Revised Guideline - Alcohol Withdrawal Seizures

Introduction Among the many mechanisms by which alcohol use may lead to seizures, Alcohol withdrawal seizures (AWSz) is probably the best-defined entity, being a symptom of the alcohol withdrawal syndrome (AWS) and occurring in more than 90% of cases within 48h of cessation of sustained drinking. As recurrence is common, acute treatment and prevention is important. Potential complications such as Wernicke encephalopathy need early attention. A major challenge is the lack of clear definitions of the different types of alcohol-related seizures. The objective was to update the EFNS guideline published in 2005, and to set recommendations according to the GRADE system. Methods The workgroup selected 10 PICO questions for an updated literature search in Pubmed, EMBASE, the Cochrane library, and CINAHL. For drugs for seizure prevention, the search strategy was adopted from recent Cochrane reviews. At a workshop in November, 2015, we reviewed the search results. Grading of outcomes is ongoing. Results Preliminary results are presented. Although important, the dosing and frequency of Thiamine treatment is virtually undocumented. Benzodiazepines but not other anticonvulsants reduced the seizure risk significantly compared to placebo. In three randomized controlled studies, phenytoin failed to prevent recurrent seizures. No recent evidence supports advice to people with epilepsy regarding safe levels or frequency of alcohol consumption. Conclusion Despite a considerable body of new literature during the last 10 years, little new evidence has emerged. The GRADE method requires experience and may be perceived as challenging, but is an important step towards a standardized method of evidence assessment.