Alcohol, recreational drugs and epilepsy

It is a fact that alcohol and, increasingly, recreational drugs, are part of many people's lives. Not surprisingly Epilepsy Action receives many enquiries from people anxious to know the facts about these in relation to epilepsy. In providing this information, Epilepsy Action is not condoning, or condemning, the use of any of the substances mentioned below. Our aim is to answer the questions many people ask us and to provide the reader with clear, unbiased information.

In our information, we talk about the 'seizure threshold'. Each of us is born with a different level of threshold. Those with a low seizure threshold are more likely to experience seizures than those with a high seizure threshold. Additionally, certain things can lower the threshold people are born with. These can include damage to the brain by whatever cause and the use of certain substances, such as those detailed below.

Epilepsy and alcohol

The issue of epilepsy and alcohol consumption can be very confusing. Is it safe to drink with epilepsy? Can alcohol cause epilepsy to develop? Excessive drinking can make seizures more likely because of the effect of the alcohol on the brain. It can also interact with anti-epileptic drugs making them less effective. Late nights, missed meals or missed dosages of anti-epileptic medication, all of which can be associated with heavy drinking, can be triggers for seizures.

Assessing the risk

Half a pint of standard strength beer, one standard glass of wine, a small glass of sherry or a single pub measure of spirits each contains about one unit of alcohol. Most people with epilepsy find they can have one or two units of alcohol, perhaps more, without this increasing the chances of having a seizure. Other people find that even a small amount of alcohol triggers their seizures and consequently may choose not to drink alcohol at all.

Anti-epileptic medication

Having epilepsy and taking anti-epileptic drugs (AEDs) doesn't necessarily mean you can't drink alcohol, but it's important to bear the following facts in mind.

AEDs can make you more sensitive to the effects of alcohol and alcohol can exaggerate some side effects of AEDs. If your AEDs make you feel sleepy, dizzy or light -headed for example, alcohol might make this worse.

Drinking a lot can cause you to have 'withdrawal seizures'. These seizures may begin within seven to 72 hours of stopping drinking.

It's important not to deliberately miss taking your AEDs because you want to drink alcohol. You're far more likely to have a seizure by missing your AEDs than by having an occasional drink.

Can alcohol cause epilepsy?

A 'binge' on alcohol can cause a seizure, even in people who do not have epilepsy. Such seizures can be due to alcohol withdrawal, toxic effects of alcohol, too much fluid, and metabolic changes in the body. Withdrawal seizures may begin within seven to 72 hours of stopping drinking.

Conclusion

Alcohol can make seizures more likely to occur. It can make drug side effects worse and anti-epileptic drugs can exaggerate the effects of the alcohol. Excessive or heavy drinking is likely to increase the risks of seizures and lead to other health problems. Taken in moderation, however, many people with epilepsy will be able to enjoy an alcoholic drink. Other people will have decided that alcohol is not for them, perhaps because they don't want to take the risk, or experience has taught them that even moderate drinking can make their epilepsy worse.

Epilepsy and recreational drugs

This section is intended to provide factual information on the use of non-prescribed drugs and solvents in relation to epilepsy.

Marijuana (cannabis, grass, pot, hash, smoke)

Marijuana is available in many different qualities and there is a wide variation in how much people consume. Some reports suggest that it can reduce seizures. Other reports point to an increase in seizures.

Ecstasy (also known as Es)

According to research, ecstasy increases the amount of certain chemicals found in the nervous system, resulting in over stimulation. One of the results of this stimulation can be seizures. Additionally, ecstasy is often taken alongside other illicit drugs and there is some evidence to suggest that a combination could trigger seizures. Taking ecstasy can lead to dehydration. This may be as a result 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 may lead to water intoxication, which in turn could cause a seizure.

Heroin (smack, scag, brown)

Heroin, in itself, can cause seizures. More often, seizures are related to taking other illicit drugs or alcohol at the same time or to the overall effect of a heroin overdose. As heroin can be administered intravenously, some people may experience seizures as a result of an infection from using dirty needles. And as heroin can be mixed with other unknown substances, these may, in themselves, also trigger seizures. Some of the medications used in treating heroin addiction can have an effect on the seizure threshold. People with epilepsy seeking help for heroin addiction should discuss their treatment medication with their doctor.

Amphetamines (speed, pep pills, uppers)

Amphetamines can cause seizures when abnormally high dosages are used, causing intoxication. Amphetamines are also sometimes taken with other illicit drugs which may be known to trigger seizures. As amphetamines are a stimulant, people may use them to keep themselves 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.

Cocaine (coke, crack)

Cocaine can provoke seizures in people who do not have a diagnosis of epilepsy, as well as making someone's epilepsy worse. This is because 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.

Solvents

Evidence suggests that long term use of solvents can cause brain/nerve damage which could in turn cause epilepsy. There is also a strong possibility that sniffing solvents over a longer period of time could make someone's epilepsy worse.

Temazepam

Taken in large quantities, this drug may provoke seizures as a result of the toxic effects in the body.

Steroids (Anabolic steroids, used in sports)

Anabolic steroids should be used with caution in people with epilepsy.

Tobacco

There is no evidence to suggest that smoking cigarettes or cigars can trigger a seizure. However, some nicotine preparations, used to help people stop smoking, should be used with caution as they can have a side effect of convulsions. If someone with epilepsy wants to stop smoking, before buying any nicotine preparations, they should discuss this further with their doctor.

Caffeine

Caffeine in its pure form can lower a person's seizure threshold. There is also some research that suggests that drinking excessive (very large) amounts of caffeine can increase the risk of seizures in people with epilepsy.

However there is no evidence to suggest that drinking a few cups of coffee or tea each day can trigger a seizure.

Conclusion

Recreational drugs can be made up of many different ingredients. These drugs are illegal and there are no regulations to control quality. Heavy drug taking often leads to other problems such as not getting enough sleep, and not eating properly. These in themselves are common triggers of seizures. These are the facts. Each person with epilepsy will have to decide for themselves whether they wish to take the risks involved.

Further information or advice about any of the issues discussed here can be sought from your doctor, epilepsy specialist nurse or organisations such as Alcoholic Anonymous, the National Drugs Helpline or Quitline.