Border collie with epilepsy

Re: Border collie with epilepsy

Anthony Todd — Fri, 01 Aug 2014 20:58:11 GMT

[quote user="Nicola Lawlor"]Re phenobarbitone[/quote]

+1 My blood level was always the minimum that stopped the fits.

Think of them as a TdF cyclists and the dose depends on their individual biochemical passport.

Has anyone ever shown that dogs on the minimum pheno dose that stops their fits come to harm, independent of where the dose is on the "dose rate" chart?

Re: Border collie with epilepsy

Andrew Kent — Fri, 01 Aug 2014 10:10:12 GMT

I agree that there can be a role in combining various drugs in some of these cases and also that there are some dogs who do not seem to respond as well to pexion. However, as pexion has been started I see no benefit in adding phenobarbitone unless we are getting to high doses without achieving control as we are far more likely to see side effects when it may not be needed.

so, I would double the pexion dose and then try to withdraw the levetiracetam. I would only really reach for phenobarbitone if I am getting to 30mg/kg of pexion and still not achieving control, and would in that case try phenobarbitone instead of pexion initially. As others have said the first drug is by far the most important and failing to respond to a decent dose of one drug raises the concern you may not respond well to any. But we are nowhere near that assumption in this dog yet with these doses.

one of the difficulties with pexion is the absence of an injectable to rapidly increase levels during clusters. Which makes it difficult to know which drugs to use at that time as you have seen with this dog!

Andy

Re: Border collie with epilepsy

Suzanne Kelly — Thu, 31 Jul 2014 22:51:31 GMT

+1 for phenobarbitone. You can use it with Pexion.

Re: Border collie with epilepsy

Nicola Lawlor — Thu, 31 Jul 2014 20:51:03 GMT

Re phenobarbitone - there was something I learned a while ago with a poorly controlled epileptic that I suspect others may not be aware of either - apologies if I am telling you something you know however. If your patient is still having seizures and their blood levels are not at the high end of the therapeutic range then increase the dose of phenobarbitone. It is not enough in these patients to say "they are in therapeutic range therefore this is all the drug will do". I certainly did think like that previously, but having spoken in depth to a neurologist about a case was able to revise my thinking on this sort of case. The dog in question is doing really well now on higher phenobarb doses and has an occasional seizure now and again compared to cluster seizures every couple of weeks. There was a formula given to me to help calculate the new dose

(wanted blood level/current blood level) x mg currently being given bid = new dose in mg bid.

Re: Border collie with epilepsy

alison silvester — Thu, 31 Jul 2014 08:54:35 GMT

Thanks everyone,

He was already started on pexion by his vet so I guess he should stay on this rather than stopping and switching to pheno at the moment? I suspect if he remains uncontrolled on this he will need pheno added rather than exchanged for. The dose of pexion can be increased from where it is. The levetiracetum has halted the cluster for now. I have maybe been unlucky but we have a couple of dogs who are now on pheno, KBR, pexion and levetiracetum and poorly controlled.

Re: Border collie with epilepsy

Richard Carter — Wed, 30 Jul 2014 18:21:21 GMT

My favourite approach now is to stabilise phenobarb + KBr until fitting controlled, then reduce the phenobarb until only KBr and then treat clusters if they occur with short term phenobarb. Have 3 current cases on this approach and all much more settled without the phenobarb depression/ lethargy, clusters now lasting two or three fits over 12 hours rather than 2 - 3 days and one (a border collie) now down to a fit every 6 months or so on KBr alone.

Re: Border collie with epilepsy

Rob Reid — Wed, 30 Jul 2014 18:13:31 GMT

Remember that 20% dogs won't respond or show any improvement on the first medication you use and of this group, theirchance of responding to a second medication is much lower (only around 40% of them improve.) So based on this alone, the prognosis for this particular dog is poorer with regards to control.

As far as I am aware there is no 'resistance' to a particular drug in Collies, only that they are more susceptible as a breed.

Re: Border collie with epilepsy

Bob Russell — Wed, 30 Jul 2014 17:25:56 GMT

Start with phenobarb, add KBr if nec then add Keppra if that is not enough.

We have a box of pexion on the shelf but had poor results. Collies seem to be one of the most troublesome dogs to get to settle on medication.

Re: Border collie with epilepsy

David Mills — Wed, 30 Jul 2014 17:06:07 GMT

Despite the marketing, pexion evidence very weak cf pheno. I'd be using the latter. Levetiracetam is now in generic form which is cheap as chips, pennies per tablet. Wanes in effectiveness in dogs but great as short term bridge at 20-30mg/kg.

Re: Border collie with epilepsy

Michael Woodhouse — Wed, 30 Jul 2014 16:54:40 GMT

To be fair we've only ever used phenobarb (Phenoleptil) and have had good control in a number of collie dogs. Have 2 working collies on meds currently and doing very well.

Never needed Keppra - but did have a holidaymakers dog come in for some as they left meds at home - eye wateringly expensive IIRC.