DO NOT USE FOR CLINICAL PRACTICE
Please use current guidelines available on the UHNM intranet for patient treatment
Please use current guidelines available on the UHNM intranet for patient treatment
RECOGNITION AND ASSESSMENT
- Exclude other causes for loss of consciousness and/or uncontrolled movements
- e.g. vasovagal episodes, postural hypotension, arrhythmias, hypoglycaemia, extrapyramidal side effects
- Assess history of seizures and risk factors e.g. cerebral disease
- Assess compliance and ability to take current anti-epileptic medications
SEIZURE PREVENTION
- Dying patients may be unable to take oral anti-epileptic drugs
- anti-epileptic drugs have long half-life therefore not all patients will need additional anticonvulsant treatment
- in patients with history or risk of seizures, prescribe midazolam 5-10 mg IM PRN in addition to normal end of life PRN medication
- If recent seizures or significant concern about seizures, contact palliative care team (UHNM palliative care advice available 24 hr/day - see Rotawatch for details)
- consider midazolam 20-30 mg/24hrs by CSCI for prevention and control - see Continuous subcutaneous infusions (CSCI) in palliative care guideline
- in some situations, consider a continuous subcutaneous infusion of leviteracetam under the supervision of the palliative care team
- If non convulsive seizures identified on EEG, seek specialist advice from either neurology (UHNM neurology advice available from the neurology registrar on-call. See Rotawatch for details) or palliative care team
ACUTE SEIZURES
- It is distressing to witness a seizure
- if seizures occur, treat
- Investigations to find the underlying cause are unlikely to help
- Seek neurology or palliative care team help at the earliest opportunity
Immediate care
- Put in a comfortable position, prevent injury
- Consider oxygen, assess patient, treat cause if possible and appropriate
Resolves quickly
- Assess regularly, reassure, and proceed to seizure prevention guidance
Does not resolve in 5 min
- Cannula in situ: lorazepam 4 mg slow IV
- No cannula: do not cannulate, give midazolam 5-10 mg IM
- If seizure persists. repeat dose once after 10-20 min
- If seizure still persists, contact palliative care team
- consider Midazolam 20-30 mg SC over 24 hr via CSCI - see Continuous subcutaneous infusions (CSCI) in palliative care guideline
Caution
- Phenytoin and other anti-epileptic medications by IV infusion are unlikely to be appropriate in the last days of life
- require IV access and may require filter and cardiac monitoring