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alcohol withdrawal seizure
Clinical manifestations:
1) seizures occur in 10% of patients in alcohol withdrawal
2) onset generally 6-48 hours after alcohol cessation
3) frequently occur in binge drinkers (average duration of alcoholic binge is 2 weeks)
4) usually generalized tonic-clonic (grand mal) seizure
5) no prodome
6) loss of consciousness is common
7) multiple seizures in 60%
a) generally <5
b) occur relatively close together, generally within 6 hour period
8) alcohol withdrawal seizures are a single event; multiple seizures should prompt workup of a different etiology [2]
Laboratory:
- normal baseline EEG
Management:
1) supportive care
- 100 mg of thiamine IM
- D5 1/2NS with 1 g of Mg+2 & 20 meq KCl @ 250 mL/hr
- MVI, folate
- MgSO4, 10 g over 24 hours
2) pharmacologic agents
a) benzodiazepines
- lorazepam or oxazepam if liver disease
- diazepam
- midazolam
b) phenytoin loading & long term therapy is not necessary
c) barbiturates not recommended
- abuse potential
- narrow therapeutic index
- barbiturate withdrawal is associated with seizures
d) butyrophenones:
- haloperidol
- droperidol
- no intrinsic anti-seizure activity
- may be synergistic with benzodiazepines
e) phenothiazines are contraindicated
- induce hypertension
- lower seizure threshold
- disrupt central temperature regulation
3) status epilepticus (5% of alcohol-related seizures)
Related
status epilepticus
General
seizure; epileptic seizure
alcohol withdrawal syndrome
References
- McMicken DB & Freeland ES
Alcohol-related seizures. Pathophysiology, differential
diagnosis, evaluation, and treatment
Emergency Medicine Clinics of North America, 12:1057, 1994
PMID: 7956887
- Medical Knowledge Self Assessment Program (MKSAP) 14,
American College of Physicians, Philadelphia 2006