Outcome from status epilepticus after portosystemic shunt attenuation in 3 dogs treated with propofol and phenobarbital

Abstract

In this case series, we describe the treatment of 3 dogs with propofol and phenobarbital for refractory SE following attenuation of a single congenital PSS. After weaning of the propofol constant rate infusion, and tapering and discontinuation of phenobarbital over the following months, all dogs experienced a complete recovery. This study provides evidence that use of propofol in combination with phenobarbital may be efficacious for management of SE in dogs after PSS surgery.

Incidence of Postoperative Seizures with and without Levetiracetam Pretreatment in Dogs Undergoing Portosystemic Shunt Attenuation

“…Cortical necrosis and polioencephalomalacia are reported in dogs after shunt ligation and development of status epilepticus. These changes, however, are suggested to be secondary to seizure activity rather than being causative …”

“…Neurologic abnormalities after shunt attenuation occur in 0–18% of dogs, with signs varying in severity from ataxia to generalized convulsive seizures . Postoperative seizures are reported in 5–18% of dogs typically occur within 72 hours of surgery, are often refractory to standard anticonvulsant drug (ACD) treatment, and frequently progress to status epilepticus.…”

“…Postoperative seizures are reported in 5–18% of dogs typically occur within 72 hours of surgery, are often refractory to standard anticonvulsant drug (ACD) treatment, and frequently progress to status epilepticus. The difficulties associated with treating postligation seizures have resulted in high‐case fatality proportions in affected dogs …”

“…Administration of benzodiazepines, barbiturates (eg, phenobarbital, pentobarbital), and propofol, as either bolus treatment or constant rate infusions, have been described for treatment of status epilepticus after CPS ligation with limited success . Treatment with potassium bromide for 2 weeks before surgery has not been shown to decrease postligation seizure incidence .…”

Successful treatment of refractory seizures with phenobarbital, propofol, and medetomidine following congenital portosystemic shunt ligation in a dog

“…Dogs appear to be less commonly affected, with a neurological complication rate of 0–20.6% . General motor seizures following CPSS surgery have been well documented but are poorly understood . Aronson postulates that seizures might be caused by sudden changes in release of endogenous benzodiazepines or neurotransmitters .…”