With advances in medicine and people living longer with chronic medical conditions new subsets of patients emerge. One such subset is a group of patients for which seizure control is paramount yet they are not actively dying and their oral and intravenous route of administration has become unavailable/inappropriate. Traditional treatment for seizure management has been subcutaneous (S/C) midazolam, however this often does not balance Quality of Life (QOL) favourably for this interim period, primarily due to associated drowsiness. There have been numerous case reports using continuous subcutaneous infusion (CSCI) levetiracetam as an alternative for this group of patients, as a consequence of the perceived more favourable side effect profile.
We have collated the research published to date which outlines the appropriate scenarios and limitations of levetiracetam S/C route (either intermittent or CSCI). We have outlined the side effects, dose regimens and practical issued regularly encountered.
We have sought expert neurological advice and explored the limitations of other anti-epileptics via the S/C route and noted hopeful upcoming newer therapies such as Brivaracetam and Lacosamide.
We have made recommendations regarding starting doses, disease aetiology considerations and practical titration and conversion issues.
Within this area of rapidly progressing research, collating what has been studied so far and gaining support out-with specialist palliative care organises our thoughts and creates an overview on which we can base future research and develop guidelines to encourage consistent safe practice.