LATE-ONSET SEIZURES IN ALCOHOL-WITHDRAWAL

Purpose: To describe the clinical characteristics of alcohol withdrawa l seizures in patients treated with a standardized protocol of short-a cting benzodiazepines. Methods: Grand mal seizures were prospectively identified in a cohort of 1044 patients consecutively admitted to an i npatient alcohol detoxification unit at a Veterans Affairs Medical Cen ter. All patients received a 72-hr structured taper of oxazepam with a dditional oxazepam given without limit in amount and duration in respo nse to alcohol withdrawal symptoms. Results: Eleven seizures occurred for an overall rate of 1.1%. All were single grand mal seizures. Seizu res occurred from 52 to 306 hr after admission, with a mean of 122 hr (5 days). A consistent relationship between the seizures and the cessa tion of oxazepam was noted, with peak incidence occurring 12-48 hr aft er the last oxazepam dose. In no case did recurrent withdrawal symptom s or delirium tremens develop after the seizure. Patients with seizure s were slightly older, more likely to have had withdrawal seizures bef ore (50% vs. 13%, p = 0.03), and had a more severe withdrawal course t han controls. Conclusions: Seizures continued to occur at a low but me asurable rate in alcohol withdrawal treated with a short-acting benzod iazepine. Clinical characteristics of the seizures are different from that classically described in untreated patients, with the seizures be ing closely related to the cessation of oxazepam rather than the cessa tion of alcohol.