Cat seizures

Re: Cat seizures

Jo Cobbett — Wed, 17 Jul 2013 13:22:52 GMT

[quote user="KMurphy"]

Thanks everyone, especially Mark for the very detailed reply. That's very interesting about the levetiracetam even if only for future cases or for problem dogs.

I'll be speaking with the owner later today so I'll try and found out just exactly what her expectations/worries are. It would be nice to give the cat a bit more time but the decision will ultimately rest with the owner.

Kind regards to you all,

Karen.

[/quote]

I've used levetiracetam in one case (a cat that started to have seizures despite phenobarb), and it responded really well. I think it worked out more expensive than the phenobarb though, but maybe that's just our suppliers!

Re: Cat seizures

KMurphy — Wed, 17 Jul 2013 09:16:55 GMT

Thanks everyone, especially Mark for the very detailed reply. That's very interesting about the levetiracetam even if only for future cases or for problem dogs.

Kind regards to you all,

Karen.

Re: Cat seizures

Mark Lowrie — Wed, 17 Jul 2013 08:47:55 GMT

The dose of phenobarbitone you have given is reasonable although I agree often that we need to give a higher dose than the licensed dog dose (even in cats). However, you have started treatment just as I would have so nothing to change here.

It does sound like you have seen a dramatic improvement despite the owner’s concerns. It is also very early days as will take about 10 days to reach steady state and so far you are a several days from achieving this. Therefore I would suggest re-iterating this point to the owner. We cannot offer a cat with seizures a quick fix but hopefully after 10 days we will have a good idea of where we stand with regards prognosis. It is also worth establishing what the owner is expecting. If it is a seizure-free cat then unfortunately this patient may be a lost cause and PTS is the correct option. However, if they can accept they are most likely to end up with a cat with potentially life-long recurrent seizures occurring in an infrequent number then PTS may be premature.

I appreciate the owners are already concerned regarding cost. However, another drug I would consider at this stage is levetiracetam (obviously off-licence, but all feline anti-epileptic meds are off-licence) as it is fast acting (steady state within 24-48 hours) and the cost is now very acceptable if the generic form is given (usually works out cheaper than licensed phenobarbitone). I would use a dose of 20-30mg/kg TID. Seems really effective.

Re: Cat seizures

Gillian Mostyn — Tue, 16 Jul 2013 22:37:52 GMT

I agree Fran- if the owners are already considering PTS then it is likely to be hard to please them as the cat is very likely to need ongoing diagnostics and treatment. They need to be fully onboard to get this sorted - treating seizures can be a thankless task otherwise!

Re: Cat seizures

Francisco Gomez — Tue, 16 Jul 2013 22:23:40 GMT

Thank you Mark.

I mean, I agree that I may be wrong, but whoever is not happy with my answer could at least give an alternative...

Re: Cat seizures

Mark Hedberg — Tue, 16 Jul 2013 22:02:33 GMT

Why did fran deserve a single star for that?

In reply to the PTS side of things; while it's frustrating to not have a diagnosis, if o won't pay for workup and cat is suffering, pts isn't necessarily wrong.

Re: Cat seizures

Francisco Gomez — Tue, 16 Jul 2013 20:50:33 GMT

Hello,

I'm not an expert but I can tell you what I think.

12.5/4.5 = 2.7mg/kg. So you are giving almost 3mg/kg BID to this cat.

Epiphen datasheet for dogs (http://www.noahcompendium.co.uk/V_AOk-toquinol_UK_Ltd/Epiphen_30_mg_and_60_mg_Tablets/-31902.html), with same active drug, recommends 2-5mg/kg DIVIDED in two equal dosages. So 1-2.5mg/kg BID. I've got to be honest with you, I always have to give a bit more for my dog patients. (but cats are a different world as you know).

My take on this is that maybe your cat could do with a smaller dose(if your cat is a bit overweight, then more so)? Could you try epiphen liquid (be aware the recommended starting dose varies for the liquid for some reason)? Now, make sure you get an off-license consent form!

PD. If an owner is already thinking euthanasia, tred very careful here. You could be blamed for 'letting this cat to suffer' just because your client doesn't want to go through the trouble of treating a epileptic animal. In my experience epileptic animals will need some adjustments in the future. I.e. more headaches for your client. If she or he is already giving up... I'm not sure if they really want to go ahead. (just my opinion)