What are the guidelines for management of seizures in alcohol-dependent individuals?

The Bottom Line: Alcohol withdrawal seizures should be promptly treated with benzodiazepines, clomethiazole or barbiturates to prevent status epilepticus.

Reference: Hillbom M, Pieninkeroinen I, Leone M.  Seizures in Alcohol-Dependent Patients: Epidemiology, Pathophysiology and Management.  CNS Drugs. 2003;17(14):1013-30.

Summary: In conclusion, there is powerful evidence to suggest that treatment with benzodiazepines is effective in preventing both first seizures and recurrent seizures during alcohol withdrawal. The most effective drug regimen and the preferred route of admin-istration, however, remain to be clarified.  Nevertheless, not all of the patients admitted for detoxification should be given medication for seizure prophylaxis. For patients with a low risk of seizures,monitoring and supportive non-pharmacological treatment might be sufficient. The patients at a high risk include those with epilepsy, a history of withdrawal seizures, multiple previous detoxifications or known high dependency on alcohol.  The Swedish guidelines suggest that such patients should be given seizure prophylaxis immediately after admission for detoxification, irrespective of whether they have had a seizure before admission or not.  The decision to start prophylactic drug treatment may also be symptom oriented.

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