1. INTRODUCTION Acute alcohol withdrawal syndrome occurs when individuals with alcohol dependency abruptly stop or substantially reduce their alcohol consumption. Most patients manifest minor symptoms or complex syndrome, which may start as early as six to eight hours after an abrupt reduction in alcohol intake. It may include any combination of generalized hyperactivity, anxiety, tremor, sweating, nausea, retching, tachycardia, hypertension and mild pyrexia 1. These symptoms usually peak between 10 to 30 hours and subside by 40 to 50 hours. Seizures may occur in the first 12 to 48 hours and only rarely after this 2. Auditory and visual hallucinations may develop; these are characteristically frightening and may last for five to six days. In current UK practice, benzodiazepines are the most commonly used agents for alcohol detoxification, with chlordiazepoxide and diazepam favored in many places. Carbamazepine has been used in clinical practice in the management of alcohol-related withdrawal symptoms. There is however insufficient evidence to conclude they are superior to benzodiazepines in preventing seizures and NICE guidelines do not indicate that it should be used in this manner 3. Similarly, Australia Guidelines for Treatment of Alcohol (2009) does not recommend the prophylactic or long term prescribing of anticonvulsants 4. AIMS To determine incidence of alcohol withdrawal seizures in alcohol detox inpatients, Hafan Wen, specialist inpatient detoxification unit, Wrexham Maelor Hospital from March 2013 to June 2014 Prophylactic carbamazepine was prescribed until Sept 2013 METHODS This audit involved a retrospective review of discharge summaries of 208 NHS patients from North Wales who were admitted for alcohol detoxification to Hafan Wen between March 2013 to June 2014 208 discharge summaries were located electronically on the M drive with 37 patients having had both alcohol & drugs detoxification. We were unable to find discharge summaries on the M drive for 24 patients. RESULTS From March 2013 to June 2014, out of 208 cases identified, 142 patients had no history of seizures while 66 had history of seizures. 16 patients were prescribed prophylactic carbamazepine as documented on their discharge summaries and 192 patients were not prescribed carbamazepine (figure 1). Only 1 patient out of 208 patients had a seizure on the ward (figure 2). Fig 1 Fig 2 Between March 2013 to August 2013 prophylactic carbamazapine were prescribed for patients in Hafan Wen who were admitted for alcohol detoxification. 62 patients had no previous history of seizures and 27 had a history of seizure in the past (figure 3). There was not a single report of seizure on the ward during this time. Fig 3 Fig 4 From September 2013 to June 2014, prophylactic carbamazepine was no longer prescribed in Hafan Wen due to changes in local practises. Of a total of 119 patients who were admitted to Hafan Wen during this time, 80 did not have any history of seizures and 39 did have history of seizures (Figure 4). There was only one reported case of suspected alcohol withdrawal seizure during this time. It was of a 52 year old man who had a history of alcohol dependency who was drinking around 4-5L of 7.5% cider daily. He has had 6 detoxes in the past. He has a history of withdrawal fits, status epilepticus (around 20 yrs ago), history of falls, haematemesis, chronic pancreatitis, renal failure, enlarged liver, sciatica. He also had a history of addiction to painkillers. He was commenced on chlordiazepoxide reducing regime & thiamine and i.m. Pabrinex. In the morning following his admission he was found on the floor in his room and was suspected to have had a seizure. He appeared to be confused and was rambling. Staff nurse did not see any apparent injuries and he was assisted with toileting and returned to bed. He successfully completed his alcohol detoxification. He was discharged as planned on 6 May 2014 and taken to residential rehabilitation unit. CONCLUSIONS There was no significant increase in number of alcohol withdrawal seizures since Sept 2013, when carbamazepine was not prescribed. RECOMMENDATIONS To closely monitor for any alcohol withdrawal symptoms including for alcohol withdrawal seizures on admission and to continue with regular the Clinical Institute Withdrawal Assessment for Alcohol (CIWA). To continue with chlordiazepoxide regime with diazepam PO/PR prn prescription for treating seizures as and when required, to prescribe chlordiazepoxide as and when required when CIWA>12. To complete further audits and complete audit cycle. Dr Shichao SunCT3, MBChB Dr Qamar Jabeen ST4, M.B.B.S MRCPSych Dr Faye Tarrant ST6, BSc, MBChB, MRCPsych Dr Julian Race Addiction Psychiatry Consultant 1.Sullivan JT, Sykora K, Schneiderman J et al. (1989) Assessment of alcohol withdrawal: the revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar). British Journal of Addiction 84:1353–1357 2.Rogawski M (2005) Update on the Neurobiology of Alcohol Withdrawal Seizures. Epilepsy Currents. 5(6): 225–230 3.NICE Guidelines on Alcohol Use Disorders (2015) 4.Australian Guidelines for the Treatment of Alcohol Problems (2009) Carbamazepine Prescription for Alcohol Withdrawal Seizures during Inpatient Alcohol Detoxification in a Specialist Inpatient Setting