1. Audit on the Incidence of Alcohol Withdrawal Seizures in an Adult Drug and Alcohol Detoxification Unit CT3 psych: Dr Sun Supervisor: Dr Race Hafan Wen Wrexham Maelor Hospital

2. Alcohol Withdrawal Seizures  Generalized tonic-clonic convulsions that usually occur within 12 to 48 hours after last drink  may occur after 2 hours of abstinence  occur predominantly in patients with a long hx of chronic alcoholism

4. Management Benzodiazepines for seizures, diazepam 10mg For prophylaxis, chlordiazepoxide 30mg qds reducing regime Frequent reassessment e.g. CIWA 10 to 20mg chlordiazepoxide prn if CIWA >12

7. Anticonvulsants  Some anticonvulsants found to be efficacious compared to placebo  Insufficient evidence to conclude they are superior to benzodiazepines in preventing seizures  Carbamazepine & valproic acid safe + effective in treating alcohol withdrawal

10. Author’s conclusions  Results of this review do not provide sufficient evidence in favour of anticonvulsants for treatment of AWS  Limited data on anticonvulsants vs placebo for AWS  Comparisons with other drugs show no clear differences

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16. Aims To determine incidence of alcohol withdrawal seizures in alcohol detox inpatients Hafan Wen, WMH March 2013 to June 2014 Prophylactic carbamazepine was prescribed until Sept 2013

17. Methods Retrospective review of discharge summaries of North Wales patients admitted for alcohol detox, to Hafan Wen March 2013 to June 2014 208 discharge summaries found on M drive - 37 patients had both alcohol & drugs detox 24 patients, unable to find discharge summaries

18. Results from March 2013 to June 2014

22. Results from March 2013 to Aug 2013 when carbamazepine was px

26. Results from Sept 2013 to June 2014 when carbamazepine was stopped

30. Result  1 seizure on admission, April 2014  Mr X, 52 male, single hx of alcohol dependency drinking 4-5L of 7.5% cider daily 6 detoxes in the past, 2 in Hafan Wen

31. Mr X  Hx of withdrawal fits status epilepticus, 20 yrs ago hx of falls, haematemesis chronic pancreatitis, renal failure enlarged liver, sciatica  Hx of addiction to painkillers, no recent illicit drugs  Hx of DSH, hallucinations, sectioned x2

32. Mr X  Commenced on chlordiazepoxide reducing regime & thiamine, IM Pabrinex  In the morning following his admission he was found on the floor in his room, ? seizure  He appeared confused and was rambling  No injuries apparent & he was assisted toileting & back to bed

33. Mr X  Commenced on chlordiazepoxide reducing regime & thiamine, IM Pabrinex  In the morning following his admission he was found on the floor in his room, ? seizure  He appeared confused and was rambling  No injuries apparent & he was assisted toileting & back to bed

34. Mr X He was discharged as planned on 6 May 2014 Taken to Tyn Rodin rehabilitation

35. Conclusion No significant increase in no. of alcohol withdrawal seizures since Sept 2013, when carbamazepine was not prescribed

36. Recommendations Close monitoring of alcohol withdrawal symptoms inc seizures on admission, regular CIWA Continue with chlordiazepoxide regime, diazepam prn chlordiazepoxide prn when CIWA>12 Further audits & complete audit cycle

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