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Alcohol and Epilepsy: Are You at Risk?

Teen male drinking alcohol  

Severe alcohol withdrawal can cause non-epileptic seizures, and people who have chronic heavy alcohol use disorders (AUD) have a substantially increased risk for seizure activity during withdrawal. However, alcohol does not cause epilepsy, and epileptic seizures and alcohol-related seizures have very different causes and effects.

What Is Epilepsy?

According to The Epilepsy Foundation, epilepsy is defined as “a chronic disorder, the hallmark of which is recurrent, unprovoked seizures.” Epilepsy is an “idiopathic” disorder, meaning that it arises spontaneously from unknown origins. Epileptic seizures are caused by abnormally high levels of activity in the brain and, depending on where the seizure activity occurred, can have very different symptoms.

Can Alcohol Cause Epilepsy?

An important distinction must be made between seizures and epilepsy: epilepsy is characterized by seizures, but not all seizures are epileptic. Because epilepsy is defined by “unprovoked seizures,” alcohol-induced seizures are not epileptic.

However, there is one rare situation where chronic AUD may predispose someone to epilepsy: people who have experienced multiple instances of withdrawal that included seizures may develop a spontaneous seizure disorder. Whether this disorder is truly epilepsy is controversial and, for the most part, alcohol is not considered to be able to cause epilepsy.

Interestingly, epileptic seizures and alcohol-related seizures have different after-seizure signs and symptoms 72 hours after the seizure. People who experienced epileptic seizures were found to have normal vital signs and they were calm, even drowsy.

On the other hand, people who had experienced alcohol-related seizures were tremulous, had high blood pressure, fast pulse rates, increased temperature, and excess sweating. They also reported anxiety and sleeplessness. When brain activity was measured by an electroencephalogram (EEG), epileptic seizures were associated with abnormally low activity, and alcohol-related seizures were associated with normal levels of brain activity. These results indicate that epileptic seizures and alcohol-related seizures have different mechanisms of action.

Alcohol-Related Seizures

The link between chronic use of alcohol and seizures was first described by Hippocrates nearly 2500 years ago, and the Romans called alcohol-related seizures “morbus convivalus”, which translates roughly to “disorder related to partying”. However, the mechanisms that contribute to alcohol-related seizures have only recently been well-characterized.

In order to understand alcohol-induced seizures, it is helpful to understand normal brain activity and the effects of alcohol on the brain. Under normal circumstances, the inhibitory neurotransmitter GABA and the excitatory neurotransmitter NMDA cooperatively regulate brain activity and maintain an appropriate level of activity. With chronic alcohol consumption, GABA signaling is increased (more inhibition) and NMDA signaling is decreased (less excitation). The result is a global reduction in brain activity that is maintained as long as alcohol is present.

Abrupt cessation of alcohol use is associated with alcohol withdrawal seizures: if alcohol is suddenly absent, the “brake” that was slowing the brain down is removed and brain activity accelerates rapidly. The consequence is a state of widespread hyperexcitability that underlies the symptoms of alcohol withdrawal, including anxiety, tremors, sweating, hyperthermia, and, if severe enough, seizures.

Can People with Epilepsy Drink Alcohol?

The Epilepsy Foundation has issued guidelines stating that moderate alcohol consumption (2 drinks or less, consumed slowly) is safe for most people with epilepsy. However, there are important things that people with epilepsy must be aware of before consuming alcohol:

  • Avoid binge drinking: A 2018 study questioned 204 people with epilepsy about their alcohol use and seizure activity. Every person who reported seizures had consumed large amounts of alcohol in the 24-hour period before the seizure, and none of the people who did not drink or who drank in moderation experienced a seizure.
  • Alcohol may affect epilepsy medications: Several antiepileptic drugs (AEDs) can interact with alcohol, and alcohol can reduce the efficacy of some AEDs. Benzodiazepines (particularly clonazepam and diazepam) are commonly used to prevent or stop seizure activity, and combining benzodiazepines and alcohol can have dangerous, even lethal consequences. In addition, AEDs often lower the tolerance to alcohol, meaning that someone will become intoxicated more quickly than normal.

Teens, Epilepsy, and Alcohol

Teenagers with epilepsy need to be aware of the potential consequences associated with alcohol use. As with adults, one or two drinks is probably safe. However, the warnings given to adults must be taken equally seriously by teenagers. Binge drinking and even regular consumption of moderate amounts of alcohol are likely to increase the risk of seizures.

In addition, it is imperative that teenagers have a clear understanding of how any medications they are on may interact with alcohol. For example, benzodiazepines are often prescribed as anti-seizure medications and, if they are taken with alcohol, dangerous respiratory depression could be the result.

Teenagers with epilepsy should have an honest conversation with their doctor about alcohol use and the potential consequences.

Avoiding Seizures When Drinking Alcohol

Alcohol withdrawal is the primary cause of alcohol-related seizures. However, acute alcohol poisoning can also cause seizures, likely by causing dangerously low blood pressure or significantly altering levels of calcium and magnesium in the brain.

Occasional moderate alcohol use is unlikely to trigger a seizure even in someone with epilepsy. However, binge drinking and chronic AUD can increase seizure risk as well as risks associated with myriad other adverse effects in people with and without epilepsy. The most reliable way to avoid alcohol-related seizures is to avoid alcohol or use it infrequently and in moderation.

Key Points: Epilepsy and Alcohol

  • Epilepsy is characterized by seizures, but not all seizures are epileptic.
  • People with epilepsy can safely consume moderate amounts of alcohol (no more than two drinks per day).
  • Alcohol does not cause epilepsy, but alcohol can cause seizures.
  • Alcohol-related seizures typically occur during severe withdrawal.
  • Anti-epileptic drugs may be affected by alcohol.
  • Teenagers with epilepsy don’t need to completely abstain from alcohol use, but even regularly consuming moderate amounts of alcohol can increase their risk for seizures.
  • Teenagers with epilepsy are encouraged to have a frank conversation with their doctor to learn how alcohol will affect them.

Alcohol is a powerfully addictive drug that can cause significant damage to developing brains. If you are concerned about your teen’s alcohol use, the experts at Next Generation Village can help. Call today to learn about our comprehensive rehab programs and how we can help your teen get his or her life back.

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