Seizures at End of Life

Seizures occur when abnormal electrical activity in the brain causes a temporary change in a person’s behavior. While seizures can occur at any point in life from causes like epilepsy, a brain injury, or an infection of the central nervous system, they become more difficult to manage at end of life.

Seizures at end of life can be due to primary or metastatic brain cancers, toxic/metabolic causes such as hepatic encephalopathy and hypoglycemia, infection, drug withdrawal, stroke, or pre-existing epilepsy. About 25% to 50% of palliative patients who develop seizure activity have cancer metastases to the brain.

Caring for a Terminally Ill Loved One During a Seizure

Seizures can be difficult for families to witness. If a loved one is experiencing seizures, caregivers should make sure the patient is safe from failing or other injury. Nothing should be put in their mouth as this can injure the jaw or teeth. They should not be held down, but if possible, they can be turned gently onto one side to help them breathe easier.

As hard as it is to witness a seizure, caregivers should also be aware of the side effects of anti-seizure medication including sedation and cardiopulmonary depression. Treatment decisions for terminally ill patients should be made in accordance with their personal goals of care.

How do we manage seizures at end of life?

If a terminally ill patient has had a single seizure, it is important to check for reversible causes like hypoglycemia. If the cause is unknown, antiepileptic drugs (AEDs) may be considered.

If the patient presents as acute seizures or status epilepticus, intranasal midazolam may be considered for initial seizure control. It works quickly – usually within 3 to 8 minutes. Once the seizure is controlled, a benzodiazepine such as diazepam or clonazepam may be used to prevent future seizures.

For refractory seizures in terminally-ill patients, midazolam continuous infusion may also be used for a short period of time.

If a patient has a seizure after treatment, the nurse should be informed in case a change to their medication is needed.

DiGi Graham, Doctor of Pharmacy
Chief Corporate Pharmacist
Crossroads Hospice & Palliative Care

Crossroads Hospice & Palliative Care provides support to patients facing serious and terminal illness. To learn more about hospice care criteria, please call 1-888-564-345.

References:
Tradounsky G. Seizures in palliative care. Can Fam Physician. 2013;59(9):951-e405.

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