{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T03:48:32Z","timestamp":1792036112809,"version":"4.4.0"},"reference-count":22,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2021,6,4]],"date-time":"2021-06-04T00:00:00Z","timestamp":1622764800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Palliative Medicine"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>\n                      The aim of this study is to report the results of a second cycle audit of the use of subcutaneous levetiracetam (Keppra\n                      <jats:sup>\u00ae<\/jats:sup>\n                      ) and an updated literature review of management of seizures in palliative care patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>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\u20132020 was performed. Ethical approval was not required and was therefore not sought.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                    <jats:p>We report 19 further cases of subcutaneous levetiracetam administration between April 2019 and April 2020. Doses ranged from 500\u2009mg to 4000\u2009mg daily. Doses above 2000\u2009mg 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/jpm.2020.0414","type":"journal-article","created":{"date-parts":[[2020,12,9]],"date-time":"2020-12-09T14:17:15Z","timestamp":1607523435000},"page":"976-981","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":12,"title":["Subcutaneous Levetiracetam for the Management of Seizures at the End of Life: An Audit and Updated Literature Review"],"prefix":"10.1177","volume":"24","author":[{"given":"Anna","family":"Sutherland","sequence":"first","affiliation":[{"name":"Department of Palliative Medicine, Michael Sobell House Hospice, Churchill Hospital, Oxford, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Meldon","sequence":"additional","affiliation":[{"name":"Department of Palliative Medicine, Michael Sobell House Hospice, Churchill Hospital, Oxford, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Harrison","sequence":"additional","affiliation":[{"name":"Department of Palliative Medicine, Michael Sobell House Hospice, Churchill Hospital, Oxford, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Palliative Medicine, Michael Sobell House Hospice, Churchill Hospital, Oxford, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,6,4]]},"reference":[{"key":"e_1_3_7_2_2","first-page":"951","article-title":"Seizures in palliative care","volume":"59","author":"Tradounsky G","year":"2013","unstructured":"Tradounsky G: Seizures in palliative care. Can Fam Physician, 2013; 59:951\u2013955.","journal-title":"Can Fam Physician"},{"key":"e_1_3_7_3_2","unstructured":"Scottish Palliative Care Guidelines www.palliativecareguidelines.scot.nhs.uk\/guidelines\/palliative-emergencies\/seizures.aspx. (Last accessed June 05 2020)"},{"key":"e_1_3_7_4_2","unstructured":"Parenteral anti-epileptics \u2013 What is your experience? PalliativeDrugs.com Survey www.palliativedrugs.com\/download\/150819_parenteral_anti_epileptics_V03_sc_final.pdf (Last accessed October 23 2020)"},{"key":"e_1_3_7_5_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjspcare-2016-001261"},{"key":"e_1_3_7_6_2","doi-asserted-by":"publisher","DOI":"10.2147\/NDT.S2937"},{"key":"e_1_3_7_7_2","unstructured":"Palliative Care Formulary; www.medicinescomplete.com. (Last accessed August 05 2020)"},{"key":"e_1_3_7_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11910-009-0080-z"},{"key":"e_1_3_7_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/archneurol.2009.335"},{"key":"e_1_3_7_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/nop045"},{"key":"e_1_3_7_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2013.01.006"},{"key":"e_1_3_7_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.neurol.2015.01.567"},{"key":"e_1_3_7_13_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjspcare-2016-001102"},{"key":"e_1_3_7_14_2","doi-asserted-by":"publisher","DOI":"10.3109\/15360288.2014.959234"},{"key":"e_1_3_7_15_2","first-page":"0269","article-title":"Tolerability and efficacy of subcutaneous levetiracetam in palliative care patients with symptomatic epilepsy - A case series","volume":"8","author":"Steigleder T","year":"2014","unstructured":"Steigleder T, , Ostagathe C: Tolerability and efficacy of subcutaneous levetiracetam in palliative care patients with symptomatic epilepsy - A case series. Palliat Med, 2014; 8:0269.","journal-title":"Palliat Med"},{"key":"e_1_3_7_16_2","unstructured":"von Hornstein W O'Gorman A Richardson et al.: Successful Management of Seizures until the End of Life using Levetiracetam Continuous Subcutaneous Infusion 2014 NCRI Cancer Conference abstract http:\/\/conference.ncri.org.uk\/abstracts\/2014\/abstracts\/B031.html. (Last accessed May 17 2015)"},{"key":"e_1_3_7_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afv195"},{"key":"e_1_3_7_18_2","first-page":"30","article-title":"The use of additional antiepileptic drugs with subcutaneous levetiracetam for the management of seizures at the end of life: A case series","author":"Ryan S","year":"2016","unstructured":"Ryan S, , Krawczyk-Sredniawa A, , Wallace E, et al.: The use of additional antiepileptic drugs with subcutaneous levetiracetam for the management of seizures at the end of life: A case series. Palliat Med, 2016; 30.","journal-title":"Palliat Med"},{"key":"e_1_3_7_19_2","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2017-222340"},{"key":"e_1_3_7_20_2","first-page":"343","article-title":"Administration of levetiracetam in subcutaneous infusion: A case report","volume":"41","author":"Heim A","year":"2019","unstructured":"Heim A, , Mehring M, , Bouothmani A, et al.: Administration of levetiracetam in subcutaneous infusion: A case report. Int J Clin Pharm, 2019; 41:343.","journal-title":"Int J Clin Pharm"},{"key":"e_1_3_7_21_2","first-page":"254","article-title":"Tolerabilidad y efectividad de levetiracetam y midazolam en infusion continua subcutanea: Caso clinic [Tolerability and effectiveness of levetiracetam and midazolam in subcutaneous continuous infusion: Case report]","volume":"26","author":"Sancho Zamora M","year":"2019","unstructured":"Sancho Zamora M, , Espadas Herv\u00e1s N, , L\u00f3pez Castellano G, et al.: Tolerabilidad y efectividad de levetiracetam y midazolam en infusion continua subcutanea: Caso clinic [Tolerability and effectiveness of levetiracetam and midazolam in subcutaneous continuous infusion: Case report]. Med Paliat, 2019; 26:254\u2013256.","journal-title":"Med Paliat"},{"key":"e_1_3_7_22_2","doi-asserted-by":"publisher","DOI":"10.33588\/rn.6909.2019210"},{"key":"e_1_3_7_23_2","article-title":"Pharmacokinetics of subcutaneous levetiracetam in palliative care patients","author":"Papa P","year":"2020","unstructured":"Papa P, , Oricchio F, , Gine\u00b4s M, et al.: Pharmacokinetics of subcutaneous levetiracetam in palliative care patients. 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