Assessing seizures in palliative care

Follow the principles of symptom assessment when assessing a seizure in patients with palliative care needs. Investigation may be inappropriate if death is imminent.

Seizures can occur as a new event or in the setting of a known history of seizures. Acute symptomatic seizures are caused by a transient systemic or central nervous system insult. Seizure classification helps determine the cause, inform ongoing management and distinguishes it from other involuntary movements (eg myoclonus). Epilepsy is a disorder characterised by a tendency to experience recurrent seizures; for advice on epilepsy classification, see the Neurology guidelines.

Common or important causes of acute symptomatic seizures in patients with palliative care needs includeKalviainen, 2019:

• brain cancer and its complications (eg leptomeningeal disease)
• brain trauma
• drug adverse effects
• withdrawal from substances (eg alcohol, benzodiazepines)
• intracranial infection (eg meningitis, encephalitis)
• kidney, liver or respiratory failure
• metabolic disturbance (eg hypoglycaemia, hyponatraemia, hypocalcaemia)
• raised intracranial pressure
• stroke.