Management of Refractory Status Epilepticus in an Actively Dying Patient

Abstract

No consensus guidelines exist for the treatment of refractory myoclonic status epilepticus or refractory myoclonus in the palliative care setting. Evidence-based guidelines for the general medical population are often neither practical nor applicable at the end of life. Many challenges, including medication availability, route of administration, monitoring, and work-up are all unique to the palliative care setting. Two patients with refractory myoclonus versus refractory myoclonic status epilepticus are described here, illustrating the challenges involved in treatment as well the need for further research for therapy in the palliative care setting.

Palliative Care: End-of-Life Symptoms

“…Midazolam may be administered SC, intranasally or IV and diazepam or lorazepam IV or rectally. 83 For seizure prevention in the absence of IV access, a continuous infusion of midazolam SC or clonazepam once or twice daily SC can be prescribed. 84 For refractory seizures phenobarbital may be used IV, SC or IM.…”