Contents:
Background information
The management of seizures in patients approaching the end of life has previously relied on the use of benzodiazepines and phenobarbitone administered via a syringe driver. The transition from oral anti-epileptic medications to these agents, whilst standard accepted practice, has no established, widely used conversion. There is a small but growing body of evidence to suggest that using the injectable form of levetiracetam subcutaneously is a safe and effective alternative way to administer anti-epileptic medication towards the end of life.
In the UK, the drug levetiracetam is increasingly used in patients with secondary epilepsy caused by brain tumours as well as being used prophylactically in patients post-neurosurgery to remove or debulk tumours. In addition, NICE guidance recommends levetiracetam as first-line treatment for myoclonic and focal seizures and as an adjunct for generalised tonic-clonic and absence seizures.
Its mechanism of action is presumed to be an interference of neurotransmitter release from the synaptic vesicle via binding to synaptic vesicle protein SV2A. Unlike many other anti-epileptic medications, levetiracetam does not require the CYP450 enzymes for metabolism. A third is metabolised predominantly by non-hepatic hydrolysis, and the remainder is excreted by the kidneys unchanged. It therefore has fewer drug interactions than other antiepileptics, which is particularly advantageous in palliative care.
Disclaimer
These Guidelines are intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.
Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.
Whilst SPAGG takes every care to compile accurate information , we cannot guarantee its correctness and completeness, and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.