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Alcohol Withdrawal Seizures – Management — SCE Neurology MCQ

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EasyEpilepsy & Seizure DisordersAlcohol Withdrawal Seizures – ManagementSCE Neurology

A 60-year-old man with alcohol dependence presents with two generalised tonic-clonic seizures within 24 hours of his last drink. He has no previous seizure history. His blood glucose, electrolytes, and CT head are normal. What is the recommended management?

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Correct answer: B — Treat with IV lorazepam and symptom-triggered benzodiazepine regimen (e.g. CIWA protocol); long-term AEDs are not routinely needed for alcohol withdrawal seizures

Alcohol withdrawal seizures typically occur 6–48 hours after the last drink and are provoked (acute symptomatic) seizures. They are best managed with benzodiazepines (lorazepam, diazepam, chlordiazepoxide) as part of alcohol withdrawal management. Long-term AEDs are not routinely indicated unless the patient has a diagnosis of epilepsy independent of alcohol withdrawal (i.e. seizures occurring outside the withdrawal period). Phenytoin is ineffective for alcohol withdrawal seizures. A: Long-term AEDs are not indicated for provoked withdrawal seizures. C: Phenytoin does not prevent alcohol withdrawal seizures. D: LP is not needed if there is a clear withdrawal history and normal CT. E: Active treatment is required to prevent further seizures and progression to delirium tremens.

Reference: NICE CG100 Alcohol-Use Disorders (2010); NICE NG217 (2025)