Objectives To report the results of a combined case series analysis of subcutaneous levetiracetam (Keppra) for the management of seizures in palliative care patients. Methods A comprehensive literature review on the use of subcutaneous levetiracetam was performed, and these data were combined with a prospective observational audit of its use in terminal care undertaken in a regional palliative care network. Results 7 papers were identified from the literature review-four case reports and three observational case series-reporting on a total of 53 cases where subcutaneous levetiracetam was administered. We report 20 further cases of subcutaneous levetiracetam administration from a prospective observational audit. Doses ranged from 250mg to 4000 mg daily. Oral to subcutaneous conversion ratios where stated were 1:1. Levetiracetam was reported as the sole administered antiepileptic drug (AED) in eight cases, and no seizures were reported until death in five cases. Five were switched back to enteral levetiracetam. In seven cases, levetiracetam was combined with AEDs to provide seizure control at the end of life. There was one report of a sterile abscess after 25 days of continuous subcutaneous administration. Conclusions Combined analysis of 73 reported cases of subcutaneous levetiracetam suggests this treatment may have a role in the management of seizures at the end of life. However, randomised controlled trials are urgently needed to establish the efficacy and tolerability of subcutaneous levetiracetam administration. If proven to be safe and effective, subcutaneous levetiracetam offers the potential to prevent and treat seizures without causing unnecessary sedation at the end of life.

中文翻译：

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皮下注射左乙拉西坦治疗临终癫痫发作

目的 报告皮下注射左乙拉西坦 (Keppra) 用于治疗姑息治疗患者癫痫发作的联合病例系列分析的结果。方法 对皮下注射左乙拉西坦的使用情况进行了全面的文献回顾，并将这些数据与区域姑息治疗网络中对其在终末护理中的使用情况进行前瞻性观察审核相结合。结果 从文献综述中确定了 7 篇论文——4 个病例报告和 3 个观察性病例系列报告——总共 53 例皮下注射左乙拉西坦的病例。我们通过前瞻性观察审核报告了另外 20 例皮下注射左乙拉西坦的病例。剂量范围为每天 250 毫克至 4000 毫克。所述的口服至皮下转化率是1:1。据报道，在 8 例病例中，左乙拉西坦是唯一服用的抗癫痫药 (AED)，5 例病例中直到死亡均未报告癫痫发作。五个改回肠内左乙拉西坦。在 7 个案例中，左乙拉西坦与 AED 联合使用以在生命结束时控制癫痫发作。有一份报告称连续皮下给药 25 天后出现无菌脓肿。结论 对 73 例报告的皮下注射左乙拉西坦病例的综合分析表明，这种治疗可能对治疗临终癫痫发作有一定作用。然而，迫切需要随机对照试验来确定皮下注射左乙拉西坦的疗效和耐受性。如果证明是安全有效的，