Seizures in Patients with Alcohol Dependence

Introduction: Patients who present for treatment of alcohol dependence often report a history of seizures. These are generally attributed to alcohol withdrawal and not further investigated. Methods: We systematically assessed 381 consecutive male inpatients with alcohol dependence admitted to the deaddiction services of the National Institute of Mental health & Neurosciences (NIMHANS), Bangalore, India for a history of seizures. We obtained detailed lifetime seizure history and pattern of drinking from both patients and their immediate relative (s) who lived with them. Patients with history of seizures underwent electroencephalography (EEG) and cranial CT scan. Results: A definite history of seizures was obtained in 60 (16%) of 381 patients. Median number of seizures was 3.5. A family history of seizures was present in a quarter of the subjects (25%). Only 26 patients (43%) were able to give clear drinking histories temporal to the seizure. In only 17 patients (28.3%) reporting seizures, seizures could be confidently diagnosed as alcohol withdrawal. CT scan revealed cortical atrophy in 40 (73%) subjects and focal abnormalities in 9 (16%). Conclusion: A confident diagnosis of alcohol withdrawal seizures could be made in only a minority of subjects with alcohol dependence and seizures. This finding has immense clinical implications considering 1) that seizures are commonly reported in patients presenting with alcohol dependence 2) they could not be confidently attributed to alcohol withdrawal, 2) a quarter of patients had a family history of seizures. Routine imaging may be recommended to rule out focal causes (German J Psychiatry 2007; 10: 54-57).