WASHINGTON, DC—Alcohol is a major seizure precipitant in the context of hazardous drinking and withdrawal, according to a study presented at the 71st Annual Meeting of the American Epilepsy Society. Occasional social drinking, however, is an uncommon cause of seizure breakthrough in predominantly focal epilepsy, said the researchers.
The seizure-inducing effect of alcohol withdrawal in chronic alcohol abuse is apparent, but the effect of binge drinking and modest social drinking among patients with epilepsy is less clear. Christian Samsonsen, MD, a neurologist at St. Olav’s University Hospital in Trondheim, Norway, and colleagues conducted a prospective, observational cross-over study to examine the relationship between alcohol and seizure disorders in acutely hospitalized patients. They also examined the clinical characteristics of patients with alcohol-related seizures and their drinking patterns.
Evaluating Drinking Patterns
The study included 134 consecutive patients with seizures. Ninety-two patients had epilepsy, and 42 patients had isolated seizures not diagnosed as epilepsy. At hospital admission, researchers conducted a semistructured interview and applied the Alcohol Use Disorders Identification Test (AUDIT).
Investigators defined withdrawal seizure as having an AUDIT score of 8 or greater and alcohol intake within the last two days. They defined binge drinking as drinking more than four units in one session for females and more than five units in one session for males. They defined social drinking as having an AUDIT score of less than 8 and not drinking more than 12 units in one day.
The researchers recorded daily alcohol consumption during the five days prior to the seizure, as well as sleep time during the prior three days. Researchers then performed a follow-up telephone interview on a seizure-free day at least four weeks later.
Seizures Were More Common on Sunday and Monday
In all, 28% of patients had an AUDIT score of 8 or greater (ie, hazardous drinking), including 22% of patients with epilepsy and 43% of patients with isolated seizures. Alcohol consumption and nonfocal seizures were increased in isolated seizures, suggesting withdrawal.
One in five patients with epilepsy had been binge drinking, and 59 (64%) patients with epilepsy had been socially drinking. Among the patients who had been socially drinking, alcohol intake was not different prior to seizure, compared with follow-up, downgrading the role of modest social drinking as a seizure precipitant, said the researchers. Among the 19 patients with idiopathic generalized epilepsy, however, “even social drinking two days prior to seizure was associated with seizures,” the researchers said. Patients with epilepsy were more likely to have had their seizures on a Sunday (21%) or Monday (23%)than on other days. Patients with single seizures were more likely to have had their seizures on a Monday (29%) than on other days. Seizures associated with binge drinking were more common on Sunday.
Overall, binge drinking was associated with loss of seizure control in people with epilepsy; however, “alcohol alone should not always be blamed,” said the researchers. “In people with epilepsy, alcohol intake is often combined with other seizure precipitants,” such as sleep loss, they concluded.
Samsonsen C, Sand T, Brathen G, et al. The impact of sleep loss on the facilitation of seizures: A prospective case-crossover study. Epilepsy Res. 2016;127:260-266.