The lack of efficacy of phenytoin in the prevention of recurrent alcohol-related seizures.
OBJECTIVE
To determine the effectiveness of IV phenytoin in the prevention of recurrent alcohol-related seizures during a six-hour observation period.


METHODS
Prospective, randomized, double-blind trial comparing IV phenytoin with normal saline placebo, conducted from January 1990 through December 1991.


METHODS
Emergency department of an inner-city, university-affiliated, teaching hospital.


METHODS
One hundred forty-seven consecutive adults more than 25 years of age who presented with a witnessed generalized seizure in the setting of chronic alcohol abuse.


METHODS
Eligible subjects received 15 mg/kg of phenytoin or normal saline at an equivalent volume over 20 minutes by IV pump. Patients were observed for six hours in the ED after drug administration. Those experiencing a second seizure were admitted to the hospital.


RESULTS
One hundred patients completed the study. Recurrent alcohol-related seizures occurred in ten of 49 patients (20.4%) in the phenytoin group and in 12 of 51 patients (23.5%) in the placebo group. chi 2 analysis revealed no statistically significant difference between the two groups (chi 2 = 0.142; P = .706). The 95% confidence interval for the difference was -0.13 to + 0.19. The relative risk of recurrence between groups was 0.868 with a 95% confidence interval of 0.412 to 1.826.


CONCLUSIONS
No significant benefit of phenytoin administration in the prevention of recurrent alcohol-related seizures during a six-hour observation period was demonstrated.
Rathlev
N K
NK
Emergency Department, Boston City Hospital, Massachusetts.
D'Onofrio
G
G
Fish
S S
SS
Harrison
P M
PM
Bernstein
E
E
Hossack
R W
RW
Pickens
L
L
D000328:Adult; D000437:Alcoholism / Q000150:complications*; D016009:Chi-Square Distribution; D004311:Double-Blind Method; D000431:Ethanol / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D010672:Phenytoin / Q000627:therapeutic use*; D011446:Prospective Studies; D012008:Recurrence; D012306:Risk; D012640:Seizures / Q000209:etiology / Q000517:prevention & control*; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy; D016896:Treatment Outcome
D000431:Ethanol; D010672:Phenytoin