The withdrawal syndrome may begin hours after the EtOH peak;
Ethanol withdrawal seizures are classically seen in up to 33% (some say 75%) of habituated drinkers within 7–30 hours of cessation or reduction of ethanol intake. They typically consist of 1–6 tonic-clonic generalized seizures without focality within a 6 hour period. 1)
Seizures usually occur before delirium develops. They may also occur during intoxication (without withdrawal).
The seizure risk persists for 48 hrs (risk of delirium tremens (DTs) continues beyond that); thus a single loading dose of PHT is frequently adequate for prophylaxis. However, since most EtOH withdrawal seizures are single, brief, and self-limited, PHT has not been shown to be of benefit in uncomplicated cases and is thus usually not indicated. Chlordiazepoxide (Librium®) or other benzodiazepines administered during detoxification reduces the risk of withdrawal seizures 2).