Evaluation of therapeutic phenobarbital concentrations and application of a classification system for seizures in cats: 30 cases (2004–2013)

Finnerty, Katherine E.; Heller, Heidi Barnes; Mercier, Miyu N.; Giovanella, Carley J.; Lau, Vivian W; Rylander, Helena

doi:10.2460/javma.244.2.195

Cited by 32 publications

(56 citation statements)

References 20 publications

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“…Epileptic seizures are the most common reason cats are presented to veterinary neurologists and often antiepileptic drugs (AED) are recommended for long‐term seizure control regardless of the etiologic diagnosis. Although many cats have favorable seizure control with PO administration of phenobarbital and intermediate‐release levetiracetam (IRL), administration 2–3 times daily long‐term may be difficult for owners, leading to poor compliance.…”

Section: Introductionmentioning

confidence: 99%

Serum levetiracetam concentrations and adverse events after multiple dose extended release levetiracetam administration to healthy cats

Heller

Granick

Hesteren

et al. 2018

Veterinary Internal Medicne

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BackgroundMultiple dose administration of antiepileptic drugs to cats presents a challenge for owners. Extended release levetiracetam (XRL) has once daily recommended dosing interval, but multiple dose administration of XRL has not been evaluated in cats.ObjectiveEvaluate serum levetiracetam concentrations and adverse clinical effects after 11 days of once daily XRL administration to healthy cats.AnimalsNine healthy privately owned cats, body weight ≥ 5 kgMethodsExtended release levetiracetam (500 mg/cat) was administered PO q24h for 10 days. On day 11, blood was collected at trough, 4, 6, and 8 hours after tablet administration. Owners maintained records of adverse effects throughout study. Levetiracetam was quantitated in serum using immunoassay validated in cats.ResultsMedian dose 94.3 mg/kg q24h. Median (range) trough, 4, 6, and 8 hour serum levetiracetam concentrations were 7.0 (2.3‐14.1), 82.6 (7.8‐125.3), 92.3 (13.3‐97.3), and 72 (22.8‐96.4) μg/mL, respectively. Peak was not observed in 4 cats because of missed samples (n = 2) and failure to reach maximal concentration (C max) by 8 hours (n = 2). Median time of maximal concentration (T max) for the remaining 5 cats 5.2 (range 4‐6) hours. Adverse effects were minimal and included ataxia (n = 1), sedation (n = 1), and vomiting or regurgitation (n = 1). All signs resolved without dose adjustment or additional treatment.Conclusions and Clinical ImportanceMean trough serum levetiracetam concentrations were ≥5 μg/mL and adverse effects were minimal throughout dosing period, indicating that the drug was well tolerated. Once daily XRL (500 mg/cat) administration may provide an easier alternative to 3 times daily dosing of intermediate‐release levetiracetam for epileptic cats.

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Section: Introductionmentioning

confidence: 99%

Serum levetiracetam concentrations and adverse events after multiple dose extended release levetiracetam administration to healthy cats

Heller

Granick

Hesteren

et al. 2018

Veterinary Internal Medicne

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“…In this prospective clinical trial, seizure freedom was achieved in 50% of cats, however the follow-up period was relatively short for a definitive conclusion on long-term outcome [17]. Clinical experiences with phenobarbital resulted in seizure freedom in about 40–50% of patients treated [22–24]. A similar rate was reported for bromide, however associated with more adverse events including idiosyncratic allergic pneumonitis [25].…”

Section: Discussionmentioning

confidence: 99%

Imepitoin is well tolerated in healthy and epileptic cats

et al. 2017

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Background: Epilepsy in the cat is a serious medical condition. To date there are no licensed treatments for feline epilepsy and no well-controlled clinical studies on the efficacy or safety of antiepileptic drugs in cats. The aim of this study was to collect tolerability data and first exploratory efficacy data of imepitoin in both healthy and epileptic cats. Results: In two tolerability studies, 30 healthy cats received imepition twice daily in doses of 0, 30, 40 or 80 mg/kg bodyweight for 30 days. No serious adverse events were observed in any of the dose groups. In the imepitoin treated groups, emesis was observed in some animals temporarily and intermittently mainly in the second and third weeks of treatment. In a small, single-arm, open label, uncontrolled clinical trial eight cats suffering from idiopathic epilepsy were treated with imepitoin twice daily at doses of 30 mg/kg bodyweight for 30 days. Four of these cats (50%) achieved seizure freedom for at least 8 weeks under treatment. Adverse events, mostly lethargy, decreased appetite and emesis, were often mild and transient. Conclusion: In summary, imepitoin was well tolerated in healthy and epileptic cats and showed in a pilot trial indication for efficacy in treating feline epilepsy.

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“…Focal epileptic seizures occur with near equal frequency in cats with idiopathic and cats with structural epilepsy (Pakozdy et al, 2010;Quesnel et al, 1997b;Schriefl et al, 2008). The frequency of intracranial disease as the most common underlying cause of epileptic seizures in cats is controversial (Barnes et al, 2004;Finnerty et al, 2014;Quesnel et al, 1997a;Schriefl at el., 2008).…”

Section: Clinical Signsmentioning

confidence: 99%

“…Phenobarbital (PB) is the current drug of choice in cats with multiple seizure episodes (Berg et al, 2006;Dewey, 2006;Finnerty et al, 2014;Thomas and Dewey, 2008). It is available in both oral and intravenous formulations (Bailey and Dewey, 2009).…”

Section: Antiepileptic Treatmentmentioning

confidence: 99%

“…Phenobarbital is relatively affordable and historically has a low incidence of adverse effects, thus PB is an excellent AED choice for cats (Parent and Quesnel, 1996;Platt, 2001;Schwartz-Porsche and Kaiser, 1989).There is one report in which adverse effect of PB in a cat is mentioned; it included depression, anorexia, cutaneous eruptions and severe generalized lymphadenopathy, the signs appeared 21 days after PB administration and resolved 7-14 days after PB discontinuation (Ducote et al, 1999). There are several studies supporting the efficacy of PB of seizure control in epileptic cats (Finnerty et al, 2014). Seizure control was achieved in most cats with serum PB concentrations between 15-45 μg/ml, regardless of the cause of the seizures (Finnerty et al, 2014).…”

Section: Antiepileptic Treatmentmentioning

confidence: 99%

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Feline Epilepsy: An update

Baka

Polizopoulou

2020

J Hellenic Vet Med Soc

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Epileptic seizures are the most common neurological disorder in the clinical setting. Their etiology is multifactorial and is mainly divided into structural, reactive and idiopathic epilepsy. Structural epilepsy can be caused by vascular events, inflammatory conditions (encephalitis), traumatic injuries, neoplasia, congenital and inherited (degenerative) disorders. Reactive epilepsy is caused by exposure in toxins or metabolic derangements. Although idiopathic epilepsy was thought to be rare in cats, it is now established as a common cause. Epileptic seizures in cats appear with various clinical presentations including generalized, focal with or without secondary generalization epileptic seizures. Diagnostic investigation is crucial in order to establish final diagnosis and to determine the therapeutic plan. Diagnostics include physical and neurological examination with detailed history (drug or toxin exposure), routine hematology (CBC, biochemistry, urinalysis), specific laboratory tests if concurrent or metabolic disease are suspected, advanced diagnostic imaging (CT/MRI) whether intracranial disease is suspected and cerebrospinal fluid (CSF) analysis. Most commonly used antiepileptic drugs (AED) in cats are phenobarbital and levetiracetam. Bromide is contraindicated in cats due to severe respiratory disease caused as an adverse life-threatening reaction. Diazepam is an emergency AED used to eliminate cluster seizures or status epilepticus but it should be avoided as a long-term medication because it has been associated with fatal hepatotoxicity. Gabapentin in another potential antiepileptic drug however its longterm efficacy has to be evaluated. Prognosis depends on the underlying etiology and treatment response. In most cats quality of life is improved and (>50% reduction of epileptic seizures) regardless of etiology. The complete remission of epileptic seizures in cats is rare and most cats should be maintained on anti-epileptic therapy.

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Evaluation of therapeutic phenobarbital concentrations and application of a classification system for seizures in cats: 30 cases (2004–2013)

Cited by 32 publications

References 20 publications

Serum levetiracetam concentrations and adverse events after multiple dose extended release levetiracetam administration to healthy cats

Serum levetiracetam concentrations and adverse events after multiple dose extended release levetiracetam administration to healthy cats

Imepitoin is well tolerated in healthy and epileptic cats

Feline Epilepsy: An update

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