Dear Dr. Sethi,
Thank you so much for replying. My mother did see a neurologist immediately following her seizure where she was supposedly diagnosed with Epilepsy, which you did say is an underlying seizure disorder, I believe. But what I was wondering is, even with Epilepsy, could the seizure have been brought on by alcohol? I don’t think she was on an intense binge of drinking and suddenly stopped, she just usually drinks like 2-4 glasses of wine a day and occasionally binges for a night like once a week. Also, she is on Topomax, an anti-seizure medication, and shouldn’t she be completely abstaining from all alcohol on that drug? Thank you so much for helping, I really appreciate your answers.
Dear Pamela,
alcohol likely is bringing her seizures out. My advise to her would be to abstain from alcohol completely.
Personal Regards,
Nitin Sethi, MD
Hi,
i have had alcohol induced seizures i believe five to be exact. i do not consider myself an alcoholic as i only have a few beers with my friends on the weekends. i do not drink everyday, or even every weekend. i go good for about a year and then it seems like i just over do it one night, but when i drink in moderation nothing happens and in my case i always have the seizure the next morning after a night of drinking more than i should. i have seen doctors and had mri’s and eeg’s and they said i am not epileptic. i am trying to quit and have been doing really good although i dont want to quit because i am 22 years old and i enjoy drinking socially with friends and family. i was wondering if there is any cure or medicine to take just in case u have too many one night.
Dear Nick,
thank you for writing in. Unfortunately no medicine to take the “night after”. My advise to you would to be to drink in moderation. If you drinking to the extent that you have a seizure, then you are drinking way too much. It may be fun at that time but you are playing with your life.
Personal Regards,
Nitin Sethi, MD
My wife is 59 and recently had what the ER doctor described as an alcoholic siezure. Yes, she drinks wine excessively everyday and has done so for at least ten years. She does not have a history of epilepsy. She is reluctant to see a doctor and chooses to abstain with great success for the last full week.
The siezure made her eyes roll back, she was foaming at the mouth and starting to get gray in skin color. We thought she was choking so we performed the Heimlech manuver which seemingly brought her back to consciousness.
Having read the above articles, I tend to think she is not an acoholic, but I would appreciate your comments especially about the seizure description. I need to mention, that my wife did aerobics, yard work and tennis all day and did not eat much. I have seen her consume more wine than she did that evening so do you think that this was probably an isolated incident or aside from drinking too much wine a serious condition that I can more firmly argue for a doctor visit?
Dear James,
thank you for writing in. Your description of your wife’s seizure sounds typical for what we as doctors refer to a generalized tonic clonic convulsion-the patient stiffens up, the eyes roll back followed by convulsive movements involving the arms and legs. The patient may bite his/her tongue and have loss of bladder control (wetting their pants in the process). Usually once the convulsion is over the patient is confused and disoriented for a short while (we refer to this state as the post convulsive or post-ictal state).
It is difficult for me to predict whether your wife indeed had a seizure (and if that was the case whether it indeed was due to over indulgence in alcohol) or whether she had some other paraoxysmal event which may resemble a seizure superficially such as a syncopal episode or a syncopal convulsion. My advise to you would be to coax her to see a doctor. A relatively simple work-up shall help clarify the diagnosis. Till then abstaining from alcohol seems like a wise thing to do.
Personal Regards,
Nitin Sethi, MD
My boyfriend suffered his first ever seizure this weekend, around mid day. The signs all look like a general seizure, pre-indicator to the event, severe shaking,loss of conciousness,eyes rolling, red/blue face lateral bite to the tongue etc.It lasted several minutes followed by a period of heavy breathing and unawareness.
This seizure came on following a very long day at a corporate event, where he consumed a very large amount of alcohol (from lunchtime to 10pm)and was taking high strength paracetamol-asprin (6 consumed over the period of the day every 4 hours-).
Ridculously, he then went on a bike ride the following morning (9am) in a sweat suit to try and sweat out some of the toxins.Following this he appeared ok, but had not drunk much fluid or eaten.
He is going to have an EEG and scan, but do you think the excessive behaviors are likely to have caused this and can they eliminate any underlying condition?
Dear Michelle,
from your history it seems likely that your boyfriend had a convulsion which was provoked by the combination of consuming too much alcohol, use of over the counter pain medications and dehydration. The EEG shall help to identify whether he has an underlying predisposition to seizures and the CT scan shall help to rule out any underlying brain lesion.
Depending upon the results of these tests, his doctors shall determine whether this was a one time event or whether he has epilepsy making him prone to having seizures in the future. The work up shall also determine whether he needs to be on anti-seizure medications.
Personal Regards,
Nitin Sethi, MD
Dear Dr. Sethi,
I am up late at night as I am having an EEG at 7:30am and am not supposed to sleep…For about 20 years I’ve been a fairly heavy drinker. When I was younger I seemed to binge more when I was in college and so forth. These days I drink about a 1/2 bottle or 2-3 (sometimes 4 – mostly 3..) glasses of red wine 4 nights a week or so. I don’t drink during the day and have never been spoken to about my drinking or have ever been in any kind of trouble for it. However, I assume it is not healthy. But I have a tremendous amount of anxiety (Generalized Anxiety Disorder), have battled Chronic Fatigue Syndrome and Fibromylgia for years and just have terrible sleep problems. So the alcohol helps with my anxiety and helps me sleep. But about a year and a half ago I started having what my neurologist wonders might be seizures. I have had a CT brain scan, did a sleep study, blood tests and the EEG will be the last test. They only happen precisely when I am transitioning to sleep on the nights I don’t drink. Sometimes I have mild ones on the nights I do drink – but mostly these happen only on nights I do not. I don’t loose consiousness (sp?), my eyes don’t roll back. But I have involuntary movements – sometimes it’s a finger, leg, my whole torso, a foot – very random. I also experience a sensation of dizziness – or a feeling of going down a roller coaster – it is very unsettling. I sometimes lose my breath, sometimes I have vocalizations. I might not have mentioned, I also take 2 benedryl every night and have for 7 years. My sleeping problems are so bad – that sometimes I’ve taken 3 benedryl and drank wine and cannot sleep. I eat well, take vitamins and run 4-5 miles every other day. But I also am a perfectionist, suffer from some depression as well as the anxiety – so this is why I’ve been drawn to wine. I keep in in check – with regard to taking a few nights off, and not continuing to increase the wine I drink – but something is telling me it could be the cause of these movements – unless it is anxiety related. Will the EEG be the test that determines if these are some kind of seizure related to alcohol? I am seeing a neurologist that seems pretty competent – but I would love any guidance you could provide.
Most Sincerely, Jennifer
Dear Jennifer,
you likely had a sleep deprived EEG. I doubt these jerks/ involuntary movements at night represent seizures. One of the ways to characterize them though is to have a video-EEG study. Basically you are admitted to the hospital and hooked up to an EEG machine which is time locked to a video-camera. If you have the jerks and there is no EEG correlate (meaning you have the jerks but the brain waves do not change), then likely these are not of cortical origin and hence not epileptic.
Personal Regards,
Nitin Sethi, MD
Dear Dr Sethi
Thank you for the informative post and thread. I have been a fairly steady drinker since my early twenties and am about to turn 40. I rarely go out, or stay in, with the intention of ‘getting drunk’ but I enjoy the taste of wine and bourbon. I also suffer from varying degrees of anxiety and am a Type 1 diabetic and I like how a glass of wine or two with dinner helps both my anxiety and sensitizes the insulin that I take.
Last year, when my mother died, I was under an incredible amount of stress and was drinking much more heavily in order to “self-medicate” with the anxiety. One morning I awoke from a a dream that I was laying back on a couch with my head tilted back and I felt all the blood rush into my head as if I suspended in the air by my legs. I immediately woke up but when I did, that awful feeling still persisted for at least a minute or so. I was afraid to stand up and had to call to my roommate of the time, to help me. Eventually the dizziness stopped but I was so shaken with this experience, that I had to sit on the couch and do nothing for fear of it happening again and eventually checked myself into ER. They gave me some fluids and a Xanax and then took me for an MRI and found nothing wrong. They attributed it to stress, fatigue, and dehydration.
I have not had anything like that for a year but this morning I had two almost exact episodes, one after another. I had just returned from a trip out of state for a friend’s wedding where I not only overindulged but also got into a big fight with my wife which probably made my stress hormones skyrocket. It happened this morning, again as I was dreaming about my head being tilted back and at that exact time that I dreamt of blood rushing to my head, I would wake up but feel like everything was moving around and we were having an earthquake. 30-40 secs later it would stop.
According to what I’ve been reading about this doesn’t sound like an alcohol induced or alcohol withdrawal induced “seizure”. Or is it? My blood glucose when I tested it was a little high but not outrageous (170). Any opinions on what these couple of episodes and symptoms might mean?
Many thanks
Dear John,
thank you for writing in. I shall not attempt to diagnose you over the internet, that is the privilege of your doctor who has had the chance to take a detailed history and exam you. Your events as you describe them though sound atypical for seizures. It is possible they are “stress induced”. There are many times when patients have neurolgical events which remain undiagnosed. You should though bring it to the attention of your doctor. He shall be the best man to decide if any further diagnostic work-up is warranted.
Personal Regards,
Nitin Sethi, MD
Dr. Sethi,
How far gone is ones internal organs when they start to have internal bleeding and the liver and kidneys stop functioning correctly?
This gal I’m questioning about has been a heavy drinker since she was about 18, and she’s now 37. She was just admitted to the hospital last week for this situation, and is now home. I don’t know all the details, but I’m concerned because she isn’t getting help for her alcohlism, and she has a young son at home. We know she’s not going to stop even though she knows this is killing her.
Dear Julie,
thank you for writing in. I think you mean what we refer to as alcoholic liver disease. Alcoholic liver disease passes through 3 stages–stage 1 is the stage of fatty liver (the liver starts accumulating fat but otherwise functions well), stage 2-is the stage of alcoholic hepatitis (the patient starts having jaundice and other signs that the liver is not doing so well), stage 3–is the stage of alcoholic cirrhosis (in this stage the liver starts failing–the patient may present with signs and symptoms of liver failure). He or she might have oral bleeding due to rupture of dilated blood vessels near the junction of the esophagus and stomach. We call these gastroesophageal varices. The liver does not clear ammonia and the high ammonia affects the brain making the patient encephalopathic. We call this hepatic encephalopathy.
Afraid at this advanced stage the only thing which can help is a liver transplant. Provided the patient is sober and determined to be so. I wish your friend my very best.
Personal Regards,
Nitin Sethi, MD
My seizures started in 2003 in NY and I did nt know i had on e with my tongue bite.
i then noticed that if I took more drinks i will have a seizure free night.
All my seizures have occurred when i am either falling asleep or trying to wake up.
what I have established is that that after a night of heavy drinking the following day I must have some beers else trying to sleep will be living hell.
I have never had a seizure while awake.But after 2 very serious seizure in the last 7 days I have decided to only take 4 beers coz if I dont definetely i will have an attasck
Dear James,
thank you for writing in. Many people have an underlying seizure tendency (propensity) and alcohol “brings the seizure out”. My advise to you would be to gradually stop drinking alcohol altogether.
Personal Regards,
Nitin Sethi, MD
This is actually quite a fascinating article to find. I am not certain if it pertains to what I experienced a few weekends ago or not, but I thought that I would post my story to see if I could get any insight from you.
I don’t drink all that often. A drink or two here and there with a friend, but not even every weekend. A few weeks ago I had gone to visit some friends, and there was drinking to be involved in the night’s plans. I had eaten, although probably not as much as I should have. I had maybe two beers and 2-3 rum and cokes. After this, I turned down any other drinks as I was feeling intoxicated, but still quite aware of what was going on around me. After an hour or two, I accepted a final drink, but only had a little bit of it before I lose almost all memory of the night.
According to the friends that I was with, I continued the conversation that I was having for a little while longer. All of the sudden, they said that I slumped over onto the person next to me. They tried to get me to stand up so that I could drink some water, and I ended up collapsing. At this point, I started breathing heavily – like a cross between hyperventilating and not being able to breath. I did this while pulling in toward my left side and could not respond to anyone. I did this for about five minutes, and they had everyone clear out of the room and I seemed to come out of it. I was in an altered state of mind and was mixing up the past with the present and had to be told several times who I was talking to before I would calm down. However, I never lost consciousness and was able to talk to people in between these episodes.
This happened multiple times throughout the night – on and off like this (five minutes of weird breathing/twitching, then five minutes of calm). As the breaks got longer, the episodes would get shorter. Eventually, they got me to go to sleep. Later that night, one of them heard me breathing weird again. They came out to find that I had gotten sick everywhere. I was calm for a bit, and went in and out of these episodes again.
When they woke me up the next morning, I knew that something had happened that I didn’t fully understand, but I had (and still do not have) almost no memory of the events that occurred. I had an MRI and an EEG done, and both tests came back normal. This is the first episode like this that I have ever had, even though I have gone with only a few drinks here and there for a long time and then drank a bit more excessively on rare occasion. I have never had anything like this happen to me in the past when I have done this, and I have yet to find any answers as to what may have happened.
Dear Evan,
thank you for writing in. Your doctors may never figure out what happened to you that night (and this by the way is quite common). Some neurological episodes of impaired consciousness (note I did not say loss of consciousness) frequently remain undiagnosed and one is not able to rule out or rule in a seizure disorder. MRI brain and EEG come back normal as was in your case.
At times when our index of suspicion for a seizure is high, we may order a longer duration EEG (we call this a 24 hour ambulatory EEG study).
Whatever was the etiology of that episode, it shall be wise to drink in moderation from now on.
Personal Regards,
Nitin Sethi, MD