Rationalising antiepileptics used for seizures in palliative care

Follow the principles of medication rationalisation when rationalising antiepileptics in palliative care.

Antiepileptic therapy can be used in patients with palliative care needs to prevent seizures and manage them, should they occur. Discuss antiepileptic therapy with the specialist managing the patient’s therapy; discussions should include appropriateness of withdrawing therapy and planning for when the patient is no longer able to swallow. The approach will depend on the indication, seizure history, distress caused by seizures, care setting and patient preferences. Options that may be considered for when the patient is no longer able to swallow are listed in Antiepileptic therapy for seizures in the last days of life in patients who already take an antiepileptic.

For general considerations for when and how to withdraw and stop antiepileptic therapy, see Titrating and withdrawing antiepileptic drugs in the Neurology guidelines. Abruptly stopping antiepileptics used to treat or prevent seizures can cause rebound seizures. If antiepileptic therapy is to be stopped, withdrawal of the antiepileptic over several weeks may be required to avoid rebound seizures.

For acute management of seizures in palliative care, see Seizures in palliative care.