PCSM-05ANTIEPILEPTIC DRUG TREATMENT WITH BUCCAL CLONAZEPAM AND INTRANASAL MIDAZOLAM IN THE END OF LIFE PHASE OF GLIOMA PATIENTS: A FEASIBILITY STUDY

Abstract

BACKGROUND: A rapid deterioration in neurological functioning may hamper the oral administration of antiepileptic drugs (AEDs) in the end of life (EOL) phase of glioma patients. We aimed to assess the feasibility of treatment with non-oral AEDs in an out-of-hospital setting. METHODS: We included patients with a histopathological diagnosis of World Health Organization (WHO) grade II-IV glioma and a history of epilepsy, in whom further antitumor treatment was considered to be no longer meaningful. When swallowing difficulties developed, the patient's caregiver started to administer prophylactic AED treatment with buccal clonazepam. Acute seizures were treated with intranasal midazolam. We evaluated the adherence to the study medication, seizure prevalence as well as caregiver's satisfaction. RESULTS: Thirty-four patients were approached, of which 25 gave consent to participate and 23 had died at the end of the study. Fourteen of 19 patients (73.7%) who had developed swallowing difficulties used the study medication. Prophylactic buccal clonazepam was used by 13 patients, of which 8 patients remained seizure free until death. Six patients received treatment with intranasal midazolam at least once. In all patients seizure control could be reached. None of the patients had to be transferred to the hospital because of recurrent seizures. All caregivers reported satisfaction with the use of the study medication. CONCLUSIONS: It is feasible to treat glioma patients with seizures in the EOL phase with a combination of buccal clonazepam and intranasal midazolam. Additionally, it seems to provide an important level of comfort among caregivers to be able to manage seizures at home.