Seizures And Substance Use

The Relationship Between Seizures And Substance Use

Seizures occur when there is a sudden, uncontrollable electrical surge in the brain. This abnormal activity between brain cells causes behavioral changes, muscle movements, and an altered state of awareness. There are several different types of seizures with a wide range of symptoms. This means that experiences and triggers vary from person to person. When a person has repeat seizures, they may be diagnosed with a disorder called epilepsy. Substances, like drugs and alcohol, can trigger seizures.

Those who struggle with a substance use disorder (SUD) may experience seizures as a result of drug use or during treatment. Those who have been diagnosed with epilepsy could worsen their condition with the use of certain substances. Understanding the relationship between seizures and substance use is important to preventing future incidents or harm from seizures.

What Happens During A Seizure?

Seizures generally are the result of an imbalance between inhibitory influences and excitatory stimulation in the brain. When excitatory and inhibitory transmitters and receptors are balanced, neural activity is normal. Either increased excitatory and decreased inhibitory can cause a seizure. While the experience of having a seizure tends to vary from person to person, there are two common types: generalized and focal.

A seizure that affects both sides of the brain is labeled as generalized. The two kinds of generalized seizures are absence and tonic-clonic. Absence seizures typically only affect a person’s awareness resulting in rapid blinking, staring off into space, and/or smacking lips. Recovery from an absence seizure is often immediate. A tonic-clonic seizure is what most people picture when they think of seizures. They involve a complete loss of consciousness, stiffening of the muscles, and jerking motions. It usually takes less than 3 minutes to recover from a tonic-clonic seizure.

Focal seizures affect only a small part of the brain and can be simple or complex. A simple focal seizure affects only a small part of the brain which can cause brain twitching or a change to the senses like taste or smell. A complex focal seizure causes someone to be confused or dazed and unable to respond to questions for a few minutes. Focal seizures can become generalized if it spreads to both sides of the brain.

Seizures can be a medical emergency when they last more than 5 minutes or occur close together without time in between to recover. This type of occurrence is called status epilepticus. At this point, it is important to call for medical assistance or use any emergency medication that has been prescribed.

Epilepsy

While not everyone who has a seizure will have another one in the future, those who have two or more may receive an epilepsy diagnosis. Each year there are about 180,000 new cases of epilepsy with children and elderly adults being the most affected. For 70% of epilepsy cases, the cause of the disorder is unknown. Some known causes are head injuries, brain tumors, infections like meningitis, stroke, and low oxygen during birth. When treating epilepsy, the goal is to find the method that will stop seizures with the fewest amount of side effects. Because epilepsy is so individual, finding treatment is often a trial-and-error process.

The specific patterns or situations that may increase the likelihood of having a seizure are called triggers. Triggers are different for each person with epilepsy. It can be helpful to keep track of triggers to gain a better understanding of when a future seizure may occur and how to prepare for one. Some commonly reported triggers are time of day, lack of sleep, sickness, flashing lights, menstrual cycle, dehydration, not eating enough food, and stress.

How Substance Abuse Affects Seizures

Seizures are a common complication of substance use with up to 9% of status epilepticus cases being caused by recreational drugs or poison. This complication can be the result of substance withdrawal, specifically alcohol withdrawal which can occur 6 to 48 hours after an individual stops drinking. Alcohol withdrawal seizures are most common among those who have abused the substance for many years. All forms of cocaine can cause seizures which can occur seconds, minutes, or hours after use. Seizures caused by cocaine are uniquely dangerous as they have been associated with fatal heart issues like heart attacks. Other drugs that can cause a seizure are heroin, ecstasy, inhalants, kratom, stimulants, and synthetic cannabinoids.

For those diagnosed with epilepsy, substances can be triggers for seizures or affect their prescribed medications. Marijuana can be harmful to a person with epilepsy when they stop using it suddenly. When drinking alcohol, a person with epilepsy can have 1 to 2 drinks safely. It is important to not drink more than this because seizure medication can lower alcohol tolerance which can cause a person with epilepsy to become intoxicated more quickly. Alcohol may also increase the risk of seizures for those with epilepsy in the 6 to 48 hours after they have stopped drinking. Often the biggest interference substances have on those with epilepsy is that the altered state caused by drugs and alcohol may cause them to forget to take their medication. For epilepsy medication, following a set schedule and taking doses at prescribed times is imperative to preventing breakthrough seizures.

Epidiolex

In 2018, the FDA approved Epidiolex for the treatment of seizures associated with 2 rare forms of epilepsy: Dravet Syndrome and Lennox Gastaut Syndrome. Epidiolex contains cannabidiol, or CBD. This is the first FDA approved drug that contains the purified drug substance derived from marijuana as well as the first drug treatment for Dravet Syndrome. This syndrome is a genetic condition that involves frequent fever-related seizures in the first year of life and other types of seizures later in life. Dravet’s usually affects language and motor skills, hyperactivity, and the ability to relate to others. Lennox Gastuat also begins in childhood at around 3 to 5 years old and includes multiple types of seizures. Most children with Lennox Gastuat have learning problems, intellectual disabilities, and delayed development of motor skills.

Epidiolex has shown to be effective in reducing the number of seizures in those who are prescribed it. Despite this, the drug has several side effects such as fatigue, drowsiness, feeling weak, loss of appetite, diarrhea, skin rash, insomnia, and infections. While serious side effects of Epidiolex are rare, it is possible that the new treatment can cause liver problems, sedation, severe allergic reactions, or suicidal thoughts or behavior.

Seizures can be the result of substance use or the withdrawal of substances like alcohol. For those with epilepsy, it is important to not allow substance use to interfere with medication schedule as even skipping one dose can increase the risk of having a seizure. Individuals with epilepsy should also speak with their doctor about what substances are safe to use with their medications. If you or a loved one suffers from seizures but still finds themselves unable to stop abusing substances, contact a treatment provider for information on available treatment options.