Alcohol and seizures: a question and an answer

T

HI
My Father is an aolcoholic and last Sept he was admitted to hospital after a fall when drunk – whilst in hospital he had a fit – understandable he was cold turkey whilst there. He was treated and sent home. Since Dec he has reduced his drinking and now generally consistantly drinks 1 bottle red wine a day – yes this is still too much but about 50% what he used to drink – he reduced gradually and has maintained this intake for a few months now.
What I find strange is that all i can find about these alcohol withdrawl fits relates to 2-3 days without alcohol – Dad had a fit a few mornings ago after a normal day and normal alcohol consumption levels. The hospital saw alcohol in his notes and packed him off home again with some Vitamin B tablets.
How many alcoholics normally get fits whilst they are still drinking? How normal is this? He is eating better these days than he was but still could do with eating more. He borderline underweight and 74 years old – he has been dependant for more years than I can imagine but probably the last 12 years have been the worst. He does not drink in the morning but the first drink in the day is normally 3/4pm and last drink 6/7pm before bed. This one bottle of wine is often enough for him to fall when on his way to bed or even a few hours later I have had to carry him back to bed if he falls in the bathroom. His body just doesnt seem to be able to cope with alcohol any more – less alcohol to get drunk – is this why he is having the fits?
My apologies for long winded questions but the question needed some context to make sense I think. Any I am not delusional about his alcohol intake – I monitor it and he has no other way or place to stash any.

Thank you so much in advance

P.S. the fit was 6.30 am Thursday and now Sat pm he is still very unsteady and his memory is worse than before. What is the normal recovery from these fits?

 

Braindiseases

Dear T,
thank you for writing in to me about your father. There is no one set limit above which alcohol can induce a seizure. The limit varies from person to person. Rum fits (seizures which occur at the height of binging) of course occur when one consumes too much alcohol in too short time. Alcohol withdrawal seizures classically occur 24-48 hours after the last drink (they occur in people who are chronic alcoholics/ people who consume heavy alcohol on a daily basis and who then suddenly stop drinking). Again not every chronic heavy drinker gets alcohol withdrawal seizure if he/she stops drinking suddenly. Usually it is the person who is chronically malnourished and dehydrated who is more predisposed to an alcohol withdrawal seizure in the setting of sudden cessation of drinking. These people as you can well imagine are deficient in multiple vitamins and minerals (commonly the B group of vitamins such as Vitamin B1, B2, B6, folic acid and B12). Their electrolytes are also more likely to be off (meaning they serum sodium, potassium, magnesium is low). They may also have alcoholic liver disease (alcoholic steatosis or fatty liver, alcoholic hepatitis and finally cirrhosis). During their prolonged drinking years they may also fallen down and struck their head. So it is a combination of factors (meaning the overall health status) and not just the sudden cessation of drinking which predisposes some alcoholics to alcohol withdrawal seizures.
Finally over the course of years of heavy drinking, some alcoholics develop epilepsy. The reason for this may be any of the above I have listed. My personal feeling is that these patients likely have underlying epilepsy and alcohol (in excess or sudden cessation after years of drinking) just helps to unmask it.
Now let me answer your last question about time frame of recovery. Again if his pre-existing neurological status is compromised (his memory is already bad after years of drinking, his general medical condition is poor or if he has coexisting medical problems such as chronic lung or liver disease, diabetes or congestive heart failure) his recovery from a convulsion shall be slow as compared to a young person with no pre-existing medical problems.
I hope I have addressed some of your concerns. I wish you both my very best.

Personal Regards,

Nitin Sethi, MD

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2 thoughts on “Alcohol and seizures: a question and an answer

  1. MY SON DRINKS DUE TO PROBLEMS HE HAS HAD IN HIS LIFE HIS DAD DIED OF CANCER WHEN MY SON WAS 6 YEARS OLD.THEN HIS FIRST GIRLFRIEND WHOM HE HAS A SON WITH WENT OFF WITH MY SONS BEST FRIEND SINCE HE WAS 5 YEARS OLD AND MARRIED HIM. HE TURNED TO DRINK AND DRUGS ,HEROIN FOR A NUMBER OF YEARS. HE WAS ATTACKED ON JULY THE HIRD 2009 AND LEFT FOR DEAD. HE SUFFERED HEAD INJURIES AND HAD A STROKE . WHEN HE CAME OUT OF HOSPITAL HE SUFFERED NUMEROUS SEIZURES AND WAS WAITING TO GO TO SEE A NUEROLOGIST HE HAD A CT SCAN AND WAS THEN SENT TO SEE A PROFFESSOR WHO PRESCRIBED HIM WITH KEPPRA 500MGS 3 TIMES DAY. HE IS TRYING SO HARD TO STOP TAKING ALCOHOL AND DRUGS BUT THE GP SAYS HE HAS AN ADDICTIVE PERSONALITY. HE HAS HAD NUMEROUS SEIZURES THIS YEAR AND HAD THE LAST SEIZURE LAST SUNDAY AND I HAD TO CALL AN AMBULANCE .THE DOCTR AT THE HOSPITAL TOOK HIS BLOOD PRESSURE AND TOOK BLLOD FROM HIS FINGER . HE THEN CHECKED HIM OUT TO SEE IF HE HAD HUT HIMSELF AND THEN SAID YOU SHOULD GO AND SEE YOUR GP. THE GP IS GOING TO REFUR HIM BACK TO THE PROFFESSOR TO SEE IF HE CAN GIVE MY SON SOME OTHER MEDICATION AS WELL AS THE KEPPRA. I ASKED THE DOCTOR AT THE HOSPITAL WAS THE SEIZURE CAUSED BY MY SONS DRINKING ONLY 2 CANS OF CARLING A DAY 2 PERCENT OR WAS THE SEIZURE O TO HIS HEAD INJURYS. HE SAID HE WASNT SURE. COULD YOU PLEASE EXPLAIN WHY . BACAUSE MY SON HPIS DRINKING MORE SINCE HE HAD THE SEIZURE LAST SUNDAY BECAUSE HE IS FRIGHTENED OF HAVING ANOTHER SEIZURE. HE HAS GOT IT IN HIS HEAD THAT ITS NOT THE DRINKING THAT CAUSED THE SEIZURE . THE SEIZURE HAS MADE HIM DRINK MORE. THANKS FOR YOUR TIME . A VERY WORRIED MUM

    1. Dear Worried Mom,
      I am sorry to hear that you and your son find yourself in such troubled waters. He has indeed had a tough life. This is what I advice. If you really look at the history objectively it is immaterial whether the head injury or the excessive alcohol intake/ intake of illicit drugs is the cause of your son’s seizures. What is paramount though is that his seizures be controlled. By good seizure control I mean aiming for complete control of seizures. That at present is not the case. Now whether that is because your son is not compliant with his anticonvulsant (Keppra) or whether his continued use of alcohol is leading to poor seizure control needs to be figured out. There are numerous studies which show that excessive alcohol intake can reduce seizure threshold.

      So this is what I advice:

      –he needs to remain in close follow up with his neurologist and his GP. The answers to the above questions need to be figured out.

      –he needs to reduce his alcohol intake while under their supervision.

      I hope I have given you a few answers. My very best to both of you.

      Nitin Sethi, MD

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