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Lorazepam Prevents Recurrent Alcohol-Related Seizures

When a patient has a seizure related to alcohol, it is uncertain whether acute treatment will prevent recurrence. Phenytoin is not effective in preventing alcohol-related seizures. The ability of lorazepam to prevent recurrent alcohol-related seizures was assessed in this randomized, prospective, double-blind trial.

Investigators enrolled 186 of 229 patients with alcohol-related seizures who were evaluated over 21 months at two hospitals in Boston. Exclusion criteria included signs of alcohol withdrawal and ingestion of drugs that could cause or protect against seizures. Patients were assigned to receive 2 mg of lorazepam (54%) or placebo. In the lorazepam group, 3 patients (3%) had another seizure within 6 hours, compared with 21 patients (24%) in the placebo group. The odds ratio for seizure with the use of placebo was 10.4 (95% confidence interval, 3.6 to 30.2; P<0.001). There were no complications associated with lorazepam. Seven patients in the placebo group and one in the lorazepam group were transported to an emergency department within 48 hours of discharge because of another seizure.

Comment: Intravenous lorazepam was effective in preventing recurrent alcohol-related seizures in this study. It appears that lorazepam did not simply delay recurrence, but actually prevented it. Given the safety of a single dose of lorazepam, it seems reasonable to advocate such treatment. Patients in alcohol withdrawal and those with more complicated presentations would obviously require a more aggressive approach.

— JG Adams

Published in Journal Watch Emergency Medicine May 1, 1999

Citation(s):

D'Onofrio G et al. Lorazepam for the prevention of recurrent seizures related to alcohol. N Engl J Med 1999 Mar 25 340 915-919.

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