Seizures occur in about 3% cases of alcohol withdrawal. They usually appear within 48 hours after abrupt cessation, and are characterized by a reduction in seizure threshold secondary to adaptation to alcohol. More than 50% of individuals will experience a new seizure and in 5% of these cases, progression to a sustained epilepticus status can occur.

The aim is to do a review of the literature on alcohol withdrawal and the onset of seizures in individuals with alcohol addiction.

A literature review was conducted using the PubMed search database.

Alcohol is a central nervous system (CNS) depressant and chronic consumption causes neuroadaptation in order to maintain homeostasis. This adaptation involves the upregulation of excitatory neurotransmitters systems and the downregulation of inhibitory ones. When consumption is abruptly discontinued, the depressive contribution of alcohol to a previously established balance is disrupted, resulting in withdrawal symptoms associated to a generalized CNS’ hyperexcitability state.Critical episodes increase the risk of delirium tremens, a fatal condition in 20% of untreated cases. Thus, the treatment and prevention of seizure recurrences is essential: the clinical guidelines of the American Society of Addiction Medicine 2020, offer an action proposal. Pharmacological therapy after seizures is the preferential treatment: intravenous administration of fast-acting benzodiazepines (lorazepam and diazepam) is the first line treatment.

It is essential to monitor signs and symptoms that alert us to the appearance of seizures associated to alcohol withdrawal, effectively treat these cases, prevent recurrences, and provide a quality follow-up for these patients.

No significant relationships.

We present the case of a 36-year-old male with chronic alcoholism who suffered Delirium Tremens and other complications during hospital admission and who recovered thanks to treatment with benzodiazepines and antiepileptics using a cross tapering strategy.

Presentation of a case and review of the available literature on the pharmacological treatment of alcohol withdrawal.

A 36-year-old man was hospitalised for extensive dermatological lesions suggestive of Pellagra. He acknowledged a daily consumption of six litres of beer, was homeless and had a poor and unvaried diet. After 48 hours, the patient began to present hyperreflexia, disorientation and delusions of harm and was diagnosed with Delirium Tremens.

The case was managed jointly by Internal Medicine and Psychiatry. High doses of Chlorazepate (up to 400 mg daily), Tiapride (up to 600 mg daily) and Thiamine (300 mg daily) were prescribed. After 5 days of treatment, the patient started to improve but severe pain appeared in the lower limbs suggestive of alcoholic neuropathy. Gradually the treatment was replaced by Pregabalin (up to a dose of 1200 mg daily) which was effective in calming the late withdrawal and partially controlling the lower limb pain.

Benzodiazepines remain the first-line agent for severe withdrawal, while some antiepileptic drugs have proven useful in mild-moderate withdrawal and relapse prevention. Switching to antiepileptic drugs during follow-up should be considered because of the lower risk of dependence and respiratory depression, as well as the positive effects on the “kindling” phenomenon.

No significant relationships.

Alcohol abuse can be the cause for psychotic disorders. In the International Classification of Diseases (ICD10) they are coded F10.4-F10.9. One of the potentially life-threatening complications is the development of alcohol delirium. Mortality rates in patients with untreated alcohol delirium reach 15%. It is extremely important to identify the risk factors that contribute to the development of delirium in time to ensure the most effective treatment and to ensure the patient’s potential survival in the hospitalization and post-hospitalization phase.

To analyze and evaluate the risk factors that have coused alcohol withdrawal with the development of delirium in patients admitted at the department of Narcology of the Riga Psychiatry and Narcology Center in 2018.

This study is a retrospectively conducted cohort study based on data from inpatient medical records for patients diagnosed with alcohol-induced delirium at the Department of Narcology of the Riga Psychiatry and Narcology Center in Year 2018.

In the Riga Psychiatry and Narcology Center 113 patients were diagnosed alcohol caused delirium. That makes up to 8% of all inpatients in year 2018. Summary of the prevalence of the most significant risk factors in 2018 inpatients with alcohol delirium.

The study indicated that some easily determined parameters are potential clinical predictors for the development of delirium tremens.

No significant relationships.

Alcohol dependence affects cerebral function in complex, still unsettled ways.

Thirty exclusively alcohol-dependent patients in various stages of withdrawal and 25 matched controls were examined for regional uptake of 99mTc-HMPAO in nine homologous regions of the cerebral cortex by single photon emission tomography (SPET). Image analysis reports regional uptake/uptake in homologous hemisphere.

Alcohol dependence is associated with diminished perfusion in the anterior, and middle frontal regions, and increased perfusion in the posterior temporal regions. Frontal hypoperfusion is related to alcohol withdrawal because it disappears with longer time between imaging, last intake and correlates with a composite index of cognitive impairment at the time. Temporal hyperperfusion persists for longer periods. Severe dependence correlates with both frontal, and temporal altered perfusion.

Alcohol withdrawal leads to redistribution of blood flow favouring the temporal, and more posterior regions of the cortex at the expense of frontal flow.

Evidence suggests that symptom-triggered benzodiazepine treatment for patients with alcohol withdrawal reduces complication rates and emergency department lengths of stay. Our objective was to describe the management of alcohol withdrawal in 2 urban emergency departments.

A structured chart audit was performed for patients with alcohol-related problems who presented to 2 Toronto hospitals over a 2-year period.

A total of 209 emergency department charts were audited. Patient characteristics were similar in both hospitals. None of the patients had been assessed using the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scale. Patients at one hospital received substantially higher mean diazepam doses (64 mg v. 26 mg; p < 0.001) than did the patients at the other hospital, and the patients at the first hospital had fewer seizures during their emergency department stay (1% v. 9%; p = 0.012). Patients spent an average of 9 hours and 40 minutes in the emergency department.

There is significant variability in the documentation and treatment of alcohol withdrawal. Lower benzodiazepine doses are associated with higher rate of withdrawal seizures and prolonged emergency department length of stay. A standardized approach using symptom-triggered management is likely to improve outcomes for patients presenting with alcohol withdrawal.