胶质瘤病人晚期，如何选择抗癫痫药物？
+ 氯硝安定预防晚期胶质瘤病人的癫痫发作！
公元2008年5月，参议员爱德华-肯尼迪住院，被确诊为胶质母胶质瘤（WHO 4级）。他是约翰-肯尼迪总统（1976年被暗杀，43岁当选美国总统）的弟弟，是美国历史上在任时间最长的参议员。他2009年8月25日在家中去世。爱德华不缺钱，美国也不缺胶质瘤治疗指南，美国更不可能存在着过度治疗，爱德华本人也不可能被胶质瘤吓个半死，然而他就活了不到15个月！所以在胶质瘤面前人人平等！
晚期胶质瘤患者，因为无法吞咽，所以德巴金，左乙拉西坦，奥卡西平等无法服用；静脉注射或者肌肉注射药物在家里更是无法实现。所以选用含服或鼻内喷剂更适合此类病人。
来自荷兰的学者KoekkoekJA等采用口腔内含服氯硝安定或鼻内直喷咪达唑仑取得了非常好的控制癫痫发作的效果，避免了去医院的不便，值得我提倡给大家借鉴！
Antiepileptic drug treatment in the end-of-life phase of gliomapatients: a feasibility study.
(PMID:26404860 PMCID:PMC4766209)
Koekkoek JA , Postma TJ , Heimans JJ , Reijneveld JC , Taphoorn MJ
Department of Neurology, LeidenUniversity MedicalCenter, PO Box 9600, 2300 RC, Leiden,The
Supportive Care in Cancer : Official Journal of the MultinationalAssociation of Supportive Care in Cancer [2016, 24(4):1633-1638]
Abstract
During the end-of-life (EOL) phase of glioma patients, a rapiddeterioration in neurological functioning may interfere with the oral intake ofantiepileptic drugs (AEDs). We aimed to assess the feasibility of non-oral AEDtreatment in an out-of-hospital setting according to an expert-basedguideline.Glioma patients with a history of epilepsy, in whom further antitumortherapy was considered to be no longer meaningful, were recruited at two Dutchhospitals. As soon as swallowing difficulties developed, the patient'scaregiver administered prophylactic treatment with buccal clonazepam. Acuteseizures were treated with intranasal midazolam. We evaluated the adherence tothe study medication, seizure prevalence, and caregiver's satisfaction.Of the34 patients who were approached, 25 gave consent to participate and 23 had diedat the end of the study. Thirteen of 19 patients (68.4 %) who had developed swallowingdifficulties showed adherence to the study protocol. Thirteen patients usedprophylactic buccal clonazepam, of which eight patients remained seizure-freeuntil death. Six patients received treatment with intranasal midazolam at leastonce. In all patients, seizure control was reached. None of the patients neededto be transferred to the hospital due to recurrent seizures. All caregiverswere to some degree satisfied with the use of the study medication.Our resultsdemonstrate that it is feasible to treat seizures with a combination ofnon-oral benzodiazepines in the EOL phase of glioma patients, as it seems toprovide an important level of comfort among caregivers to be able to manageseizures at home.
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