Seizures & Delerium Tremens: Understanding the Dangers of Alcohol Withdrawal

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When individuals who abuse alcohol suddenly abstain, they’re 50-60% likely to experience withdrawal symptoms. This is called alcohol withdrawal syndrome. Symptoms of alcohol withdrawal syndrome can include stomach upset, diarrhea, anxiety and agitation, hallucinations, headaches and migraines, vomiting, tremors, heart palpitations, seizures, and can cause death.

This is a dangerous medical state, not merely a natural detoxification process with unkind symptoms. Consumers need to be aware of the potentially fatal short-term effects as well as the possible long-term effects of alcohol withdrawal syndrome.

What are some of the dangers of alcohol withdrawal syndrome?

  • Seizure
  • Delirium Tremens
  • Status Epilepticus
  • Thiamine Deficiency

Why are seizures dangerous?

First of all, seizures are dangerous not only to the person in withdrawal, but can endanger the life of others if they happen while the person is driving, riding an escalator, or standing close to a candle at the onset of a seizure. If you are experiencing seizures during alcohol withdrawal, it is important not to drive for this reason alone. It’s also important not to swim during any stage of withdrawal, to prevent drowning due to the possible onset of a seizure, delirium tremens, or status epilepticus. Taking a bath could also present a clear danger.

The main reason seizures are so dangerous is because they can cause brain damage. A third of all alcohol withdrawal syndrome patients will experience seizures. Seizures can develop as early as six hours after your last drink and will either be singular events or happen in clusters of multiple, shorter seizures.

Seizures can also be circumstantially dangerous in environments that are normally perceived as safe places. Standing close to a table with sharp edge at the onset of a seizure, for instance, could result in blunt trauma to the head. Being aware of your body and making safe choices during alcohol withdrawal syndrome can make a life or death difference.

Magnesium deficiencies (hypomagnesemia) are caused by electrolyte disturbances that occur during alcohol withdrawal. Without a proper level of magnesium, the body is at an increased risk for seizure and can cause your heart to beat irregularly, muscle cramps, and tremors. Most people experiencing Delerium Tremens will have hypomagnesia, another reason why it’s important to take alcohol withdrawal symptoms seriously and treat them with diligence.

Benzodiazepines are prescribed to prevent seizures during alcohol withdrawal syndrome. Controlling your environmental stimuli can also help reduce the chance of triggering a seizure. Avoid sharp sensory changes such as walking into bright neon lighting after being in the dark, colorful blinking lights like those at a concert, loud noises, and anything that generally taxes the brain in a sudden or severe manner.

What is delerium tremens?

Alcohol withdrawal syndrome progresses to delirium tremens in between 5-10% of cases. Even with treatment, delirium tremens can be deadly. Without treatment, delirium tremens has a 35% mortality rate. When a person hallucinates a little bit and for short spells, this is alcohol hallucinosis, and generally isn’t cause for alarm. Delerium tremens is a complete and total hallucination, which can be a frightening experience in and of itself.

What is status epilepticus?

About 1 in 20 alcohol-related seizures are status epilepticus. Status epilepticus is a severe, unrelenting seizure with a 15-20% mortality rate, which means that roughly 1 in 6 people are killed by it. These seizures carry a great risk of brain damage and are unlikely to stop by themselves after five minutes. The havoc wrought on the brain during status epilepticus during alcohol withdrawal increases the risks of developing epilepsy.

What happens to a person with a thiamine deficiency?

The body absorbs less thiamine when exposed to prolonged, heavy drinking, so the body compensates by producing more of it naturally. When someone stops drinking altogether, their bodies may be thiamine deficient, which can be fatal. It’s very difficult to diagnose thiamine deficiencies, so it can go unnoticed when deficiencies progress into serious conditions like Wernicke’s Disease and Korsakoff’s Psychosis.

Wernicke’s Disease is extremely fatal; in fact, 95% of all Wernicke’s diagnoses are post-mortem. Korsakoff’s Psychosis causes amnesia, apathy, confabulation, personality changes, and repetitive behaviors. It is not a form of dementia, although symptoms closely resemble the behaviors of people with Alzheimer’s Disease.

Long Term Effects

The outlook is positive for individuals who successfully quit drinking alcohol and have detoxified without brain damage. However, individuals who return to alcohol abuse will find their detoxifications worsen significantly each time, which puts them at risk of cognitive impairment, damage to GABA-a receptors, and brain damage in the amygdala and prefrontal cortex.

GABAa receptor damage significantly decreases the effectiveness of benzodiazepine, which prevents seizures and treats psychological disorders. This can also make one more susceptible to stress and periods of high anxiety, excitability, and can even cause anxiety disorders. Thus, multiple alcohol detoxes will elevate risk of seizure and incapacitate the pharmaceuticals that would otherwise prevent them.

If you’ve ever had a stroke, brain ischemia, brain tumor, or suffered head trauma, alcohol abuse increases your risk of of developing symptomatic epilepsy. These insults to the central nervous system can make a person susceptible to unprovoked seizures called remote symptomatic seizures, which have a 49-67% chance of subsequent seizures for years to come. This form of recurring seizure is a seizure disorder that isn’t classified as epilepsy, but highly increases your chances of developing epilepsy.

Sources
Alcohol-related seizures
http://www.efns.org/fileadmin/user_upload/guidline_papers/EFNS_guideline_2011_Alcohol-related_seizures.pdf

Neurologic Complications of Systematic Diseases
http://tulane.edu/som/departments/neurology/programs/clerkship/upload/wch22.pdf

University of Illinois Medical Center at Chicago: Rx Press
https://www.uic.edu/pharmacy/services/di/SeptOct_Final1.pdf

Update on the Neurobiology of Alcohol Withdrawal Seizures
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1312739/

Epileptic Seizures in Critically Ill Patients
http://www.ncbi.nlm.nih.gov/pubmed/19605972

Recommendation for a definition of acute symptomatic seizure
http://onlinelibrary.wiley.com/doi/10.1111/j.1528-1167.2009.02285.x/full

Cognitive and emotional consequences of binge drinking: role of amygdala and prefrontal cortex
http://rstb.royalsocietypublishing.org/content/363/1507/3169

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