A Seizure is a transient occurrence of signs or symptoms due to abnormal excessive or synchronous activity in the brain 1. A seizure is a temporary epileptic symptom of abnormal brain activity. They disappear during the course of an acute medical or neurological condition when the underlying condition has been treated1,2.

1 The two main regulators of calcium homeostasis are parathyroid hormone and vitamin D. The excitability of muscle cells and neurons is caused by the free ionized calcium fraction, not calcium that is bound to proteins. Hypocalcaemia's symptoms are influenced by two things.

• The severity of the fall in blood ionised (free) calcium concentration and the extent of the serum calcium level reduction.
• Neurologic symptoms are primarily brought on by acute hypocalcaemia due to increased neuromuscular excitability.

Symptoms include 1. Circumoralparaesthesia, 2. numbness and tingling in the fingers and toes 3. Muscular pain 4. Carpopedal spasm 5. Laryngeal stridor 6. Tremors ,Chorea and 7. Seizures. Of all the patients who presented with hypocalcaemia during the medical emergency 20 to 25 percent of people experienced seizures.2

The Hypocalcaemia can cause a variety of seizures, including generalized tonic-clonic, focal, motor, absence, and akinetic seizures are less common.3,4,5

When consumed, alcohol spreads throughout the body. It has an impact on practically all of the body's systems. Almost all neurochemical processes in the central nervous system are altered. Numerous physical and psychological disorders, such as diabetes mellitus and depression, are briefly mimicked by alcoholism.6

Both the developing and developed neurological systems in the body are directly affected by ethanol and its oxidative metabolite, acetaldehyde. Alcohol consumption is complicated by vitamin deficiency and malnutrition since alcohol provides calories that are not nutritious. Epileptic seizures are brought on by excessive drinking.

Seizures caused by alcohol are generally brief. Occurs within six to forty-eight hours of the last drink, generalised tonic-clonic seizures are typically the result. 60% of individuals who are untreated get several seizures. Usually, less than six hours pass between the first and last seizure.

Seizures caused by alcohol typically occur without additional symptoms of alcohol withdrawal or sympathetic activity, such as tachycardia, hypertension, or fever.7 One of the earliest recognized human diseases is epilepsy- a chronic neurological condition. The most prevalent neurological condition affecting people of all ages is epilepsy. According to estimates, 50 million people worldwide have epilepsy at any given moment, with 80 percent of them living in developing nations. About 1% of all diseases in the world are caused by seizures.(8,9) Approximately 75% of epilepsy patients in these nations are not receiving the proper care, despite the fact that the 3 majority of cases are treatable.10 The incidence and prevalence of the disease vary significantly around the world. Low socioeconomic level, infections, and lack of access to healthcare are some of the causes of increased prevalence and incidence.

Alcohol withdrawal or Chronic Alcohol may both contribute to alcohol-related seizures. One or more generalised tonic-clonic seizures may happen within 48 hours 6 of stopping alcohol use after a period of excessive drinking.11 These individuals need to be hospitalised for at least 24 hours of observation to track the severity of their withdrawal symptoms. The likelihood of an accompanying structural abnormality, which is frequently traumatic in origin, must be checked out if the seizures are consistently of the focal type. Head CT scans or MRIs should be done on individuals who have generalised seizures and focal features. Alcohol withdrawal seizures typically don't require anticonvulsant medication since they are self-limiting. The preferred medication for stopping more seizures is benzodiazepines since they are secure. Rarely, status epilepticus may happen after alcohol abstinence.12

In addition, alcohol also reduces seizure threshold in a known seizure disorder patient. The EEG could exhibit focused spikes. A thorough examination and inquiry are needed when a seizure first appears, although often no immediate treatment is required.13

MECHANISM OF HYPOCALCEMIA IN ALCOHOLICS

Alcohol abuse has a number of consequences on the kidney's ability to regulate acid base, electrolytes, and water (34-36). Hypocalcaemia is a frequent finding among the 17 electrolyte abnormalities seen in alcoholic individuals and may originate from a number of as-yet-unidentified pathophysiologic causes. i. Magnesium depletion may result in lower calcium levels, mostly as a result of poor parathormore (PTH) release and skeletal resistance to PTH action. (37) ii. The action of ethanol in lowering the Na+-K+ ATPase activity in the proximal tubular cells reduces the tubular reabsorption of calcium in the kidneys.(38) iii. Additional factors that might affect the reduced tubular reabsorption of calcium include hypomagnesaemia or acute alcohol intoxication, which suppresses PTH production.(39) iv. Severe pulmonary alkalosis, which causes hypophosphatemia, calciuria, and hypocalcaemia, causes renal PTH resistance. (40) v. chronic pancreatitis in alcoholics can cause vitamin D3 deficiency due to its decreased intestinal absorption.

According to the WHO, alcohol use is responsible for an estimated 3.0 million deaths and 5.1% of Disability-Adjusted Life Years (DALYs) worldwide each year . In terms of risk variables connected to fatalities and DALYs in 2016, alcohol intake was placed seventh. Alcohol consumption is a prominent cause of disease burden and health loss globally. All of India's states and union territories (UT) have widespread alcohol use, and an estimated 160 million people do so. National Family Health Survey-4 (NFHS-4) data show that 1.2% of women and 29.2% of men drink alcohol. Alcohol abuse is thought to cost the Indian economy 1.45% of its yearly gross domestic product (GDP) on average per year .

 OBJECTIVES:

1. To evaluate for Serum calcium level among Alcohol related seizures and non-alcoholic primary idiopathic seizures.
2. To establish the role of Hypocalcaemia in alcohol related seizures in contrast to non-alcoholic primary idiopathic seizures.

Primary source – Patients attending Medicine department ,Hassan institute of medical sciences ,Hassan  .

 Secondary source of information from published articles, journals, books, case sheets, discharge summary, related websites. 

 Study Design: Cross Sectional - Observational study. 

Study Duration: 1 Year (July 2024 – June  2025)

 Methods of collection of data

After obtaining clearance and approval from Institutional Ethics Committee, a Cross-sectional Observational study was conducted from Department of General Medicine,Hassan institute of medical sciences ,Hassan , Karnataka.

All patients fulfilling the inclusion criteria was interviewed as per proforma and a detailed clinical examination was done. Blood samples for Complete blood count, Serum Calcium, Serum Magnesium Level, CT brain were done .

 Inclusion Criteria

• Patients with newly detected seizure episodes secondary to alcohol consumption according to ICD 10 criteria. 
• Patients with newly detected seizures who are non-alcoholic and with no past history related to seizures.
• Age >18years.

 Exclusion Criteria

Patients with

1. Previous head injury.
2. Stroke
3. Structural brain lesions
4. CNS infections
5. Other illicit drugs.

 Methodology:

After getting approval from Institutional ethics committee, written informed consent was taken. Patients were selected according to inclusion and exclusion criteria. The aims and objectives of the intended study was properly explained to the subject.

All patients fulfilling the inclusion criteria was interviewed as per proforma and a detailed clinical examination was done. Blood samples for Complete blood count, Serum Calcium,Serum Magnesium Level, CT brain were done.

Table No. 1:

  Table No. 2:

 Figure No. 1:

 Figure No. 2:

 Figure No. 3:

In this study a total of 152 seizure patients were screened in the emergency department of which 52 were excluded from the study due to secondary causes of seizures and due to the presence of other biochemistry abnormalities.14-15

Among the 100 patients in study population, 58 patients satisfied CAGE questionnaire of alcohol dependence and were grouped as cases. Rest 42 patients were Nonalcoholic primary seizure patients and were grouped together.16

Of the population screened in our emergency department who presented with history of seizure, 58% of patients were alcoholics and 42% of patients were non alcoholics.17-18

Thus, Half of the patients admitting with seizures in our hospital are either alcohol related seizures or seizure disorder patient with habit of alcohol abuse.

Out of 100 subjects,94 were males and 6 were females,which shows a male predominance in the study subjects probably due to males having high incidence of alcohol consumption in the developing country like India.

Out of 58 cases in alcoholic group mean calcium level noted was 8.60mg/dl and 8.70mg/dl among non-alcoholic group

The low level of calcium in the alcoholic group as compared to non-alcoholic group in the present study as compared to the other study could be also due to associated hypoalbuminemia secondary to malnutrition, unidentified pancreatitis secondary to alcoholism which could be the confounding factors affecting serum Calcium Levels among the alcoholic Group.19

The prevalence of hypocalcemia among the alcoholic group was 56.9%(33 subjects out of 58) with a p value of 0.24 ,whereas only 40.5% among non-alcoholic there was no statistical significance in hypocalcaemia among alcoholic group ,the prevalence of hypocalcaemia in alcoholic seizures were found to be high . Nearly half of the alcohol related seizures had hypocalcaemia in our study. The prevalence of hypocalcaemia among non-alcoholic group was 40.5 alcoholic groups had hypocalcemia.20

Out of 50 hypocalcaemia subjects,14(14%) individual were also noted to have hypomagnesmia with a p value of 0.011, which is statistically significant indicating the importance of analyzing magnesium levels along with calcium level.

The burden of alcohol related health problems developing countries is very high .It is a well-known fact that Alcohol overuse produces seizures. Alcohol related seizures may be either due to alcohol withdrawal or chronic alcohol abuse. Various etiologies have been postulated for alcohol related seizures one among them being electrolyte abnormalities.

This study emphasizes the importance of analyzing the serum calcium,magnesium and other electrolytes in every alcoholic patient presenting with seizures , as they are a curable and reversible forms of seizures.

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