Subsequent drug therapy for status epilepticus in palliative care

If the acute seizure stops promptly after initial drug therapy, further acute treatment is not needed.

If the acute seizure continues despite initial drug therapy or the seizure stops but there is concern it may recur, reconsider the potential benefits and burdens of treatment, and the patient’s prognosis, preferences and goals of care to guide subsequent care:

• If consistent with goals of care, additional antiepileptic therapy (eg parenteral levetiracetam or sodium valproate), hospitalisation, intubation or critical care admission may be appropriate—see the Neurology guidelines for management.
• For patients whose goals of care are comfort and are not for hospital or critical care admission, repeated doses of benzodiazepines may be required to stop the seizure and provide comfort.

If intravenous access cannot be obtained quickly for subsequent management of status epilepticus in patients whose goals of care are comfort and are not for hospital or critical care admission, consider:

If intravenous access is available quickly, consider:

For ongoing management of seizures in the last days of life, see Seizures in the last days of life.