title: Guidelines for seizure management in palliative care: Proposal for an updated clinical practice model based on a systematic literature review.
abstract: BACKGROUND
  Very little has been written on seizure management in palliative care (PC). Given this situation, and considering the forthcoming setting up of the Palliative Care Unit at our neurorehabilitation centre, the Clínica San Vicente, we decided to establish a series of guidelines on the use of antiepileptic drugs (AEDs) for handling seizures in PC.
  
  
  METHODS
  We conducted a literature search in PubMed to identify articles, recent manuals, and clinical practice guidelines on seizure management in PC published by the most relevant scientific societies.
  
  
  RESULTS
  Clinical practice guidelines are essential to identify patients eligible for PC, manage seizures adequately, and avoid unnecessary distress to these patients and their families. Given the profile of these patients, we recommend choosing AEDs with a low interaction potential and which can be administered by the parenteral route, preferably intravenously. Diazepam and midazolam appear to be the most suitable AEDs during the acute phase whereas levetiracetam, valproic acid, and lacosamide are recommended for refractory cases and long-term treatment.
  
  
  CONCLUSIONS
  These guidelines provide general recommendations that must be adapted to each particular clinical case. Nevertheless, we will require further well-designed randomised controlled clinical trials including large samples of patients eligible for PC to draft a consensus document recommending adequate, rational, and effective use of AEDs, based on a high level of evidence, in this highly complex area of medical care.
authors.affiliation: Servicio de Neurología, Clínica San Vicente, Madrid, España. Electronic address: pistolpete271285@hotmail.com.
authors.forename: M
authors.initials: M
authors.lastname: León Ruiz
authors.affiliation: Departamento de Gerencia, Clínica San Vicente, Madrid, España.
authors.forename: M L
authors.initials: ML
authors.lastname: Rodríguez Sarasa
authors.affiliation: Departamento de Dirección de Gestión Sanitaria, Clínica San Vicente, Madrid, España.
authors.forename: L
authors.initials: L
authors.lastname: Sanjuán Rodríguez
authors.affiliation: Departamento de Gerencia, Clínica San Vicente, Madrid, España; Servicio de Rehabilitación y Medicina Física, Clínica San Vicente, Madrid, España.
authors.forename: M T
authors.initials: MT
authors.lastname: Pérez Nieves
authors.affiliation: Servicio de Medicina Interna, Clínica San Vicente, Madrid, España.
authors.forename: F
authors.initials: F
authors.lastname: Ibáñez Estéllez
authors.affiliation: Servicio de Psiquiatría, Clínica San Vicente, Madrid, España; Departamento de Dirección Médica, Clínica San Vicente, Madrid, España.
authors.forename: S
authors.initials: S
authors.lastname: Arce Arce
authors.affiliation: Servicio de Neurología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad de Alcalá, Alcalá de Henares, Madrid, España.
authors.forename: E
authors.initials: E
authors.lastname: García-Albea Ristol
authors.affiliation: Servicio de Neurología, Hospital Universitario 12 de Octubre, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, España.
authors.forename: J
authors.initials: J
authors.lastname: Benito-León
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use*; D002220:Carbamazepine / Q000627:therapeutic use*; D017408:Guidelines as Topic; D006801:Humans; D000077287:Levetiracetam; D010166:Palliative Care / Q000379:methods*; D012640:Seizures / Q000188:drug therapy*; D014635:Valproic Acid / Q000627:therapeutic use
chemical_list: D000927:Anticonvulsants; D002220:Carbamazepine; D000077287:Levetiracetam; D014635:Valproic Acid
keywords: Antiepileptic drug; Cancer; Crisis epiléptica; Cuidados paliativos; Cáncer; Epilepsia; Epilepsy; Epileptic seizure; Fármaco antiepiléptico; Palliative care; Situación de enfermedad terminal; Terminal illness