Late-Onset Seizures in Alcohol Withdrawal

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Abstract
Purpose: To describe the clinical characteristics of alcohol withdrawal seizures in patients treated with a standardized protocol of short-acting benzodiazepines. Methods: Grand ma1 seizures were prospectively identified in a cohort of 1044 patients consecutively admitted to an inpatient alcohol detoxification unit at a Veterans Affairs Medical Center. All patients received a 72-hr structured taper of oxazepam with additional oxazepam given without limit in amount and duration in response to alcohol withdrawal symptoms. Results: Eleven seizures occurred for an overall rate of 1.1%. All were single grand ma1 seizures. Seizures occurred from 52 to 306 hr after admission, with a mean of 122 hr (5 days). A consistent relationship between the seizures and the cessation of oxazepam was noted, with peak incidence occurring 12–48 hr after the last oxazepam dose. In no case did recurrent withdrawal symptoms or delirium tremens develop after the seizure. Patients with seizures were slightly older, more likely to have had withdrawal seizures before (50% vs. 13%, p = 0.03), and had a more severe withdrawal course than controls. Conclusions: Seizures continued to occur at a low but measurable rate in alcohol withdrawal treated with a short-acting benzodiazepine. Clinical characteristics of the seizures are different from that classically described in untreated patients, with the seizures being closely related to the cessation of oxazepam rather than the cessation of alcohol.