Synopsis
Recognise an acutely provoked seizure related to alcohol or drugs, treat immediate threats and withdrawal safely, and avoid mislabelling a reversible toxic presentation as chronic epilepsy.
- Call a seizure provoked only when there is a credible time-linked insult; alcohol use, a positive toxicology result or a missed prescription does not by itself prove causation.
- Alcohol-withdrawal seizures are usually generalised tonic-clonic events occurring roughly 6–48 hours after a marked reduction or cessation, but timing varies and alternative causes remain common.
- Check capillary glucose immediately, protect the airway, give oxygen when indicated, time the event and treat at 5 minutes as convulsive status epilepticus according to the local protocol.
Key red flags
Generalised convulsions after recent marked reduction or cessation, accompanied by autonomic withdrawal features and a credible dependence history, support but do not prove alcohol withdrawal.
Investigation priorities
Find immediately reversible danger and quantify respiratory, cardiovascular and temperature disturbance.
Management branches
Convulsive activity is continuing or recurs without full recovery.
- Start ABCDE care, protect from injury, time the seizure, check capillary glucose and obtain airway and senior resuscitation help without restraining limbs or placing objects in the mouth.
- At 5 minutes follow the local convulsive status pathway, using an appropriate first-line benzodiazepine route and escalating promptly if the seizure continues.
The convulsion has stopped and immediate physiology is stable.
Key medicines
Lorazepam for an alcohol-withdrawal seizureFollow the local emergency protocol; NICE describes intravenous lorazepam as a rapid-acting option after a withdrawal seizure.
Parenteral thiamineUse the local high-potency intravenous or intramuscular regimen for suspected Wernicke encephalopathy or high-risk harmful drinking.