The prevalence of epilepsy in alcohol-dependent patients of western industrialised countries may be at least triple that in the general population. During withdrawal from alcohol, usually 6-48 hours after the cessation of drinking, seizures may occur. Alcohol abuse is a major precipitant of status epilepticus (9-25% of cases).
A systematic review and meta-analysis 2 analyzing the association between alcohol consumption and epilepsy included 6 case-control studies. A strong and consistent association between alcohol consumption and epilepsy/unprovoked seizures was found with an overall relative risk (RR) of 2.19 (95% CI 1.83 to 2.63). There was a dose-response relationship between the amount of alcohol consumed daily and the probability of the onset of epilepsy. Individuals consuming an average of 4, 6, and 8 drinks daily had RRs of 1.81 (95% CI 1.59 to 2.07), 2.44 (95% CI 2.00 to 2.97), and 3.27 (95% CI 2.52 to 4.26), respectively, compared to nondrinkers. Most of the relevant studies found that a high percentage of alcohol users with epilepsy would qualify for the criteria of alcohol dependence. Data were inconclusive regarding a threshold for the effect of alcohol, but most studies suggest that the effect may only hold for heavy drinking (4 and more drinks daily).
Comment: The quality of evidence is downgraded study limitations (case-control studies) and upgraded by a clear dose-response gradient.
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