Substance use: seizures in alcohol withdrawal: practice question

A Psychiatry question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Psychiatry · Substance use: seizures in alcohol withdrawal

Sample item

A 44-year-old man has a generalised tonic-clonic seizure 24 hours after stopping heavy drinking. He has no history of epilepsy and CT head is normal. Which statement about management is correct?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Give benzodiazepines; no long-term anticonvulsant is needed

Alcohol withdrawal seizures arise from GABA hypofunction and glutamate excess, and respond to benzodiazepines, which also reduce progression to delirium tremens. Phenytoin is ineffective for uncomplicated withdrawal seizures, and chronic anticonvulsants are not needed if there is no underlying epilepsy.

Option by option

  • A. Phenytoin is the drug of choice to prevent further withdrawal seizures

    Phenytoin does not prevent withdrawal seizures and is not the treatment of choice.

  • B. Withdrawal seizures need no treatment since they are self-limited

    Untreated seizures can recur and progress to delirium tremens, so treatment is needed.

  • C. Give benzodiazepines; no long-term anticonvulsant is needed (correct)

    Correct. Benzodiazepines treat the underlying withdrawal state and prevent recurrence.

  • D. Long-term valproate should be started before discharge

    Long-term valproate is unnecessary because the seizure is a provoked event.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Psychiatry question

What is the answer to this Psychiatry question?

The best answer is C, Give benzodiazepines; no long-term anticonvulsant is needed. Alcohol withdrawal seizures arise from GABA hypofunction and glutamate excess, and respond to benzodiazepines, which also reduce progression to delirium tremens.

Why is "Phenytoin is the drug of choice to prevent further withdrawal seizures" not the answer?

Phenytoin does not prevent withdrawal seizures and is not the treatment of choice.

Why is "Withdrawal seizures need no treatment since they are self-limited" not the answer?

Untreated seizures can recur and progress to delirium tremens, so treatment is needed.

Why is "Long-term valproate should be started before discharge" not the answer?

Long-term valproate is unnecessary because the seizure is a provoked event.

What concept does this question test?

It tests Substance use: seizures in alcohol withdrawal in Psychiatry. Phenytoin is ineffective for uncomplicated withdrawal seizures, and chronic anticonvulsants are not needed if there is no underlying epilepsy.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Substance use: seizures in alcohol withdrawal?

Learn each diagnosis by its core features and its first-line treatment. Then use the flashcards and the other Psychiatry questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.