Alcohol
In Australia, drinking alcohol is often associated with socialising and relaxation. However, people with epilepsy must be aware of the possible risks from drinking alcohol.
Alcohol can cause seizures in a number of situations such as drinking too much, too quickly or too often, and also when withdrawing from alcohol.
The relationship of alcohol to epilepsy and seizures is complex, and some people are more vulnerable to the effects of alcohol than others.
Some common questions that people with epilepsy ask are:
Can alcohol cause seizures?
Some people with epilepsy can enjoy a drink or two, whilst others find they can’t tolerate alcohol at all. Studies have shown that small to modest amounts of alcohol do not cause seizures or drastically change the blood levels of antiseizure medications.
The effects of alcohol differ from person to person but adults with epilepsy should be able to drink alcohol in moderation if they wish. Some people find they prefer to drink low alcohol products or alternate non-alcoholic drinks.
Alcohol may cause or worsen seizures when associated with long term regular or ‘binge’ drinking. Seizures related to alcohol misuse are encountered more often than with any other form of substance.
Can I drink alcohol?
Medical opinions vary on whether someone with epilepsy can drink alcohol. Some doctors recommend that alcohol should be avoided, while others say a moderate amount in most cases will do no harm.
Alcohol can be a strong trigger for people with certain types of epilepsy, for instance Juvenile Myoclonic Epilepsy.
It is up to the individual to decide what suits them and to discuss any issues with their doctor.
If you have had a reaction or seizures in connection with alcohol in the past, then it is best to avoid it.
How do alcohol related seizures happen?
Seizures linked with alcohol intake can happen with:
- Alcohol withdrawal – that is, when a heavy drinker or alcoholic stops drinking, but they can also happen after a binge. These seizures generally occur within the first 6 to 48 hours of stopping drinking. If they happen frequently, it may lead to that person developing epilepsy
- Drinking large amounts of alcohol (binge drinking) causing the concentration in the bloodstream to be toxic to the body
- Drinking large amounts of alcohol causing dehydration. In some circumstances, this may cause a seizure
- Head trauma – head injuries that may happen from accidents or falls while drunk
- Long term alcohol use is often associated with poor diet, poor health and a lifestyle which can contribute to poor seizure control
- Poor sleep quality is linked with alcohol use because alcohol reduces or even inhibits REM sleep
- Mixing alcohol with other substances, which may also increase the risk of seizures.
A history of abuse of substances or alcohol dependence is believed to be strongly associated with a high risk of sudden unexpected death in epilepsy (SUDEP)
How do alcohol and antiseizure medication mix?
People taking medications for epilepsy are likely to be more sensitive to the effects of alcohol. Alcohol can:
- Interfere with the absorption of antiseizure medications, making them less effective
- Worsen the side effects of these medications
- Some antiseizure medications can enhance the effects of alcohol so feeling intoxicated after a small amount of alcohol is quite common.
Taking extra medication or changing the time of taking regular medications before drinking will not change this reaction and may cause additional side effects or seizures.
Good practice
People need to practice care when drinking alcohol because:
- Alcohol can mix with antiseizure medications preventing them from reaching the necessary levels in the bloodstream to control seizures
- Large amounts of alcohol 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 over-hydration
- Alcohol consumption is often associated with late nights, poor sleep quality, missed meals and forgotten medications, all of which can trigger seizures.
What is moderate drinking?
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.
Having a 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.
If you like to have a drink sometimes, perhaps:
- Limit your intake
- Drink slowly
- Drink low alcohol drinks
- Drink non-alcoholic drinks in-between the alcoholic drinks
- Don’t make it an all-nighter
For more information
Dr Andrew Bleasel (Neurologist) – Alcohol and epilepsy video
EAA Factsheet – Alcohol & Epilepsy
Energy drinks
There have been reports of seizures associated with energy drinks. Excessive consumption of caffeinated non-alcoholic energy drinks has been associated with seizures in not only people with epilepsy, but in people without epilepsy.
Energy drinks content may vary but they typically contain high levels of caffeine, sugar, and other ingredients such as taurine, B-complex vitamins, ginseng, and guarana seed extract.
Most of the energy from these drinks comes from the sugar and caffeine, which can be very dehydrating. It is not clear whether caffeine or taurine has more hazardous effects when combined with alcohol consumption. However, suspected deaths linked to energy drinks in combination with alcohol have been reported.
Although there is no serious danger of too much caffeine with one drink, more than one drink can lead to side effects such as nervousness, irritability, frequent urination, and rapid heart rate and heart rhythm abnormalities and seizures.
It may be best to avoid drinking energy drinks.
Ingesting energy drinks with alcohol can be a dangerous combination and is not recommended.
Generally speaking, daily coffee and tea intake can be part of a healthy balanced diet and their consumption does not need to be stopped if you have epilepsy.
For more information
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 illicit drugs, especially (but not exclusively) stimulants such as cocaine, MDMA/ecstasy, crystal meth 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. Other illicit drugs such as depressants and hallucinogens can also cause problems.
Drug taking is often also associated with not getting enough sleep, dehydration, and not eating properly. These in themselves are common triggers of seizures.
The decision to use illicit drugs is a personal one, but it is important to be aware that there is an increased risk of seizures and this is further increased if more than one drug is taken or it is mixed with alcohol or high-energy drinks.
One can never predict what side effects will occur when mixing antiseizure medications and other drugs.
Also remember that the recreational use of these substances is illegal in Australia.
Cannabis (recreational)
Cannabis is a frequently used recreational drug. When you smoke or ingest cannabis, chemicals called cannabinoids are released into your body. One main cannabinoid is THC. THC acts on certain receptors in your brain which creates the “high” some people feel.
Cannabis has a range of effects that vary based on the person and the potency. The more you use, the longer you use it, and the more THC it contains, the more effects you’ll feel.
Short term, cannabis can affect your:
- Ability to think and solve problems, judgement, mood and memory
- Coordination and reaction time
Over the long term, regular use can lead to:
- Memory loss
- Difficulties learning and thinking
Recreational cannabis can also affect your health in many ways. Such as:
- Lung problems, such as a chronic cough and trouble breathing
- Stomach upsets
- Faster heart rate, which may raise your risk for a heart attack
- Mental health problems such as depression, anxiety, and psychosis
Is it a useful for seizure control?
The recreational form of cannabis contains high levels of THC which is the component that causes a “high” and many other unwanted effects. This type of cannabis can have a range of effects and potency, so it is not recommended to be used as an antiseizure agent.
Research about the effects of a medicinal form of cannabis on seizure activity is continuing.
There are significant differences in the makeup of recreational cannabis and medicinal cannabis.
Recreational cannabis use in Australia is not legal and therefore not recommended as an antiseizure agent.
Cannabis for medicinal purposes is a different form and different effects.
For more about medicinal cannabis and epilepsy go to our Medical Cannabis page or Cannabis 4 Epilepsy.
For more information about medicinal cannabis and a wide range of health conditions go to CanGuide.
Is it dangerous for people with epilepsy to use cannabis?
Recreational use can impair short-term memory for short periods, and, like alcohol use, may increase the risk of not taking or forgetting to take antiseizure medication. It has also been linked with effects on mental health.
Recreational cannabis use and withdrawal could potentially trigger seizures in susceptible people.
Some studies and anecdotal reports show that high doses of cannabis can trigger seizures.
For more information
Ecstasy
Ecstasy (MDMA) is a commonly used club drug. It is an illegal synthetic drug that is both a nervous system stimulant and a hallucinogen and in high doses can cause seizures and vomiting.
Ecstasy may also contribute to death as a result of heart attack, stroke, overheating or if a person drinks too much water.
Taking ecstasy can lead to other seizure triggers such as sleep deprivation and dehydration. This may be because of being hyperactive and, for example, dancing all night. Problems may arise if someone with epilepsy starts to drink excessive amounts of water as this can lead to water intoxication, which in turn could cause changes in consciousness or a seizure.
For more information click here.
Amphetamines and methamphetamines (speed, ice)
Amphetamine is an addictive stimulant drug that abnormally speeds up the functions of the brain and body.
There are many health effects associated with amphetamines including increased wakefulness increased physical activity, decreased appetite, increased breathing rate, fever and euphoria. Other effects include irritability, insomnia, confusion, tremors, convulsions, anxiety, paranoia, and aggressiveness. Fever and convulsions can result in death. (NIDA USA)
As amphetamines are a stimulant, people may use them to stay 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. Long term misuse can damage the brain and may lead to psychosis, malnutrition and violent behaviour.
For more information
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 in the veins, some people may experience seizures as a result of serious 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.
For more information click here.
Cocaine
Cocaine can is a stimulant and can provoke seizures in people who don’t have epilepsy, as well as making someone’s epilepsy worse. 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.
For more information click here.
Inhalants
Inhalants are chemical substances that give off fumes and sometimes inhaled to become “high”. These include solvents like petrol, cleaning fluids, paints, liquid shoe polish, nail polish remover, and glue; aerosols like spray paint, insecticides, and hair spray; and anaesthetics 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 cause epilepsy. There is also a strong possibility that sniffing solvents over a longer period of time could make someone’s epilepsy worse.
For more information click here.
Tobacco/Nicotine
Nicotine is both a stimulant and a depressant to the central nervous system. Although it is associated with many serious health effects, 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 seizures.
There have also been reports of seizures associated with e-cigarettes.
Smoking harms your health and is not recommended
If you have epilepsy and want to stop smoking, before buying any nicotine preparations, discuss this further with your doctor.
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