Alcohol withdrawal syndrome: mechanisms, manifestations, and management

Abstract

The alcohol withdrawal syndrome is a well‐known condition occurring after intentional or unintentional abrupt cessation of heavy/constant drinking in patients suffering from alcohol use disorders (AUDs). AUDs are common in neurological departments with patients admitted for coma, epileptic seizures, dementia, polyneuropathy, and gait disturbances. Nonetheless, diagnosis and treatment are often delayed until dramatic symptoms occur. The purpose of this review is to increase the awareness of the early clinical manifestations of AWS and the appropriate identification and management of this important condition in a neurological setting.

The impact of sleep loss on the facilitation of seizures: A prospective case-crossover study

“…The mechanism behind the alcohol withdrawal seizure might also be strongly linked to sleeplessness, pointing to the importance of the therapeutic effect of sleep induction in the alcohol withdrawal syndrome (Jesse et al, 2016). Moreover, the notion that sleep loss by itself can facilitate the development of seizures is supported by a previous study on the weekday distribution of seizures in relation to alcohol consumption.…”

“…The pathophysiological mechanisms of alcohol induced seizures are not yet fully understood as the effect of alcohol on the central nervous system is complex, and affect several systems of neurotransmitters, most notably the GABA-/ and glutamate systems (Faingold et al, 1998, Jesse et al, 2016. In patients with a first-time seizure, alcohol appeared to be a contributing factor in more than 30% of admissions (Bråthen et al, 1999).…”

“…More than half of the individuals present with repeated seizures, and in up to 5% they may progress to status epilepticus. More than 50% of withdrawal seizures are associated with concurrent risk factors such as prior epilepsy, structural brain lesions or use of other drugs (Jesse et al, 2016).…”

“…Insomnia is a core symptom of the alcohol withdrawal syndrome along with other signs of glutamate-mediated central nervous excitation, including autonomic symptoms of sympathetic overactivity, restlessness, anxiety as well as seizures (Jesse et al, 2016). A single occasional alcohol dose causes a reduction of sleep onset latency, a more consolidated first half of sleep, but an increase in sleep disruption during the second half.…”

Investigating the management of alcohol‐related presentations in an Australian teaching hospital

“…To prevent progression to a more severe withdrawal, benzodiazepine is recommended to be used early in the management of alcohol withdrawal [17]. Despite the fact that within the first 2 days of withdrawal, benzodiazepine reduces the incidence of seizures by up to 84% and prevent the development of delirium tremens [9], a previous study found that only 37% of patients with AUD were prescribed with benzodiazepine for alcohol withdrawal management [30].…”