Alcoholic epilepsy is a group of pathological conditions in which convulsive or non-convulsive seizures associated with alcohol consumption are observed. It develops more often in patients with alcoholism. Sometimes it occurs with one-time alcoholic excesses in people who do not suffer from alcohol addiction. It belongs to the group of symptomatic epilepsies. It can be accompanied by convulsions, automatic actions and disturbances of consciousness. Treatment involves complete abstinence from alcohol and taking anticonvulsants.
G40.5 Special epileptic syndromes. Epileptic seizures associated with alcohol consumption
Alcoholic epilepsy is a type of symptomatic epilepsy that occurs in connection with alcohol consumption. Usually develops at the II-III stage of alcoholism. In some cases, it can be observed with episodic intake of large doses of alcohol. It includes several pathological conditions accompanied by convulsive or non-convulsive seizures. It is more common in men aged 30-40 years. The characteristic features of this pathology are a clear connection between seizures and episodes of alcohol intake, a high frequency of convulsive seizures, as well as the absence of epileptic signs on the EEG.
With convulsive seizures, injuries of varying severity may occur as a result of falling or hitting hard objects. Before the onset of a seizure, sudden mood changes are possible, accompanied by aggression towards others. Epipripadki in chronic alcoholism are often harbingers of alcoholic delirium. The treatment of this disease is carried out by specialists in the field of narcology in cooperation with epileptologists.
Causes of alcoholic epilepsy
The main cause of development is damage to brain cells as a result of the toxic effects of alcohol. The likelihood of seizures increases with prolonged binge drinking, taking low-quality alcoholic beverages and alcohol-containing liquids that are not intended for internal use. Other risk factors include traumatic brain injuries (both recent and past), hereditary predisposition to epilepsy, disorders of cerebral circulation, infectious diseases and brain tumors.
In the literature, the concept of “alcoholic epilepsy” can be used to determine several pathological conditions: epileptic reaction, epileptic syndrome and true alcoholic epilepsy.
- Epileptic reaction – single or episodic seizures that occur against the background of one-time alcoholic excesses in people who do not suffer from chronic alcoholism. Usually the attack develops the next day after drinking alcohol. After the signs of a hangover disappear, the attacks stop.
- Epileptic syndrome is more widespread than alcoholic epilepsy. It is observed in chronic alcoholism. It is characterized by the presence of repeated seizures. It is accompanied by mental and somatic disorders characteristic of alcoholism. In some cases, auras resembling illusions or hallucinations may occur during seizures.
- Alcoholic epilepsy develops rarely, usually against the background of long-term constant consumption of alcoholic beverages (from 10 years or more) and accounts for about 10% of the total number of epileptiform seizures caused by alcohol consumption. Seizures usually occur during withdrawal syndrome and often turn into alcoholic psychosis.
Symptoms of alcoholic epilepsy
With true alcoholic epilepsy, there is the same clearly expressed relationship between an attack and the intake of alcoholic beverages as between alcohol consumption and the development of abstinence or alcoholic psychosis. All of these pathological conditions, as a rule, do not occur during the period of active use, but some time after the cessation of alcohol intake. Most often, epileptic seizures appear 2-4 days after the withdrawal or a significant reduction in the dose of alcohol, at the peak of the withdrawal syndrome.
Both convulsive and non-convulsive seizures are possible. The nature and severity of seizures can vary – from short-term disturbances of consciousness to serial tonic-clonic seizures and seizures with the development of epileptic status. Convulsive seizures are more common than convulsive seizures and may be accompanied by motor automatism, impaired consciousness or episodes of pronounced dysphoria. A distinctive feature is the absence of polymorphism – once occurring, seizures proceed according to the same pattern, without changing the clinical picture.
With convulsions, the predominance of the tonic phase is noted. Absences (short-term “shutdowns” of consciousness), psychosensory (ringing, a sense of discharge or flash) and psychomotor (changes in consciousness in combination with convulsions or motor automatism) seizures are rarely observed. Before the onset of a generalized convulsive seizure, pallor and cyanosis of the upper body occur. During an attack, the patient falls, throws back his head, strongly (often to the point of grinding) clenches his teeth, groans, bends his arms and legs. Breathing disorders and involuntary urination are possible.
Some types of epileptic seizures are not recognized by others because of unusual symptoms unknown to people far from medicine. Among such attacks are sudden stops of speech, as well as pronouncing words or phrases that do not fit the occasion, do not correspond to the topic of conversation and do not persist in the patient’s memory. Sometimes seizures occur against the background of precursors (dysphoria, a sharp increase in anxiety and irritability), which others take for signs of alcohol withdrawal.
A distinctive feature is some features of the condition and behavior of patients in the post-seizure period. Patients suffering from idiopathic epilepsy usually feel tired, lethargic, and broken after seizures. Less often there is a phase of twilight clouding of consciousness or psychomotor agitation.
Patients with alcoholic epilepsy have sleep disorders after a seizure: insomnia, frequent nocturnal and early awakenings and emotionally intense fantastic dreams. In 50% of patients suffering from seizures due to alcohol consumption, delirium develops against the background of insomnia 1-2 days after the attack, accompanied by vivid visual hallucinations in which devils, aliens, fantastic creatures are present, etc. Over time, seizures do not become heavier, as often happens with idiopathic epilepsy. There is a predominance of personality changes characteristic of alcoholic degradation, and not for the epileptic process.
The diagnosis is made taking into account the anamnesis and clinical manifestations. Indications of prolonged use of alcoholic beverages, the absence of seizures before the onset of alcohol dependence and the relationship between seizures and refusal to take alcohol are of diagnostic importance. The data of additional studies are uninformative, epileptic signs on the electroencephalogram are usually absent.
Treatment of alcoholic epilepsy
Patients with epileptic status and multiple seizures are hospitalized in the intensive care unit to maintain vital body functions. Glucose and saline solutions are transfused, diazepam, hexobarbital and thiopental are injected. The rest of the patients are sent for examination and treatment to the narcological department. Anticonvulsants are used. Barbiturates are rarely used, since these drugs are contraindicated in alcoholism. The exception is seizures that are resistant to the action of other anticonvulsants. If there are sufficient indications, barbiturates are prescribed only in a hospital setting, under constant monitoring of the patient’s condition.
A prerequisite for successful therapy of this pathology is the complete cessation of alcohol intake. The tactics of alcohol addiction treatment are determined by a narcologist. Individual and group psychotherapy, hypnosuggestive techniques, drug coding using implants and intravenous drugs can be used. If necessary, the patient is given a referral to a specialized rehabilitation clinic.
With a complete rejection of alcohol, the prognosis is favorable. In most cases, seizures disappear completely. There are no personality changes characteristic of epilepsy, the severity of mental disorders and personality disorders is determined by the duration and severity of alcoholism. If you continue to drink alcohol, seizures may become more frequent. A threat to the patient’s life may occur with the development of epileptic status and alcoholic psychosis, as well as with injuries due to generalized convulsive seizures.