Emergency department treatment of alcohol withdrawal seizures with phenytoin.

STUDY OBJECTIVE

Prevention of recurrent alcohol withdrawal seizures is a common emergency department problem. A prospective, randomized, placebo-controlled, double-blind study of adequate size was designed to assess the efficacy of phenytoin in preventing recurrence of alcohol withdrawal seizures.

METHODS

Fifty-five patients who had seized from alcohol withdrawal were randomly assigned to treatment with IV phenytoin or placebo. Patients with known seizure disorders and those receiving any anticonvulsant were excluded. The study was terminated after seizure recurrence or passage of a six-hour, high-risk seizure interval.

RESULTS

Six of 28 phenytoin-treated patients (21%) had recurrent seizures compared with five of 27 placebo-treated patients (19%). The 95% confidence interval for the difference in response probabilities was +16% to -20%. There was no statistically significant difference between the response rates for the two treatments (P greater than .05).

CONCLUSION

Phenytoin does not show significant benefit over placebo in preventing recurrence of alcohol withdrawal seizures.