Background Seizures are common at the end of life (EOL) and can be due to cerebral neoplasms as well as uncontrolled epilepsy. Uncontrolled seizures can be a distressing symptom for patients and caregivers and can also risk further brain damage. The oral route for anticonvulsant drugs (ACD) becomes less reliable towards EOL due to disease progression. Most guidelines suggest the use of subcutaneous (sc) midazolam for seizures at EOL , which can be sedating. Moreover, patients and families may prefer to continue treatment with their usual ACD. We report a case series of seven patients using sc sodium valproate at EOL for seizures.

Aim To evaluate the tolerability and clinical effects of sc sodium valproate for the treatment of seizures at EOL.

Methods A retrospective case note analysis with collection of data on age, diagnosis, previous use of oral ACD, dose of drugs, number of days, diluent used and site reactions.

Results Seven patients were included in the case series. The median age was 68 (53–91) and all the patients had a non-cancer diagnosis with epilepsy as a pre-existing comorbidity. Six were already on oral sodium valproate, it was added to the seventh for uncontrolled seizures. Three of them had another ACD (midazolam/levetiracetam) in addition due to uncontrolled seizures. The median number of days of using sc sodium valproate was 2(1–18), none of the patients had any site reactions or adverse effects and seizures were effectively controlled in all. The reason of discontinuing was death in all, and one patient died at home. The median dose used was 1000 mg with an oral: sc dose ratio of 1:1 administered as continuous infusion. Water for injection was used as a diluent in all.

Conclusion We conclude that sc sodium valproate is an effective treatment for seizures at EOL and is well tolerated. Further research is needed on compatibility with other drugs used at EOL.