Faculty Bibliography

We review the safety of alcohol or marijuana use by patients with epilepsy. Alcohol intake in small amounts (one to two drinks per day) usually does not increase seizure frequency or significantly affect serum levels of antiepileptic drugs (AEDs). Adult patients with epilepsy should therefore be allowed to consume alcohol in limited amounts. However, exceptions may include patients with a history of alcohol or substance abuse, or those with a history of alcohol-related seizures. The most serious risk of seizures in connection with alcohol use is withdrawal. Alcohol withdrawal lowers the seizure threshold, an effect that may be related to alcohol dose, rapidity of withdrawal, and chronicity of exposure. Individuals who chronically abuse alcohol are at significantly increased risk of developing seizures, which can occur during withdrawal or intoxication. Alcohol abuse predisposes to medical and metabolic disorders that can lower the seizure threshold or cause symptoms that mimic seizures. Therefore, in evaluating a seizure in a patient who is inebriated or has abused alcohol, one must carefully investigate to determine the cause. Animal and human research on the effects of marijuana on seizure activity are inconclusive. There are currently insufficient data to determine whether occasional or chronic marijuana use influences seizure frequency. Some evidence suggests that marijuana and its active cannabinoids have antiepileptic effects, but these may be specific to partial or tonic-clonic seizures. In some animal models, marijuana or its constituents can lower the seizure threshold. Preliminary, uncontrolled clinical studies suggest that cannabidiol may have antiepileptic effects in humans. Marijuana use can transiently impair short-term memory, and like alcohol use, may increase noncompliance with AEDs. Marijuana use or withdrawal could potentially trigger seizures in susceptible patients

BACKGROUND: Epileptic and nonepileptic seizures can occur in the same patient, but usually occur at different times. In 1885, Gowers suggested that minor seizures can elaborate into hysterical seizures, but the concurrence of epileptic and nonepileptic seizures is not well documented. METHODS: We reviewed all patients with nonepileptic seizures documented with video-EEG recordings at our center to identify those with temporally associated epileptic seizures. RESULTS: Four patients were identified in whom video-EEG-documented epileptic seizures were temporally associated with nonepileptic seizures. In one woman, the nonepileptic event followed an absence seizure. Given the high frequency of absence seizures, the occurrence of the nonepileptic seizure may have been coincidental. In three patients, the seizures were partial and arose from right frontotemporal regions. In these patients, epileptic seizures were infrequent. CONCLUSIONS: Epileptic and nonepileptic seizures can be temporally related, and in patients with partial seizures, there may be a pathophysiologic relation in which ictal changes facilitate the development of conversion symptoms. Ictal activation or disinhibition of emotions or impulse control may contribute to these nonepileptic events