Alcohol Withdrawal Seizures: A Most Severe Symptom of Alcohol Withdrawal Syndrome Symptoms

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Most Severe Symptom of Alcohol Withdrawal Syndrome Symptoms

What is meant by alcohol withdrawal syndrome?

Alcohol withdrawal syndrome is a critical emergency situation that refers to the changes that the human body feels after a sudden stop of heavy alcohol intake. Long-term drinking of alcohol causes a soothing effect on bain. Alcohol consumption makes its consumer addicted to it. Sudden withdrawal from alcohol is dangerous for the brain as it disrupts the chemistry, balance between neurotransmitters and causes severe effects. These adverse effects of sudden alcohol withdrawal that cause tremors are termed alcohol withdrawal seizures.

In general, alcohol withdrawal syndrome is a combination of emotional and physical symptoms that might range from mild to severe and create life-threatening situations. 

Symptoms of alcohol withdrawal syndrome 

Symptoms of alcohol withdrawal syndrome range from mild to severe. For the diagnosis, patients must have exhibited at least two typical signs and symptoms from following mentioned list 

  • Headache
  • Tremors
  • Anxiety
  • Mild fever
  • Sweating
  • Irritability
  • Confusion
  • Insomnia
  • High blood pressure
  • Nightmares

Severe symptoms include:

  • Seizures
  • Severe confusion
  • Severe agitation
  • Fever
  • Visual hallucinations
  • Auditory hallucinations
  • Tactile hallucinations
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Alcoholic withdrawal seizures

In alcoholic withdrawal syndromes, seizures and hyperexcitability occur due to compensatory changes in GABA A receptors following chronic alcohol exposures. Alcoholic withdrawal seizures are reported to occur in approximately 10% of patients withdrawing from alcohol. It happens 7 – 8 hours after cessation of alcohol and appears to be tonic-clonic. Alcohol itself may induce seizures, so it needs a proper diagnosis to differentiate that either seizure occurs due to high blood alcohol level or due to sudden cessation of alcohol. Alcohol itself gives rise to other contributing factors like epilepsy that worsen the situation. Other contributing factors to seizures are 

  • Brain infarctions
  • Hemorrhagic strokes
  • Subarachnoid haemorrhage
  • Structural alterations

Progression of alcohol withdrawal syndrome

The severity of alcohol withdrawal syndrome and symptoms experienced is typically based on the following factors

  • Amount of alcohol consumption
  • Duration of prior alcohol consumption
  • Number and severity of previous alcohol withdrawals

Most severe symptoms have the probability of occurring 2 hours after cessation. This rapid onset of syndrome needs either pre-planned hospitalization or fast access to medical care. 

Six to 12 hours after the last consumption of alcoholic drinks tends to initiate withdrawal symptoms like nausea, vomiting, anxiety, and headache. Withdrawal symptoms may proceed to hallucinations, tremors, confusion, and agitation after 12 to 24 hours of cessation of alcohol. Usually, the patient’s condition begins to improve after 48 hours, but sometimes withdrawal symptoms continue to increase in frequency and intensity. This condition gives rise to severe health problems like seizures, hallucinations, and fever that may last from 4 to 12 days. 

Possibility of seizures should be anticipated at 24 to 48 hours following the last ethanol ingestion. Alcohol withdrawal seizures carry the risk of death for the victim. 

Causes of alcohol withdrawal syndrome AWS

Alcohol withdrawal syndromes are caused due to dependence on the nervous system due to excessive alcohol consumption and drinking. The central nervous system fails to adapt quickly to a sudden lack of alcohol. Significant reduction in the amount of alcohol consumption or sudden cessation to drinking can cause Alcohol withdrawal syndrome. 

Individual who are at high-risk for alcohol withdrawal syndrome

AWS is most commonly observed in adults and teenagers who consume excessive alcohol and may also experience the symptoms. If you have previously had withdrawal symptoms or needed medical detox, you are also at a high AWS risk. The centers for disease control and prevention explain heavy drinking as more than 15 drinks per week for men and more than eight drinks per week for women. One drink is equivalent to the following:

  • 1.5 ounce of vodka, whiskey, or distilled spirits
  • 5 ounces of wine
  • 8 ounces of malt liquor
  • 12 ounces of beer

Diagnosis of alcohol withdrawal

It is easy to diagnose alcohol withdrawal syndrome when exhibiting two or more above-mentioned typical signs and symptoms that occur after sudden cessation of heavy and chronic drinking. There is no need for any specific test to diagnose alcohol withdrawal syndrome.

If you are experiencing an alcohol withdrawal syndrome from drinking, then it’s a sign that you may consume enough alcohol to damage other organs. It gives a clue to your doctor to proceed further by examining you carefully though 

  • A blood test to check normal RBCs count 
  • Toxicology screening to check the amount of alcohol in the body 
  • Evaluation of usual diet to check malnutrition 
  • Vitamins in diet 
  • Drinking history 

Other common sign and symptoms that your doctor will look for are 

  • Fever
  • Hand tremors
  • Irregular heart rate
  • Dehydration

Your doctor may ask a few questions to examine your memory and power of recalling recent events like:

  • What is your grandfather’s name?
  • What day is it?
  • What is the date today?
  • Do you feel stomach upset?

Treatment strategies

1. Management at home 

Home care helps to treat and manage mild symptoms of AWS. A friend or relative must stay with you to observe your condition and call an emergency or get you to the hospital immediately. 

Only Management of mild alcohol withdrawal symptoms is possible at home. 

2. Hospitalization

Severe symptoms of AWS like seizures, vomiting, and delirium tremens require hospitalization. Hospitals are the safest place for patients under the supervision of professional health care. Treatment for delirium tremens in an intensive care unit (ICU) is often required. Your heart rate, blood pressure, oxygen saturation, and breathing pattern can be easily monitored and controlled in an ICU. Following medical conditions need hospitalization:

  • Any surgical condition need inpatient treatment
  • Medical condition requiring additional treatment with any changes in mental status
  • Uncontrolled nausea and vomiting 
  • Evidence of dehydration
  • Severe withdrawal syndromes like delirium tremens

3. Medications

Benzodiazepine is a class of medication that is required to treat alcohol withdrawal syndromes. Long-acting and short-acting benzodiazepines differ in their duration of action. It’s important to note that the combination of benzodiazepine with alcohol leads to intense and severe type of adverse psychological effects that may give rise to suicidal thoughts. Therefore alcohol during treatment with a benzodiazepine is strictly contraindicated. Most commonly used benzodiazepines 

  • Clonazepam
  • Alprazolam
  • Lorazepam
  • Diazepam

In the case of poor nutrition or vitamin deficiencies, vitamin supplements are being prescribed for overcoming vitamin deficiencies in nutrition. Once a withdrawal is completed, then additional supplements and vitamins are needed to take in for the sake of avoiding nutritional deficiencies and complications as a result of chronic alcohol use. 


Alcohol has serious effects on the CNS that give rise to Alcoholic withdrawal syndromes upon immediate cessation of alcohol. Seizures and hyperexcitability may develop in alcohol withdrawal. Individuals who are used to excessive consumption of alcohol must consult with health care professionals to take the right steps for alcohol withdrawal. It should be taken into serious consideration to avoid any life-threatening situations.