EFNS guideline on the diagnosis and management of alcohol‐related seizures: report of an EFNS task force

Abstract

Despite being a considerable problem in neurological practice and responsible for onethird of seizure-related admissions, there is little consensus as to the optimal investigation and management of alcohol-related seizures. The final literature search was undertaken in September 2004. Consensus recommendations are given graded according to the EFNS guidance regulations. To support the history taking, use of a structured questionnaire is recommended. When the drinking history is inconclusive, elevated values of carbohydrate-deficient transferrin and/or gammaglutamyl transferase can support a clinical suspicion. A first epileptic seizure should prompt neuroimaging (CT or MRI). Before starting any carbohydrate containing fluids or food, patients presenting with suspected alcohol overuse should be given prophylactic thiamine parenterally. After an alcohol withdrawal seizure (AWS), the patient should be observed in hospital for at least 24 h and the severity of withdrawal symptoms needs to be followed. For patients with no history of withdrawal seizures and mild to moderate withdrawal symptoms, routine seizure preventive treatment is not necessary. Generally, benzodiazepines are efficacious and safe for primary and secondary seizure prevention; diazepam or, if available, lorazepam, is recommended. The efficacy of other drugs is insufficiently documented. Concerning long-term recommendations for non-alcohol dependant patients with partial epilepsy and controlled seizures, small amounts of alcohol may be safe. Alcohol-related seizures require particular attention both in the diagnostic work-up and treatment. Benzodiazepines should be chosen for the treatment and prevention of recurrent AWS.

Carbohydrate-deficient transferrin (CDT) as a marker of alcohol abuse: A critical review of the literature 2001–2005

“…Also European Federation of Neurological Societies (EFNS) guidance regulations on diagnosis and treatment of alcohol related seizures suggest the use of CDT and GGT to support the clinician's suspicion [71].…”

Multicenter evaluation of pharmacologic management and outcomes associated with severe resistant alcohol withdrawal

“…Abrupt cessation of alcohol results in the hyperexcitatory clinical manifestations seen in withdrawal. Benzodiazepines (BZDs) are considered first-line agents for the management of AWS, as they are GABA agonists [5,6]. However, a subset of severe AWS patients does not respond adequately, despite escalating doses of BZDs [7].…”

BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP

“…Bråthen et al (2005) (Ia) have produced consensus recommendations for diagnosis and management of alcohol-related seizures based on a systematic review of the evidence. They recommend longer-acting benzodiazepines, for example diazepam, or if not available lorazepam, since they are efficacious for primary and secondary seizure prevention.…”