The Last Stand DDO guide

There's only one in DDO's Last Stand dungeon, a necklace for casters called the "Twisted Talisman". It has a blood sacrifice ability which allows you to turn hit points into spell points. The other two items below are part of the quest's end reward list.

Elder's Focus.
Raven's Sight.
Twisted Talisman.

"The crystal on this necklace's chain glows darkly with a profane energy. It was found near High Priestess Slikir after her defeat, and will grant the wielder more power for his or her spells, but at a price...

Sometimes two named creatures will spawn in the Last Stand. The first is between the second and third wave. He's a sahaugin spellcaster that will attack the drow town. The final one is a giant ochre slime who appears after the necromancer has been defeated. Both of these optionals are somewhat rare and reward you with experience and an extra chest.

Have someone talk to Viercha Ettervs to begin the Last Stand quest. There are many dialogue options here, but it doesn't really matter which you pick. You'll still be rewarded no matter what you say. Choose whatever you think'll have your favorite response. :)

This will trigger a defense scenario. There are many drow elves around you, but you only have to keep one alive for the optional bonus and chest. The last stand is a much easier DDO adventure if you save as many as you can. The third wave in particular is quite nasty without them. Viercha heals himself fairly well. Remember to watch his health too if you're a divine class or carrying healing wands.

Most of what you'll be fighting are sahaugin. There are a few casters, but they're melees for the most part. Mudmen are also part of their attacks. Head out around the area after the first wave to defend the town. Viercha Ettervs will claim to be safe, but some of them actually spawn within range of him. This is especially true if he was outside in the swamp at the time.

Two more waves will attack the city. You'll be given a chance to use the rest shrine between them. The resurrection area is outside the town, beside one of the smaller buildings. The final attack will be a sahaugin necromancer, along with the usual boss trash talking in DDO quests. He'll spawn many drowned zombies to attack. Kill him to win the Last Stand. All of his zombie minions will die once he falls.