Remember Keppra: seizure control with subcutaneous levetiracetam infusion

Subcutaneous levetiracetam for the management of seizures at the end of life

“…The use of subcutaneous levetiracetam might be alluring due to the potential avoidance of sedation associated with subcutaneous midazolam or phenobarbital and the ensuing ethical implications 7. However, the paucity of published and unpublished randomised controlled trials on its use and limited clinical experience currently limit its use.…”

“…Use of off licence subcutaneous levetiracetam offers the possibility of maintaining seizure control when the oral route is lost without increasing the level of sedation7.…”

Subcutaneous Drugs and Off-label Use in Hospice and Palliative Care: A Scoping Review

“…Of the included sources, 57.9% (n = 33/57) were of European origin. Almost half and thus the majority of the European sources (48.5%, n = 16/33) originated from the United Kingdom [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] followed by Spain (n = 7/33, 21.2%), [38][39][40][41][42][43][44] France, [45][46][47] and Germany [48][49][50] (both with n = 3/33, 9.1% each). Other represented countries were Denmark, 51 Italy, 52 Portugal, 53 and Norway, 54 each contributing one source.…”

“…29,52,62,63,74 One randomized placebo-controlled double-blind trial 59 and one randomized double-blind cross-over trial 61 were identified. The other articles (n = 47/57, 82.5%) were studies with more than a third (n = 21/57, 36.8%) case reports or series, 23,24,28,31,32,35,36,38,39,43,45,46,[53][54][55]57,58,66,72,73,75 followed by 17.5% (n = 10/57) descriptive analyses/ reports, 21,22,27,30,33,34,37,40,44,[47][48][49][50]56,64,65,[67][68][69][70]77,78 with nine of those specifically pe...…”