Faculty Collaboration Database

Alcohol for seizure induction in the epilepsy monitoring unit. Epilepsy Behav 2024 Jan;150:109572

Date

12/10/2023

Pubmed ID

38070406

Pubmed Central ID

PMC10842723

DOI

10.1016/j.yebeh.2023.109572

Scopus ID

2-s2.0-85179465797 (requires institutional sign-in at Scopus site)

Abstract

RATIONALE: Seizure induction techniques are used in the epilepsy monitoring unit (EMU) to increase diagnostic yield and reduce length of stay. There are insufficient data on the efficacy of alcohol as an induction technique.

METHODS: We performed a retrospective cohort study using six years of EMU data at our institution. We compared cases who received alcohol for seizure induction to matched controls who did not. The groups were matched on the following variables: age, reason for admission, length of stay, number of antiseizure medications (ASM) at admission, whether ASMs were tapered during admission, and presence of interictal epileptiform discharges. We used both propensity score and exact matching strategies. We compared the likelihood of epileptic seizures and nonepileptic events in cases versus controls using Kaplan-Meier time-to-event analysis, as well as odds ratios for these outcomes occurring at any time during the admission.

RESULTS: We analyzed 256 cases who received alcohol (median dose 2.5 standard drinks) and 256 propensity score-matched controls. Cases who received alcohol were no more likely than controls to have an epileptic seizure (X²(1) = 0.01, p = 0.93) or nonepileptic event (X²(1) = 2.1, p = 0.14) in the first 48 h after alcohol administration. For the admission overall, cases were no more likely to have an epileptic seizure (OR 0.89, 95 % CI 0.61-1.28, p = 0.58), nonepileptic event (OR 0.97, CI 0.62-1.53, p = 1.00), nor require rescue benzodiazepine (OR 0.63, CI 0.35-1.12, p = 0.15). Stratified analyses revealed no increased risk of epileptic seizure in any subgroups. Sensitivity analysis using exact matching showed that results were robust to matching strategy.

CONCLUSIONS: Alcohol was not an effective induction technique in the EMU. This finding has implications for counseling patients with epilepsy about the risks of drinking alcohol in moderation in their daily lives.

Author List

Emmert BE, Xie K, Conrad EC, Ghosn NJ, Bauman K, Korzun J, Kulick-Soper CV, Naveed O, Hartmann N, LaRocque JJ, Mindy Ganguly T, Gugger JJ, Raghupathi R, Gelfand MA, Davis KA, Sinha SR, Litt B, Shinohara RT, Ellis CA

Author

Joshua J. Larocque MD Assistant Professor in the Neurology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Electroencephalography
Epilepsy
Ethanol
Humans
Monitoring, Physiologic
Retrospective Studies
Seizures