Experience of Subcutaneous Levetiracetam in Palliative Care.

BACKGROUND: Seizures are common in palliative care patients and its control is essential in the management of these patients as it helps to reduce suffering at the end of life. Subcutaneous levetiracetam has been used off-license for seizure control in palliative care. OBJECTIVE: The objective of the study was to describe our experience with subcutaneous levetiracetam in two hospitals in Bogota, Colombia. METHODS: We conducted a retrospective review of patients treated with subcutaneous levetiracetam in two hospitals in Colombia during 2019-2021. Data were extracted from medical records, and participants were followed up as outpatients. RESULTS: Twenty-one patients were included into the study. No severe adverse effects or rise in ictal frequency were documented. Twelve patients died during hospitalization and nine continued treatments as outpatients. The principal diagnosis was structural focal epilepsy. The daily dose of levetiracetam ranged from 1,000 mg to 3,000 mg, and the duration of treatment varied among subjects between 1 and 360 days. CONCLUSION: Subcutaneous levetiracetam was well tolerated and effective in controlling seizures in palliative care when oral administration or intravenous access was not an option. Randomized controlled trials are needed to elucidate the efficacy and tolerability of subcutaneous levetiracetam in clinical practice.

Spatial analysis of service areas for stroke centers in a city with high traffic congestion.

The effect that traffic congestion has on the service areas of stroke centers has received scarce attention. We aimed to determine the effect of traffic conditions on the characteristics of service areas of stroke centers in Bogotá, Colombia. Using a webservice, we sampled travel times from a set of census blocks to medical centers offering stroke management in the city. We obtained 179.340 transport times under different conditions. The size of service areas was reduced significantly with congestion (up to 94.83%). Overlap in the locations of centers led to large areas covered by only five centers. We identified areas with transport times to the closest center consistently exceeding 30-minutes to 1-hour in the west and south-west. Traffic conditions in Bogotá significantly affect service areas of centers capable of offering comprehensive stroke care. Spatial overlap of centers led to small catchment areas.