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CONTRIBUTOR(S): Vetstream Ltd, Laurent Garosi, Fear Free,

Epilepsy treatment

Epilepsy treatment

If your dog has recently been diagnosed as having epilepsy you may be concerned about the future. Discuss your concerns with your veterinarian – it is important that you fully understand the goals of treatment right from the start.

©Douglas McCallum

Will my dog get better?

Epileptic animals are born with the condition and cannot be cured. The aim of treatment is to control their seizures. Whilst anti-epileptic drugs will make some animals seizure-free, for most treatment is judged to be successful if the frequency and severity of the seizures is reduced with few side-effects with the best quality of life for both you and your pet. You must understand that, if your dog is epileptic, they are likely to continue to have some seizures despite being on treatment. It is not possible to achieve seizure control in some dogs despite adequate therapy.

When should treatment be started?

Once treatment for epilepsy starts it is likely to be continued lifelong. Many dogs only have a single seizure episode, and so it is not sensible to put all these animals on permanent treatment (when many would not have another seizure anyway).

There are two schools of thought. Many dogs will have a single seizure episode in their lives, therefore it may not be feasible to treat every dog that seizures. The first school of thought advises treatment of seizures as soon as a dog is diagnosed as having recurrent seizures (ie after the second seizure episode). Experimental evidence and a single study in dogs suggest that early treatment for epilepsy in dogs offers better long-term control of the seizures as compared to animals that are allowed to have numerous seizures prior to the onset of treatment.

The second school requires balancing the benefits gained from the introduction of anti-epileptic therapy with the adverse effects caused by the medication and the demands on the owner.

Although largely arbitrary, the following would be a reasonable guide to starting treatment for epilepsy in dogs:

  • They are having more than one seizure a month and/or you find the frequency distressing.
  • They have a very severe seizure or cluster of seizures, whatever the frequency.
  • Their seizures are increasing in frequency or severity.
  • Underlying brain disease has been identified as the cause of the seizures.

What drugs are used for the treatment of epilepsy?

Many drugs used in people with epilepsy are either toxic to pets or are removed from the body so quickly that good control of seizures cannot be achieved. The first line treatment in dogs is usually either phenobarbitone or imepitoin (Pexion®) which are both veterinary licensed drugs. These two drugs have similar efficacy in term of seizure control and your veterinarian who will be able to discuss with you pros and cons of each. Consideration must be taken for seizures’ frequency, presence of cluster (= more than one seizure in one day), need of regular blood testing for drug monitoring and potential side effects. Diazepam is not suitable for maintenance treatment of epilepsy in dogs as the duration of effect is too short.

Why does my veterinarian need to take blood tests from my pet?

Regular blood testing is necessary when using phenobarbitone but not with imepitoin.

Individual animals respond in different ways to anti-epileptic treatment. If using imepitoin your veterinarian will usually start at a low dose and increase up to the maximum recommended dose to effect (eg reduction in seizure frequency with no/minimum side effects).

If using phenobarbitone, it is not the number of tablets given that is important but the level of drug in the body. The blood level of drug determines not only the good effects (also known as therapeutic effects) but also the toxic effects. Blood levels of phenobarbitone can be measured to ensure that they are within a certain range (therapeutic range) that controls seizures with minimal side effects. Failure to be within this range (concentration too low or too high) means that the quantity of tablet should be adapted and the concentration re-checked a few weeks later. Response to treatment for epilepsy is extremely variable between animals. Some will need to be at the low end of the therapeutic range while others will need to be at the top end to experience therapeutic effect. This means that checking the concentrations are within the therapeutic range is not enough and consideration must be given to what effects (beneficial or undesirable) it has on the animal.

Furthermore, the concentration of phenobarbitone tends to drop with time in dogs (more or less quickly depending on the dog) if the quantity of tablet is kept unchanged. This means that the quantity of tablet will likely need to be increased to keep the blood concentration at the same level. Again this does not imply the animal will more likely suffer side effects as the inefficient, therapeutic and toxic effects are related to the quantity of drug in the blood and not the quantity of tablets given.

When should blood samples be taken?

Blood levels of phenobarbitone should be measured:

  • 2 weeks after starting treatment or changing the dosage.
  • If the seizures seem to be occurring more often.
  • Every 3 to 6 months to check that blood concentration does not drift out of the intended range.
  • When drug-related side effects are suspected.

What are the side effects of anti-epileptic drugs?

Occasionally the side effects of drugs used in the management of epileptic seizures can be worse than the seizures themselves. Mild side effects are common when treatment is first started (or the dose is increased). Phenobarbitone can cause increased thirst and appetite, more frequent urination, mild sedation and mild wobbliness in the back legs. More serious side effects are rarely seen with phenobarbitone but include liver toxicity and blood abnormalities (low red blood cells, low platelets and low white blood cell count). Complete blood profiles (liver function tests and hematology) are recommended on a three month basis in the first year then every six month thereafter to monitor for such potential side-effects.

Imepitoin is usually well tolerated by dogs and most dogs suffer no ill effects from the dose they receive. Increase sedation, appetite, drinking and wobbliness are occasionally seen. Some dogs have shown signs of vomiting and diarrhea but this is very rare.

My dog is not responding to anti-epileptic drugs what now?

There are many reasons why an animal may not respond to treatment:

  • Incorrect diagnosis of epilepsy (if there is an underlying cause for the epileptic seizures or the animal is not having an epileptic seizure but for example a paroxysmal dyskinesia).
  • Insufficient dose of medication.
  • Development of resistance to the effect of the drug (also known as refractory/pharmacoresistant epilepsy).

If the quality of life of an epileptic animal is compromised by frequent and/or severe seizures despite appropriate choice and blood concentration of drug, they can be classified as having refractory epilepsy.

If your pet is on either phenobarbitone or imepitoin and not responding well to the treatment in terms of frequency despite checking for the above reasons, then one option is to add either imepitoin (Pexion®) or phenobarbitone respectively. Other options include the use of potassium bromide which is licensed as an add-on drug in dogs not responding to phenobarbitone. Finally, your veterinarian may elect to use one of the following human anti-epileptic medications which can be used in dogs: levetiracetam (Keppra®), zonisamide (Zonigram®) or topiramate (Topamax®).

Rectal diazepam can be used at home in dogs with a tendency of severe cluster seizures to reduce the total number of seizure events during a cluster.

Does my dog need to stay on anti-epileptic drug for life?

It is very likely that your pet will have to stay on treatment for the rest of its life. It is important not to alter or stop your pet’s treatment without veterinary advice. Dosage reduction should only be considered if your pet has had no seizures for at least a year. Sudden changes in the blood levels of anti-epileptic drugs can trigger seizures. If drug doses are reduced this should be done very gradually over many months. However, if your pet is not experiencing significant side effects, you should not be concerned that they need to remain on treatment.

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