Koekkoek Johan A F, Boddaert Manon S A, Taphoorn Martin J B
VU medisch centrum, afd. Neurologie, Amsterdam.
Ned Tijdschr Geneeskd. 2014;158(1):A6924.
In patients with high-grade glioma seizures occur relatively frequently during the end-of-life phase. At some point, the use of oral anti-epileptic drugs is no longer possible due to swallowing difficulties caused by advanced tumour progression. We have established a draft guideline and propose that anti-epileptic drugs be prescribed by alternative routes of administration in the end-of-life phase in glioma patients with known epilepsy who develop swallowing difficulties. Buccal clonazepam would be our drug of first choice as a maintenance treatment in addition to intranasal midazolam for the acute management of seizures. Adequate treatment of epileptic seizures, particularly during the end-of-life phase, can help to maintain quality of life as long as possible in patients with high-grade glioma.
在高级别胶质瘤患者中，癫痫发作在生命终末期相对频繁发生。在某些时候，由于肿瘤进展晚期导致吞咽困难，口服抗癫痫药物已不再适用。我们制定了一份指南草案，并建议对于已知患有癫痫且出现吞咽困难的胶质瘤患者，在生命终末期通过替代给药途径开具抗癫痫药物。除了使用鼻内咪达唑仑用于癫痫发作的急性处理外，颊部应用氯硝西泮将作为维持治疗的首选药物。充分治疗癫痫发作，尤其是在生命终末期，有助于尽可能长时间维持高级别胶质瘤患者的生活质量。
