Scientific article
Open access

Long‐term outcome of alcohol withdrawal seizures

Published inEuropean journal of neurology, vol. 31, no. 1, e16075
Publication date2023-10-12
First online date2023-10-12

Background and purpose

Alcohol withdrawal seizures (AWS) are a well‐known complication of chronic alcohol abuse, but there is currently little knowledge of their long‐term relapse rate and prognosis. The aims of this study were to identify risk factors for AWS recurrence and to study the overall outcome of patients after AWS.


In this retrospective single‐center study, we included patients who were admitted to the Emergency Department after an AWS between January 1, 2013 and August 10, 2021 and for whom an electroencephalogram (EEG) was requested. AWS relapses up until April 29, 2022 were researched. We compared history, treatment with benzodiazepines or antiseizure medications (ASMs), laboratory, EEG and computed tomography findings between patients with AWS relapse (r‐AWS) and patients with no AWS relapse (nr‐AWS).


A total of 199 patients were enrolled (mean age 53 ± 12 years; 78.9% men). AWS relapses occurred in 11% of patients, after a median time of 470.5 days. Brain computed tomography ( n = 182) showed pathological findings in 35.7%. Risk factors for relapses were history of previous AWS ( p = 0.013), skull fractures ( p = 0.004) at the index AWS, and possibly epileptiform EEG abnormalities ( p = 0.07). Benzodiazepines or other ASMs, taken before or after the index event, did not differ between the r‐AWS and the nr‐AWS group. The mortality rate was 2.9%/year of follow‐up, which was 13 times higher compared to the general population. Risk factors for death were history of AWS ( p < 0.001) and encephalopathic EEG ( p = 0.043).


Delayed AWS relapses occur in 11% of patients and are associated with risk factors (previous AWS >24 h apart, skull fractures, and pathological EEG findings) that also increase the epilepsy risk, that is, predisposition for seizures, if not treated. Future prospective studies are mandatory to determine appropriate long‐term diagnostic and therapeutic strategies, in order to reduce the risk of relapse and mortality associated with AWS.

  • EEG
  • Alcohol-withdrawal seizures
  • Head trauma
  • Mortality
  • Risk factors
Citation (ISO format)
SANSONETTI, Riccardo Giulio et al. Long‐term outcome of alcohol withdrawal seizures. In: European journal of neurology, 2023, vol. 31, n° 1, p. e16075. doi: 10.1111/ene.16075
Main files (1)
Article (Accepted version)
ISSN of the journal1351-5101

Technical informations

Creation02/23/2024 9:46:06 PM
First validation04/29/2024 9:00:20 AM
Update time04/29/2024 9:00:20 AM
Status update04/29/2024 9:00:20 AM
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