Phenytoin in Alcohol Related Seizures
Date First Published:
August 24, 2005
Last Updated:
January 14, 2011
Report by:
Rachel Vivian, Alison Crawford, SHOs Accident and Emergency (Glasgow Royal Infirmary)
Search checked by:
Dr Donogh Maguire, Glasgow Royal Infirmary
Three-Part Question:
In [patients experiencing alcohol related seizures] is [phenytoin] of [proven therapeutic benefit]?
Clinical Scenario:
A 54 year old man with a history of chronic alcohol excess presents with generalised seizure activity. You wonder if treatment with phenytoin would be of benefit in preventing recurrence of seizures in the A&E department.
Search Strategy:
Medline 1966-2005 week 27
EMBASE 1988-2005 week 27
Cochrane Central Register of Controlled Trials
Cochrane Database of Systematic Reviews
All using OVID interface
EMBASE 1988-2005 week 27
Cochrane Central Register of Controlled Trials
Cochrane Database of Systematic Reviews
All using OVID interface
Search Details:
phenytoin.mp AND alcohol.mp AND seizures.mp
LIMIT to human and English
LIMIT to human and English
Outcome:
51 papers were found by Medline, 147 by EMBASE, 8 by the Cochrane Central Register of Controlled Trials and 0 by the Cochrane Database of Systematic Reviews. Of all of these papers only 2 were relevant to this BET.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| The lack of efficacy of phenytoin in the prevention of alcohol-related seizures Rathlev NK, D'Onofrio G, Fish SS, Harrison PM, Berstein E, Hossack RW, Pickens L Mar-94 USA | 147 adults >25 years (known chronic alcohol abuse) with generalised seizure randomly assigned to treatment with IV phenytoin or normal saline for 6h observation period. | Prospective, randomised, double-blind trial | Recurrence of seizure within 6h | No statistical difference between the 2 groups (p=0.706) | Only 100 completed study |
| Emergency department treatment of alcohol withdrawal seizures with phenytoin Chance JF May-91 USA | 55 patients with alcohol withdrawal seizures randomly assigned to IV phenytoin of placebo and observed for 6h | Prospective, randomised, placebo-controlled, double-blind study | Recurrence of seizures within 6h | No statistically significant difference between response rates for phenytoin or placebo (p>0.05) | Small study population |
Author Commentary:
There are two prospective, randomised, placebo-controlled, double-blind studies which answer the proposed question.
Bottom Line:
The evidence available suggests that there is no significant benefit of phenytoin administration in the prevention of recurrent alcohol-related seizures during a 6h observation period.
References:
- Rathlev NK, D'Onofrio G, Fish SS, Harrison PM, Berstein E, Hossack RW, Pickens L. The lack of efficacy of phenytoin in the prevention of alcohol-related seizures
- Chance JF. Emergency department treatment of alcohol withdrawal seizures with phenytoin