Effect of prophylactic treatment with levetiracetam on the incidence of postattenuation seizures in dogs undergoing surgical management of single congenital extrahepatic portosystemic shunts

Abstract

Objective: To report the incidence of postattenuation seizures (PAS) in dogs that underwent single congenital extrahepatic portosystemic shunt (cEHPSS) attenuation and to compare incidence of PAS in dogs that either did or did not receive prophylactic treatment with levetiracetam (LEV). Study design: Multi-institutional retrospective study. Population: Nine hundred forty dogs. Methods: Medical records were reviewed to identify dogs that underwent surgical attenuation of a single cEHPSS from January 2005 through July 2017 and developed PAS within 7 days postoperatively. Dogs were divided into 3 groups: no LEV (LEV−); LEV at ≥15 mg/kg every 8 hours for ≥24 hours preoperatively or a 60 mg/kg intravenous loading dose perioperatively, followed by ≥15 mg/kg every 8 hours postoperatively (LEV1); and LEV at <15 mg/kg every 8 hours, for <24 hours preoperatively, or continued at <15 mg/kg every 8 hours postoperatively (LEV2).Preliminary results of this study were presented at the Association

Long‐term clinical outcomes of dogs with single congenital extrahepatic portosystemic shunts attenuated with thin film banding or ameroid ring constrictors

“…Postoperative seizures were recorded in 10 (8%) dogs in our study, with nine of those dogs consequently dying. These findings are similar to those previously published . Preoperative levetiracetam use was different between the TFB and ARC groups, with a larger proportion of dogs in the TFB group receiving preoperative levetiracetam.…”

“…In two recent studies of dogs undergoing gradual attenuation of a CEHPSS, prophylactic administration of levetiracetam did not influence the occurrence of postoperative seizures . Our results provide additional evidence regarding the lack of preventive effects of preoperative administration of levetiracetam on postoperative seizures in dogs undergoing gradual attenuation of CEHPSS …”

“…The surgeon's choice of administration of levetiracetam likely increased after publication of a study that provided evidence that preoperative treatment with the drug reduced the incidence of postoperative seizures . In two recent studies of dogs undergoing gradual attenuation of a CEHPSS, prophylactic administration of levetiracetam did not influence the occurrence of postoperative seizures . Our results provide additional evidence regarding the lack of preventive effects of preoperative administration of levetiracetam on postoperative seizures in dogs undergoing gradual attenuation of CEHPSS …”

“…These findings are similar to those previously published. 10,[18][19][20] Preoperative levetiracetam use was different between the TFB and ARC groups, with a larger proportion of dogs in the TFB group receiving preoperative levetiracetam. At both institutions, gradual attenuation of CEHPSS with TFB was more frequently performed than the use of an ARC after 2011.…”

“…There was no difference in frequency of postoperative seizures occurring between dogs with preoperative CNS signs (3/64 [4.7%]) and those without preoperative CNS signs (7/59 [11.9%]; P = . 19).…”