Alcohol withdrawal seizures

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Background

  • Onset after last drink: 6-48h
  • Multiple seizures: 60% of patients
  • Progression to Delerium tremens: 33% of patients
  • May occur in spectrum or independent of Alcohol withdrawal syndrome

Clinical Features

  • Single or multiple brief tonic-clonic seizures in the appropriate time setting for alcohol withdrawal[1]

Differential Diagnosis

Ethanol related disease processes

Seizure

Evaluation

  • Clinical features
  • Elevated CIWA

CIWA score

Clinical Institute Withdrawal Assessment – Alcohol – revised (CIWA-Ar)

  • Headache 0-7
  • Orientation 0-4
  • Tremor 0-7
  • Sweating 0-7
  • Anxiety 0-7
  • Nausea (and Vomiting) 0-7
  • Tactile Hallucinations 0-7
  • Auditory Hallucinations 0-7
  • Visual Hallucinations 0-7
  • Agitation 0-7

Maximum Score = 67

  • <8: Typically do not require medication
  • 8-19: Medication
  • ≥20: Medication and admission

Management

Disposition

  • Admission

See Also

External Links

References

  1. Manasco A, Chang S, Larriviere J, et al. Alcohol withdrawal. Southern Medical Journal. 2012; 105(11):607–612.