Planning seizure management in palliative care

For patients with palliative care needs who are at significant risk of a seizure, discuss and plan the care of a potential event. Ensure the patient has an advance care plan and a seizure management plan. Planning considerations include:

• whether hospital or intensive care admission or resuscitation would occur
• the role and availability of anticipatory drugs for acute seizure management
• ensuring the carer knows the management plan, including who (and when) to call (eg palliative care team, general practitioner, ambulance)
• ensuring the carer is educated in first aid for a seizure, for example:
  • easing the patient to the floor
  • gently positioning the patient on their side with their airway protected
  • removing harmful objects from the patient’s vicinity
  • not restraining the patient
  • not placing objects in the patient’s mouth
  • drug administration, if appropriate.

Antiepileptic prophylaxis is unlikely to be beneficial in patients who have not had a seizure, and may increase the risk of adverse effects and drug interactions. Short-term antiepileptic prophylaxis may be used before surgery for brain cancer but should be withdrawn postoperativelyGreenhalgh, 2020Leon Ruiz, 2019.

For information about rationalising antiepileptics, see Rationalising antiepileptics used for seizures in palliative care.