A Cochrane review [Abstract] 1 included 56 studies with a total of 4 076 subjects. 17 studies compared anticonvulsant versus placebo, 32 studies compared anticonvulsant versus other drug, 10 studies compared different anticonvulsants between themselves, 6 studies compared anticonvulsant combined with other drug versus other drug, and 1 study compared anticonvulanst combined with other drug vs different anticonvulsant.
Anticonvulsant versus placebo: There was no difference in alcohol withdrawal seizures between any anticonvulsant and placebo (RR 0.61, 95% CI 0.31 to 1.20; 9 studies, n=883), or between phenytoin and placebo (RR RR 0.78, 95% CI 0.35 to 1.77; 4 studies, n=381). There were no statistically significant differences in adverse events (anticonvulsant versus placebo, RR 1.56, 95% CI 0.74 to 3.31; 7 studies, n=516), drop out rates (anticonvulsant versus placebo , RR 0.82, 95% CI 0.50 to 1.34; 7 studies, n= 344; chlormethiazole versus placebo, RR 1.05, 95% CI 0.22 to 5.11; 3 studies, n=140), or drop out due to adverse events (anticonvulsant versus placebo, RR 0.67, 95% CI 0.13 to 3.36; 8 studies, n=623).
Anticonvulsant versus other drug: 19 outcomes were considered; results favoured anticonvulsants only in the comparison carbamazepine versus benzodiazepine (oxazepam and lorazepam) for alcohol withdrawal symptoms (CIWA-Ar score) (MD -1.04, 95% CI -1.89 to -0.20; 3 studies, n=262), none of the other comparisons reached statistical significance.
Different anticonvulsants: No statistically significant differences between different anticonvulsants were found in the two outcomes considered (adverse events and dropouts).
Anticonvulsant plus other drug versus other drug: There were no differences in alcohol withdrawal delirium (RR 0.79, 95% CI 0.18 to 3.52; 3 studies, n=311) or dropouts (RR 0.56, 95% CI 0.18 to 1.72; 3 studies,n=267) between anticonvulsant plus other drug versus other drugs. Paraldehyde plus chloral hydrate had less severe-life threatening side effects than chlordiazepoxide (RR 0.13, 95% CI 0.02 to 0.89; 1 study, n=49).
In another Cochrane review [Abstract] 2 benzodiazepines performed better than antipsychotics for seizures (RR 0.24, 95% CI 0.07 to 0.884; 4 studies, n=633) high quality of the evidence.
Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment), by inconsistency (heterogeneity in interventions and outcomes), and by imprecise results (limited study size for each comparison).
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