Epilepsy: How much alcohol is safe?

People with epilepsy often ask whether it is safe or not for them to drink alcohol. While current research indicates that adults with epilepsy may have one or two alcoholic drinks a day without any worsening of their seizures or changes in the blood level of their antiepileptic medication, the effects of alcohol can vary between individuals and their specific medication.

The following information is a guide to help people with epilepsy assess the risks associated with the consumption of alcohol.

Interactions of AEDs and alcohol

AEDs and alcohol interact in specific ways. AEDs can make you more sensitive to the sedating effects of alcohol while alcohol can reduce the effectiveness of AEDs, making seizures more likely. Alcohol can also exaggerate the side effects of some AEDs. This means it will take fewer drinks to "get drunk" than if you were not taking medication. The results of mixing alcohol with AEDs also depend on which medication you are taking, and this should be discussed with your doctor.

It is also important to bear in mind that taking drugs which act on the brain is likely to make you more sensitive to the effects of alcohol.  This means that rather less than the recommended amounts of alcohol for activities such as driving might well affect your competence. 

Alcohol and seizures

The risk of seizures for many people with epilepsy is greatly increased after consuming three or more alcoholic drinks, however there will be those who are more sensitive to the effects of alcohol after fewer drinks. Generally alcohol does not provoke a seizure while the person is drinking; the seizure is more likely to occur 4 to 72 hours after the drinking has stopped.

The risk of binge drinking

Binge drinking can cause a seizure, even in people who do not have epilepsy. Such seizures can be due to the toxic effects of alcohol, too much fluid, alcohol withdrawal and metabolic changes in the body and can occur within 4 to 72 hours of stopping drinking.

Recent studies have shown that the chronic abuse of alcohol is associated with the development of epilepsy in some people, as repeated alcohol withdrawal seizures may make the brain more excitable. Therefore, people who have experienced seizures brought on by binge drinking may begin to have unprovoked epileptic seizures whether alcohol is consumed or not.

Withdrawal seizures

Withdrawal seizures are most common among persons who have abused alcohol for years. When alcohol consumption is stopped suddenly or is markedly reduced over a short period of time, a seizure may occur.

To drink or not to drink?

Socialising and relaxing with friends can often involve drinking alcohol, whether it be at a pub, nightclub or that lazy Sunday BBQ.

To drink alcohol is always an individual decision and many people with epilepsy will have decided that alcohol is not for them, perhaps because they don’t want to take the risk, or experience has taught them that even moderate drinking can make their epilepsy worse.

Guidelines

• Drink in moderation. This means having one or two standard drinks a day. A standard drink is equal to:
  • One small glass of wine (100ml);
  • One glass of full strength beer (285ml); or
  • 30ml of spirits.
• Stick to your limits and do not allow anyone to persuade you to drink more;
• Avoid excessive drinking. This can result in poor seizure control due to late nights, missed meals, or forgotten doses, while withdrawal seizures are likely to occur as the alcohol level in the blood falls;
• Do not deliberately miss your dose, take extra medication or alter the time you regularly take your medication before drinking. This will not alter any reactions and may cause additional side effects or seizures. You are far more likely to have a seizure by missing your AEDs than by having an occasional drink;
• Do not drink and drive; the possible interaction with AEDs can greatly affect your competence; and
• Most importantly, ask your doctor about the effects of drinking alcohol with the medication you have been prescribed.  

(Source: Epilepsy Australia: May 2009)