For the vast majority of people who have epilepsy, light to moderate alcohol consumption (less than two drinks per day) does not increase seizure activity. However, alcohol use by people with epilepsy is not without risk, particularly if binge drinking is involved. People who struggle with severe alcohol use disorder (AUD) are at risk for seizures during withdrawal, but these seizures are generally not considered to be epileptic. There is some evidence that people with chronic AUD who have gone through multiple withdrawal episodes that have caused seizures are at risk for developing epilepsy.
What to Know About Epilepsy and Alcohol Abuse
Alcohol is prevalent and is nearly ubiquitous in social situations. Although caution is urged, people with epilepsy can safely consume alcohol in moderation. The Epilepsy Foundation recommends limiting daily alcohol consumption to a maximum of two drinks. If someone with epilepsy is taking medication to manage seizures, it is important to understand how anti-epileptic drugs (AEDs) or any other drug they have been prescribed will interact with alcohol. They should consult with their doctor before drinking alcohol.
When used in moderation, alcohol does not cause seizures. When alcohol is present in the body, seizure threshold is actually increased, which means that seizures are less likely to occur. Alcohol-related seizures nearly always occur in the 6 to 48 hours following alcohol consumption.
Even people who struggle with AUD rarely suffer from alcohol-induced seizures. These observations suggest that alcohol-induced seizures most commonly occur in people with severe AUD and that it is not the alcohol that causes the seizure, but rather the maladapted brain’s response to a lack of alcohol.
Does Alcohol Abuse Cause Epilepsy?
Although there is a clear link between chronic use of alcohol and seizures, epilepsy is a separate disorder. The Epilepsy Foundation defines epilepsy as “a chronic disorder, the hallmark of which is recurrent, unprovoked seizures.” Because most alcohol-induced seizures are provoked, they do not strictly fit the definition of epilepsy. However, there is an exception. People who struggle with chronic AUD and who have experienced multiple detox/withdrawal and setback cycles that have caused seizures may develop epilepsy. This is a rare exception, though; alcohol is generally not believed to cause epilepsy.
Interestingly, epileptic seizures and alcohol-related seizures have been shown to have different after-seizure signs and symptoms in the 72 hours following the seizure. Epileptic seizures were associated with normal vital signs and the people who experienced epileptic seizures were calm, even drowsy. Conversely, people who had experienced alcohol-related seizures had tremors, elevated blood pressure, pulse rate and temperature, hyperthermia and sweating, and reported anxiety and sleeplessness. However, when brain activity was measured using EEG, people who had experienced epileptic seizures had abnormally low activity whereas people who had experienced alcohol-related seizures had normal levels of brain activity. These findings support the theory that epilepsy and AUD-associated seizures are different disorders.
Can I Drink Alcohol if I Have Epilepsy?
People with epilepsy can drink alcohol in moderation. The Epilepsy Foundation suggests a maximum of two drinks per day and they recommend that drinks be consumed slowly. Several studies assessed the relationship between alcohol and seizures in people with epilepsy. In nearly every case, people with epilepsy were able to consume light-to-moderate amounts of alcohol (one to two drinks) without increasing seizure activity, but heavy alcohol consumption could cause seizures. For example, a 2018 study evaluated seizure activity in 204 people with epilepsy who reported alcohol consumption. Thirty-seven people out of 204 (18.1%) reported that they had experienced alcohol-related seizures. The average amount of alcohol consumed by each of the 37 people in the 24 hours preceding the seizure was 13 drinks, and the minimum amount consumed was seven drinks. Thus, evidence supports that one to two drinks are safe for most people who have epilepsy, but that heavy drinking increases the risk of seizure.
Dangers of Mixing Alcohol and Epilepsy Medication
Although combining alcohol and epilepsy medicine can be done safely, there are risks. Alcohol can interact negatively with many drugs, and several anti-epileptic drugs (AEDs) reduce alcohol tolerance, meaning that the effects of alcohol appear more quickly and with more intensity than normal. In addition, alcohol can reduce the efficacy of AEDs. Benzodiazepines (particularly clonazepam and diazepam) are commonly used to manage epilepsy. Alcohol and benzodiazepines are both central nervous system depressants, meaning that they reduce activity in the brain. Combining alcohol with benzodiazepines can have dangerous, even lethal consequences. If you are taking a benzodiazepine, drinking can be dangerous. It is strongly recommended that alcohol and benzodiazepines not be used together. If you are on epilepsy medication, make sure you discuss alcohol use with your doctor before consuming any alcohol.
Relationship Between Epilepsy and Alcohol Withdrawal
People who struggle with profound AUD are at an increased risk for seizures when they stop drinking. Alcohol-related seizures are the consequence of rapidly changing brain chemistry. Long-term, heavy alcohol use chronically inhibits brain activity. When alcohol consumption is stopped abruptly, the brain loses the brake that was preventing normal activity, leading to a state of hyperexcitability. Most AUD withdrawal symptoms, including seizures, are a consequence of this hyperexcitability. People who experience recurring seizures because of severe AUD are at increased risk for epilepsy development, but this outcome is uncommon.
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The Epilepsy Foundation. “Alcohol.” March 2014. Accessed August 18, 2019.
Hillbom, Matti; Pieninkeroinen, Ilkk; Leone, Maurizio. “Seizures in alcohol-dependent patients: Epidemiology, pathophysiology and management.” CNS Drugs, January 2013. Accessed August 18, 2019.
Bråthen, Geir; et al. “Alcohol-related seizures.” European Handbook of Neurological Management, 2011. Accessed August 18, 2019.
The Epilepsy Foundation. “What is Epilepsy?” January 2014. Accessed August 18, 2019.
Hamerle, Michael; Ghaeni, Leyli; Kowski, Alexander; Weissinger, Florian; Holtkamp, Martin. “Alcohol Use and Alcohol-Related Seizures in Patients With Epilepsy.” Frontiers in Neurology, June 2018. Accessed August 18, 2019.
Leach, John Paul; Mohanraj; Rajiv Borland, William. “Alcohol and drugs in epilepsy: Pathophysiology, presentation, possibilities, and prevention.” Epilepsia, September 2012. Accessed August 18, 2019.