Idiopathic epilepsy remains a common problem in companion animal practice. At the time of diagnosis, we pay particular attention to the breed of dog/cat affected, as some seizures can have a specific genetic cause.
Recent advances in seizure therapy, combined with careful monitoring and accurate diagnosis, facilitate successful management for the majority (over 80%) of affected dogs and cats. Most patients will require a lifetime of medication, and it is vital that we avoid causing harm with these drugs. Our Seizure Clinics are designed to assist owners in achieving good quality of life for their pets, safely and with minimal side effects.
What do we monitor during clinic visits?
Aspects of clinical history
We review your pets’ history frequently, as in veterinary medicine epilepsy mimics so many other causes of collapse: it still remains primarily a diagnosis of exclusion, so we must keep an open mind if things change!
Seizure frequency and severity
We strongly encourage owners to record times and dates of seizures: without this information it is terribly difficult to assess efficacy of the treatments, or to adjust things if something changes. There are many excellent on-line tools which make recording easier (see resources below), or we have hard copy calendars free for owners’ use.
Many of the drugs drive an increase in appetite and thirst. We aim to help you keep your dog or cat slim, avoiding the adverse effects of obesity.
Serum antiepileptic drug concentrations
Monitoring the serum concentration enables
- The lowest effective dose to be used
- Dosing to be accurately adjusted
- Possible toxicosis to be avoided
- Better seizure control
Serum concentrations should be determined
- After starting on a new drug/dosage
- If seizures become more frequent or more severe/prolonged
- Every 6 to 12 months
- Serum concentration of unlicensed third generation ‘human’ anti-epileptic drugs may be determined through the NHS Therapeutic Drug Monitoring Unit
- The newest licenced drug, imepitoin (Pexion) does not require serum concentration monitoring
Other laboratory tests
- Periodic thyroid function testing is advised in older breeds predisposed to hypothyroidism. A diagnosis of hypothyroidism cannot be made on the basis of thyroid hormone concentrations alone as epilepsy and phenobarbitone therapy can result in a euthyroid sick syndrome
- We monitor haematology and serum biochemistry every six to 12 months (for interpretation of liver parameters we use the following guidelines reproduced from Rusbridge (2013a), reference Webster and Cooper (2009)
Guidelines: The drugs can often double ALT, and can increase SAP five-fold. Increases greater than these levels, or if the GGT, AST, bilirubin, bile acids, albumin or cholesterol are abnormal all suggest that there may be genuine liver damage happening, and will warrant further investigation/s.
Generally things do go well, but if not, we again review history, seizure diary, blood tests and clinical findings. On occasion we elect to use alternative, or combinations of drugs.
Resources that may be useful for owners of epileptic dogs
The Royal Veterinary College, University of London (RVC) has developed the first ever app that allows dog owners to monitor and improve the lives of pets that suffer from epilepsy.
The app has been developed in collaboration with the human epilepsy charity Epilepsy Society, who created a successful app to manage the condition in humans. It is available to download on Google Play now for Android devices and Apple iTunes App Store for Apple devices.
The app has lots of useful information about epilepsy and areas where you can record seizures and medication. Simply email your recorded seizure diary to us firstname.lastname@example.org before an appointment so we have all the latest information about your pet’s seizure control.
In additional to general information, this Boehringer Ingelheim UK website has specific information for owners about the antiepilepsy drug imepitoin.
In addition to general information, this website has an online monitoring tool that allows owners to record seizures, monitor trends and print off reports for their veterinary surgeon.