Epilepsy and Pancreatitis

Re: Epilepsy and Pancreatitis

Mark Norcott — Thu, 03 Feb 2011 14:44:55 GMT

Re poor control of seizures,although this may not be very scientific (n=1), I have so far been having a good response (6 months+ - touch wood!) to control of cluster seizures in epileptic with zonisamide. Dog had gabapentin and Keppra neither of which were effecitve at controlling seizures for more than a month or two. Started at the recommended 10mg/kg bid (300mg bid) although this absolutely zonked the dog out but worked well at 200mg bid. Owner purchases from a pharmacy.

Have you checked blood levels of Pb or KBr to see if therapuetic?

Re: Epilepsy and Pancreatitis

Alex Gough — Thu, 27 Jan 2011 10:18:05 GMT

Might be worth a cPLi and abdominal ultrasound to confirm pancreatitis, but it sounds pretty likely, and also as everyone says KBr could be the culprit. I would withdraw it. I like levetiracetam (Keppra) for difficult to control cases. It kicks in quickly, you can withdraw it abruptly, (so you can use it strategically for cluster seizures rather than long term maintenance), it doesn't appear to be particularly sedating, and has next to no side effects observed so far. Downsides are expense as noted above, and tolerance when used for a year or so. The published studies generally involve using it as a third drug on top of KBR and phenobarb, but I have used it on its own, or in combination with either one. Keppra also seems to be more effective in treating partial seizures than some of the more traditional drugs.

Zonisamide is another anti-epileptic that is used a lot in the states, and seems to be quite effective, but is even more expensive than Keppra, and tolerance develops quicker.

Alex

Re: Epilepsy and Pancreatitis

Dagmar Steele — Wed, 26 Jan 2011 17:13:24 GMT

agree that KBr might cause most of the problems and if seizures are not controlled sufficiently maybe it is worth having a look at Levetiracetam. Unfortunately it is quite expensive, but there are some reports out that it solved some of the difficult cases.

Re: Epilepsy and Pancreatitis

Bob Russell — Wed, 26 Jan 2011 16:47:47 GMT

KBr is likely to be the main culprit. Well worth speaking to a neurologist! These cases can be a nightmare!

Re: Epilepsy and Pancreatitis

Kate Richardson — Wed, 26 Jan 2011 16:44:47 GMT

I've just looked in the formulary and only Potassium bromide appears to have some link to pancreatitis, so I wouldn't go blaming the other meds at this point in time. Amylase and lipase can be insensitive for diagnosis of pancreatitis but in the face of appropriate clinical signs, would be supportive. Dehydration can also increase amylase/lipase due to reduced renal clearance.

I would treat as you would normally treat a pancreatitis case, fluids and pain relief with opioids, +/- antibiotics, but just double check any drug dosages/poss side effects wrt to the epilepsy just in case.

Any liver enzyme changes could be secondary to the phenobarbitone as well.

re the 'epilepsy' how long has she been on treatment? and what doses is she on?

Re: Epilepsy and Pancreatitis

Hannah Wynne Richards — Wed, 26 Jan 2011 16:33:13 GMT

Ive got the same prob in an elderly Yorkie-luckily epilepsy well controlled on epiphen and KBr-treat the pacreatitis like any other pancreatitis, but beware you may need extra anti-seizure therapy due to dilution

Wynne