title: Epilepsy in the end-of-life phase in patients with high-grade gliomas.
abstract: Epilepsy is common in patients with brain tumors. Patients presenting seizures as the first sign of a malignant glioma are at increased risk of recurrent seizures despite treatment with antiepileptic drugs. However, little is known about the incidence of epilepsy in the last stage of disease and in the end-of-life phase of brain tumor patients. We retrospectively analyzed the incidence of seizures in the last months of life in a series of patients affected by high-grade gliomas who were assisted at home during the whole course of the disease until death. A total of 157 patients were available for analysis. Of these patients, 58 (36.9 %) presented seizures in the last month before death. The risk of seizures in the end-of-life phase is higher in patients presenting previous history of epilepsy, particularly in patients with late-onset epilepsy. Out of the 58 patients presenting seizures in the last month of life, 86.2 % had previously had seizures and 13.8 % were seizure free. Most patients may encounter swallowing difficulties in taking anticonvulsants orally due to dysphagia and disturbances of consciousness, thus anticonvulsant treatment needs to be modified in advance. Loss of seizure control in the end-of-life phase may influence the quality of life of patients and their caregivers.
authors.affiliation: Palliative Home Care Unit for Brain Tumor Patients, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy. pace@ifo.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Pace
authors.forename: Veronica
authors.initials: V
authors.lastname: Villani
authors.forename: Cherubino
authors.initials: C
authors.lastname: Di Lorenzo
authors.forename: Lara
authors.initials: L
authors.lastname: Guariglia
authors.forename: Marta
authors.initials: M
authors.lastname: Maschio
authors.forename: Alfredo
authors.initials: A
authors.lastname: Pompili
authors.forename: Carmine Maria
authors.initials: CM
authors.lastname: Carapella
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use; D001921:Brain / Q000187:drug effects / Q000473:pathology; D001932:Brain Neoplasms / Q000150:complications* / Q000188:drug therapy; D004827:Epilepsy / Q000188:drug therapy / Q000209:etiology*; D005910:Glioma / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D060787:Neoplasm Grading; D010865:Pilot Projects; D011379:Prognosis; D012189:Retrospective Studies; D013727:Terminal Care; D019452:Terminally Ill
chemical_list: D000927:Anticonvulsants