title: Antiepileptic drug treatment in the end-of-life phase of glioma patients: a feasibility study.
abstract: BACKGROUND
  During the end-of-life (EOL) phase of glioma patients, a rapid deterioration in neurological functioning may interfere with the oral intake of antiepileptic drugs (AEDs). We aimed to assess the feasibility of non-oral AED treatment in an out-of-hospital setting according to an expert-based guideline.
  
  
  METHODS
  Glioma patients with a history of epilepsy, in whom further antitumor therapy was considered to be no longer meaningful, were recruited at two Dutch hospitals. As soon as swallowing difficulties developed, the patient's caregiver administered prophylactic treatment with buccal clonazepam. Acute seizures were treated with intranasal midazolam. We evaluated the adherence to the study medication, seizure prevalence, and caregiver's satisfaction.
  
  
  RESULTS
  Of the 34 patients who were approached, 25 gave consent to participate and 23 had died at the end of the study. Thirteen of 19 patients (68.4 %) who had developed swallowing difficulties showed adherence to the study protocol. Thirteen patients used prophylactic buccal clonazepam, of which eight patients remained seizure-free until death. Six patients received treatment with intranasal midazolam at least once. In all patients, seizure control was reached. None of the patients needed to be transferred to the hospital due to recurrent seizures. All caregivers were to some degree satisfied with the use of the study medication.
  
  
  CONCLUSIONS
  Our results demonstrate that it is feasible to treat seizures with a combination of non-oral benzodiazepines in the EOL phase of glioma patients, as it seems to provide an important level of comfort among caregivers to be able to manage seizures at home.
authors.affiliation: Department of Neurology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. j.koekkoek@vumc.nl.|Department of Neurology, Medical Center Haaglanden, PO Box 432, 2501 CK, The Hague, The Netherlands. j.koekkoek@vumc.nl.|Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands. j.koekkoek@vumc.nl.
authors.forename: Johan A F
authors.initials: JA
authors.lastname: Koekkoek
authors.affiliation: Department of Neurology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
authors.forename: Tjeerd J
authors.initials: TJ
authors.lastname: Postma
authors.affiliation: Department of Neurology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Heimans
authors.affiliation: Department of Neurology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
authors.forename: Jaap C
authors.initials: JC
authors.lastname: Reijneveld
authors.affiliation: Department of Neurology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.|Department of Neurology, Medical Center Haaglanden, PO Box 432, 2501 CK, The Hague, The Netherlands.|Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
authors.forename: Martin J B
authors.initials: MJ
authors.lastname: Taphoorn
mesh_terms: D000278:Administration, Buccal; D000281:Administration, Intranasal; D000368:Aged; D001932:Brain Neoplasms; D002998:Clonazepam / Q000008:administration & dosage / Q000494:pharmacology; D005240:Feasibility Studies; D005260:Female; D018757:GABA Modulators / Q000008:administration & dosage / Q000494:pharmacology*; D005910:Glioma; D006801:Humans; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000494:pharmacology; D008875:Middle Aged; D012640:Seizures / Q000188:drug therapy*; D013727:Terminal Care; D016896:Treatment Outcome
chemical_list: D018757:GABA Modulators; D002998:Clonazepam; D008874:Midazolam
keywords: Antiepileptic drugs; Clonazepam; End of life; Epilepsy; Glioma; Midazolam