Clinical Presentation and Prevalence

Alcohol withdrawal seizures typically occur 6 to 48 hours after the last drink is consumed (50% between 13 and 24 hours; 90% within 48 hours). The prevalence of alcohol withdrawal seizures is estimated at between 2 and 9 per cent of alcohol dependent people. Withdrawal seizures occur as blood alcohol levels fall, and in some people with severe alcohol dependence, seizures can occur even if the blood alcohol level is still high (for example, greater than 20 mmol/L). and are usually generalised (tonic-clonic) seizures. These seizures are typically brief, and not associated with post ictal sequelae like Todds Paresis. Alcohol withdrawal seizures, particularly among people who are older or with cognitive impairment, may be followed by the onset of delirium. The risk of seizure recurrence within 6 to 12 hours after a seizure is estimated at about 25 percent. While the incidence of status epilepticus is low, alcohol withdrawal is a major cause of this life threatening condition. 

People who have experienced an alcohol withdrawal seizure are more likely to experience further seizures in subsequent alcohol withdrawal episodes. It is estimated that alcohol-related seizures account for one-third of all seizure-related hospital admissions.