Can Alcohol Withdrawal Cause Seizures? Signs and Treatment

Alcohol withdrawal seizures are a severe complication that may emerge after suddenly quitting drinking alcohol.

This article will explain the brain changes caused by alcohol addiction and how these can precipitate withdrawal symptoms, including seizures.

It will also discuss which individuals are at risk of developing alcohol withdrawal seizures, how these are treated and practical ways to quit alcohol safely and start a new, sober and healthy life.

Can Alcohol Withdrawal Cause Seizures?

Yes, alcohol withdrawal seizures may occur as a rebound effect of abruptly ceasing alcohol consumption.

Alcohol is a sedative that potentiates GABA tone, a calming neurotransmitter. With chronic use, the brain compensates for alcohol’s effects by increasing NMDA activity. This brain region is where glutamate, an excitatory neurotransmitter, exerts its stimulating effects.

Sudden cessation of alcohol intake can result in a state of neuronal hyperexcitability caused by excess glutamate that, in some individuals, produces generalized tonic-clonic seizures.

They can be life-threatening, and their unpredictable nature, sometimes occurring without other acute withdrawal symptoms, is why medical detox is a critical component of recovery.

Unsupervised “cold turkey” quitting exposes a person to risk of seizures and other withdrawal complications. Medical detox provides a supervised environment where the consequences of symptoms like seizures are drastically minimized due to medications and holistic support.

Where Seizures Fit on the Withdrawal Spectrum

• Most people experience minor symptoms, such as tremors and anxiety.
• Approximately 2% can develop alcoholic hallucinosis, experiencing tactile, visual and auditory hallucinations.
• Generalized tonic-clonic seizures affect 2%-5% of individuals addicted to alcohol. Seizures tend to be short, with rapid consciousness recovery.
• Up to 5% of people with alcohol withdrawal progress to delirium tremens (DT), a potentially fatal condition with rapid onset and lasting confusion, irregular heartbeat, and elevated body temperature.

Seizures may occur alone or precede DT, as not every individual progresses through every stage of the alcohol withdrawal timeline. 

When Do Withdrawal Seizures Happen?

Typical Timeline of Withdrawal Seizures

Withdrawal seizures generally occur 6-48 hours after the last drink, reaching their peak in the first 24 to 48 hours and rarely appearing after 72 hours.

A person may present with clusters within a few hours, yet late seizures are rare and may indicate other conditions or withdrawal of other substances, including sedatives.

Clinical expertise in managing alcohol withdrawal seizures is fundamental for being able to distinguish underlying reasons and potential complications.

In medical detox, if a seizure occurs, it’s rapidly managed with medication and support. The person is evaluated constantly to analyze their response and modify treatment if necessary, with monitoring adjusted to the timing of withdrawal symptoms to guide safe discharge planning..

Who’s at Higher Risk?

Key Risk Factors & “Kindling”

Risk factors that can increase the risk of alcohol withdrawal seizures include:

• History of withdrawal seizures and DT
• Chronic use of large amounts of alcohol
• Concurrent benzodiazepine or barbiturate use or withdrawal
• Electrolyte disturbances 
• Liver disease 
• Head injury
• Older age
• Recent surgery or anesthesia
• Malnutrition

When a person experiences repeated alcohol withdrawal episodes, the risk of ‘’kindling’’ or sensitization increases. This can lower the seizure threshold and increase severity, making seizures more likely and their effects potentially more dangerous.

Co-occurring or undiagnosed epilepsy, as well as traumatic brain injuries, can raise the risk of developing alcohol withdrawal seizures, so they warrant a higher-acuity setting for their management.

Individuals with a history of alcohol withdrawal seizures have almost a four times higher risk of death, suggesting a connection between these seizures and the devastating consequences of long-term alcoholism on cerebral health.

Warning Signs & What To Do

Alcohol Withdrawal Seizures Red Flags 

These symptoms may indicate that alcohol related seizures may occur or the need to seek medical help:

• Increased tremors
• Intense agitation
• Profuse sweating
• First seizure
• Repeated seizures
• A seizure lasting over 5 minutes (seek immediate help)
• Head injury 
• Cyanosis (bluish-purple coloration on the mouth, lips, and fingernails)
• Confusion not resolving 
• Chest pain 
• Fast heart rate
• Nausea
• Vomiting
• Hallucinations
• Fever

Immediate Steps to Take

If you or someone experiences signs that suggest an alcohol withdrawal seizure is happening, follow these steps:

• Call emergency services
• Protect the head 
• Clear hazards 
• Turn to the side
• Do not drive
• Do not restrain or put anything in the mouth 
• Do not give food or drinks
• Keep airways clear, monitoring breathing
• Time seizure duration to share with clinicians, as this information can be used to guide treatment. 

Alcohol withdrawal seizures are medical emergencies. Seek assistance as quickly as possible.

How Clinicians Assess & Monitor

CIWA-Ar and Bedside Monitoring Basics

Clinicians assess and monitor the intensity of alcohol withdrawal symptoms by employing validated diagnostic tools that help evaluate a patient’s condition.

CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol Scale) assesses 10 symptoms that characterize alcohol withdrawal syndrome. 

Medical professionals use CIWA-Ar to guide symptom-triggered benzodiazepine dosing to control seizures, but this tool demands trained staff and frequent reassessment as symptoms can escalate quickly.

Clinicians will periodically track vitals, orientation, tremor, diaphoresis (excessive sweating), and sometimes glucose and electrolyte levels (Mg, K, Na, phosphate) to prevent complications.

Level of care will escalate if:

• A history of severe alcohol seizures or brain injury exists 
• Symptoms’ intensity worsens based on CIWA-Ar scores 
• Other complications emerge, such as low oxygen levels (hypoxia) and autonomic instability 

Staff will keep the airway protected while analyzing other causes that may predispose to or aggravate seizures.

Treatment that Prevents and Treats Seizures

First-Line Medications

Benzodiazepines (such as diazepam, lorazepam and chlordiazepoxide) are first-line medications that help in preventing and treating seizures as they calm brain regions that are hyperactive during alcohol withdrawal. 

• As benzodiazepines have addictive potential, they are sometimes used in symptom-triggered protocols and titrated as withdrawal symptoms subside.
• A comprehensive medical assessment is necessary to evaluate if a person is using or abusing benzodiazepines, as their withdrawal can also elevate seizure risk, making the alcohol withdrawal syndrome worse.

Phenobarbital, a barbiturate, may be employed by experienced clinicians or when benzodiazepines are inadequate due to underlying medical conditions. 

• It’s best to avoid antiepileptics as monotherapy for withdrawal seizures. 
• Polysubstance factors must be explored in case they augment the risk of complications, and due diligence applied to avoid prescribing agents that lower seizure threshold when possible.

Supportive Care

Patients addicted to alcohol tend to be deficient in thiamine, which increases the risk of Wernicke–Korsakoff syndrome, a severe neurological complication. 

Intravenous thiamine before glucose or any carbohydrate load (as they can precipitate Wernicke’s encephalopathy) to prevent Wernicke–Korsakoff is essential, as well as correct hydration and electrolyte balance, especially Mg, K, and phosphate.

Other supportive recovery measures for alcohol withdrawal include:

• A quiet environment
• Sleep support 
• Adequate nutrition
• Treating comorbidities such as active infections, head trauma and mental health conditions.

A clinician may prescribe adjuncts, such as clonidine or beta-blockers, to target autonomic symptoms resulting from alcohol withdrawal, yet these do not replace anticonvulsants as first-line treatment.

Where Detox Happens

Outpatient vs Inpatient Criteria & Safety Planning

Each person’s detox needs are unique. Drinking patterns and underlying medical and socioeconomic conditions will help a clinician determine the best level of care for an individual.

Outpatient treatment is best for people with: 

• Mild withdrawal symptoms 
• No previous history of withdrawal seizures 
• Stable vitals 
• Reliable social support
• A commitment to daily follow-up to monitor progress

Inpatient or monitored detox is better suited for individuals who: 

• Have a history of prior seizures or DTs episodes 
• Score high on CIWA-Ar 
• Are pregnant 
• Have significant comorbidities 
• Use multiple substances
• Are on withdrawal from benzos or other drugs
• Have insufficient social support 
• Are at risk of suicide

Recovery from alcohol requires careful planning. Qualified detox centers help individuals design safety plans that facilitate long-term sobriety.

These include transportation access solutions, medication adherence strategies, observation window (first 48 hours) plans, and clear instructions on when to “return to ED” based on medically-established triggers.

Preventing Future Episodes

AUD Medications & Relapse-Prevention After Stabilization

Detox is only the first step of recovery. After managing withdrawal symptoms, it is essential to start treatment to deal with the underlying reasons for alcohol abuse.

There are three approved medications for alcohol addiction treatment in the US:

1. Naltrexone: Best for most patients with alcohol use disorder who are not on treatment with opioid agonists. Avoid if liver status is poor.
2. Acamprosate: Ideal in case of liver disease. Not recommended in patients with renal problems.
3. Disulfiram: Best for patients who are very motivated complete abstinence and will be adherent to a daily medication. Not recommended for individuals with liver disease or seizure disorder.

Behavioral therapies such as CBT and MET can address thought patterns fueling addiction, while peer support groups can provide encouragement.

Contingency management, treatment for insomnia and anxiety, and support for unmet social needs are often additional components of a holistic plan that may improve recovery outcomes.

Aftercare plans that incorporate proactive follow-up reduce relapse, which lowers the risk of repeated withdrawals, kindling, and future seizures.

FAQs

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Not sure where to start? Call the number below to talk to someone about your treatment options and see if your insurance will cover rehab. 

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