Abstract 1728P
Background
Seizures are a frequently occurring symptom in patients with gliomas; approximately 40% of patients may experience seizures prior to surgical intervention, while an additional 20% of patients may have seizures later in the disease course. As these seizures will most commonly occur outside the hospital setting it is important to have clear strategies to cope for patients and their families. Buccal midazolam (BM) is a medication which can be used at home for cessation of prolonged seizures (>5mins) in patients with tumorigenic epilepsy. Opportunities to optimise use of effective antiepileptic drugs (AEDs) is therefore an important area of unmet need. We assess the (1) pattern of prescribing of BM to patients with primary brain malignancy and (2) the awareness of patient and carers on how to administer midazolam.
Methods
Patients attending the oncology day ward with a diagnosis of high grade glioma, on systemic anticancer treatment (either intravenous or oral) were included. All patients had undergone prior surgical resection. Patients were divided into 2 groups according to whether or not they had seizures associated with their underlying glioma. Data was collected prospectively, after consenting to participation, by the one physician during routine clinical review over a 3-week period from Dec. 1st - 21st, 2020.
Results
A total of 53 patients were reviewed with a median age of 50 years (range 25-80) and median time since diagnosis of 8 months (range 2-72). The key highlights are presented in the table. Table: 1728P
Summary of findings as per seizure history
| Seizure history | Seizure history n=30 | No seizure history n=23 |
| More than 1 generalised seizure | n=18 (60%) | not applicable (n/a) |
| Aware of BM | n=14 (47%) | n=1 (4%) |
| Family skilled to administer BM | n=29 (97%) | n/a |
| Personal supply of BM | n=11 (37%) | n=1 (4%) |
| Taking regular AEDs | n=28 (93%) | n=7 (30%) |
| Neurologist Assessment | n=12 (40%) | n/a |
| Seizure Nurse Specialist Assessment | n=9 (30%) | n/a |
Conclusions
AEDs are a commonly prescribed medicine for patients with high-grade glioma, reducing the risk of life-interfering/life-threatening seizures. In this study we identify that less than half of patients are aware of the role of BM in terminating prolonged seizures and how to administer it appropriately, despite the majority of patients being on regular AEDs. Greater involvement by dedicated seizure control services may provide enhanced support for patients and their carers.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.