Microsoft word - seizures-treatment of resistant cases.docx

Marc Kent, DVM, DACVIM (Smal Animal and Neurology) Simon R. Platt, BVM&S, MRCVS, DACVIM (Neurology), DECVN ANTIEPILEPTIC DRUGS FOR
Diazepam (Valium) is not a new drug and is widely used in the Treatment Options
emergency treatment of seizures. Diazepam is often used in hos- Several newer drugs are available for treating seizures. They can pitalized animals, because it is given intravenously during a sei- be used in combination with phenobarbital and potassium bromide zure. Diazepam can also be administered into the nose or the to improve seizure control in severely affected animals. These rectum. Dogs with severe seizures can be given diazepam rectally medications may also be tried as the sole treatment for seizures in at home to reduce seizure severity and to try and prevent repeated some cases, but their effectiveness as a sole therapy is unknown at seizures. In dogs, the effect of diazepam is short lived, so the drug present. Most of these newer drugs are also expensive. Once sei- is not used for long-term management of seizures. On rare occa- zure control has been achieved with any of these drugs, the dosage sions, cats on oral diazepam can develop severe, often fatal, liver of phenobarbital or potassium bromide can often be decreased. damage, so oral administration of diazepam is done with caution Levetiracetam
Levetiracetam (Keppra) is an antiepileptic drug that has few side effects and may offer good seizure control in dogs. It is effective in Follow-up Care
many cases refractory to other drugs. Levetiracetam is not elimi- Once antiepileptic therapy is started, treatment commonly con- nated from the body by the liver, so it can be used in animals with tinues for life. Many antiepileptic drugs have side effects, so liver disease. Levetiracetam comes as a tablet and is usually given follow-up evaluations and close monitoring are required. At the beginning of treatment, follow-up evaluations and telephone con- Gabapentin
sultations are used to ensure the successful control of seizures via Gabapentin (Neurotin) is also effective in many animals with seizures appropriate dosing. Once the seizures are controlled, the animal refractory to other drugs. The most common side effect is sedation. is evaluated at least every 6 months. In addition to drug blood Gabapentin is eliminated from the body by the liver and kidneys but levels, other routine laboratory tests are used to monitor for side has not yet been shown to cause liver disease. Gabapentin comes as effects and to evaluate the animal’s general health. Always dis- a capsule and is administered three times daily. cuss any changes in medications with your veterinarian; it is dan- Zonisamide
gerous to make dosage adjustments on your own. Even if side Zonisamide (Zonegran) may be as effective as levetiracetam effects occur, antiepileptic drugs should not be abruptly discon- or gabapentin. It is well tolerated by dogs. Side effects include tinued without consultation with a veterinarian. Discontinuation decreased appetite, sedation, and incoordination. Allergic reac- of these drugs is usually done gradually, under the direction of tions, decreased tearing (dry eye), and blood disorders are poten- tial side effects. Zonisamide is eliminated from the body by the liver, so is avoided in animals with liver disease. It comes as a tablet and is administered twice daily. If you have other questions or concerns about this, or other health topics, please call Copyright 2011 by Saunders, an imprint of Elsevier Inc. All rights reserved.



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