From the Research
The risk of alcohol withdrawal seizures typically occurs in individuals who have been consuming large amounts of alcohol regularly, defined as more than 8 standard drinks per day for men or more than 5 standard drinks per day for women over a period of weeks to months, and then suddenly reduce or stop drinking. Withdrawal seizures usually occur within 6-48 hours after the last drink, with the highest risk around 24 hours 1. The risk increases with longer duration of heavy drinking, previous episodes of withdrawal seizures, and co-occurring medical conditions.
Key Factors
- Heavy alcohol consumption: more than 8 standard drinks per day for men or more than 5 standard drinks per day for women over a period of weeks to months
- Sudden reduction or cessation of alcohol consumption
- Previous episodes of withdrawal seizures
- Co-occurring medical conditions
Treatment
Treatment typically involves benzodiazepines like diazepam (5-10mg every 4-6 hours as needed), chlordiazepoxide (25-100mg every 6 hours as needed), or lorazepam (1-4mg every 4-6 hours as needed), which are tapered over 3-7 days 2, 3. These medications work by activating GABA receptors in the brain, similar to alcohol, preventing the hyperexcitability that occurs during withdrawal and can lead to seizures.
Recommendations
- If you're concerned about withdrawal, don't stop drinking suddenly; instead, seek medical supervision for detoxification.
- Benzodiazepines are the most evidence-based treatment for alcohol withdrawal, and they decrease the risk of seizures and other withdrawal symptoms 1, 4.
- Phenobarbital may be considered as an alternative to benzodiazepines in certain cases, but more evidence is needed to determine its safety and effectiveness in the emergency department setting 5, 1.