How does alcohol withdrawal contribute to seizures, and what is the recommended management?

• A. Abrupt withdrawal can provoke seizures; management includes benzodiazepines, adequate fluids, electrolyte correction, and monitoring for withdrawal severity.
• B. Start antipsychotics immediately
• C. Seizures occur only with liver disease
• D. No treatment needed

Answer: (A)

Alcohol withdrawal raises seizure risk because the brain adapts to chronic depressant exposure by dampening inhibition and increasing excitation; when alcohol is suddenly removed, reduced GABAergic tone and heightened glutamatergic activity create a hyperexcitable state that can trigger seizures, typically within the first day or two after last drink.

The recommended management centers on safely controlling withdrawal and preventing seizures. Use benzodiazepines to quell hyperexcitability and prevent withdrawal seizures, with dosing guided by a withdrawal scale and clinical response. Provide adequate IV or oral fluids and correct electrolyte disturbances (such as magnesium, potassium, and sodium) to reduce seizure risk and support overall stabilization. Monitor withdrawal severity regularly to adjust treatment and determine the need for inpatient care. Also give thiamine before glucose administration to prevent Wernicke’s encephalopathy, and be vigilant for delirium tremens, which requires more intensive management. Antipsychotics are not first-line for withdrawal seizures and aren’t the primary approach to management.