Advertisement

Seizures

  • Eswaran WaranEmail author
Reference work entry

Abstract

Seizures are a common occurrence in patients with a life-limiting illness. The assessment and management of seizures in the palliative patient require the interplay of many factors, including patient and treatment goals, counterbalanced with the need to maintain quality of life. Throughout this chapter, the reader is provided with current evidence regarding definitions, classification, assessment, and management of seizures. Antiepileptic medications are discussed in detail, with an emphasis on the administration routes, commonly used in the palliation population. Current concepts regarding status epilepticus are outlined, including pathophysiology and management. The chapter concludes with a comment on seizures, driving, and the palliative patient.

Keywords

Seizure Epilepsy Antiepileptic Status epilepticus Brain tumor Stroke 

References

  1. Aranda A, Foucart G, Ducasse J, Grolleau S, McGonigal A, Valton L. Generalized convulsive status epilepticus management in adults: a cohort study with evaluation of professional practice. Epilepsia. 2010;51(10):2159–67.PubMedGoogle Scholar
  2. Avila E, Graber J. Seizures and epilepsy in cancer patients. Curr Neurol Neurosci Rep. 2010;10(1):60–7.PubMedGoogle Scholar
  3. Bausewein C, Hau P, Borasio G, Voltz R. How do patients with primary brain tumours die? Palliat Med. 2003;17(6):558–9.PubMedGoogle Scholar
  4. Berg A, Berkovic S, Brodie M, Buchhalter J, Cross J, van Emde Boas W, et al. Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005–2009. Epilepsia. 2010;51(4):676–85.PubMedGoogle Scholar
  5. Bladin C, Alexandrov A, Bellavance A, Bornstein N, Chambers B, Cote R, et al. Seizures after stroke: a prospective multicentre study. Arch Neurol. 2000;57(11):1617–22.PubMedGoogle Scholar
  6. Brigo F, Nardone R, Tezzon F, Trinka E. Nonintravenous midazolam versus intravenous or rectal diazepam for the treatment of early status epilepticus: a systematic review with meta-analysis. Epilepsy Behav. 2015;49:325–36.PubMedGoogle Scholar
  7. Brophy G, Bell R, Claassen J, Alldredge B, Bleck T, Glauser T, et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care. 2012;17:3–23.PubMedGoogle Scholar
  8. Camilo O, Goldstein L. Seizures and epilepsy after ischemic stroke. Stroke. 2004;35(7):1769–75.PubMedGoogle Scholar
  9. Cancer Institute NSW. Brain tumours and driving: a guide for clinicians [Internet]. Cited 2016 Oct 15. Available from: https://www.nsa.org.au/documents/item/48.
  10. Chen J, Wasterlain C. Status epilepticus: pathophysiology and management in adults. Lancet Neurol. 2006;5:246–56.PubMedGoogle Scholar
  11. Coeytaux A, Jallon P, Galobardes B, Morabia A. Incidence of status epilepticus in French-speaking Switzerland: (EPISTAR). Neurology. 2000;55(5):693–7.PubMedGoogle Scholar
  12. Cramer J, Mintzer S, Wheless J, Mattson R. Adverse effects of antiepileptic drugs: a brief overview of important issues. Expert Rev Neurother. 2010;10(6):885–91.PubMedGoogle Scholar
  13. DeLorenzo R, Hauser W, Towne A, Boggs J, Pellock J, Penberthy L, et al. A prospective, population-based epidemiologic study of status epilepticus in Richmond, Virginia. Neurology. 1996;46(4):1029–35.PubMedGoogle Scholar
  14. Dickman A, Schneider J. The syringe driver: continuous subcutaneous infusions in palliative care. 4th ed. Oxford: Oxford University Press; 2016.Google Scholar
  15. Droney J, Hall E. Status epilepticus in a hospice inpatient setting. J Pain Symptom Manag. 2008;36(1):97–105.Google Scholar
  16. Fisher R, Acevedo C, Arzimanoglou A, Bogacz A, Cross H, Elger C, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia. 2014;55(4):475–82.PubMedGoogle Scholar
  17. Glauser T, Ben-Menachem E, Bourgeois B, Cnaan A, Guerreiro C, Kalviainen R, et al. Updated ILAE evidence review of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia. 2013;54(3):551–63.PubMedGoogle Scholar
  18. Glauser T, Shinnar S, Gloss D, Alldredge B, Arya R, Bainbridge J, et al. Evidence-based guideline: treatment of convulsive status epilepticus in children and adults: report of the guideline Committee of the American Epilepsy Society. Epilepsy Curr. 2016;16(1):48–61.PubMedPubMedCentralGoogle Scholar
  19. Grewal J, Grewal H, Forman A. Seizures and epilepsy in cancer: etiologies, evaluation, and management. Curr Oncol Rep. 2008;10(1):63–71.PubMedGoogle Scholar
  20. Hirtz D, Ashwal S, Berg A, Bettis D, Camfield C, Camfield P, et al. Practice parameter: evaluating a first nonfebrile seizure in children: report of the quality standards subcommittee of the American Academy of Neurology, The Child Neurology Society, and The American Epilepsy Society. Neurology. 2000;55(5):616–23.PubMedGoogle Scholar
  21. Hirtz D, Berg A, Bettis D, Camfield C, Camfield P, Crumrine P, et al. Practice parameter: treatment of the child with a first unprovoked seizure: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2003;60(2):166–75.PubMedGoogle Scholar
  22. Hosgood J, Kimbrel J, Protus B, Grauer P. Evaluation of subcutaneous phenobarbital administration in hospice patients. Am J Hosp Palliat Med. 2016;33(3):209–13.Google Scholar
  23. Jacoby A, Gamble C, Doughty J, Marson A, Chadwick D. Quality of life outcomes of immediate or delayed treatment of early epilepsy and single seizures. Neurology. 2007;68(15):1188–96.PubMedGoogle Scholar
  24. Kalviainen R. Intranasal therapies for acute seizures. Epilepsy Behav. 2015;49:303–6.PubMedGoogle Scholar
  25. Koekkoek J, Postma T, Heimans J, Reijneveld J, Taphoorn M. Antiepileptic drug treatment in the end-of-life phase of glioma patients: a feasibility study. Support Care Cancer. 2016;24(4):1633–8.PubMedGoogle Scholar
  26. Krouwer H, Pallagi J, Graves N. Management of seizures in brain tumor patients at the end of life. J Palliat Med. 2000;3(4):465–75.PubMedGoogle Scholar
  27. Krumholz A, Wiebe S, Gronseth G, Shinnar S, Levisohn P, Ting T, et al. Practice parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review): report of the quality standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2007;69(21):1996–2007.PubMedGoogle Scholar
  28. Krumholz A, Wiebe S, Gronseth G, Gloss D, Sanchez A, Kabir A, et al. Evidence-based guideline: management of an unprovoked first seizure in adults: report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2015;84(16):1705–13.PubMedPubMedCentralGoogle Scholar
  29. Lacerda G, Krummel T, Sabourdy C, Ryvlin P, Hirsch E. Optimizing therapy of seizures in patients with renal or hepatic dysfunction. Neurology. 2006;67(12 Suppl 4):s28–33.PubMedGoogle Scholar
  30. Leppik I, Patel S. Intramuscular and rectal therapies of acute seizures. Epilepsy Behav. 2015;49:307–12.PubMedGoogle Scholar
  31. Lorenzl S, Mayer S, Noachtar S, Borasio G. Nonconvulsive status epilepticus in terminally ill patients-a diagnostic and therapeutic challenge. J Pain Symptom Manag. 2008;36(2):200–5.Google Scholar
  32. Lorenzl S, Mayer S, Feddersen B, Jox R, Noachtar S, Borasio G. Nonconvulsive status epilepticus in palliative care patients. J Pain Symptom Manag. 2010;40(3):460–5.Google Scholar
  33. Louie A, Chan E, Hanna M, Bauman G, Fisher B, Palma D, et al. Assessing fitness to drive in brain tumour patients: a grey matter of law, ethics, and medicine. Curr Oncol. 2013;20(2):90–6.PubMedPubMedCentralGoogle Scholar
  34. Lowenstein D, Alldredge B. Status epilepticus. New Engl J Med J Med. 1998;338:970–6.Google Scholar
  35. McDonald K. Brain tumors and driving. J Neuro-Oncol. 2011;104(1):399–400.Google Scholar
  36. Mula M, Kanner A, Schmitz B, Schachter S. Antiepileptic drugs and suicidality: an expert consensus statement from the Task Force on Therapeutic Strategies of the ILAE Commission on Neuropsychobiology. Epilepsia. 2013;54(1):199–203.PubMedGoogle Scholar
  37. Murray-Brown F, Stewart A. Remember Keppra: seizure control with subcutaneous levetiracetam infusion. BMJ Support Palliat Care. 2016;6(1):12–3.PubMedGoogle Scholar
  38. Nasr Z, Paravattil B, Wilby K. Levetiracetam for seizure prevention in brain tumor patients: a systematic review. J Neuro-Oncol. 2016;129(1):1–13.Google Scholar
  39. O’Connor N. Personal communication. 2016.Google Scholar
  40. Oberndorfer S, Schmal T, Lahrmann H, Urbanits S, Lindner K, Grisold W. The frequency of seizures in patients with primary brain tumors or cerebral metastases. An evaluation from the Ludwig Boltzmann Institute of Neuro-Oncology and the Department of Neurology, Kaiser Franz Josef Hospital, Vienna. Wien Klin Wochenschr. 2002;114(21–22):911–6.PubMedGoogle Scholar
  41. Pace A, Villani V, DiLorenzo C, Guariglia L, Maschio M, Pompili A, et al. Epilepsy in the end-of-life phase in patients with high-grade gliomas. J Neuro-Oncol. 2013;111(1):83–6.Google Scholar
  42. Palliative Care Expert Group. Therapeutic guidelines: palliative care. 3rd ed. Melbourne: Therapeutic Guidelines Limited; 2010.Google Scholar
  43. Patsalos P, Froscher W, Pisani F, van Rijn C. The importance of drug interactions in epilepsy therapy. Epilepsia. 2002;43(4):365–85.PubMedGoogle Scholar
  44. Perucca P, Gilliam F. Adverse effects of antiepileptic drugs. Lancet Neurol. 2012;11:792–802.PubMedGoogle Scholar
  45. Perucca E, Meador K. Adverse effects of antiepileptic drugs. Acta Neurol Scand Suppl. 2005;112(Suppl 181):30–5.Google Scholar
  46. Pharmaceutical Society of Australia. Australian medicines handbook. Adelaide: Australian Medicines Handbook Pty Ltd; 2014.Google Scholar
  47. Remi C, Lorenzl S, Vyhnalek B, Rastorfer K, Feddersen B. Continuous subcutaneous use of levetiracetam: a retrospective review of tolerability and clinical effects. J Pain Palliat Care Pharmacother. 2014;28(4):371–7.PubMedGoogle Scholar
  48. Remi C, Zwanzig V, Feddersen B. Subcutaneous use of lacosamide. J Pain Symptom Manag. 2016;51(2):e2–4.Google Scholar
  49. Ropper A, Samuels M, Klein J. Adam and Victor’s principles of neurology. 10th ed. New York: McGraw-Hill; 2014.Google Scholar
  50. Rosati A, De Masi S, Guerrini R. Antiepileptic drug treatment in children with epilepsy. CNS Drugs. 2015;29(10):847–63.PubMedPubMedCentralGoogle Scholar
  51. Rosetti A, Hurwitz S, Logroscino G, Bromfield E. Prognosis of status epilepticus: role of aetiology, age, and consciousness impairment at presentation. J Neurol Neurosurg Psychiatry. 2006;77(5):611–5.Google Scholar
  52. Rossetti A, Stupp R. Epilepsy in brain tumor patients. Curr Opin Neurol. 2010;23(6):603–9.PubMedGoogle Scholar
  53. Rossetti A, Jeckelmann S, Navy J, Weller M, Stupp R. Levetiracetam and pregabalin for antiepileptic monotherapy in patients with primary brain tumors. A phase II randomized study. Neuro-Oncology. 2014;16(4):584–8.PubMedGoogle Scholar
  54. Schiff D, Lee E, Nayak L, Norden A, Reardon D, Wen P. Medical management of brain tumors and the sequelae of treatment. Neuro-Oncology. 2015;17(4):488–504.PubMedGoogle Scholar
  55. Schneider J, Good P, Ravenscroft P. Effect of tubing on loss of clonazepam administered by continuous subcutaneous infusion. J Pain Symptom Manag. 2006;31(6):563–7.Google Scholar
  56. Scholtes F, Renier W, Meinardi H. Non-convulsive status epilepticus: causes, treatment, and outcome in 65 patients. Epilepsia [Internet]. 1994;35(5):1104–12. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC486466/Google Scholar
  57. Silverman I, Restrepo L, Mathews G. Poststroke seizures. Arch Neurol. 2002;59(2):195–201.PubMedGoogle Scholar
  58. Singh G, Rees J, Sander J. Seizures and epilepsy in oncological practice: causes, course, mechanisms and treatment. J Neurol Neurosurg Psychiatry. 2007;78(4):342–9.PubMedPubMedCentralGoogle Scholar
  59. Sizoo E, Koekkoek J, Postma T, Heimans J, Pasman H, Deliens L, et al. Seizures in patients with high-grade glioma: a serious challenge in the end-of-life phase. BMJ Support Palliat Care. 2014;4:77–80.PubMedGoogle Scholar
  60. Sofou K, Krisjansdottir R, Papachatzakis N, Ahmadzadeh A, Uvebrant P. Management of prolonged seizures and status epilepticus in childhood: a systematic review. J Child Neurol. 2009;24(8):918–26.PubMedGoogle Scholar
  61. Sykes L, Wood E, Kwan J. Antiepileptic drugs for the primary and secondary prevention of seizures after stroke. Cochrane Database Syst Rev. 2014;(1):CD005398.  https://doi.org/10.1002/14651858.CD005398.pub3.
  62. Thomas S, Mehta M, Kuo J, Robins H, Khuntia D. Current practices of driving restriction implementation for patients with brain tumors. J Neuro-Oncol. 2011;103(3):641–7.Google Scholar
  63. Tremont-Lukats I, Ratilal B, Armstrong T, Gilbert M. Antiepileptic drugs for preventing seizures in people with brain tumors. Cochrane Database Syst Rev. 2008;16(2):CD004424.Google Scholar
  64. Trinka E, Cock H, Hesdorffer D, Rossetti A, Scheffer I, Shinnar S, et al. A definition and classification of status epilepticus – report of the ILAE task force on classification of status epilepticus. Epilepsia. 2015;56(10):1515–23.PubMedGoogle Scholar
  65. Twycross R, Wilcock A, Howard P, editors. Palliative care formulary. 5th ed. Nottingham: Palliativedrugs.com Ltd; 2014.Google Scholar
  66. van Breemen M, Wilms E, Vecht C. Epilepsy in patients with brain tumours: epidemiology, mechanisms, and management. Lancet Neurol. 2007;6(5):421–30.PubMedGoogle Scholar
  67. Wallace E, O’Reilly M, Twomey M. A review of the use of antiepileptic drugs in high grade central nervous system tumors. Am J Hosp Palliat Med. 2012;29(8):618–21.Google Scholar
  68. Wells G, Mason L, Foreman E, Chambers J. Continuous subcutaneous levetiracetam in the management of seizures at the end of life: a case report. Age Ageing. 2016;45(2):321–2.PubMedGoogle Scholar
  69. Yang C, Dao R, Lee T, Lu C, Huang S, Chung W. Severe cutaneous adverse reactions to antiepileptic drugs in Asians. Neurology. 2011;77(23):2025–33.PubMedGoogle Scholar
  70. Young B, Jordan K, Doig G. An assessment of nonconvulsive seizures in the intensive care unit using continuous EEG monitoring: an investigation of variables associated with mortality. Neurology. 1996;47:83–9.PubMedGoogle Scholar

Copyright information

© Crown 2019

Authors and Affiliations

  1. 1.Royal Darwin HospitalTiwiAustralia
  2. 2.Territory Palliative CareTiwiAustralia

Personalised recommendations