Diphenylhydantoin in Alcohol Withdrawal

Abstract

To the Editor.— The apprehension of Gessner ( 216 :887, 1971) about "widespread adoption of diphenylhydantoin for the treatment of alcohol withdrawal" is unwarranted. The seizure-inhibiting properties of diphenylhydantoin are well established and recorded in standard textbooks of pharmacology. It does appear to make sense to use central nervous system ( CNS ) depressants to subdue or prevent seizures attributable to depressant-drug withdrawal. However, it makes better physiological sense to achieve the desired result by modifying the pathological processes without redepression of the CNS. Diphenylhydantoin, a nondepressant in average doses, with diazepam if necessary for tremors, agitation and apprehension, elevates the seizure threshhold, diminishes the recirculation of excitatory impulses, promotes sodium efflux from neurons, decreases the posttetanic potentiation of synaptic transmission. This is a more corrective approach to diminish the likelihood, intensity, or frequency of seizures than the continuation of depressant drugs. A standard textbook of psychiatry in the chapter on alcoholism advises