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Saint‐Maxent M, Juette T, Parent J, Castel A, Parmentier T. Factors influencing serum concentrations of levetiracetam in dogs with epilepsy. J Vet Intern Med 2024; 38:2249-2256. [PMID: 38888491 PMCID: PMC11256123 DOI: 10.1111/jvim.17128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/17/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Factors affecting serum concentrations of levetiracetam in dogs are unknown and could affect the efficacy of levetiracetam in controlling seizures in dogs with epilepsy. HYPOTHESIS/OBJECTIVES Higher PO doses of levetiracetam will be needed in dogs to achieve serum concentrations shown to be effective in humans. Determine factors that could influence serum levetiracetam concentrations and justify dose adjustment in some epileptic dogs. ANIMALS Sixty-nine client-owned dogs with epilepsy treated with levetiracetam alone or in combination, based on 127 trough serum concentration measurements of levetiracetam. METHODS Retrospective cohort study. Linear mixed models were used to assess the effect of patient signalment and concurrent drug administration on serum concentrations of levetiracetam and the effect of serum concentration of levetiracetam on seizure frequency reduction. RESULTS The PO dose of levetiracetam significantly explained changes in serum levetiracetam concentration, and this causal link was stronger with monotherapy (R2 = 0.59, P < .001). Phenobarbital significantly decreased serum levetiracetam concentration in a dose dependent manner (R2 = 0.30, P = .003). Based on our model, a levetiracetam dosage of 99-216 mg/kg/day is necessary to obtain a serum levetiracetam concentration of 20 μg/mL when used alone or concurrently with 7 mg/kg/day of phenobarbital. No other factors were found to influence serum levetiracetam concentrations. No therapeutic range could be identified. CONCLUSION AND CLINICAL IMPORTANCE Our data suggest that a dosage of 99-216 mg/kg/day of levetiracetam is needed to achieve a serum concentration known to be therapeutically effective in humans, especially when administered concomitantly with phenobarbital.
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Affiliation(s)
- Marine Saint‐Maxent
- Département de Sciences Cliniques, Faculté de Médecine VétérinaireUniversité de MontréalSaint‐HyacintheQuebecCanada
- Present address:
Kleintierklinik, Vetsuisse‐FakultätUniversität BernBernSwitzerland
| | - Tristan Juette
- Vice‐décanat à la Recherche, Faculté de Médecine VétérinaireUniversité de MontréalSaint‐HyacintheQuebecCanada
| | - Joane Parent
- Département de Sciences Cliniques, Faculté de Médecine VétérinaireUniversité de MontréalSaint‐HyacintheQuebecCanada
| | - Aude Castel
- Département de Sciences Cliniques, Faculté de Médecine VétérinaireUniversité de MontréalSaint‐HyacintheQuebecCanada
| | - Thomas Parmentier
- Département de Sciences Cliniques, Faculté de Médecine VétérinaireUniversité de MontréalSaint‐HyacintheQuebecCanada
- Centre Interdisciplinaire de Recherche sur le Cerveau et L'apprentissage (CIRCA)Université de MontréalMontrealQuebecCanada
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Gouveia D, Mandigers P, Cherubini GB. Bromide: the good, the bad, and the ugly of the oldest antiseizure medication. Front Vet Sci 2024; 11:1433191. [PMID: 38988980 PMCID: PMC11233540 DOI: 10.3389/fvets.2024.1433191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 06/12/2024] [Indexed: 07/12/2024] Open
Abstract
Bromide is the first effective antiseizure medication used in human medicine since the XIX century. Initially met with skepticism, bromide quickly gained enthusiasm within the medical field until being largely replaced by newer antiseizure medications with significantly fewer adverse effects in people. In veterinary medicine, bromide continues to be used in the management of epileptic patients for over 30 years, yet adverse effects can impact owners and patients alike. We sought to provide the general practitioner and veterinary neurologist with insightful information on both the positive and negative attributes of bromide, explore factors that may influence its desirability as an antiseizure medication in specific veterinary cases and elucidate its current role in modern epilepsy treatment for veterinary patients. It's also our endeavor to discuss the current use as an alternative or add-on with other known antiseizure medications and potential future studies that might enhance our understanding and use of this medication.
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Affiliation(s)
- Diogo Gouveia
- Dick White Referrals – Linnaeus, Cambridgeshire, United Kingdom
| | - Paul Mandigers
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Giunio Bruto Cherubini
- Department of Veterinary Sciences, Veterinary Teaching Hospital “Mario Modenato”, University of Pisa, Pisa, Italy
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Mahon E, Marsh O, Uriarte A, Stabile F. The effect of oral zonisamide treatment on serum phenobarbital concentrations in epileptic dogs. Front Vet Sci 2024; 11:1389615. [PMID: 38868500 PMCID: PMC11168201 DOI: 10.3389/fvets.2024.1389615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/26/2024] [Indexed: 06/14/2024] Open
Abstract
Zonisamide is used in dogs for the treatment of epileptic seizures. It is predominantly metabolised by CYP450 hepatic enzymes. When used concurrently with phenobarbital (PB), zonisamide clearance is increased and its elimination half-life decreases. However, the effect that zonisamide may have on serum PB concentrations in dogs has not been previously described. Eight dogs diagnosed with idiopathic epilepsy and two dogs with structural epilepsy commenced zonisamide at 8.0 mg/kg/12 h [7.4-10 mg/kg/12 h] following an increase in the frequency of epileptic seizures. Nine dogs were receiving PB every 12 h (4.2 mg/kg/12 h [3.8-6 mg/kg/12 h]), and one dog was receiving PB every 8 h (6 mg/kg/8 h). Following the addition of zonisamide and despite no increase in PB dosage, an increase in phenobarbital serum PB concentration was observed in 9 out of 10 dogs in subsequent measurements. In five dogs, phenobarbital serum concentrations were raised to concentrations higher than the reported hepatotoxic concentrations (trough>35 mg/L). This required a reduction in daily doses of PB. This case series suggests that zonisamide affects the metabolism of PB and causes an increase in PB serum concentrations over time.
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Affiliation(s)
- Elizabeth Mahon
- Department of Neurology and Neurosurgery, Southfields Veterinary Specialists, Part of Linnaeus Ltd, Essex, United Kingdom
| | - Oliver Marsh
- Department of Neurology and Neurosurgery, Dick White Referrals, Part of Linnaeus Ltd, Newmarket, United Kingdom
| | - Ane Uriarte
- Department of Neurology and Neurosurgery, Southfields Veterinary Specialists, Part of Linnaeus Ltd, Essex, United Kingdom
| | - Fabio Stabile
- Department of Neurology and Neurosurgery, Wear Referrals, Part of Linnaeus Ltd, Bradbury, United Kingdom
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4
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Kajin F, Meyerhoff N, Charalambous M, Volk HA. "Resistance Is Futile": A Pilot Study into Pseudoresistance in Canine Epilepsy. Animals (Basel) 2023; 13:3125. [PMID: 37835731 PMCID: PMC10571656 DOI: 10.3390/ani13193125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 09/30/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
Epilepsy is a common neurological disorder in veterinary practice, complicated by frequent occurrence of medication-resistant epilepsy. In human medicine, it has been noted that some patients with medication-resistant epilepsy have in fact other reasons for their apparent medication-resistance. The aim of this retrospective study was to describe the issue of pseudoresistance using as an example a population of dogs presented with presumed medication-resistant epilepsy and provide an in-depth review of what is known in human medicine about pseudoresistant epilepsy. One-hundred fifty-two cases were identified with medication-resistant epilepsy, of which 73% had true medication-resistant epilepsy and 27% patients had pseudoresistance. Low serum anti-seizure medication levels were the most common cause of pseudoresistance, present in almost half of the cases (42%), followed by inadequate choice of drugs or dosages (22%), misclassification (22%) or misdiagnosis (9%) of epilepsy and poor compliance (9%). All cases of pseudoresistance, except for one, responded to a modification of the initial therapy protocol. Pseudoresistance can bias clinical trials, misinform the clinical decision-making process, delay diagnosis and treatment, and misinform owners about their pets' prognosis. A substantial proportion of these cases can have improvement of their seizure frequency or achieve seizure freedom upon modification of their therapeutic protocol.
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Affiliation(s)
- Filip Kajin
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, 30559 Hannover, Germany; (F.K.); (N.M.); (M.C.)
- Clinic for Internal Diseases, Faculty of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Nina Meyerhoff
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, 30559 Hannover, Germany; (F.K.); (N.M.); (M.C.)
| | - Marios Charalambous
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, 30559 Hannover, Germany; (F.K.); (N.M.); (M.C.)
| | - Holger Andreas Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, 30559 Hannover, Germany; (F.K.); (N.M.); (M.C.)
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Kriechbaumer SRP, Jurina K, Wielaender F, Schenk HC, Steinberg TA, Reese S, Buhmann G, Doerfelt S, Potschka H, Fischer A. Pregabalin Add-On vs. Dose Increase in Levetiracetam Add-On Treatment: A Real-Life Trial in Dogs With Drug-Resistant Epilepsy. Front Vet Sci 2022; 9:910038. [PMID: 35873699 PMCID: PMC9298511 DOI: 10.3389/fvets.2022.910038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Epilepsy is a common neurological disorder affecting 0.6–0.75% of dogs in veterinary practice. Treatment is frequently complicated by the occurrence of drug-resistant epilepsy and cluster seizures in dogs with idiopathic epilepsy. Only few studies are available to guide treatment choices beyond licensed veterinary drugs. The aim of the study was to compare antiseizure efficacy and tolerability of two add-on treatment strategies in dogs with drug-resistant idiopathic epilepsy. The study design was a prospective, open-label, non-blinded, comparative treatment trial. Treatment success was defined as a 3-fold extension of the longest baseline interseizure interval and to a minimum of 3 months. To avoid prolonged adherence to a presumably ineffective treatment strategy, dog owners could leave the study after the third day with generalized seizures if the interseizure interval failed to show a relevant increase. Twenty-six dogs (mean age 5.5 years, mean seizure frequency 4/month) with drug-resistant idiopathic epilepsy and a history of cluster seizures were included. Dogs received either add-on treatment with pregabalin (PGB) 4 mg/kg twice daily (14 dogs) or a dose increase in levetiracetam (LEV) add-on treatment (12 dogs). Thirteen dogs in the PGB group had drug levels within the therapeutic range for humans. Two dogs in the PGB group (14.3%; 2/14) and one dog in the LEV group (8.3%; 1/12) achieved treatment success with long seizure-free intervals from 122 to 219 days but then relapsed to their early seizure frequency 10 months after the study inclusion. The overall low success rates with both treatment strategies likely reflect a real-life situation in canine drug-resistant idiopathic epilepsy in everyday veterinary practice. These results delineate the need for research on better pharmacologic and non-pharmacologic treatment strategies in dogs with drug-resistant epilepsy.
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Affiliation(s)
- Sandra R. P. Kriechbaumer
- Centre for Clinical Veterinary Medicine, Clinic of Small Animal Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
- AniCura Small Animal Clinic Haar, Haar, Germany
| | | | - Franziska Wielaender
- Centre for Clinical Veterinary Medicine, Clinic of Small Animal Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Henning C. Schenk
- Centre for Clinical Veterinary Medicine, Clinic of Small Animal Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
- Small Animal Clinic Lüneburg, Lüneburg, Germany
| | | | - Sven Reese
- Department of Veterinary Sciences, Institute of Anatomy, Histology and Embryology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Gesine Buhmann
- Centre for Clinical Veterinary Medicine, Clinic of Small Animal Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Stefanie Doerfelt
- Centre for Clinical Veterinary Medicine, Clinic of Small Animal Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
- AniCura Small Animal Clinic Haar, Haar, Germany
| | - Heidrun Potschka
- Department of Veterinary Sciences, Institute of Pharmacology, Toxicology, and Pharmacy, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Andrea Fischer
- Centre for Clinical Veterinary Medicine, Clinic of Small Animal Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
- *Correspondence: Andrea Fischer
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Plonek M, Diaz-Espineira MM, Stassen QEM, Santifort KM, Leegwater PAJ, Mandigers PJJ. Phenotypic characterization of idiopathic epilepsy and epilepsy of unknown cause in Irish Setters. Front Vet Sci 2022; 9:1066094. [PMID: 36578438 PMCID: PMC9791031 DOI: 10.3389/fvets.2022.1066094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022] Open
Abstract
Canine epileptic seizures are common neurological symptom presenting to veterinary practice. Idiopathic epilepsy (IE) with a suspected genetic background has been reported in several dog breeds. Although it has been reported in the Irish Setter (IS), the phenotypic characteristics have not yet been described. The aim of this study was to characterize the phenotype of IE in this breed and to trace its mode of inheritance. Owners of IS were requested to fill in a questionnaire via the Dutch Irish Setter Club concerning the epileptic seizures in their dogs. The data was assessed retrospectively using descriptive statistics. Forty-eight privately owned IS dogs fulfilling tier I criteria for IE according to the International Veterinary Epilepsy Task Force of both sexes were included in the study. The mean age of seizure onset was 41 months. Five of the dogs included in the study had an onset of seizures >6 years of age. These dogs were classified with epilepsy of unknown cause (EUC). Primary generalized tonic-clonic seizures were the most common type of seizure and were seen in almost all dogs. Cluster seizures were reported in 54% of the studied population. Most owners reported pre- (56%) and post-ictal (97%) signs in their dogs. A pedigree analysis of one subpopulation was performed and traced the lineage of 13 affected IS. A segregation analysis of this population rejected a simple autosomal recessive inheritance pattern. The present study supports the occurrence of IE and EUC in the IS. The results provide clinical insight into epileptic seizures in this breed and may be a starting point for further, including genetic, analysis.
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Affiliation(s)
- Marta Plonek
- Neurology Section, Evidensia Hospital Arnhem, Arnhem, Netherlands
| | - Montse M. Diaz-Espineira
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Quirine E. M. Stassen
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | | | - Peter A. J. Leegwater
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Paul J. J. Mandigers
- Neurology Section, Evidensia Hospital Arnhem, Arnhem, Netherlands
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
- *Correspondence: Paul J. J. Mandigers
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7
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Doran CE, McGrath S, Bartner LR, Thomas B, Cribb AE, Gustafson DL. Drug-drug interaction between cannabidiol and phenobarbital in healthy dogs. Am J Vet Res 2022; 83:86-94. [PMID: 34727050 DOI: 10.2460/ajvr.21.08.0120] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess drug-drug interactions between cannabidiol (CBD) and phenobarbital (PB) when simultaneously administered to healthy dogs. ANIMALS 9 healthy, purpose bred Beagles. PROCEDURES A 3-phase prospective, randomized pharmacokinetic (PK) interaction study of CBD and PB was performed as follows: phase 1, CBD PK determination and evaluation of CBD tolerability by 3 single-dose CBD (5 mg/kg, 10 mg/kg, and 20 mg/kg) protocols followed by 2-week CBD dosing; phase 2, a single-dose, 3-way, crossover PK study of CBD (10 mg/kg), PB (4 mg/kg), or CBD (10 mg/kg) administration plus PB (4 mg/kg); and phase 3, evaluation of chronic PB (4 mg/kg, q 30 d) administration followed by single-dose CBD (10 mg/kg) PK study. RESULTS Although there were variations in CBD PK variables in dogs receiving CBD alone or in conjunction with PB, significance differences in CBD PK variables were not found. No significant difference was observed in PB PK variables of dogs receiving PB alone or with CBD. During chronic CBD administration, mild gastrointestinal signs were observed in 5 dogs. At daily CBD doses of 10 to 20 mg/kg/d, hypoxia was observed in 5 dogs and increased serum alkaline phosphatase (ALP) activities (range, 301 to 978 U/L) was observed in 4 dogs. A significant increase in ALP activity was observed with chronic administration of CBD during phase 1 between day 0 and day 14. CONCLUSIONS AND CLINICAL RELEVANCE No significant PK interactions were found between CBD and PB. Dose escalation of CBD or adjustment of PB in dogs is not recommended on the basis of findings of this study.
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Affiliation(s)
- Caitlin E Doran
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO
| | - Stephanie McGrath
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO
| | - Lisa R Bartner
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO
| | - Breonna Thomas
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO
| | - Alastair E Cribb
- Department of Biomedical Sciences, Cummings School of Veterinary Medicine at Tufts University, Grafton, MA
| | - Daniel L Gustafson
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO
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Use of Levetiracetam in Epileptic Dogs with Chronic Kidney Disease: A Retrospective Study. Vet Sci 2021; 8:vetsci8110263. [PMID: 34822636 PMCID: PMC8617888 DOI: 10.3390/vetsci8110263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022] Open
Abstract
In human medicine, doses of levetiracetam (LEV) are individualized for patients with epilepsy, depending on the status of the patient’s renal function. However, there are not reports on the individualized dosing of LEV for small animals. The aim of this study is to investigate whether a dose adjustment of LEV is needed in dogs with chronic kidney disease (CKD). Patient databases were searched, and 37 dogs with seizures or epilepsy were retrospectively included in this study. Based on pre-existing CKD, patients were divided into a CKD group (n = 20) and a non-CKD group (n = 17). We collected kidney panels before and after LEV treatment. Side-effects were monitored for 1 month after the start of LEV administration. In the CKD group, more dogs developed adverse effects (85%) than in the non-CKD group (52.94%). After LEV administration, an increase in blood urea nitrogen and/or serum creatinine was more often reported in the CKD group than it was in the non-CKD group. Our data indicate that in dogs with seizures or epilepsy with pre-existing CKD, an LEV dose-adjustment is needed. During LEV treatment, CKD patients should be monitored for side-effects and may require laboratory evaluation of renal function.
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Mullins RA, Escribano Carrera A, Anderson DM, Billet JP, Brissot H, Broome C, de Rooster H, Kirby BM, Pratschke KM, Tivers MS, White RN, Yool DA, Youmans KR. Postattenuation neurologic signs after surgical attenuation of congenital portosystemic shunts in dogs: A review. Vet Surg 2021; 51:23-33. [PMID: 34585759 DOI: 10.1111/vsu.13729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/26/2021] [Accepted: 03/18/2021] [Indexed: 11/27/2022]
Abstract
The development of postattenuation neurologic signs (PANS) is a poorly understood and potentially devastating complication after surgical attenuation of congenital portosystemic shunts in dogs. Postattenuation neurologic signs include seizures but also more subtle neurologic signs such as depression, behavioral changes, tremors, and twitching. They most commonly occur within 7 days postoperatively and are typically unrelated to hyperammonemia, hypoglycemia, or electrolyte disturbances. This narrative review summarizes the findings of 50 publications from 1988-2020 that report occurrence of PANS. While most published reports included only dogs affected by postattenuation seizures (PAS), others included dogs with any form of PANS. Overall, PANS (including PAS) affected 1.6%-27.3% of dogs, whereas incidence of PAS ranged from 0%-18.2%. The etiology of PANS remains unknown; however, several theories have been proposed. Risk factors include preoperative hepatic encephalopathy, increasing age, and possibly certain breeds and extrahepatic shunt morphology. There is increasing evidence that prophylactic antiepileptic drugs do not prevent PANS. Treatment is centered around controlling neurologic signs with antiepileptic drugs and providing supportive intensive care. The 30-day survival rate in studies that included a minimum of four dogs affected by PANS was 0%-100% (median, 50.0%) and 0%-75.0% (median, 37.5%) for those with PAS. Mortality associated with PANS was typically related to occurrence of generalized seizure activity. Prognostic factors positively associated with short-term survival included having a history of preoperative seizures and development of focal seizures only. If affected dogs survived to discharge, survival for several years was possible, and the majority of neurologic signs manifested as part of the phenomenon of PANS appeared to resolve.
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Affiliation(s)
- Ronan A Mullins
- Section of Small Animal Clinical Sciences, University College Dublin, Dublin, Ireland
| | | | | | | | | | - Cameron Broome
- Veterinary Referral Hospital, Melbourne, Victoria, Australia
| | - Hilde de Rooster
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Barbara M Kirby
- Section of Small Animal Clinical Sciences, University College Dublin, Dublin, Ireland
| | - Kathryn M Pratschke
- Veterinary Clinical Services, The Royal (Dick) School of Veterinary Studies and The Roslin Institute, Easter Bush Campus, Midlothian EH25 9RG, UK
| | - Michael S Tivers
- Paragon Veterinary Referrals, Paragon Business Village, Red Hall Crescent, Wakefield, UK
| | - Robert N White
- School of Veterinary Medicine & Science, University of Nottingham, Sutton Bonington Campus, Loughborough, UK
| | - Donald A Yool
- University of Glasgow, School of Veterinary Medicine, Glasgow, UK
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Berk BA, Law TH, Packer RMA, Wessmann A, Bathen‐Nöthen A, Jokinen TS, Knebel A, Tipold A, Pelligand L, Meads Z, Volk HA. A multicenter randomized controlled trial of medium-chain triglyceride dietary supplementation on epilepsy in dogs. J Vet Intern Med 2020; 34:1248-1259. [PMID: 32293065 PMCID: PMC7255680 DOI: 10.1111/jvim.15756] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 03/12/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Medium-chain triglyceride (MCT) enriched diet has a positive effect on seizure control and behavior in some dogs with idiopathic epilepsy (IE). OBJECTIVE To evaluate the short-term efficacy of MCTs administered as an add-on dietary supplement (DS) to a variable base diet to assess seizure control and antiseizure drug's (ASD) adverse effect profiles. ANIMALS Twenty-eight dogs with International Veterinary Epilepsy Task Force Tier II (IVETF) level diagnosis of treated IE with 3 or more seizures in the last 3 months were used. METHODS A 6-month multicenter, prospective, randomized, double-blinded, placebo-controlled crossover trial was completed, comparing an MCT-DS with a control-DS. A 9% metabolic energy-based amount of MCT or control oil was supplemented to the dogs' diet for 3 months, followed by a control oil or MCT for another 3 months, respectively. Dogs enrolled in this study satisfied most requirements of IE diagnosis stated by the IVETF II level. If they received an oil DS or drugs that could influence the metabolism of the investigated DS or chronic ASD, the chronic ASD medication was adjusted, or other causes of epilepsy were found, the dogs were excluded from the study. RESULTS Seizure frequency (median 2.51/month [0-6.67] versus 2.67/month [0-10.45]; P = .02) and seizure-day frequency were significantly (1.68/month [0-5.60] versus 1.99/month [0-7.42], P = .01) lower when dogs were fed MCT-DS in comparison with the control-DS. Two dogs were free of seizures, 3 had ≥50% and 12 had <50% reductions in seizure frequency, and 11 dogs showed no change or an increase in seizure frequency. CONCLUSIONS AND CLINICAL IMPORTANCE These data show antiseizure properties of an MCT-DS compared to a control oil and support former evidence for the efficacy of MCTs as a nutritive, management option for a subpopulation of drug-resistant dogs with epilepsy.
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Affiliation(s)
- Benjamin A. Berk
- Department of Clinical Science and ServicesRoyal Veterinary CollegeHatfieldUK
- BrainCheck.PetMannheimGermany
| | - Tsz H. Law
- Department of Clinical Science and ServicesRoyal Veterinary CollegeHatfieldUK
| | - Rowena M. A. Packer
- Department of Clinical Science and ServicesRoyal Veterinary CollegeHatfieldUK
| | | | | | - Tarja S. Jokinen
- Faculty of Veterinary Medicine, Department of Equine and Small Animal MedicineHelsinkiFinland
| | - Anna Knebel
- Department of Small Animal Medicine and SurgeryUniversity of Veterinary MedicineHanoverGermany
| | - Andrea Tipold
- Department of Small Animal Medicine and SurgeryUniversity of Veterinary MedicineHanoverGermany
| | - Ludovic Pelligand
- Department of Comparative Biomedical SciencesRoyal Veterinary CollegeHatfieldUK
| | - Zoe Meads
- Department of Clinical Science and ServicesRoyal Veterinary CollegeHatfieldUK
| | - Holger A. Volk
- Department of Clinical Science and ServicesRoyal Veterinary CollegeHatfieldUK
- Department of Small Animal Medicine and SurgeryUniversity of Veterinary MedicineHanoverGermany
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11
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Vitale S, Hague DW, Foss K, de Godoy MC, Selmic LE. Comparison of Serum Trace Nutrient Concentrations in Epileptics Compared to Healthy Dogs. Front Vet Sci 2019; 6:467. [PMID: 31921923 PMCID: PMC6930867 DOI: 10.3389/fvets.2019.00467] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 12/02/2019] [Indexed: 12/11/2022] Open
Abstract
Idiopathic epilepsy (IE) is a common cause of seizures in dogs. There are several investigations regarding serum concentrations of trace nutrients, including copper, selenium, zinc, manganese, and iron in human epileptics and animal models. However, research of this nature in dogs with epilepsy is lacking. The purpose of this prospective study was to compare serum concentrations of several trace nutrients in healthy dogs to dogs with idiopathic epilepsy. Healthy client-owned dogs (n = 50) and dogs with IE (n = 92) were enrolled and blood samples were collected for trace nutrient analysis. Epileptics were subdivided into three groups: controlled: n = 27, uncontrolled: n = 42, and untreated: n = 23. Serum was evaluated for concentrations of copper, selenium, zinc, cobalt, manganese, molybdenum, and iron using inductively coupled plasma mass spectroscopy. Uncontrolled epileptics had significantly higher manganese concentrations compared to normal dogs (p = 0.007). Untreated epileptics had higher iron levels than the other three groups (p = 0.04). Significantly higher levels of copper (p < 0.0001) were found in controlled and uncontrolled epileptics compared to normal or untreated dogs. Significantly higher levels of molybdenum (p = 0.01) were found in controlled epileptics compared to normal or untreated epileptics. Uncontrolled and controlled epileptics had significantly higher levels of selenium (p = 0.0003) vs. normal dogs, and uncontrolled epileptics had higher levels of zinc (p = 0.0002) than normal and untreated dogs. The significant difference in serum concentrations of several trace nutrients (manganese, selenium, and zinc) may suggest a role for these nutrients in the pathophysiology and/or treatment of epilepsy. Additionally, these results suggest that anti-convulsant therapy may affect copper and molybdenum metabolism.
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Affiliation(s)
- Samantha Vitale
- Department of Veterinary Clinical Medicine, University of Illinois, Urbana, IL, United States
| | - Devon Wallis Hague
- Department of Veterinary Clinical Medicine, University of Illinois, Urbana, IL, United States
| | - Kari Foss
- Department of Veterinary Clinical Medicine, University of Illinois, Urbana, IL, United States
| | | | - Laura E Selmic
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, United States
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12
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Mullins RA, Sanchez Villamil C, de Rooster H, Kummeling A, White RN, Thieman Mankin KM, Tivers MS, Yool DA, Anderson DM, Pratschke KM, Gordo I, Brissot H, Singh A, Olive M, Billet JP, Selmic LE, Kirby BM. Effect of prophylactic treatment with levetiracetam on the incidence of postattenuation seizures in dogs undergoing surgical management of single congenital extrahepatic portosystemic shunts. Vet Surg 2018; 48:164-172. [DOI: 10.1111/vsu.13141] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 10/12/2018] [Accepted: 11/06/2018] [Indexed: 02/01/2023]
Affiliation(s)
- Ronan A. Mullins
- Section of Veterinary Clinical Sciences; University College Dublin; Belfield Dublin Ireland
| | | | - Hilde de Rooster
- Small Animal Department, Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - Anne Kummeling
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine; Utrecht University; Utrecht The Netherlands
| | - Robert N. White
- Willows Veterinary Centre and Referral Service; Shirley, Solihull West Midlands United Kingdom
- Abbey House Veterinary Hospital; Morley Leeds United Kingdom
- School of Veterinary Medicine & Science; University of Nottingham, Sutton Bonington Campus; Loughborough United Kingdom
| | - Kelley M. Thieman Mankin
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences; Texas A&M University; College Station Texas
| | - Michael S. Tivers
- Bristol Veterinary School; University of Bristol, Langford House; Langford Bristol United Kingdom
| | - Donald A. Yool
- The Royal (Dick) School of Veterinary Studies, Easter Bush Campus; Midlothian Edinburgh United Kingdom
| | - Davina M. Anderson
- Anderson Moores Veterinary Specialists; Hursley Winchester United Kingdom
| | - Kathryn M. Pratschke
- North East Veterinary Referrals, Northumberland Business Park West; Cramlington Northumberland United Kingdom
- University of Glasgow School of Veterinary Medicine; Bearsden Glasgow United Kingdom
| | - Ines Gordo
- Pride Veterinary Centre; Derby Derbyshire United Kingdom
| | - Herve Brissot
- Pride Veterinary Centre; Derby Derbyshire United Kingdom
| | - Ameet Singh
- Department of Clinical Studies, Ontario Veterinary College; University of Guelph; Guelph Ontario Canada
| | - Melanie Olive
- Centre Hospitalier Vétérinaire Atlantia; Nantes France
| | | | - Laura E. Selmic
- Department of Veterinary Clinical Sciences; The Ohio State University, 601 Vernon L Tharp St; Columbus OH 43210
| | - Barbara M. Kirby
- Section of Veterinary Clinical Sciences; University College Dublin; Belfield Dublin Ireland
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13
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Muñana KR, Otamendi AJ, Nettifee JA, Papich MG. Population pharmacokinetics of extended-release levetiracetam in epileptic dogs when administered alone, with phenobarbital or zonisamide. J Vet Intern Med 2018; 32:1677-1683. [PMID: 30238679 PMCID: PMC6189379 DOI: 10.1111/jvim.15298] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 06/08/2018] [Accepted: 07/17/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Extended-release levetiracetam (LEV-XR) has gained acceptance as an antiepileptic drug in dogs. No studies have evaluated its disposition in dogs with epilepsy. HYPOTHESIS/OBJECTIVES To evaluate the pharmacokinetics of LEV-XR in epileptic dogs when administered alone or with phenobarbital or zonisamide. ANIMALS Eighteen client-owned dogs on steady-state maintenance treatment with LEV-XR (Group L, n = 6), LEV-XR and phenobarbital (Group LP, n = 6), or LEV-XR and zonisamide (Group LZ, n = 6). METHODS Pharmacokinetic study. Blood samples were collected at 0, 2, 4, 8, and 12 hours after LEV-XR was administered with food. Plasma LEV concentrations were determined by high-pressure liquid chromatography. A population pharmacokinetic approach and nonlinear mixed effects modeling were used to analyze the data. RESULTS Treatment group accounted for most of the interindividual variation. The LP group had lower CMAX (13.38 μg/mL) compared to the L group (33.01 μg/mL) and LZ group (34.13 μg/mL), lower AUC (134.86 versus 352.95 and 452.76 hours·μg/mL, respectively), and higher CL/F (0.17 versus 0.08 and 0.07 L/kg/hr, respectively). The half-life that defined the terminal slope of the plasma concentration versus time curve (~5 hours) was similar to values previously reported for healthy dogs. CONCLUSIONS AND CLINICAL IMPORTANCE Considerable variation exists in the pharmacokinetics of LEV-XR in dogs with epilepsy being treated with a common dose regimen. Concurrent administration of phenobarbital contributed significantly to the variation. Other factors evaluated, including co-administration of zonisamide, were not shown to contribute to the variability. Drug monitoring may be beneficial to determine the most appropriate dose of LEV-XR in individual dogs.
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Affiliation(s)
- Karen R. Muñana
- Department of Clinical SciencesCollege of Veterinary Medicine, North Carolina State UniversityRaleighNC
| | - Arturo J. Otamendi
- Department of Clinical SciencesCollege of Veterinary Medicine, North Carolina State UniversityRaleighNC
| | - Julie A. Nettifee
- Department of Clinical SciencesCollege of Veterinary Medicine, North Carolina State UniversityRaleighNC
| | - Mark G. Papich
- Department of Molecular and Biomedical SciencesCollege of Veterinary Medicine, North Carolina State UniversityRaleighNC
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14
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Investigating owner use of dietary supplements in dogs with idiopathic epilepsy. Res Vet Sci 2018; 119:276-284. [PMID: 30064067 DOI: 10.1016/j.rvsc.2018.07.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 06/01/2018] [Accepted: 07/21/2018] [Indexed: 12/29/2022]
Abstract
Epilepsy is the most common chronic neurological disorder in dogs. Some diets have been shown to have a positive impact upon the seizure activity in dogs with idiopathic epilepsy (IE), while other diets and dietary supplements (DS), although marketed as providing health benefits, lack conclusive scientific evidence on their actual beneficial effects. A web-based owner questionnaire was designed to assess how and why owners of dogs with IE use different dietary regimes and DS. The study cohort, with 297 valid responses, consisted mainly of pure-breed (82.5%) male neutered (52.9%) dogs. Over two-thirds of owners (67.7%) changed their dog's diet after their dog received a diagnosis of IE. Nearly half of the owners (45.8%) reported giving DS, the most common being coconut oil or derived medium-chain triglyceride oil (71.3%). Some owner justifications of DS use included improvement of seizure frequency (88.2%), seizure severity (61.8%) and protection from potential drug side effects (62.5%). Many owners give DS to their dog with IE. The pharmacokinetic properties of anti-epileptic drugs, such as efficacy, absorption and clearance can be influenced by other medications, diets and possibly by DS. We propose that use of DS should be considered and monitored by veterinary surgeons in epilepsy management.
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15
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Cagnotti G, Odore R, Gardini G, Amedeo S, Bertone I, Guerriero G, Lentini L, Dappiano E, D'Angelo A. Pharmacokinetics of rectal levetiracetam as add-on treatment in dogs affected by cluster seizures or status epilepticus. BMC Vet Res 2018; 14:189. [PMID: 29914474 PMCID: PMC6006693 DOI: 10.1186/s12917-018-1522-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 06/12/2018] [Indexed: 12/02/2022] Open
Abstract
Background Levetiracetam can be used for seizure control alone or in combination with other antiepileptic medications. A previous study achieved the minimum targeted serum drug concentration after rectal administration of levetiracetam in healthy dogs. The purpose of the present study was to determine the pharmacokinetics of rectal LEV in dogs presented for cluster seizures or status epilepticus and potentially in treatment with other anti-epileptic drugs. Furthermore, preliminary information on response to this treatment as add-on to the standard treatment protocol is reported. Results Eight client-owned dogs were enrolled. Plasma levetiracetam concentrations (measured at 0, 30, 60, 90, 120, 180, 240, 360, 720, and 1440 min after drug administration) reached the minimum target concentration (5 μg/ml) at 30 min in all but one patient. At T1 (30 min) the mean concentration was 28.2 ± 15.5 μg/ml. Plasma concentrations remained above the targeted minimum concentration in all patients until 240 min and in 7/8 until 360 min. Six out of eight patients experienced no seizures in the 24-h period after hospitalization and were classified as “responders”. Conclusions Minimum plasma levetiracetam concentration can be reached after rectal administration of 40 mg/kg in dogs affected by cluster seizures and status epilepticus and concurrently receiving other antiepileptic drugs. These preliminary results may encourage the evaluation of rectal levetiracetam as an additional treatment option for cluster seizures and status epilepticus in a larger number of dogs. Electronic supplementary material The online version of this article (10.1186/s12917-018-1522-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Giulia Cagnotti
- Department of Veterinary Science, University of Turin, Via Largo Braccini 2, 10095, Grugliasco, Turin, Italy.
| | - Rosangela Odore
- Department of Veterinary Science, University of Turin, Via Largo Braccini 2, 10095, Grugliasco, Turin, Italy
| | - Giulia Gardini
- Department of Veterinary Science, University of Turin, Via Largo Braccini 2, 10095, Grugliasco, Turin, Italy
| | - Stefano Amedeo
- Department of Veterinary Science, University of Turin, Via Largo Braccini 2, 10095, Grugliasco, Turin, Italy
| | - Iride Bertone
- Department of Veterinary Science, University of Turin, Via Largo Braccini 2, 10095, Grugliasco, Turin, Italy
| | - Giulia Guerriero
- Department of Veterinary Science, University of Turin, Via Largo Braccini 2, 10095, Grugliasco, Turin, Italy
| | - Laura Lentini
- Department of Veterinary Science, University of Turin, Via Largo Braccini 2, 10095, Grugliasco, Turin, Italy
| | - Elena Dappiano
- Department of Veterinary Science, University of Turin, Via Largo Braccini 2, 10095, Grugliasco, Turin, Italy
| | - Antonio D'Angelo
- Department of Veterinary Science, University of Turin, Via Largo Braccini 2, 10095, Grugliasco, Turin, Italy
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16
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Meland T, Carrera-Justiz S. A Review: Emergency Management of Dogs With Suspected Epileptic Seizures. Top Companion Anim Med 2018; 33:17-20. [PMID: 29793724 DOI: 10.1053/j.tcam.2018.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 03/16/2018] [Accepted: 03/17/2018] [Indexed: 11/11/2022]
Abstract
Dogs with seizure disorders are commonly presented to the general practitioner for initial evaluation. The most common diagnosis provided is idiopathic epilepsy. As witnessing seizures is often traumatic for owners, it is important for the practitioner to understand seizure classification, know when to initiate antiepileptic drug therapy and be comfortable with client education regarding seizures. This review briefly discusses the most up-to-date classification of seizures, the necessity to obtain accurate histories and complete examinations, base-line diagnostics to perform, the importance of owner education, and when to start medications. This is not intended to discuss detailed differential lists, in-depth information on antiepileptic drug therapy, long-term management of epileptics or those refractory to their current treatment.
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Affiliation(s)
- Tessa Meland
- Department of Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, FL, USA
| | - Sheila Carrera-Justiz
- Department of Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, FL, USA.
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17
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Kelly D, Raimondi F, Shihab N. Levetiracetam monotherapy for treatment of structural epilepsy in dogs: 19 cases (2010-2015). Vet Rec 2017; 181:401. [DOI: 10.1136/vr.104190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 06/27/2017] [Accepted: 07/29/2017] [Indexed: 01/11/2023]
Affiliation(s)
- Darren Kelly
- Department of Internal Medicine; Southern Counties Veterinary Specialists LLP; Ringwood UK
| | - Francesca Raimondi
- Department of Neurology and Neurosurgery; Southern Counties Veterinary Specialists LLP; Ringwood UK
| | - Nadia Shihab
- Department of Neurology and Neurosurgery; Southern Counties Veterinary Specialists; Ringwood Hampshire UK
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18
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Vuu I, Coles LD, Maglalang P, Leppik IE, Worrell G, Crepeau D, Mishra U, Cloyd JC, Patterson EE. Intravenous Topiramate: Pharmacokinetics in Dogs with Naturally Occurring Epilepsy. Front Vet Sci 2016; 3:107. [PMID: 27995128 PMCID: PMC5136567 DOI: 10.3389/fvets.2016.00107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 11/15/2016] [Indexed: 11/13/2022] Open
Abstract
RATIONALE Barriers to developing treatments for human status epilepticus include the inadequacy of experimental animal models. In contrast, naturally occurring canine epilepsy is similar to the human condition and can serve as a platform to translate research from rodents to humans. The objectives of this study were to characterize the pharmacokinetics of an intravenous (IV) dose of topiramate (TPM) in dogs with epilepsy and evaluate its effect on intracranial electroencephalographic (iEEG) features. METHODS Five dogs with naturally occurring epilepsy were used for this study. Three were getting at least one antiseizure drug as maintenance therapy including phenobarbital (PB). Four (ID 1-4) were used for the 10 mg/kg IV TPM + PO TPM study, and three (ID 3-5) were used for the 20 mg/kg IV TPM study. IV TPM was infused over 5 min at both doses. The animals were observed for vomiting, diarrhea, ataxia, and lethargy. Blood samples were collected at scheduled pre- and post-dose times. Plasma concentrations were measured using a validated high-performance liquid chromatography-mass spectrometry method. Non-compartmental and population compartmental modeling were performed (Phoenix WinNonLin and NLME) using plasma concentrations from all dogs in the study. iEEG was acquired in one dog. The difference between averaged iEEG energy levels at 15 min pre- and post-dose was assessed using a Kruskal-Wallis test. RESULTS No adverse events were noted. TPM concentration-time profiles were best fit by a two compartment model. PB co-administration was associated with a 5.6-fold greater clearance and a ~4-fold shorter elimination half-life. iEEG data showed that TPM produced a significant energy increase at frequencies >4 Hz across all 16 electrodes within 15 min of dosing. Simulations suggested that dogs on an enzyme inducer would require 25 mg/kg, while dogs on non-inducing drugs would need 20 mg/kg to attain the target concentration (20-30 μg/mL) at 30 min post-dose. CONCLUSION This study shows that IV TPM has a relatively rapid onset of action, loading doses appear safe, and the presence of PB necessitates a higher dose to attain targeted concentrations. Consequently, it is a good candidate for further evaluation for treatment of seizure emergencies in dogs and people.
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Affiliation(s)
- Irene Vuu
- Center for Orphan Drug Research, University of Minnesota, Minneapolis, MN, USA; Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Lisa D Coles
- Center for Orphan Drug Research, University of Minnesota, Minneapolis, MN, USA; Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Patricia Maglalang
- Center for Orphan Drug Research, University of Minnesota, Minneapolis, MN, USA; College of Science and Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Ilo E Leppik
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA; UMP MINCEP Epilepsy Care, Minneapolis, MN, USA
| | | | | | - Usha Mishra
- Center for Orphan Drug Research, University of Minnesota , Minneapolis, MN , USA
| | - James C Cloyd
- Center for Orphan Drug Research, University of Minnesota, Minneapolis, MN, USA; Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, USA
| | - Edward E Patterson
- College of Veterinary Medicine, University of Minnesota , Saint Paul, MN , USA
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19
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Podell M, Volk HA, Berendt M, Löscher W, Muñana K, Patterson EE, Platt SR. 2015 ACVIM Small Animal Consensus Statement on Seizure Management in Dogs. J Vet Intern Med 2016; 30:477-90. [PMID: 26899355 PMCID: PMC4913615 DOI: 10.1111/jvim.13841] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 01/18/2016] [Accepted: 01/18/2016] [Indexed: 11/27/2022] Open
Abstract
This report represents a scientific and working clinical consensus statement on seizure management in dogs based on current literature and clinical expertise. The goal was to establish guidelines for a predetermined, concise, and logical sequential approach to chronic seizure management starting with seizure identification and diagnosis (not included in this report), reviewing decision‐making, treatment strategies, focusing on issues related to chronic antiepileptic drug treatment response and monitoring, and guidelines to enhance patient response and quality of life. Ultimately, we hope to provide a foundation for ongoing and future clinical epilepsy research in veterinary medicine.
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Affiliation(s)
- M Podell
- Medvet Chicago, Medical and Cancer Centers for Pets, Chicago, IL.,Department of Neurosurgery, Pritzker School of Medicine, The University of Chicago, Chicago, IL
| | - H A Volk
- Department of Clinical Sciences and Services, Small Animal Medicine and Surgery Group, The Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - M Berendt
- Department of Veterinary and Clinical Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - W Löscher
- Department of Pharmacology, Toxicology and Pharmacy, University of Veterinary Medicine, Hannover, Germany.,Center for Systems Neuroscience, Hannover, Germany
| | - K Muñana
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
| | - E E Patterson
- Department of Veterinary Clinical Sciences, University of Minnesota College of Veterinary Medicine, St. Paul, MN
| | - S R Platt
- Department of Small Animal Medicine & Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA
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20
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Fredsø N, Sabers A, Toft N, Møller A, Berendt M. A single-blinded phenobarbital-controlled trial of levetiracetam as mono-therapy in dogs with newly diagnosed epilepsy. Vet J 2015; 208:44-9. [PMID: 26639829 DOI: 10.1016/j.tvjl.2015.10.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 09/28/2015] [Accepted: 10/05/2015] [Indexed: 11/18/2022]
Abstract
Treatment of canine epilepsy is problematic. Few antiepileptic drugs have proven efficacy in dogs and undesirable adverse effects and pharmacoresistance are not uncommon. Consequently, the need for investigation of alternative treatment options is ongoing. The objective of this study was to investigate the efficacy and tolerability of levetiracetam as mono-therapy in dogs with idiopathic epilepsy. The study used a prospective single-blinded parallel group design. Twelve client-owned dogs were included and were randomised to treatment with levetiracetam (30 mg/kg/day or 60 mg/kg/day divided into three daily dosages) or phenobarbital (4 mg/kg/day divided twice daily). Control visits were at days 30, 60 and then every 3 months for up to 1 year. Two or more seizures within 3 months led to an increase in drug dosage (levetiracetam: 10 mg/kg/day, phenobarbital: 1 mg/kg/day). Five of six levetiracetam treated dogs and one of six phenobarbital treated dogs withdrew from the study within 2-5 months due to insufficient seizure control. In the levetiracetam treated dogs there was no significant difference in the monthly number of seizures before and after treatment, whereas in the phenobarbital treated dogs there were significantly (P = 0.013) fewer seizures after treatment. Five phenobarbital treated dogs were classified as true responders (≥50% reduction in seizures/month) whereas none of the levetiracetam treated dogs fulfilled this criterion. Adverse effects were reported in both groups but were more frequent in the phenobarbital group. In this study levetiracetam was well tolerated but was not effective at the given doses as mono-therapy in dogs with idiopathic epilepsy.
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Affiliation(s)
- N Fredsø
- Department of Veterinary Clinical and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlaegevej 16, 1870 Frederiksberg C, Denmark.
| | - A Sabers
- The Epilepsy Clinic, Department of Neurology, University State Hospital (Rigshospitalet), Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - N Toft
- National Veterinary Institute, Section for Epidemiology, Technical University of Denmark, Bülowsvej 27, 1870 Frederiksberg C, Denmark
| | - A Møller
- Centre of Functional Integrative Neuroscience, Aarhus University/Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark
| | - M Berendt
- Department of Veterinary Clinical and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlaegevej 16, 1870 Frederiksberg C, Denmark
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21
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Bhatti SFM, De Risio L, Muñana K, Penderis J, Stein VM, Tipold A, Berendt M, Farquhar RG, Fischer A, Long S, Löscher W, Mandigers PJJ, Matiasek K, Pakozdy A, Patterson EE, Platt S, Podell M, Potschka H, Rusbridge C, Volk HA. International Veterinary Epilepsy Task Force consensus proposal: medical treatment of canine epilepsy in Europe. BMC Vet Res 2015; 11:176. [PMID: 26316233 PMCID: PMC4552371 DOI: 10.1186/s12917-015-0464-z] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 06/29/2015] [Indexed: 12/14/2022] Open
Abstract
In Europe, the number of antiepileptic drugs (AEDs) licensed for dogs has grown considerably over the last years. Nevertheless, the same questions remain, which include, 1) when to start treatment, 2) which drug is best used initially, 3) which adjunctive AED can be advised if treatment with the initial drug is unsatisfactory, and 4) when treatment changes should be considered. In this consensus proposal, an overview is given on the aim of AED treatment, when to start long-term treatment in canine epilepsy and which veterinary AEDs are currently in use for dogs. The consensus proposal for drug treatment protocols, 1) is based on current published evidence-based literature, 2) considers the current legal framework of the cascade regulation for the prescription of veterinary drugs in Europe, and 3) reflects the authors' experience. With this paper it is aimed to provide a consensus for the management of canine idiopathic epilepsy. Furthermore, for the management of structural epilepsy AEDs are inevitable in addition to treating the underlying cause, if possible.
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Affiliation(s)
- Sofie F M Bhatti
- Department of Small Animal Medicine and Clinical Biology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, Merelbeke, 9820, Belgium.
| | - Luisa De Risio
- Animal Health Trust, Lanwades Park, Kentford, Newmarket, CB8 7UU, Suffolk, United Kingdom.
| | - Karen Muñana
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1052 William Moore Drive, Raleigh, NC, 27607, USA.
| | - Jacques Penderis
- Vet Extra Neurology, Broadleys Veterinary Hospital, Craig Leith Road, Stirling, FK7 7LE, Stirlingshire, United Kingdom.
| | - Veronika M Stein
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany.
| | - Andrea Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany.
| | - Mette Berendt
- Department of Veterinary and Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg C, Denmark.
| | - Robyn G Farquhar
- Fernside Veterinary Centre, 205 Shenley Road, Borehamwood, SG9 0TH, Hertfordshire, United Kingdom.
| | - Andrea Fischer
- Clinical Veterinary Medicine, Ludwig-Maximillians-University, Veterinärstr. 13, 80539, Munich, Germany.
| | - Sam Long
- University of Melbourne, 250 Princes Highway, Weibee, 3015, VIC, Australia.
| | - Wolfgang Löscher
- Department of Pharmacology, Toxicology and Pharmacy, University of Veterinary Medicine Hannover, Bünteweg 17, 30559, Hannover, Germany.
| | - Paul J J Mandigers
- Department of Clinical Sciences of Companion Animals, Utrecht University, Yalelaan 108, 3583 CM, Utrecht, The Netherlands.
| | - Kaspar Matiasek
- Section of Clinical & Comparative Neuropathology, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-University, Veterinärstr. 13, 80539, Munich, Germany.
| | - Akos Pakozdy
- Clinical Unit of Internal Medicine Small Animals, University of Veterinary Medicine, Veterinärplatz 1, 1210, Vienna, Austria.
| | - Edward E Patterson
- University of Minnesota College of Veterinary Medicine, D426 Veterinary Medical Center, 1352 Boyd Avenue, St. Paul, MN, 55108, USA.
| | - Simon Platt
- College of Veterinary Medicine, University of Georgia, 501 DW Brooks Drive, Athens, GA, 30602, USA.
| | - Michael Podell
- Chicago Veterinary Neurology and Neurosurgery, 3123 N. Clybourn Avenue, Chicago, IL, 60618, USA.
| | - Heidrun Potschka
- Department of Pharmacology, Toxicology and Pharmacy, Ludwig-Maximillians-University, Königinstr. 16, 80539, Munich, Germany.
| | - Clare Rusbridge
- Fitzpatrick Referrals, Halfway Lane, Eashing, Godalming, GU7 2QQ, Surrey, United Kingdom.
- School of Veterinary Medicine, Faculty of Health & Medical Sciences, University of Surrey, Guildford, GU2 7TE, Surrey, United Kingdom.
| | - Holger A Volk
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, AL9 7TA, Hertfordshire, UK.
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