Seizures in palliative care

At a glance

• Seizures are distressing to watch and common in primary brain tumours, brain metastases and leptomeningeal disease. They also occur with metabolic disturbance and drug toxicity in any dying patient.
• A seizure lasting 5 minutes or recurring without recovery is treated as status. In palliative care the drug is midazolam by a non-IV route.
• The common preventable cause is losing oral antiseizure drugs or dexamethasone when the patient can no longer swallow.