Sizoo Eefje M, Koekkoek Johan A F, Postma Tjeerd J, Heimans Jan J, Pasman H Roeline W, Deliens Luc, Taphoorn Martin J B, Reijneveld Jaap C
Department of Neurology, VU University Medical Centre, Amsterdam, The Netherlands.
BMJ Support Palliat Care. 2014 Mar;4(1):77-80. doi: 10.1136/bmjspcare-2013-000456. Epub 2013 Jul 23.
To analyse the prevalence of seizures and use of antiepileptic drugs (AEDs) in the end-of-life (EOL) phase of patients with high-grade glioma (HGG) and to identify patient characteristics associated with the occurrence of seizures in the last week of life.
Patients were recruited from a cohort of adults with HGG diagnosed in 2005 and 2006 in three tertiary referral centres for patients with brain tumour. Physicians involved in the EOL care of patients who had HGG and had died were asked to fill in a questionnaire regarding seizures and antiepileptic treatment in the last 3 months and in the last week of life. Data on seizures and use of AEDs before the EOL phase were obtained from medical correspondence and hospital medical charts.
Out of 155 patients who had died, data for 92 patients were eligible for analysis. Twenty-nine percent of these 92 patients had seizures during the last week of life; 33% of patients had a history of seizures and 22% did not. Besides a history of status epilepticus (p=0.047), we identified no other significant risk factors for developing seizures in the last week of life. Seventy percent of all patients used AEDs before the last week of life. In 35% of patients in whom AEDs were tapered, seizures occurred in the last week of life.
Our results demonstrate that seizures are a common symptom in patients with HGG during the last week of life and emphasise the importance of adequate AED treatment throughout the EOL phase.
分析高级别胶质瘤（HGG）患者临终阶段癫痫发作的患病率及抗癫痫药物（AEDs）的使用情况，并确定与生命最后一周癫痫发作相关的患者特征。
从2005年和2006年在三个脑肿瘤三级转诊中心诊断为HGG的成年患者队列中招募患者。参与HGG患者临终护理且已死亡的医生被要求填写一份关于患者在过去3个月及生命最后一周癫痫发作和抗癫痫治疗情况的问卷。临终阶段前癫痫发作及AEDs使用的数据从医疗信函和医院病历中获取。
在155例死亡患者中，92例患者的数据符合分析要求。这92例患者中，29%在生命的最后一周出现癫痫发作；33%的患者有癫痫发作史，22%没有。除癫痫持续状态病史外（p = 0.047），我们未发现其他与生命最后一周癫痫发作相关的显著危险因素。所有患者中有70%在生命最后一周前使用过AEDs。在35%逐渐减少AEDs用量的患者中，在生命最后一周出现了癫痫发作。
我们的结果表明，癫痫发作是HGG患者生命最后一周的常见症状，并强调了在整个临终阶段进行充分AED治疗的重要性。
