Doctors and pharmacists are constantly warning patients with epilepsy about the effects of alcohol. If you have epilepsy, alcohol consumption can have serious consequences. Although moderate alcohol consumption is not associated with increased seizure activity, binge drinking and alcohol withdrawal can cause seizures and even status epilepticus, a serious and potentially fatal condition. Most people with epilepsy are told to abstain from alcohol, and they are less likely than the general population to use or abuse alcohol.
In small amounts, alcohol does not cause seizures. A drink or two now and then does not increase seizure activity. Nor does it alter the amounts of seizure medicines in your blood or change findings on EEG studies. When alcohol is related to seizures, it has been found that it is nearly always the state of alcohol withdrawal that aggravates seizures, rather than drinking itself. Your risk of seizures may be much higher after consuming three or more alcoholic beverages. These alcohol withdrawal seizures may begin between 6 and 72 hours after you stop drinking. Studies suggest that alcohol withdrawal seizures most often occur 7 or 8 hours after heavy or prolonged drinking has stopped.
Seizure medicines can seriously lower your tolerance for alcohol, so the immediate effects of alcohol consumption are greater. The rate of intoxication is far higher among people taking seizure medicines. Rapid intoxication is extremely problematic because many of the side effects of these medicines, which can be made worse by alcohol, are similar to the acute effects of alcohol itself. If you are sensitive to the adverse effects of alcohol or seizure medicines, you may find the combination especially troublesome. For example, the side effects of Tegretol (carbamazepine), including dizziness, drowsiness, and headache, could be enhanced by alcohol. Combining those effects with the adverse effects of alcohol, including slurred speech, unsteadiness, dizziness, and fatigue, can be extremely dangerous.
Alcoholism, or chronic abuse of alcohol, has been shown in recent studies to be associated with the development of epilepsy in some people. These experiments suggest that repeated alcohol withdrawal seizures may make the brain more excitable. Thus, people who have experienced seizures provoked by binge drinking may begin to experience unprovoked epileptic seizures ("alcoholic epilepsy") regardless of alcohol consumption.
What effect does alcohol have on seizures?
- In small to moderate amounts, alcohol actually has properties to counteract seizures, but it should never be consumed in the hope of controlling seizures.
- Alcohol does not often provoke seizures while the person is drinking but it may cause "withdrawal" seizures 6 to 72 hours later, after drinking has stopped.
- Withdrawal seizures are most common among persons who have abused alcohol for years. When alcohol consumption is stopped suddenly or is markedly reduced over a short period of time, a seizure may occur. This is an example of provoked seizures rather than true epilepsy.
- Long-standing alcohol abuse can increase a person's risk of developing epilepsy.
- Many persons with epilepsy are at a markedly increased risk of seizures after consuming three or more alcoholic beverages.
- Research indicates that adults with epilepsy may have one or two alcoholic beverages a day without any worsening of their seizures or changes in the blood levels of their antiepileptic medications.
- Moderate to heavy alcohol consumption is never recommended for persons with epilepsy. Alcohol and some antiepileptic drugs share similar adverse effects. As a result, persons who are sensitive to the adverse effects of alcohol or antiepileptic drugs may find the combination especially troublesome and extremely dangerous when driving.
Topic Editor: Steven C. Schachter, M.D.