Epileptic Dalmatian

Re: Epileptic Dalmatian

Sandra Milburn — Fri, 18 Jan 2013 15:37:27 GMT

Thats why I love this site. So much help, so fast. Thanks for that :)

Mark: there is a history of chronic recurrent diarrhoea. Has been on hypoallergenic food, but this has not made a difference to seizure frequency/ severity. He had blood tests as well to help with diagnosing which foods he is allergic to (although I am not huge on trusting these). The owner is very astute and does seem to know what will cause diarrhoea in his case and what does not. (btw: thanks also for the flow charts!)

Will increase the dose for now and repeat bloods in a couple of week to see where we go!

A good weekend to ya all

Sandra

Re: Epileptic Dalmatian

Mark Lowrie — Fri, 18 Jan 2013 15:14:22 GMT

I did these flow-charts some time ago that can be quite helpful in managing epileptic patients:

http://www.canineepilepsy.co.uk/Documents/3090_Epiphen_Seiz_pstr.pdf

http://www.canineepilepsy.co.uk/Documents/3091_Epiphen_Stat_pstr.pdf

In general, however, it sounds like you do have scope to increase the phenobarbitone. I tend not to add other drugs unless:

a) you have adverse effects that are intolerable to the owner

b) you have achieved a mid range therapeutic concentration of the first drug

Other bright ideas? You mention IBD. How is this suspected? The only reason I ask is we get occasional patients with seizures plus a concurrent allergy e.g. atopy, diarrhoea etc. If these patients are maintained on a strict hypoallergenic diet they can become seizure-free (mechanism not understood). This is only anecdotal (and so please don’t place too much emphasis on it), but on rare occasions this response can be marked, e.g. a patient I had some time ago was a dog with cluster seizures every day refractory to phenobarb, KBr + Keppra and others etc that became seizure free on a hypoallergenic diet. It also does not replace conventional medication in the first instance.

There was a BSAVA abstract on this some years ago (Luján A, Scott SD, Anderson TJ et al. The role of diet in refractory canine epilepsy – a retrospective case series. In: BSAVA Congress 2004: Scientific Proceedings. Quedgeley, UK: British Small Animal Veterinary Association, 2004:53) and also a Vet Clinics article on this (Collins JR. Seizures and other neurologic manifestations of allergy. Vet Clin North Am Small Anim Pract 1994;24:735–48).

Re: Epileptic Dalmatian

Gillian Mostyn — Fri, 18 Jan 2013 15:05:48 GMT

With that blood Pb level I would probably just increase the Pb dose - 90mg BID seems perfectly reasonable. If the fits continue, I'd be happy to keep increasing the Pb level (within reason) until the fits stop. (Up to about 120mg BID). You will then need to recheck blood levels 2-4 weeks later to just check that the blood levels aren't too high.

Only if the blood levels are excessive, or if the fits are uncontrolled, would I start a different drug.

But I'm not a neurologist....other opinions are sure to follow!

Re: Epileptic Dalmatian

Andrew Kent — Fri, 18 Jan 2013 15:04:05 GMT

I usually regard 20 mg/dl as the minimum therapeutic level of phenobarbitone which I think would work out as about 86 umol/L which would put you just below the therapeutic range. (I have never understood why lots of labs seem to start the pheno therapeutic range so low!)

Re: Epileptic Dalmatian

Andrew Kent — Fri, 18 Jan 2013 14:58:33 GMT

Hi Sandra,

I think that phenobarbitone is still the most important part of seizure management in dogs and so I would try to get the levels higher within the therapeutic range before considering additional drugs. I'm not that familiar with the units of your pheno reference range but it certainly looks like you have room to increase.

I would then consider adding KBr if you have a good therapeutic dose of pheno and the seizures continue.

Andy