Antiepileptic therapy for seizures in the last days of life in patients who already take an antiepileptic

For patients in the last days of life who take an antiepileptic for a seizure disorder, it is important to continue it to maintain seizure control. When patients are no longer able to swallow their regular oral antiepileptic, seek specialist advice. Options for management include either switching to regular benzodiazepine therapy or switching to a formulation of an antiepileptic that can be administered via subcutaneous infusion (eg levetiracetam); the dose of levetiracetam may be limited by the injection volume—seek advice from a specialist palliative care service.

When switching from the patient’s usual antiepileptic to regular benzodiazepine therapy, ideally use a cross-tapering process—reduce the dose of and stop the oral antiepileptic while the benzodiazepine is started and titrated to the recommended dose. If this is not possible, seek specialist palliative care advice on performing a safe direct switch.

For acute seizure management, see Managing acute seizures in palliative care.