The relationship between alcohol and seizure/epilepsy is complex. On the one hand, ethanol misuse promotes the occurrence of brain diseases or metabolic changes that can provoke seizure (such as stroke, traumatic brain injuries, dementia and acute hyponatremia). On the other hand, the toxicity of ethanol changes neurotransmitter pathways modifying the epileptic threshold. The risk for alcohol-related seizures depends on the daily amount of alcohol intake but is also modulated by multiple individual factors as sex, age, genetic factors, environmental factors and co-morbidities. Psychiatric co morbidities associated with alcohol misuse can also aggravate neurological status or diminish the epileptic threshold.