Anyone starting dogs on pexion as first choice?

RE: Anyone starting dogs on pexion as first choice?

Bob Russell — Mon, 28 Oct 2019 11:53:03 GMT

I have been epileptic for all of my adult life. I had my one and only MRI after 25 years and not since.

It showed nothing useful but was a very relaxing in the scanner. Very sleep inducing.

MRI is not that useful unless you suspect something other than idiopathic epilepsy. IMO it is not gold standard to do an MRI. A good history and clinical examination is gold standard with further tests only if required.

Still not impressed with Pexion!

RE: Anyone starting dogs on pexion as first choice?

Julie Innes — Mon, 28 Oct 2019 10:20:29 GMT

interesting, I have definitely been less than impressed with pexion, but some of the dogs we have put on it seem to be doing ok (although I guess the question is would they have had seizures without it...). I am a bit torn, however, as pexion is licensed and could be argued is a "safer" drug than phenobarbitone, so unless they are having clusters I will sometimes try pexion first.

RE: Anyone starting dogs on pexion as first choice?

Clive Ansell — Sun, 27 Oct 2019 10:24:52 GMT

[quote user="Stephen Courtney"]You don't know till you look ... could have had something weird but I wouldn't have been keen on referral either[/quote]

Yep, true enough.

In this case the demanding overbearing clients demanded a precise and complete diagnosis, almost accusing me of fobbing them off by not referring immediately. Statistically, numerically, and based on the breed, age, signalment, exclusion of extracranial causes etc; idiopathic epilepsy has to be by far top of the ddx list.

[quote user="Stephen Courtney"]As an aside, how many seizures before you start treatment?[/quote]

Usual one per month, unless seizures are very severe or long. Or if it is clear they are becoming more frequent or severe.

In answer to the OP, almost never use Pexion now. Cases That I have used it, most if not all, it has failed to work and they have been swapped to Phenobarbitone. I do discuss the option with clients in new cases, but tend to direct them towards phenobarbitone, which to my mind remains the treatment of choice.

RE: Anyone starting dogs on pexion as first choice?

Stephen Courtney — Sat, 26 Oct 2019 19:39:21 GMT

You don't know till you look ... could have had something weird but I wouldn't have been keen on referral either

As an aside, how many seizures before you start treatment? I always used to say to clients if seizure frequency is > 1 per 4 weeks, or if clusters, or if severity is increasing, then treat.

Specialists now advise treatment if more than one seizure in 6 months, based on the theory that it reduces the tendency for seizure activity to become hard-wired. Or something.

RE: Anyone starting dogs on pexion as first choice?

Clive Ansell — Sat, 26 Oct 2019 11:27:18 GMT

[quote user="Kate Richardson"]i would assume for an MRI if owners wanted to fully investigate?[/quote]

Exactly that.

some clients demand an absolute diagnosis, particularly some of the insured ones who seem to have a mindset that they want their pound of flesh out of the insurance policy.

I had a case earlier this year; 15 month otherwise healthy Labrador that had had one small seizure lasting less than a minute. I advised base line bloods including BAST which were all normal, so advised a working presumptive diagnosis of idiopathic epilepsy, and to monitor for now. Owners demanded referral for a "proper" diagnosis. So off it went for neurology referral, CSF analysis and MRI scan.

Nearly £3000, GA, repeat blood work, CSF analysis and an MRI scan later - referral report concluded Likely idiopathic epilepsy.

I think it raises an ethical question as to whether these types of investigation should be carried out? to my mind at least, this patient was subjected to an unnecessary GA and procedure, which has yielded no further useful information or altered the progression of the disease or outcome of the case. If there were other clinical signs, or the disease was refractory to treatment or progressive; then it would be a different matter and entirely justified.

RE: Anyone starting dogs on pexion as first choice?

Kate Richardson — Sat, 26 Oct 2019 07:15:28 GMT

[quote user="Michael Woodhouse"]

[quote user="Sarah Keir"]

I don't use Pexion now since trying it when it first came out and was under impressed with its efficacy. Also strange that the referral centre I set cases of epilepsy to, which was one of the centres and lead authors in the initial studies about Pexion, never sent a single case back on it!

[/quote]

Why would you refer epilepsy?

[/quote]

i would assume for an MRI if owners wanted to fully investigate?

RE: Anyone starting dogs on pexion as first choice?

Michael Woodhouse — Fri, 25 Oct 2019 23:35:07 GMT

[quote user="Sarah Keir"]

[/quote]

Why would you refer epilepsy?

RE: Anyone starting dogs on pexion as first choice?

Rob Loxley — Thu, 24 Oct 2019 17:17:27 GMT

We have a few dogs well controlled on Pexion, but I still find overall pheno to be more reliable at getting control and if managed well very safe

RE: Anyone starting dogs on pexion as first choice?

Bob Russell — Tue, 22 Oct 2019 15:32:33 GMT

We have two dogs on it and for some reason they are doing well according to the owners. My default position is it is not a good drug, at least not at the lower doses.

RE: Anyone starting dogs on pexion as first choice?

Anthony Dennison — Tue, 22 Oct 2019 14:11:36 GMT

Nope. Think it's useless and phenobarb works so well in the majority of cases.

RE: Anyone starting dogs on pexion as first choice?

Stephen Courtney — Mon, 21 Oct 2019 20:45:25 GMT

I’ve tried it several times and been underwhelmed - so at this point use it only as an add-on drug for resistant epilepsy

RE: Anyone starting dogs on pexion as first choice?

Sarah Keir — Mon, 21 Oct 2019 16:08:36 GMT

RE: Anyone starting dogs on pexion as first choice?

Joyce Whitehead — Mon, 21 Oct 2019 15:10:35 GMT

I don’t generally, it’s expensive compared to phenobarbitone for a start, and I’m happy that many cases will settle on PB alone, or at least be fairly well controlled. Interesting the stats on cluster seizures and aggression with the Pexion group...