cat seizure

Re: cat seizure

Bob Russell — Mon, 20 Jun 2011 14:00:52 GMT

May be I have missed it in the discussion but the most common cause of neurological problems in cats here is permethrin poisoning. If the cat is still being exposed to the source (or owners have given more treatment) then symptoms will continue and may get worse.

Removal from exposure (such as hospitalisation) will allow improvement in time anyway.

Common things happen commonly!

Re: cat seizure

Horcrux — Mon, 20 Jun 2011 10:33:20 GMT

[quote user="Martin Atkinson"]

The suggestion of lead poisoning is interesting, however I had a cat which had cadmium poisoning. It lived on a new housing estate which had been built on the site of an old military switchgear factory - they obviously used heavy metals in manufacturing. We'd tested for lead and it was negative but the owner suggested cadmium as he was a scientist and knew the history of the site, presumably it had leached up in contaminated ground water. By the time we'd made the diagnosis the cat had recovered and there have been no further reported cases in many years from the this estate.

[/quote]

It is interesting! And it is missing in our diagnostics. I will try to do something about it.

Thank you!

Re: cat seizure

Martin Atkinson — Mon, 20 Jun 2011 09:15:52 GMT

Re: cat seizure

Andrew Kent — Mon, 20 Jun 2011 08:17:27 GMT

I don't use KBr in cats so have only used keppra in combination with phenobarb. I regularly use all 3 in dogs and yes it works out very expensive in large dogs. Andy

Re: cat seizure

Horcrux — Mon, 20 Jun 2011 08:15:35 GMT

[quote user="Andrew Kent"]

[I do use ammonia testing and find it can add useful information - what units is that in? Also how have you sampled/run that - this is very important for ammonia.

It may be that you never reach a definitive diagnosis in this case - in which case once stable you could try the gradual withdrawal of seizure medication and see what happens. If seizures recur then long term management.

Andy

[/quote]

Ammonia - µmol/L - our lab shows normal values for dogs (6-47,0 µmol/L), but no values for cats.

For this test we use special commercial tubes. How we do it - 1 hour after feeding, lab do the test immidiately without any delay.

Yes, there is a possibility that I will never find what is it. But I try my best.

Olga

Re: cat seizure

Horcrux — Mon, 20 Jun 2011 07:59:15 GMT

[quote user="Andrew Kent"]

Have you examined or had a clinical pathologist look at a sedimentation smear of the CSF? It looks from the analysis like there could be some blood contamination which will make your analysis less reliable. It may be worth repeating this if you do GA again.

Have you got access to toxicology testing? Acute seizures in a young cat that is certainly possible.

The maintenance dose for Keppra is 10 - 30 mg/kg orally every 8 - 12 hours. I use it regularly in addition to Phenobarb/KBr in refractory cases and have used it as a sole therapy in dogs with hepatic disease. I also find it useful as a CRI is status epilepticus but the injectible form is hard to come by.

[/quote]

Yes, there is blood contamination, but I think that- still too much protein. I will repeat the tap only if the cat will be in seizures again.

Ah, no toxicology - I have to talk to our lab and our director to rule it out because routinely we never done it (10 years!).

Do you use Phenobarb/KBr/Keppra for dogs only or for the cats too? This is important. Keppra is reasonable for small dogs and cats - because it is expensive here. We do not have injectable Keppra - only tabs, and - the only medicine we can use in status is propofol!

Re: cat seizure

Andrew Kent — Sun, 19 Jun 2011 21:48:55 GMT

[quote user="Horcrux"]Do you rely on ammonia tests in cat? It is new for us and we are not sure how much we can rely on it/ This cat showed 120 which seems to be high but still can not explain the protein level in CSF. [/quote]

I do use ammonia testing and find it can add useful information - what units is that in? Also how have you sampled/run that - this is very important for ammonia.

Andy

Re: cat seizure

Andrew Kent — Sun, 19 Jun 2011 21:46:19 GMT

Have you got access to toxicology testing? Acute seizures in a young cat that is certainly possible.

Re: cat seizure

Horcrux — Sun, 19 Jun 2011 21:18:06 GMT

[quote user="Andrew Kent"]

[quote user="Michael Woodhouse"]I can't be the only person who has weird things lodged in the back of my brain. I thought KBr shouldn't be used in cats. Does it cause asthma? I can't remember. I'm not a cat vet.[/quote]

I agree that it is reported to cause a fatal bronchitis in cats. I would be using Levetiracetam (Keppra) if you need something in addition to phenobarb, it seems to be very safe in cats and gets to therapeutic levels a lot quicker (2 days).

Andy

[/quote]

About these medicines. We have never seen any complicationss with KBr in cats even for prolonged usage ( usually we prescribe KBr +NaBr 5% solution - 20 mg/kg). Keppra is a new medicine here (I am in Russia - Moscow) and we do not have experience in using it in cats. 20 mg/kg - for dogs, is it the same for cats?

Olga

Re: cat seizure

Horcrux — Sun, 19 Jun 2011 21:03:40 GMT

[quote user="Andrew Kent"]

Yes you could use Levetiracetam as a sole anticonvulsant if needed but what makes you think it is the phenobarb that is causing a reaction?

Have you got cytology on the CSF?

Andy

[/quote]

CSF: Norms

pH 9,0 7,4-7,6

SG 1,005 1,005-1,007

Protein 3 g/l 0,2-0,27

Sugar 8,9 0,5-8,1

RBC 1706 0-5

WBC 0,007

Microalbumin 32,3

Colorless

Do you think it reminds tumor or may be viral encephalitis?

The cats is much better - no fits for the last 48 hours, no aggression. Skin problem almost resolved. He went home this afternoon with prescriptions - phenobarb (2,5 mg/kg/day), antibiotic, metylprednisolone ( 4 mg/ kg/day). Iam planning to repeat FelV in 1 month time and may be to repeat MRI. To check the lead is not possible here.

Do you rely on ammonia tests in cat? It is new for us and we are not sure how much we can rely on it/ This cat showed 120 which seems to be high but still can not explain the protein level in CSF.

Olga

Re: cat seizure

Horcrux — Sun, 19 Jun 2011 05:34:24 GMT

Sorry, about allergy - the cat was already about 7 days on phenobarb and then we found these papules. For me very unusual appearance. I will try to make photo today. He did not respond to antyhistamine and steroids.

Re: cat seizure

Horcrux — Sun, 19 Jun 2011 05:29:20 GMT

[quote user="Andrew Kent"]

Yes you could use Levetiracetam as a sole anticonvulsant if needed but what makes you think it is the phenobarb that is causing a reaction?

Have you got cytology on the CSF?

Andy

[/quote]

Skin reaction - red papules all over the body was found before we have started KBr (he was clippped for ultrasound). At a glance I was in doubt that it may be kind of cutaneous lymphoma, but our dermatologist and our oncologist both are sure it is an alllergy. So we took just skin scrapings which were normal. CSF cytology - yes we did it and it was not diagnostic for anything. In 2 hours I will be in the clinic and I will post the exact numbers.

Yesterday the emergency unit reported that the cat is much bettter - no fits, no salivation, eating. So I will try to give him Keppra and reduce Phenobarb and stop KBr.

Thanks

Olga

Re: cat seizure

Andrew Kent — Sat, 18 Jun 2011 22:12:05 GMT

Yes you could use Levetiracetam as a sole anticonvulsant if needed but what makes you think it is the phenobarb that is causing a reaction?

Have you got cytology on the CSF?

Andy

Re: cat seizure

Horcrux — Sat, 18 Jun 2011 09:11:07 GMT

[quote user="Mark Hedberg"]Test for lead; the seizures and behaviour changes make this a possible ddx.

Another ddx would be an organophosphate toxicity; salivation and fitting make this a possible ddx. Can you give a premed dose of atropine? 0.02mg/kg in a cat NOT suffering from OP toxicity will stop the salivation and increase heart rate. If OP toxicity is the cause, you'll need more atropine to achieve any effect.

Pralidoxime chloride, 20mg/kg bid for 3 days is supposed to bind with the insecticide-acetylcholine complex (if it is present, of course. )

Good luck!

[/quote]

Thank you, Mark! Good suggestion!

Olga.

Re: cat seizure

Mark Hedberg — Sat, 18 Jun 2011 08:43:53 GMT

Test for lead; the seizures and behaviour changes make this a possible ddx.

Pralidoxime chloride, 20mg/kg bid for 3 days is supposed to bind with the insecticide-acetylcholine complex (if it is present, of course. )

Good luck!

Re: cat seizure

Horcrux — Sat, 18 Jun 2011 06:20:38 GMT

[quote user="Andrew Kent"]

Andy

[/quote]

Thanks! Do you think Kepppra can replace phenobarb?

Re: cat seizure

Horcrux — Sat, 18 Jun 2011 06:18:28 GMT

[quote user="Mark Hedberg"]

I'm not a specialist, but wouldn't an infection have elevated WBC's?

Might this not be a toxicity of some type?

Alternatively, the elevated ALT and AST could suggest liver damage; might this also be hepatoencephalic syndrome?

[/quote]

I thought it was. But ALT/AST just a little elevated - 169/80, amilase is worth - 2,5 thousand (sorry - dont remember exact numbers - Im at home). Bile acids - normal. What would you do next? Liver biopsy?

Re: cat seizure

Horcrux — Sat, 18 Jun 2011 06:12:31 GMT

Thank you!

Yes, I am thinking about Keppra. The only consideration about KBr - we use it in status - high loading dosages, we call it bromization - when we need to stop seizures quickly. Well, sometimes we prescribe it 20 mg/kg/24 h for a long term even in cats. Keppra is a new medicine here.

Actually I need something to replace Phenobarb - because this cat seems to be allergic to it - skin reaction. Do you think Keppra will be a good choice?

About infection/inflammation - WBC are normal, but CSF - too much protein, microalbumin and sugar ( which is odd because blood level is ok) and I cant understand why it is so alkalic.

Generally cat is not getting better. After the CSF I have started him on metylprednisolon, cephtriaxon.

Re: cat seizure

Andrew Kent — Fri, 17 Jun 2011 22:37:50 GMT

Andy

Re: cat seizure

Michael Woodhouse — Fri, 17 Jun 2011 22:31:15 GMT

I can't be the only person who has weird things lodged in the back of my brain. I thought KBr shouldn't be used in cats. Does it cause asthma? I can't remember. I'm not a cat vet.

Re: cat seizure

Mark Hedberg — Fri, 17 Jun 2011 22:29:03 GMT

I'm not a specialist, but wouldn't an infection have elevated WBC's?

Might this not be a toxicity of some type?

Alternatively, the elevated ALT and AST could suggest liver damage; might this also be hepatoencephalic syndrome?

Re: cat seizure

Emily Nightingale — Fri, 17 Jun 2011 22:18:47 GMT

Impressive work up. Hope it turns out ok.