Department of Palliative Medicine, Michael Sobell House Hospice, Churchill Hospital, Oxford, United Kingdom.
J Palliat Med. 2021 Jul;24(7):976-981. doi: 10.1089/jpm.2020.0414. Epub 2020 Dec 1.
The aim of this study is to report the results of a second cycle audit of the use of subcutaneous levetiracetam (Keppra) and an updated literature review of management of seizures in palliative care patients. A comprehensive literature review on the use of subcutaneous levetiracetam performed in 2016 was updated. A retrospective audit of the use of subcutaneous levetiracetam for inpatients at Sir Michael Sobell House Hospice during the period of 2019-2020 was performed. Ethical approval was not required and was therefore not sought. We report an additional 66 cases identified through an updated literature review and our audit. Fourteen articles were identified from the literature review, reporting a total of 120 cases where subcutaneous levetiracetam was administered. We report 19 further cases of subcutaneous levetiracetam administration between April 2019 and April 2020. Doses ranged from 500 mg to 4000 mg daily. Doses above 2000 mg were administered using a T60 syringe driver. The oral-to-subcutaneous conversion ratio was 1:1 in all but one case where the dose had to be reduced to fit a T34 syringe driver, after which the T60s were purchased. Levetiracetam was not mixed with other medications, but administered alone using water as the diluent for injection. Where necessary, the dose was appropriately adjusted for renal function. No site reactions were reported. Combined analysis of the 139 cases of subcutaneous levetiracetam administration suggests that this treatment continues to have a role in management of seizures at the end of life. Clinical outcomes suggest that therapeutic levels may be achieved, although there are only very limited data available with a few cases worldwide to support this. Randomized controlled trials are urgently needed to establish the efficacy and tolerability of subcutaneous levetiracetam administration.
本研究旨在报告皮下左乙拉西坦（开浦兰）使用情况第二轮审核的结果，并对姑息治疗患者癫痫管理的文献进行更新。对 2016 年进行的皮下左乙拉西坦使用情况进行了全面的文献回顾，并进行了更新。对 2019-2020 年期间 Sobell House Hospice 住院患者皮下左乙拉西坦使用情况进行了回顾性审核。由于不需要进行伦理审查，因此未寻求伦理审查。我们通过更新的文献回顾和审核报告了另外 66 例病例。从文献综述中确定了 14 篇文章，共报告了 120 例皮下左乙拉西坦给药的病例。我们报告了 19 例 2019 年 4 月至 2020 年 4 月期间使用皮下左乙拉西坦的进一步病例。剂量范围从 500mg 到 4000mg 每天。超过 2000mg 的剂量使用 T60 注射器驱动器给药。除了一个病例必须减少剂量以适应 T34 注射器驱动器外，所有病例的口服-皮下转换比均为 1:1，之后购买了 T60 注射器驱动器。左乙拉西坦未与其他药物混合，仅使用水作为注射稀释剂单独给药。在需要时，根据肾功能适当调整剂量。未报告局部反应。对 139 例皮下左乙拉西坦给药病例的综合分析表明，这种治疗方法在生命末期癫痫管理中仍具有作用。临床结果表明可能达到治疗水平，尽管全球只有很少的病例有有限的数据支持这一点。急需进行随机对照试验来确定皮下左乙拉西坦给药的疗效和耐受性。
