Drugs, Alcohol and Epilepsy
In Australian society, drinking alcohol is an accepted form of socialising and relaxation. A glass of beer can satisfy a genuine thirst, whilst a glass of wine can make a special meal more pleasurable, and a measure of spirit can be a welcome relaxant after a hard day’s work. Going to the pub means contact with friends, and social life is important for everyone.
Some common questions are:
Can alcohol cause seizures?
The relationship of alcohol to epilepsy and seizures is complex.
Alcohol is a substance that can cause or worsen seizures when associated with alcoholism, ‘binge’ drinking or epilepsy.
Seizures related to alcohol abuse are encountered more commonly than with any other form of substance abuse.
How do alcohol related seizures occur?
- Alcohol withdrawal – When a chronic drinker or alcoholic stops drinking. These mostly occur within the first 36 to 72 hours of stopping drinking. If these seizures occur often, and the alcohol abuse is over a long period of time (years) then degeneration of the brain may occur, leading to epilepsy and chronic seizures.
- Alcohol toxicity – When someone has ingested large amounts of alcohol and the concentration in the bloodstream is poisonous to the body.
- Excessive fluid and metabolic changes in the body – Drinking large amounts of alcohol will create an imbalance of fluids and electrolytes in the body and has a dehydrating effect.
- Trauma – Head injuries that may occur from accidents or falls while drunk.
- Vitamin or nutritional deficiencies – Chronic alcohol abuse will prevent the absorption of vitamins and is often associated with poor diet.
How do alcohol and anti-epileptic medication mix?
People taking medications for epilepsy are likely to be more sensitive to the effects of alcohol.
Alcohol can:
- Interfere with the metabolism of anti-epileptic medications,
- Enhance the side effects of these medications,
- Some anti-epileptic medications can enhance the effects of alcohol.
- So feeling intoxicated after a small amount of alcohol is quite common.
Missing a dose, taking extra medication or altering the time of taking regular anti-epileptic medications before drinking will not alter this reaction and may cause additional side effects or seizures.
Can I drink alcohol?
Medical opinions vary on whether a person with epilepsy can drink alcohol. Some doctors recommend that alcohol should be avoided at all times, while others say a moderate amount in most cases will do no harm.
It is up to the individual to decide what suits them and to discuss any issues with their doctor or an educator.
Good practice
- People need to practice care when drinking alcohol because:
- Alcohol can interact with anti-epileptic medications preventing them from reaching the necessary levels in the bloodstream to control seizures.
- Large amounts of alcoholic beverages can trigger seizures as can large intake of non-alcoholic fluids. Both create an imbalance of fluid and electrolytes within the body by either dehydration or overhydration.
- Alcohol consumption is often associated with late nights, missed meals and forgotten medications, all of which can trigger seizures.
What is moderate drinking?
Consumption of alcohol should be carefully moderated. This can mean different things to different people, and the distinction between ‘social’ drinking and ‘problem’ drinking can be very unclear. The National Health and Medical Research Council (NHMRC) suggests for healthy men and women, drinking no more than two standard drinks on any day (reduces the lifetime risk of harm from alcohol-related disease or injury). This recommendation is for healthy individuals. Although most complications with seizure and alcohol generally occur with chronic or binge drinking, having a chronic health condition such as epilepsy can alter what is considered “safe” drinking.
Many people with epilepsy choose to drink considerably less than these recommended limits. Many find that by drinking no alcohol at all, greater seizure control is achieved.
Recreational Drugs
No recreational drug is harmless. These drugs can be made up of many different substances of unknown quantity. They are illegal and there are no regulations to control quality. Like alcohol, each person will have different reactions to various drugs.
Many recreational drugs, especially stimulants such as cocaine, ‘crack’, angel dust (PCP), ecstasy and speed (amphetamines), have the potential to cause seizures and it is uncertain what interactions these, or any recreational drugs, may have with prescription medicines. As the name suggests, stimulants are types of drugs that enhance brain activity causing an increase in alertness, attention, and energy.
Drug taking is often associated with problems such as not getting enough sleep, dehydration, and not eating properly. These in themselves are common triggers of seizures.
The decision to take recreational drugs is a personal one, but it is important to be aware that there is the possibility of an increased chance of seizure(s).
One can never predict what side effects will be experienced in mixing antiepileptic drugs and other drugs. This is true for prescribed and non-prescribed medication.
Also remember that the recreational use of these substances is illegal in Australia.
Marijuana
Marijuana is a frequently used recreational drug and is now used in medicine to reduce nausea and vomiting caused by some anticancer treatments, or with AIDs patients.
Is it a useful anti-epileptic drug?
Research about the effects of marijuana on seizure activity is inconclusive. Initial studies suggest that marijuana may have anti-epileptic effects, but there is currently insufficient data to determine whether occasional or chronic marijuana use influences seizure frequency.
If tried as an anti-epileptic agent, marijuana usually needs to be used in high doses which can cause many unfavourable side effects. Also seizures have been known to occur if the dose is not maintained or following withdrawal from marijuana.
Marijuana use in Australia is not legal and therefore not recommended as an anti-epileptic agent.
Is it dangerous for people with epilepsy to use marijuana?
Use can transiently impair short-term memory, and, like alcohol use, may increase noncompliance or forgetting to take anti-epileptic drugs. Marijuana use or withdrawal could potentially trigger seizures in susceptible patients.
Because the data remains limited, and in some cases conflicting, on the potential of cannabis and cannabinoids to control epilepsy, people should use caution when considering marijuana for seizure management.
Some studies and anecdotal reports show that high doses of marijuana can trigger seizures.
Ecstasy
As with depression, several factors can be part of the cause of anxiety disorders including psychological stress related to the epilepsy, medication effects, associated neurological or psychiatric disorders, and the epilepsy itself.
Amphetamines
Amphetamine is an addictive stimulant drug that strongly activates certain systems in the brain. There are many health effects associated with amphetamines. The effects on the central nervous system (CNS) that result from taking even small amounts of this drug includes increased wakefulness increased physical activity, decreased appetite, increased breathing rate, fever and euphoria. Other CNS effects include irritability, insomnia, confusion, tremors, convulsions, anxiety, paranoia, and aggressiveness. Fever and convulsions can result in death.
As amphetamines are a stimulant, people may use them to keep themselves awake, for example, if they were going clubbing until the early hours of the morning. The resulting lack of sleep can be a trigger factor for many people with epilepsy.
Heroin
Heroin is not a stimulant but a depressant, and although it is associated with many serious health problems, seizures are not common. More often, seizures may be related to taking other drugs or alcohol at the same time or to the overall effect of a heroin overdose. As heroin can be administered intravenously, some people may experience seizures as a result of an infection from using dirty needles or impurities in the drug.
People with epilepsy seeking helping for heroin addiction should discuss their treatment medication with their doctor.
Cocaine
Cocaine can provoke seizures in people who do not have a diagnosis of epilepsy, as well as making someone’s epilepsy worse. This is because cocaine can lower the seizure threshold, or cause other medical problems, which can lead to seizures. Seizures can also occur as an indirect result of taking cocaine such as lack of sleep, lack of food and not taking anti-epileptic medication as prescribed.
Inhalants
Inhalants include solvents like petrol, cleaning fluids, paints, liquid shoe polish, nail polish remover, and glue; aerosols like spray paint, insecticides, and hair spray; and anesthetics like nitrous oxide (laughing gas). These chemicals temporarily stimulate before they depress the brain (central nervous system).
Evidence suggests that long term use of inhalants can cause brain/nervous system damage, which may in turn cause epilepsy. There is also a strong possibility that sniffing solvents over a longer period of time could make someone’s epilepsy worse.
Steroids
Although anabolic steroids are used in the treatment of some health conditions, abuse of these drugs can lead to some irreversible health problems. There is no evidence to suggest that steroids used in some sporting activities can trigger or provoke seizures.
Tobacco/Nicotine
Nicotine is both a stimulant and a depressant to the central nervous system. There is no evidence to suggest that smoking cigarettes or cigars trigger seizures in people with epilepsy. However, some nicotine preparations, used to help people stop smoking, should be used with caution as they can have a side effect of convulsions.
If someone with epilepsy wants to stop smoking, before buying any nicotine preparations, they should discuss this further with their doctor.