Background Levetiracetam is increasingly used subcutaneously to control seizure activity in selected palliative patients, whereby seizure control is paramount without the same perceived sedative effect of subcutaneous benzodiazepines. Despite this becoming a well recognised approach the literature and quality evidence to support this remains sparse.

Aim To perform a retrospective audit exploring subcutaneous Levetiracetam use and practice, over the past year across the West-Midlands, comparing it to guidance in PCF5.

Method An electronic survey sent to all palliative care units and hospital teams across the West Midlands generated information from 31 cases where subcutaneous Levetiracetam had been used. Information gathered included seizure aetiology and type, antiepileptic history, delivery of Levetiracetam, side effects and effectiveness.

Results Seizure aetiology was heterogeneous; 50% caused by space-occupying lesions. 42% of patients had seizures in the week prior to commencement and 58% of seizures were described as tonic-clonic. Nearly all (93%) had anti-epileptics prescribed prior to commencement. The majority of Levetiracetam was delivered via a continuous subcutaneous infusion (92%), the remaining given by bolus subcutaneous regimen. The mean dose on commencement was 1268 mg (range 250 mg–3000 mg) and 12% of infusions were titrated over time due to seizure activity. Levetiracetam was successfully mixed with morphine, midazolam, metoclopramide and dexamethasone with no issues reported. In 69% cases concurrent midazolam administration was used, although the rationale varied and was not solely seizure related. 81% reported no side effects attributable to Levetiracetam, 16% reported a local site skin reaction. No further seizures were documented in 70% whilst on subcutaneous Levetiracetam and 62% of subcutaneous Levetiracetam regimens continued till death.

Conclusion This study outlines current varied practice in the West-Midlands demonstrating the targeted patient group and practical issues in using subcutaneous Levetiracetam. Collating this information adds to the evidence base and will allow for composition of informed local guidelines.