День: 15.01.2021

ED clinicians are responsible for risk-stratifying patients with alcohol withdrawal syndrome under time and resource constraints, and must reliably identify those who are safe for outpatient management versus those who require more intensive levels of care [7]. Published clinical guidelines recommend stratifying patients with alcohol withdrawal based on their risk of developing complications (e.g., generalized tonic-clonic https://ecosoberhouse.com/ seizures and delirium tremens) [15,16,17,18]. These guidelines are largely limited to the primary care and outpatient settings and do not provide specific guidance for ED clinicians [15,16,17]. It is estimated that 2 million Americans experience the symptoms of alcohol withdrawal each year (1). Generalized tonic–clonic seizures (rum fits) are the most dramatic and dangerous component of the alcohol withdrawal syndrome.

WSP mice show less ethanol conditioned taste avoidance than WSR, but greater ethanol place preference (Chester et al., 1998; for review, see Ford et al., 2010). WSP and WSR lines have also been used to map genetic loci contributing to differences in alcohol withdrawal severity (Bergeson et al., 2003; Ehlers et al., 2010; Buck et al., 2012). Alcohol withdrawal symptoms usually appear when the individual discontinues or reduces alcohol intake after a period of prolonged consumption. However, healthcare workers should be aware that alcohol withdrawal symptoms can be severe and lead to death. In all cases, the management of alcohol withdrawal is monitored and managed by an interprofessional team to ensure good outcomes. In the event of alcohol withdrawal seizures, benzodiazepines are preferred over other anticonvulsants to prevent further seizures.

Can Alcohol (or Withdrawal) Cause a Seizure?

Our review supports the use of benzodiazepines as first-line treatment of severe alcohol withdrawal in the ED. However, our review of evidence from interventional studies performed in the ED does not provide sufficient evidence to recommend routine use of phenobarbital or propofol in ED treatment algorithms. A doctor can help you determine whether you are at a higher risk for alcohol withdrawal seizures based on your medical background. Early identification of problem drinking allows prevention or treatment of complications, including severe withdrawal. The U.S. Preventive Services Task Force28 recommends screening patients for problem drinking through a careful history or standardized screening questionnaire.

• Patients who experience harms from alcohol and other substance use often seek care in the emergency department (ED).
• Behavioral therapies can help those struggling with alcohol abuse focus on avoiding old patterns and identify the root causes of addiction.
• It is unclear if symptom-triggered benzodiazepine protocols are effective for use in the ED.
• An important concept in both alcohol craving and alcohol withdrawal is the “kindling” phenomenon; the term refers to long-term changes that occur in neurons after repeated detoxifications.
• Some evidence suggests that the IC plays a role in alcohol withdrawal seizures in humans, as it does in rodents.
• All too often, problem drinkers lie on the questionnaire until they face a life-threatening health issue—and even then denial often reigns supreme.

For non-randomized studies, we used the Cochrane risk of bias in non-randomized studies of interventions (ROBINS-I) tool [30]. Risk of bias assessments were performed by one trained reviewer (JK) and verified by the principal investigator (JM). Inclusion and exclusion criteria, age, sex, ethnicity, alcohol withdrawal severity at presentation, method of determining alcohol withdrawal, comorbidities, number of participants in main analysis, losses to follow-up. In this rapid review, we adapted traditional systematic review methods to generate evidence within an accelerated time frame [21,22,23].

Signs and symptoms

There is no clear evidence that any one benzodiazepine is superior to another at improving withdrawal symptoms or preventing complications related to alcohol withdrawal syndrome [32]. Seizures are a rare but serious complication that occurs during alcohol detox. Seizures can happen as early as day two during detox, but delirium tremens (DTs) can appear on days 3-4. During the DTs, the person has a high risk of having alcohol withdrawal seizures.

• Daily drinking can have serious consequences for a person’s health, both in the short- and long-term.
• Although alcohol withdrawal seizures in rodents do not represent a perfect model of human alcohol withdrawal seizures, the available evidence indicates that the animal models are valid in many respects.
• Chronic exposure to alcohol results in a compensatory decrease of GABA-A neuroreceptor response to GABA, evidenced by increasing tolerance of the effects of alcohol.
• Detox is required in order to allow the person to fully engage in treatment in a sober state.
• For patients without support, a social worker should be involved to help facilitate addiction rehabilitation.

Research has indicated that the severity of the symptoms of alcohol withdrawal progressively increases over years of alcohol abuse. Repeated detoxes and relapses increase the likelihood of alcohol withdrawal seizures. This is known as the “kindling effect.” The kindling theory is that every withdrawal incident acts as an irritation to the brain. The accumulation of several of these incidents tends to lower the intensity needed for seizures.

Drug withdrawal

While epilepsy can develop on its own in people who do not use alcohol, long-term alcohol use will increase the risk of epilepsy developing in some people. Alcohol withdrawal seizures can occur within a few hours or up to 72 hours after stopping drinking. After a long history of heavy alcohol intake, the brain pathways have become altered.