Phenytoin in Alcohol Related Seizures

Report By: Rachel Vivian, Alison Crawford - SHOs Accident and Emergency
Search checked by Dr Donogh Maguire - SpR Accident and Emergency
Institution: Glasgow Royal Infirmary
Date Submitted: 24th August 2005
Last Modified: 14th January 2011
Status: Yellow (Internal BestBET edit)

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
phenytoin.mp AND alcohol.mp AND seizures.mp
LIMIT to human and English

Search 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)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Rathlev NK, D'Onofrio G, Fish SS, Harrison PM, Berstein E, Hossack RW, Pickens L March 1994 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
Chance JF May 1991 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

Comment(s)

There are two prospective, randomised, placebo-controlled, double-blind studies which answer the proposed question.

Editor Comment

Clinical 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 Annals of Emergency Medicine 1994 Mar; 513-8
Chance JF Emergency department treatment of alcohol withdrawal seizures with phenytoin Annals of Emergency Medicine 1991 May; 520