Cluster Seizures - advice please

Re: Cluster Seizures - advice please

mariette asselbergs — Fri, 01 Nov 2013 17:00:30 GMT

I like to have them on CRI propofol with added IV phenobarb if necessary, dark and quiet as others have said and complete rest for 12 hrs or so. Keep an eye on the temperature, can shoot up high if fitting, then use a fan. Also check glucose levels.

Mariette

Re: Cluster Seizures - advice please

Rob Loxley — Sun, 27 Oct 2013 23:39:05 GMT

You can also get i/v keppra but it's pretty expensive

Re: Cluster Seizures - advice please

Tracey Carlisle — Sun, 27 Oct 2013 20:24:40 GMT

Increased keppra per os. Did not have any iv - will look into getting some. Dog had only 2 x 5 sec partial seizures today so drugs seem to be working at higher dose. Will keep on keppra until results of next blood sample.

Thanks for help.

Re: Cluster Seizures - advice please

Rob Loxley — Sun, 27 Oct 2013 13:33:22 GMT

[quote user="Francisco Gomez"]BSAVA Formulary 6th Manual has a loading dose for dogs currently on phenobarbital but has a low therapeutic dose too low[/quote]

+1 for some i/v phenobarb

Re: Cluster Seizures - advice please

Francisco Gomez — Sat, 26 Oct 2013 23:59:14 GMT

deleted my post. Seems my advice would be useless since you already started Keppra and increased pheno dose.

BSAVA Formulary 6th Manual has a loading dose for dogs currently on phenobarbital but has a low therapeutic dose too low. That's all I wanted to say.

Re: Cluster Seizures - advice please

David Mills — Sat, 26 Oct 2013 23:48:10 GMT

Have you got injectable pheno? if so go for 6mg/kg iv q12h.

Otherwise re oral it depends, but at the moment, yes. But as before oral not going to make difference at the mo. sounds like might need other oral meds in addition - pexion?

Not sure where you work but you can get iv keppra - probably from local hosps - same dose and active within 30m.

Re: Cluster Seizures - advice please

Tracey Carlisle — Sat, 26 Oct 2013 23:41:27 GMT

Would you recommend going straight to 5mg/kg phenobarb from 3mg/kg as I have only increased to 4mg/kg?

Will increase Keppra to 30mg/kg immediately.

Dog is hospitalised , quiet, dark, had iv diazepam. Have had almost 3hrs seizure free - longest interval in last 24hrs.

Thanks for all the advice. Greatly appreciated.

Re: Cluster Seizures - advice please

Tracey Carlisle — Sat, 26 Oct 2013 23:34:04 GMT

OK. Dog is 2 and 1/2 yrs old. She weighs 21kg now. Was on 62.5mg/kg BID Phenobarb. Bloods taken just before tablets to be given. Last bloods taken beginning of this month. Have increased phenobarb to 87.5mg/kg BID now with this cluster of seizures but has only had this increased dose for 2 days!!!

Re: Cluster Seizures - advice please

David Mills — Sat, 26 Oct 2013 23:32:57 GMT

You're toying with status here. Need to stop seizures for 24h at least.

Phenobarb too low - needs to be above 15-20 at least. Most authors say not seizure resistant til 5mg/kg bid.

Needs hosp, darkness, quiet and IV DiazeMULS, pheno q12h

Increase keppra to 30mg/kg. Should be at adequate levels within 24h.

Remember any change in dose phenob needs a couple of weeks, so NEEDS covering with keppra for this time

Re: Cluster Seizures - advice please

Francisco Gomez — Sat, 26 Oct 2013 23:19:51 GMT

Give us more! Weight/age of the dog and phenob dose before you had this episode. When did u take the blood sample? Mid-time between dosages or just before the next one? 13.7 sounds too low.