2015 ACVIM Small animal consensus statement on seizure management in dogs. For some people with epilepsy, the benefits of taking a benzodiazepine every day outweigh the risks. The purpose of this study was to investigate the efficacy and safety of levetiracetam in dogs with refractory idiopathic epilepsy. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. While the dog remained herself over the next 3 days during hospitalization after reintroduction of ZNS, the exact same episodes relapsed on the night after discharge. doi: 10.1111/j.1939-1676.2011.00801.x, 18. (2005) 46:3141. (2010) 257:16825. There is no clinical information on use of felbamate in cats. Figure 1. (2015) 1:CD011241. J Vet Intern Med. Prior to the referral, this dog had been managed with ZNS starting at 2.5 mg/kg per os (PO) q12h then gradually increased in the dose up to 5 mg/kg q12h with the trough blood concentration at 21.2 g/ml over the 15 months. The aggressive behavior resolved almost completely within 5 days after the abrupt cessation of ZNS in our cases. doi: 10.1007/s00415-010-5603-7, 9. by athomas989 Fri May 29, 2015 1:59 pm, Post Long-time reader, first time asking a question. Chung J, Hwang C, Chae J, Ahn J, Kim T, Seo K, et al. Zonisamide can be used in either cats or dogs for control of seizures. Her prognosis is guarded. Hepatotoxicity and liver failure in dogs have been associated with high serum concentrations (>35 mcg/mL), necessitating the serum level checks every 612 mo. The episode typically lasted for ~1 min. Prior to this, she had never had a partial seizure and her seizures were usually several hours apart. MRI study and cerebrospinal fluid analysis in two dogs were unremarkable. Bromide is renally eliminated and thus should not be used in dogs with renal dysfunction without careful monitoring. J Vet Intern Med. Brain Dev. Zonisamide, USP is a white to off white crystalline powder, pKa=10.2, and is moderately soluble in water (0.80 mg/mL) and 0.1 N HCl (0.50 mg/mL). I will talk to the vet this week about the plan. Seven days after the dose increment of LEV, ZNS was re-introduced at 6.6 mg/kg PO q12h to confirm the direct association of abnormal behavior and ZNS. In countries where bromide is not available as a pharmaceutical formulation (USA), an analytical grade may be obtained from a chemical supply company, although caution is recommended in handling and packaging. (2017) 251:145761. doi: 10.1016/j.applanim.2017.11.008, Keywords: episodic abnormal behavior, psychiatric adverse effect, anti-seizure drug, zonisamide, dog, epilepsy, Citation: Kanazono S, Ukai M and Hiramoto A (2021) Abnormal Behavior Episodes Associated With Zonisamide in Three Dogs: A Case Report. It was also interesting that the average maximum ZNS serum concentration in patients who discontinued ZNS attributable to PAE or CAE was significantly lower than maximum ZNS concentration of control group in the aforementioned study (24). If excessive sedation occurs, a lower dose should be used initially and gradually increased. Weaning a Litter of Puppies. This dog had no pre-existing abnormal behavior problems before and no seizure episodes were witnessed in association with these behavior episodes. They are usually given to people with epilepsy only when other anti-seizure medications havent helped. Although therapeutic and toxic range of ZNS in dogs has not been well-established yet, serum concentration at 47.8 g/ml in our case 2 could be considered in high end or above the therapeutic range (6, 7, 25, 28). Supplementary Video 1. I lost a LOT of weight and the more bothersome side effects--memory loss, difficulty . This sulfonamide-based anticonvulsant restricts the propagation and spread of seizures and suppresses epileptogenic focus activity. Withdrawal symptoms may include increased seizures, anxiety, and panic attacks if you miss one or more doses. Daily seizure episodes resolved after ZNS was added. As for type 3 adverse effects, the possibility of affecting thyroid function (especially decrease in total T4) and the changes in blood chemistry profile within the reference range, including the elevation of ALP and Ca and the decrease of total protein and albumin compared with those prior to the administration of ZNS, were observed (7). Use of valproic acid in dogs is limited because of rapid metabolism. However, cats not only have a longer half-life (1520 hr) than dogs but also do not develop a tolerance to the anticonvulsant effects. J Vet Intern Med. by seebr5640 Sat Jul 13, 2013 8:33 am, Post Thus, the dose of zonisamide in dogs receiving phenobarbital is 10 mg/kg, PO, bid. *Correspondence: Shinichi Kanazono, kanazono@vsec.jp, View all Precautions. This is the place for general questions about drugs, long-term treatment concerns, possible influences of other drugs (such as antibiotics, heartworm preventatives, or anesthetics) for epileptic dogs, and other concerns. The recommended dose and monitoring strategy are as follows: oral starting dose at 37 mg/kg every 12 hours (q12h) or 710 mg/kg q12h in dogs with co-administered hepatic microsomal enzymes inducers such as phenobarbital, serum concentrations should be aimed between 10 and 40 mg/L according to the human target range, and the serum concentration measurements should be performed at least 1 week after treatment initiation or dosage adjustment given the approximate elimination half-life of 15 h (6, 7). The effects of this short-acting medication typically last only 24 hours in dogs. The episodic aggression lasted up to 30 s in duration, returning back immediately following. Recently, ZNS-related anticonvulsant hypersensitivity syndrome was reported in cats (27). J Small Anim Pract. Already have a myVCA account? Approximately 25%50% of cats administered bromide developed signs of bronchial disease characterized by a cough and marked pulmonary infiltrates seen on radiographs. Changes in brain serotonin and dopamine levels are considered as a mechanism of ZNS-induced PAE (24, 35, 37) and human patients with a history of psychiatric disorder had significantly greater risk of developing PAE associated with ASDs including ZNS (24, 36, 38, 39). Front. Another report described that psychiatric adverse events (PAEs) and cognitive adverse events (CAEs) were the most frequently identified reasons for terminating ZNS therapy in 433 epileptic patients who received ZNS (24). J Neurol. Limited data suggest zonisamide may be beneficial . Because a daily maintenance dose may take 4 mo to reach steady state serum concentration, there are situations (eg, severe seizures, seizures that occur on a monthly basis, the need to rapidly switch from phenobarbital to bromide because of phenobarbital toxicity) when a loading dose of bromide should be administered. It may also require additional changes to the dose of your new medication. Seizure. Doing this may increase your risk of having more frequent and/or severe seizures. These include the drugs clonazepam, clobazam, diazepam, lorazepam, and clorazepate. I'm so sorry that you had to go through all of this, but so happy to hear that she's coming home! Effective serum levels are determined by the serum level of phenobarbital (1545 mcg/mL). ALT, serum alkaline phosphatase, and/or bile acids should be monitored. (2009) 5:24959. In general, a maintenance antiepileptic drug (AED) should be considered in animals that have had more than one or two seizures within a 6-mo period (assuming these seizures were not caused by repeated toxin exposure) or in animals that have had more than one seizure of unknown cause on any particular day. The decision to start maintenance anticonvulsant or antiepileptic therapy should be based on the frequency and severity of the seizures, the age of onset, the likely cause(s) of the seizures, and the results of diagnostic testing. by ShilohsMom Wed Aug 13, 2014 8:19 am, Post Primidone is a barbiturate that has three metabolites: phenobarbital, primidone, and phenylethylmalonamide. Two more months later, levetiracetam (LEV) at 17 mg/kg PO q12h was added on ZNS as the dog experienced another episode of cluster of seizures. Use OR to account for alternate terms The trusted provider of veterinary information since 1955, Overview of Systemic Pharmacotherapeutics of the Nervous System, Antiepileptic Drugs Used to Stop Ongoing Seizure Activity, Maintenance Anticonvulsant or Antiepileptic Therapy, Last review/revision Mar 2015 | Modified Nov 2022. International veterinary epilepsy task force consensus proposal: medical treatment of canine epilepsy in Europe. Knudsen JF, Thambi LR, Kapcala LP, Racoosin JA. Cochrane Database Syst Rev. Platt JE, Opler LA, Platt EM. A maintenance AED should also be considered if the first seizure episode is protracted or severe, or during an episode of status epilepticus (as a followup to emergency treatment, see Antiepileptic Drugs Used to Stop Ongoing Seizure Activity Antiepileptic Drugs Used to Stop Ongoing Seizure Activity In status epilepticus, treatment is essential to prevent death from hyperthermia, acidosis, hypoperfusion, and hypoxia. White JR, Walczak TS, Marino SE, Beniak TE, Leppik IE, Birnbaum AK. In foals, phenytoin has erratic plasma concentrations. It should not be used in pets with liver disease or breeding or pregnant animals. Zonisamide may be given in combination with other . This time may increase if your pet has decreased liver or kidney function. You can dip your finger in the formula and wet the puppies' noses and mouths. How Public Health Programs Support the Epilepsy Community, 3540 Crain Highway, Suite 675,Bowie, MD 20716, 2023 Epilepsy Foundation, is a non-profit organization with a 501(c)(3) tax-exempt status. The likelihood of future seizures in children with epilepsy is based on specific factors like the underlying cause, epilepsy syndrome, and seizure type. Treatment in canine epilepsy - a systematic review. doi: 10.2147/NDT.S4063, 5. Contact your veterinarian immediately if your pet stops eating, becomes dramatically lethargic, or develops a yellow color of the skin, gums, or whites of the eyes. Higher dosages (3060 mg/kg, PO, tid-qid) may be necessary but can produce sedation and ataxia. Clonazepam, unlike diazepam, can be used in dogs for oral maintenance therapy, because anticonvulsant tolerance develops less rapidly, the saturability of its metabolism reduces the elimination rate at therapeutic concentrations, and because it is more highly absorbed orally (particularly in micronized formulations). Epilepsy Behav. Tapering and withdrawing off benzodiazepines can be difficult, particularly after prolonged daily use. For longterm maintenance in cats and dogs, phenobarbital may be given at 24 mg/kg/day, PO, bid. Within 24 h after ZNS was commenced at the dose of 5 mg/kg PO q12h, this dog started acting abnormal. Especially since he started with a cluster, and had another cluster when they tried to drop the dose, it sounds like this is a dog that will need to . (2007) 30:23040. Log in 24/7 to access your pets health care information. Charalambous M, Pakozdy A, Bhatti SFM, Volk HA. 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