Raised ALT in dog with cluster seizures

Re: Raised ALT in dog with cluster seizures

Martin Atkinson — Wed, 14 Jan 2015 10:36:00 GMT

[quote user="Anthony Todd"]Would I be correct in thinking that phenobarb is still the most reliably effective drug available to stop seizures[/quote]For once the dinosaurs were not wiped out and they still rule the earth. And I would agree. The mental depression and escape seizures that go with phenobarb in humans, let alone long term side effects, are not such an issue in animals so there's less pressure on us to try novel treatments.

Re: Raised ALT in dog with cluster seizures

Anthony Dennison — Wed, 14 Jan 2015 09:18:12 GMT

In total agreement with you there Anthony (I'd better go and lie down). I've seen dogs on massive doses of phenobarb (6kg mini wire dachs on 45mg BID) and they've been fine.

I'm still not sure about Pexion, they say there's no long term problems but even dogs that were on it from the beginnings of the trials have only been on it 4 or 5 years now.

Re: Raised ALT in dog with cluster seizures

Anthony Todd — Tue, 13 Jan 2015 18:05:47 GMT

[quote user="Andrew Kent"] it wouldn't stop me putting the dog on phenobarb.[/quote]

Would I be correct in thinking that phenobarb is still the most reliably effective drug available to stop seizures always, not mostly, but always.

And Would I be right in saying it is the final and definitive choice in humans when all else has failed?

After all ,stopping the fits is the primary overriding concern; let the enzymes bounce around ,but at least the dog isn't fitting!

Re: Raised ALT in dog with cluster seizures

Graham Bilbrough — Tue, 13 Jan 2015 17:39:58 GMT

I don't think we know enough to completely exclude hepatic dysfunction yet. However, it sounds like financial constraints limit our options.

Let us know how the dog does please.

Re: Raised ALT in dog with cluster seizures

Anthony Dennison — Tue, 13 Jan 2015 17:33:26 GMT

[quote user="Graham Bilbrough"]

Was the sample haemolysed? It sounds like a difficult venepuncture. Generally, that results in the reported value being higher than truth. [The magnitude of this phenomenon varies by methodology.]

[/quote]

Ah yes, it was slightly. I was going to be sending the edta to Idexx but didn't want to waste anyones time as soon as I saw it had clotted!

Sorted, dog's getting epiphen then. Ta!

Re: Raised ALT in dog with cluster seizures

Graham Bilbrough — Tue, 13 Jan 2015 17:23:08 GMT

Was the sample haemolysed? It sounds like a difficult venepuncture. Generally, that results in the reported value being higher than truth. [The magnitude of this phenomenon varies by methodology.]

Re: Raised ALT in dog with cluster seizures

Andrew Kent — Tue, 13 Jan 2015 16:58:29 GMT

We see raised ALT quite commonly in dogs post seizure - it has a long half life and is suspected to be due to hypoxia during the seizure. In a case with financial concerns it wouldn't stop me putting the dog on phenobarb.

Andy

Re: Raised ALT in dog with cluster seizures

ChrisBVSc — Tue, 13 Jan 2015 16:15:41 GMT

I guess if there's no option of further investigation you'd just have to go ahead with treatment if he's having ongoing seizures - that's what I'd do, with the owner made aware we cant 100% rule out another cause. Is Pexion an option instead of phenobarb, bearing in mind the elevated ALT? (pexion is only contraindicated in 'severe' hepatic impairment - presumably not the case in this dog?!) Also you wouldn't have the issue of difficult follow-up bloods!