How to Help Someone Having a Seizure From Drug Withdrawal

Drug withdrawal seizures are among the most dangerous withdrawal complications. They can occur during withdrawal from alcohol, benzodiazepines, barbiturates, and gabapentin. A seizure during withdrawal is a medical emergency that requires immediate response. Knowing which substances cause withdrawal seizures, what a seizure looks like, and how to respond can save someone’s life.

Withdrawal seizures happen because certain substances suppress brain excitability during use. When the substance is removed abruptly, the brain rebounds into a hyperexcitable state. This rebound can trigger a generalized tonic-clonic (grand mal) seizure: the person loses consciousness, their muscles contract violently, and they may stop breathing temporarily.

Which Substances Cause Withdrawal Seizures

• Alcohol: Most common cause. Seizures typically occur 12 to 48 hours after the last drink. Risk is highest in people who drink heavily daily for months or years.
• Benzodiazepines: Xanax, Valium, Ativan, Klonopin. Seizures can occur during rapid taper or abrupt discontinuation, especially from short-acting benzodiazepines.
• Barbiturates: Phenobarbital, Fioricet. Similar seizure risk to benzodiazepines but less common due to reduced prescribing.
• Gabapentin/pregabalin: Seizures documented with abrupt discontinuation, particularly at higher doses.
• Baclofen: Abrupt discontinuation can cause life-threatening seizures and status epilepticus.

Opioid withdrawal does not typically cause seizures. Stimulant withdrawal does not typically cause seizures. The substances that cause withdrawal seizures share one characteristic: they act on the GABA system.

The CDC reports that alcohol withdrawal seizures occur in approximately 5% of people with alcohol use disorder who stop drinking abruptly. Among those who experience one seizure, 30% will have additional seizures within 6 hours without treatment.

What a Withdrawal Seizure Looks Like

1. Sudden onset: The person may cry out, then collapse. There is no warning in most cases.
2. Tonic phase: The body stiffens. Arms and legs extend rigidly. This lasts 10 to 30 seconds.
3. Clonic phase: Rhythmic jerking of the limbs and body. Eyes may roll back. The person may bite their tongue or lose bladder control. This phase typically lasts 30 to 120 seconds.
4. Postictal phase: After the seizure stops, the person is confused, exhausted, and may remain unconscious for several minutes. They may not remember the seizure.

How to Respond: Step by Step

1. Call 911 immediately. All withdrawal seizures require medical evaluation.
2. Do not hold the person down. You cannot stop a seizure by restraining someone, and you may cause injury.
3. Do not put anything in their mouth. The myth about swallowing the tongue is false. Putting objects in the mouth causes broken teeth and airway obstruction.
4. Clear the area. Move furniture, sharp objects, and anything that could hurt the person during convulsions.
5. Place them on their side (recovery position) once the seizure stops. This allows fluids to drain from the mouth and keeps the airway open.
6. Time the seizure. Note when it started and when it stopped. Seizures lasting more than 5 minutes (status epilepticus) are life-threatening and require emergency anticonvulsant medication.
7. Stay with them through the postictal period. They will be confused and may try to stand too soon.

When Withdrawal Seizures Become Status Epilepticus

Status epilepticus is a seizure that lasts more than 5 minutes or multiple seizures without recovery of consciousness between them. It is a life-threatening emergency. Brain damage begins after 30 minutes of continuous seizure activity. Emergency treatment involves IV benzodiazepines (lorazepam or diazepam) administered by paramedics.

Preventing Withdrawal Seizures

The most effective prevention is medical detox. Never stop alcohol, benzodiazepines, barbiturates, or baclofen cold turkey if you have been using them daily. Medical detox programs use controlled tapers and monitoring to prevent seizures.

SAMHSA (1-800-662-4357) provides free referrals to medically supervised detox programs. If you cannot access medical detox immediately and are at risk of withdrawal seizures, go to an emergency department.