title: Continuous subcutaneous levetiracetam in the management of seizures at the end of life: a case report.
abstract: We report the case of a man who developed seizures on a background of recurrent metastatic squamous cell carcinoma with intracranial involvement. Initial seizure control with enteral levetiracetam was achieved, and when enteral and intravenous (i.v.) access was no longer available, a continuous subcutaneous infusion (CSCI) of levetiracetam successfully controlled his seizures without the need for sedating anticonvulsants. As a result, end-of-life care was able to be given with the patient retaining the ability to communicate with his family and healthcare staff. This report adds to the sparse but growing evidence base for the use of subcutaneous levetiracetam to manage seizures in palliative and end-of-life care.
authors.affiliation: Department of Palliative Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
authors.forename: Geoffrey Howard
authors.initials: GH
authors.lastname: Wells
authors.affiliation: Department of Palliative Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
authors.forename: Louise D
authors.initials: LD
authors.lastname: Mason
authors.affiliation: Pharmacy Department, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Foreman
authors.affiliation: Academic Department of Elderly Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
authors.forename: John
authors.initials: J
authors.lastname: Chambers
mesh_terms: D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000008:administration & dosage*; D001932:Brain Neoplasms / Q000150:complications* / Q000556:secondary*; D002294:Carcinoma, Squamous Cell / Q000556:secondary*; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D055104:Infusions, Subcutaneous; D000077287:Levetiracetam; D008297:Male; D010166:Palliative Care; D010889:Piracetam / Q000008:administration & dosage / Q000031:analogs & derivatives*; D011788:Quality of Life; D012535:Scalp / Q000473:pathology*; D012640:Seizures / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D012878:Skin Neoplasms / Q000473:pathology*; D000077195:Squamous Cell Carcinoma of Head and Neck; D013727:Terminal Care; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D000077287:Levetiracetam; D010889:Piracetam
keywords: infusion; levetiracetam; older people; palliative; seizures; subcutaneous