Alcohol withdrawal seizures

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By Geir Brathen MD and Maurizio A Leone MD

Alcohol withdrawal seizures are also known as or subsume Rum fits.

Alcohol withdrawal seizures are frequently encountered in the emergency room. Such seizures comprise acute and serious complications to alcohol abuse that need immediate attention. Benzodiazepines should be the first choice in the pharmacological management of such seizures. There is a risk of mistakenly making an epilepsy diagnosis if a thorough alcohol anamnesis is omitted. Any patient with withdrawal seizures should be given thiamine during hospitalization, regardless of nutritional state. In this clinical summary, Geir Brathen MD PhD of Trondheim University Hospital in Norway and Maurizio Leone MD of Ospedale Maggiore della Carità in Novara, Italy, explain the clinical presentation, pathophysiology, diagnostic work-up, and management of alcohol withdrawal seizures and provide clues to the differentiation of withdrawal seizures from seizures due to epilepsy.

Key points:

  • Alcohol withdrawal is a major seizure-precipitating factor.
  • Drinking history is essential; biomarkers such as GGT and CDT may be useful supplements.
  • Investigation of first seizures must include neuroimaging.
  • Benzodiazepines are safe and effective in alleviating both seizures and general withdrawal symptoms as well as preventing further seizures. High initial doses may be necessary, but treatment should be discontinued within less than a week.
  • Parenteral thiamine should be given before any carbohydrate-containing fluids or food.
  • The recommended initial preventive thiamine dose is 200 mg; if Wernicke encephalopathy is suspected, give 200 mg three times daily for at least 2 days.

In This Article

Historical note and nomenclature
Clinical manifestations
Clinical vignette
Pathogenesis and pathophysiology
Differential diagnosis
Diagnostic workup
Prognosis and complications
References cited