Skip to main content
SpringerLink
Log in

Alcohol-Related Seizures in the Intensive Care Unit

  • Chapter
  • First Online:
Seizures in Critical Care

Part of the book series: Current Clinical Neurology ((CCNEU))

  • 1757 Accesses

Abstract

Alcohol-related seizures (ARS) are a common phenomenon in the intensive care unit. This chapter reviews the incidence, diagnostic criteria for alcohol use disorders, and management of ARS the ICU setting. Electrographic findings associated with ARS as well as genetic polymorphisms are defined, along with the pathophysiology of ARS. Review of previous literature and outcomes of treatment of ARS are presented. Critical care dilemmas including the management of behavioral and agitation issues are described as well as the choices and mechanisms of antiepileptic therapy available for management of these critically ill patients.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. VanderWeide LA, Foster CJ, MacLaren R, Kiser TH, Fish DN, Mueller SW. Evaluation of early dexmedetomidine addition to the standard of care for severe alcohol withdrawal in the icu: a retrospective controlled Cohort study. J Intensive Care Med. 2016;31(3):198–204.

    Article  Google Scholar 

  2. American Psychiatric Association Publishing. Substance-related and addictive disorders. In:Diagnostic and statistical manual of mental disorders. 5th ed: American Psychiatric Association Publishing; 2013.

    Google Scholar 

  3. Mirijello A, D’Angelo C, Ferrulli A, et al. Identification and management of alcohol withdrawal syndrome. Drugs. 2015;75(4):353–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Welch KA. Neurological complications of alcohol and misuse of drugs. Pract Neurol. 2011;11(4):206–19.

    Article  PubMed  Google Scholar 

  5. Sutton LJ, Jutel A. Alcohol withdrawal syndrome in critically ill patients: identification, assessment, and management. Crit Care Nurse. 2016;36(1):28–38.

    Article  Google Scholar 

  6. Mehta AJ. Alcoholism and critical illness: A review. World J Crit Care Med. 2016;5(1):27–35.

    Article  Google Scholar 

  7. Burnett EJ, Chandler LJ, Trantham-Davidson H. Glutamatergic plasticity and alcohol dependence-induced alterations in reward, affect and cognition. Prog Neuro-Psychopharmacol Biol Psychiatry. 2016;65:309–20.

    Article  Google Scholar 

  8. Sachdeva A, Choudhary M, Chandra M. Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond. J Clin Diagn Res. 2015;9(9):VE01–7.

    CAS  Google Scholar 

  9. Kim DW, Kim HK, Bae EK, Park SH, Kim KK. Clinical predictors for delirium tremens in patients with alcohol withdrawal seizures. Am J Emerg Med. 2015;33(5):701–4.

    Article  CAS  PubMed  Google Scholar 

  10. Schuckit MA. Recognition and management of withdrawal delirium (delirium tremens). N Engl J Med. 2014;371(22):2109–13.

    Article  PubMed  Google Scholar 

  11. Goodson CM, Clark BJ, Douglas IS. Predictors of severe alcohol withdrawal syndrome: a systematic review and meta-analysis. Alcohol Clin Exp Res. 2014;38(10):2664–77.

    Article  CAS  PubMed  Google Scholar 

  12. Maldonado JR, Sher Y, Das S, et al. Prospective validation study of the prediction of alcohol withdrawal severity scale (PAWSS) in medically ill inpatients: a new scale for the prediction of complicated alcohol withdrawal syndrome. Alcohol. 2015;50(5):509–18.

    Article  Google Scholar 

  13. Yousuf T, Brinton T, Kramer J, et al. Correlation between partial pressure of arterial carbon dioxide and end tidal carbon dioxide in patients with severe alcohol withdrawal. Ochsner J. 2015;15(4):418–22.

    PubMed  PubMed Central  Google Scholar 

  14. Stewart R, Perez R, Musial B, Lukens C, Adjepong YA, Manthous CA. Outcomes of patients with alcohol withdrawal syndrome treated with high-dose sedatives and deferred intubation. Ann Am Thorac Soc. 2016;13(2):248–52.

    Google Scholar 

  15. Visée H. The relationship between alcohol and seizures: an overview of the major data. Int J Neurorehabilitation. 2015;2(1):1000141.

    Article  Google Scholar 

  16. Rao PS, Bell RL, Engleman EA, Sari Y. Targeting glutamate uptake to treat alcohol use disorders. Front Neurosci. 2015;9:144.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Wong A, Benedict NJ, Armahizer MJ, Kane-Gill SL. Evaluation of adjunctive ketamine to benzodiazepines for management of alcohol withdrawal syndrome. Ann Pharmacother. 2015;49(1):14–9.

    Article  PubMed  Google Scholar 

  18. Morozova TV, Mackay TF, Anholt RR. Genetics and genomics of alcohol sensitivity. Mol Gen Genomics. 2014;289(3):253–69.

    Article  CAS  Google Scholar 

  19. Lechtenberg R, Worner TM. Seizure risk with recurrent alcohol detoxification. Arch Neurol. 1990;47(5):535–8.

    Article  CAS  PubMed  Google Scholar 

  20. Sandeep P, Cherian A, Iype T, Chitra P, Suresh MK, Ajitha KC. Clinical profile of patients with nascent alcohol related seizures. Ann Indian Acad Neurol. 2013;16(4):530–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. LaRoche SM, Shivdat-Nanhoe R. Subacute encephalopathy and seizures in alcoholics (SESA) presenting with non-convulsive status epilepticus. Seizure. 2011;20(6):505–8.

    Article  PubMed  Google Scholar 

  22. Sand T, Bjork M, Brathen G, Michler RP, Brodtkorb E, Bovim G. Quantitative EEG in patients with alcohol-related seizures. Alcohol Clin Exp Res. 2010;34(10):1751–8.

    Article  PubMed  Google Scholar 

  23. Coutin-Churchman P, Moreno R, Anez Y, Vergara F. Clinical correlates of quantitative EEG alterations in alcoholic patients. Clin Neurophysiol. 2006;117(4):740–51.

    Article  PubMed  Google Scholar 

  24. Sand T, Brathen G, Michler R, Brodtkorb E, Helde G, Bovim G. Clinical utility of EEG in alcohol-related seizures. Acta Neurol Scand. 2002;105(1):18–24.

    Article  CAS  PubMed  Google Scholar 

  25. Stratone A, Topoliceanu F, Driga O, et al. EEG patterns in alcohol withdrawal syndrome. Rev Med Chir Soc Med Nat Iasi. 2000;104(4):71–4.

    CAS  PubMed  Google Scholar 

  26. Alldredge BK, Lowenstein DH. Status epilepticus related to alcohol abuse. Epilepsia. 1993;34(6):1033–7.

    Article  CAS  PubMed  Google Scholar 

  27. Krauss GL, Niedermeyer E. Electroencephalogram and seizures in chronic alcoholism. Electroencephalogr Clin Neurophysiol. 1991;78(2):97–104.

    Article  CAS  PubMed  Google Scholar 

  28. Becker HC, Myrick H, Veatch LM. Pregabalin is effective against behavioral and electrographic seizures during alcohol withdrawal. Alcohol Alcohol. 2006;41(4):399–406.

    Article  CAS  PubMed  Google Scholar 

  29. Veatch LM, Becker HC. Electrographic and behavioral indices of ethanol withdrawal sensitization. Brain Res. 2002;946(2):272–82.

    Article  CAS  PubMed  Google Scholar 

  30. Sand T, Bjork M, Brathen G, Brodtkorb E, Michler RP, Bovim G. The EEG response to photic stimulation is not increased in alcohol-related seizures. Clin Neurophysiol. 2010;121(11):1810–5.

    Article  PubMed  Google Scholar 

  31. Valladares EM, Eljammal SM, Iyer AV, Irwin MR. EEG and vagal tone degradation during nocturnal sleep in abstinent alcohol dependence. Sleep Med. 2007;8(3):284–5.

    Article  PubMed  Google Scholar 

  32. Rathlev NK, Ulrich AS, Delanty N, D'Onofrio G. Alcohol-related seizures. J Emerg Med. 2006;31(2):157–63.

    Article  PubMed  Google Scholar 

  33. Riegle MA, Masicampo ML, Shan HQ, Xu V, Godwin DW. Ethosuximide reduces mortality and seizure severity in response to pentylenetetrazole treatment during ethanol withdrawal. Alcohol Alcohol. 2015;50(5):501–8.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Riegle MA, Masicampo ML, Caulder EH, Godwin DW. Ethosuximide reduces electrographical and behavioral correlates of alcohol withdrawal seizure in DBA/2 J mice. Alcohol. 2014;48(5):445–53.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. McMicken D, Liss JL. Alcohol-related seizures. Emerg Med Clin North Am. 2011;29(1):117–24.

    Article  PubMed  Google Scholar 

  36. Orser BA, Bertlik M, Wang LY, MacDonald JF. Inhibition by propofol (2,6 di-isopropylphenol) of the N-methyl-D-aspartate subtype of glutamate receptor in cultured hippocampal neurones. Br J Pharmacol. 1995;116(2):1761–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Smith H, Sinson G, Varelas P. Vasopressors and propofol infusion syndrome in severe head trauma. Neurocrit Care. 2009;10(2):166–72.

    Article  CAS  PubMed  Google Scholar 

  38. Minozzi S, Amato L, Vecchi S, Davoli M. Anticonvulsants for alcohol withdrawal. Cochrane Database Syst Rev. 2010;3:CD005064.

    Google Scholar 

  39. Perry EC. Inpatient management of acute alcohol withdrawal syndrome. CNS Drugs. 2014;28(5):401–10.

    Article  CAS  PubMed  Google Scholar 

  40. Pandharipande PP, Pun BT, Herr DL, et al. Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA. 2007;298(22):2644–53.

    Article  CAS  PubMed  Google Scholar 

  41. Wong A, Benedict NJ, Kane-Gill SL. Multicenter evaluation of pharmacologic management and outcomes associated with severe resistant alcohol withdrawal. J Crit Care. 2015;30(2):405–9.

    Article  PubMed  Google Scholar 

  42. Linn DD, Loeser KC. Dexmedetomidine for alcohol withdrawal syndrome. Ann Pharmacother. 2015;49(12):1336–42.

    Article  CAS  PubMed  Google Scholar 

  43. Feeney C, Alter HJ, Jacobsen E, et al. A simplified protocol for the treatment of alcohol withdrawal. J Addict Med. 2015;9(6):485–90.

    Article  CAS  PubMed  Google Scholar 

  44. Sohraby R, Attridge RL, Hughes DW. Use of propofol-containing versus benzodiazepine regimens for alcohol withdrawal requiring mechanical ventilation. Ann Pharmacother. 2014;48(4):456–61.

    Article  PubMed  Google Scholar 

  45. Skinner RT. Symptom-triggered vs. fixed-dosing management of alcohol withdrawal syndrome. Medsurg Nurs. 2014;23(5):307–15.

    PubMed  Google Scholar 

  46. MacLaren R, Preslaski CR, Mueller SW, et al. A randomized, double-blind pilot study of dexmedetomidine versus midazolam for intensive care unit sedation: patient recall of their experiences and short-term psychological outcomes. J Intensive Care Med. 2015;30(3):167–75.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Neurology and Neurosurgery, K-11 Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, USA

    Chandan Mehta & Mohammed Rehman

  2. Departments of Neurology and Neurosurgery, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA

    Panayiotis N. Varelas

  3. Department of Neurology, Wayne State University, Detroit, MI, USA

    Panayiotis N. Varelas

Authors
  1. Chandan Mehta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohammed Rehman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Panayiotis N. Varelas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Panayiotis N. Varelas .

Editor information

Editors and Affiliations

  1. Departments of Neurology and Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA

    Panayiotis N. Varelas

  2. Neurocritical Care, Columbia University College of Physicians & Surgeons, New York, New York, USA

    Jan Claassen

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this chapter

Cite this chapter

Mehta, C., Rehman, M., Varelas, P.N. (2017). Alcohol-Related Seizures in the Intensive Care Unit. In: Varelas, P., Claassen, J. (eds) Seizures in Critical Care. Current Clinical Neurology. Humana Press, Cham. https://doi.org/10.1007/978-3-319-49557-6_19

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-49557-6_19

  • Published:

  • Publisher Name: Humana Press, Cham

  • Print ISBN: 978-3-319-49555-2

  • Online ISBN: 978-3-319-49557-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation