[Alcohol and epilepsy].

Abstract

BACKGROUND: Although alcohol-related seizures have been recognized since antiquity, their pathophysiology, classification and treatment options remain unsettled. MATERIAL AND METHODS: On the basis of clinical studies experience and literature searches, a review of classification, diagnostics and treatment of alcohol-related seizures is given. RESULTS: The best-described entity is the alcohol withdrawal seizure, usually occurring within 48 hours after cessation of drinking. However, alcohol can also trigger seizures unrelated to withdrawal, impair seizure control in epilepsy, and has the potential to induce epilepsy. Approximately one third of patients being hospitalized for acute seizures have overused alcohol prior to the seizure. The clinical diagnosis is based on a thorough medical history. The Alcohol Use Disorders Identification Test (AUDIT) provides a reliable measure of drinking habits. Carbohydrate-deficient transferrin (CDT) is the best biomarker for alcohol abuse available and a good supplement to the clinical investigation. The diagnostic value of EEG is limited. INTERPRETATION: Acute seizure management does not differ from that of other seizures. After a withdrawal seizure, prophylactic medication should be restricted to the first few days: In co-existing epilepsy and alcohol abuse, anti-epileptic drugs should be used with caution. There is little evidence to support the general advice that well-controlled epilepsy patients need to abstain completely from alcohol.