To critically analyze the management of alcohol-related seizures including alcohol withdrawal (AW) and alcohol-induced (AI) presentations.

Although alcohol related seizures are common, there remains considerable difficulty in differentiating seizure etiologies among alcohol users which in turn complicates clinical decision making.

Between June and December 2018, 558 ED seizure visits at three urban emergency departments were reviewed to capture all alcohol-related seizures. Data was collected on patient demographics, seizure history, treatments, diagnostics, and discharge information. Data was categorized into three groups: AW (seizure > 24 hours from last drink), AI (alcohol used within 24 hours), and a non-alcohol related seizure control (SC) group. Functional seizure encounters were excluded. Chi square analysis was performed with a significance level of p <0.05.

We identified 53 AW, 60 AI, and 445 SC encounters with similar racial make-up and median age. The AW group had significantly less home anti-seizure medication (ASM) than the AI and SC groups (p <0.001) and were less likely to be given an ASM in the ED (p <0.001). Less ASMs were prescribed on discharge to the AI (p <0.02) and AW groups (p <0.001) than SC. AW group received more head CTs compared to SC (p <0.02) despite similar rates of head trauma. AW had more benzodiazepines given in the ED (p <0.001), inpatient admissions (p <0.006), and ICU admissions (p <0.001) than SC. AI group returned to the ED with seizures more often compared to SC (p <0.03).

Despite AI presenting more often with recurrent seizures, they were less likely to receive ASM treatments on discharge. AW seizures were more likely to have a head CT despite no increased history of head trauma. Larger studies are needed to determine risk factors for recurrent alcohol-related seizures to reduce ED visits and determine appropriate treatments.