Seizures and substance abuse: treatment considerations

Seizures often occur in substance abusers. The mechanism may be indirect (CNS infection, cerebral trauma, stroke, metabolic derangement) or direct (intoxication or withdrawal). These mechanisms are not mutually exclusive. A patient with obvious overdose or abstinence symptoms might also have meningitis or an acute subdural hematoma, and a polydrug abuser might be simultaneously intoxicated by one drug while withdrawing from another. Management of such patients often requires much more than simple administration of an anticonvulsant medication. Medical and surgical emergencies must be identified and nonconvulsive signs of intoxication and withdrawal must be addressed. A basic principle in treating drug withdrawal is to use an agent from the same pharmacologic class or one with a degree of cross-tolerance. Long-term anticonvulsant prophylaxis is usually not indicated when drug intoxication or withdrawal is the sole cause of a seizure.