Gliomen: tot het einde in de aanval tegen epilepsie

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.

Conflict of interest and financial support: disclosure forms provided by the authors are available along with the full text of this article at www.ntvg.nl, search for A6924; click on ‘Belangenverstrengeling’ (‘Conflict of interest’). Martin J.B. Taphoorn and Johan A.F. Koekkoek received funding from the Sint Jacobusstichting, the Hague, the ZOLEON foundation and the Chanrone Foundation.