Seizure Management In Children Requiring Palliative Care: A Review Of Current Practice

Title

Seizure Management In Children Requiring Palliative Care: A Review Of Current Practice

Creator

Harris N; Baba M; Mellor C; Rogers R; Taylor K; Beringer A; Sharples P

Identifier

http://dx.doi.org/10.1136/bmjspcare-2017-001366

Publisher

Bmj Supportive & Palliative Care

Date

2017

Description

OBJECTIVES: Controlling seizures in children approaching death can be difficult, and there is a limited evidence base to guide best practice. We compared current practice against the guidance for seizure management produced by the Association of Paediatric Palliative Medicine (APPM). METHODS: Retrospective case note review of episodes of challenging seizure management in children receiving end-of-life care over a 10-year period (2006-2015) in the south-west region of England. RESULTS: We reviewed 19 admissions, in 18 individuals. Six (33%) had a malignancy, nine (50%) had a progressive neurodegenerative condition and three (17%) had a static neurological condition with associated epilepsy. Thirteen (72%) died in their local hospice, four (22%) at home, and one (6%) in hospital. Seventeen of 19 episodes involved the use of subcutaneous or intravenous midazolam infusion, for a mean of 11 days (range 3-27). There was a wide range of starting doses of midazolam, and 9/17 (53%) received final doses in excess of current dose recommendations. Six individuals received subcutaneous phenobarbital infusions, with four of these (67%) receiving final doses in excess of current dose recommendations. Plans for adjustments of infusion rates, maximal doses or alternative approaches should treatment fail were inconsistent or absent. In 16/18 (88%) cases seizures were successfully controlled prior to the day of the child's death. Staff found the experience of managing seizures at end of life challenging and stressful. CONCLUSIONS: Pharmacological approaches to seizure management in end-of-life care are variable, often exceeding APPM dose recommendations. Despite this, safe and effective seizure control was possible in all settings.

Rights

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Citation List Month

September 2017 List

Notes

Using Smart Source Parsing Jul pii: bmjspcare-2017- doi: 10.1136/bmjspcare

Citation

Harris N; Baba M; Mellor C; Rogers R; Taylor K; Beringer A; Sharples P, “Seizure Management In Children Requiring Palliative Care: A Review Of Current Practice,” Pediatric Palliative Care Library, accessed March 28, 2024, https://pedpalascnetlibrary.omeka.net/items/show/10772.