Where seizures are anticipated in the dying phase (e.g. primary or secondary brain tumours or in known patients with a previous history of seizures) pre-emptive prescribing of an anti-epileptic by an appropriate route is recommended. This is particularly important in patients who have had recent seizures. Anti-convulsant medication is usually administered bucally or via a continuous subcutaneous syringe driver (see table general management of restlessness and agitation in the dying phase in chapter 9 for guidance on dosing in continuous subcutaneous infusion). Seek specialist palliative care team advice. References 1. Thomas K. Caring for the Dying at Home: Companions on the Journey. Radcliffe Medical Press, Oxford. 2003. 2. Ellershaw J and Wilkinson S. Editors. Care of the Dying. A pathway to excellence. Oxford University Press Inc, New York. 2003. 3. Twycross R and Wilcock A. Symptom Management in Advanced Cancer. 3rd edition. Radcliffe Medical Press, Oxford. 2002. Chapter 12 Therapeutic emergencies pp 369-371. 4. Furst CJ and Doyle D. The terminal phase. Pp 1119-1133. In: Doyle D, Hanks G, Cherny N and Calman K. (editors) Oxford Textbook of Palliative Medicine. 3rd edition. Oxford University Press, New York. 2005. 5. Bennett M et al. Using anti-muscarinic drugs in the management of death rattle: evidence-based guidelines for palliative care. Palliative Medicine, 2002, 16:369-374. 6. Twycross R, Wilcock A (Eds). Palliative Care Formulary: Fourth Edition. Palliativedrugs.com 2011.
SEIZURES IN THE DYING PHASE