anticonvulsivant therapy

Re: anticonvulsivant therapy

verena roustan — Tue, 31 Mar 2015 19:26:57 GMT

Thanks a lot Anthony :)

Re: anticonvulsivant therapy

Anthony Dennison — Mon, 30 Mar 2015 08:58:50 GMT

Levetiracetam is a good second line anti-epileptic drug, no doubt about it. However, when researching for my case report I came a cross a couple of papers that made me think about how readily I would dispense it. One discussed the huge variation in serum levels, some animals absorb better than others. The other, which was only published on the JVIM website in February, showed that use of long term phenobarbital or KBr alongside levetiracetam increased it's clearance, meaning serum levels were much lower than expected.

Re: anticonvulsivant therapy

Alex Gough — Fri, 27 Mar 2015 13:35:08 GMT

David, I've had a cat that died horribly of idiosyncratic hepatic necrosis after a short course of oral diazepam. Sadly it was prescribed by a homeopath when the owner consulted him for a help with a stress related condition. I also remember a Boxer fitting after ACP, that was in around 1998 I believe ;)

I have used levetiracetam in many cases on a long term bases, and it seems to help, but its hard to know. I don't think the evidence is robust enough yet to say whether long term use is indicated or not, given the difficulties with knowing whether any anti-epileptic drug genuinely works.

Re: anticonvulsivant therapy

David Mills — Fri, 27 Mar 2015 13:11:52 GMT

[quote user="Stephen Courtney"] if i remember rightly keppra ( leva whotsit) only works for a while so treating for a period then stopping, then restarting is the way to go.[/quote]

I believe there is some (very limited) evidence that cats don't upregulate the enzyme that destroys it, so unlike dogs it may be suitable for long-term therapy. I have seen some (a very small number) vets use it as sole therapy without apparent waning of effects - but of course this could just be that the disease has regressed to the mean.

I am always unsure of the validity of the diazepam/KBr horror stories in cats. Suspect there is heavy recollection bias with these. A bit like the Boxer/ACP dogma that still persists... (n=8 in 1972 I believe)

Re: anticonvulsivant therapy

Andrew Kent — Fri, 27 Mar 2015 11:02:11 GMT

[quote user="verena roustan"]

Did somebody ever used Levetiracetam then?

They don't say much about this medication in the Formulary or the Nelson&Couto SA medecine book...

Or do you know who I could call to get dome advices about that?

Many thanks for all your answers x

[/quote]

Hi Verena,

If you wanted to discuss the case then probably a call to your local neurologist would be the best bet. Difficult otherwise to give more specific advice on here as we don't know the full history or whether any investigations have been performed.

Regarding Keppra (levetiracetam) - we use it frequently and dose are listed in the BSAVA formulary (at least in the last 2 editions).

Andy

Re: anticonvulsivant therapy

Sammy82 — Fri, 27 Mar 2015 10:55:26 GMT

My very thoughts. In food producing animals we obviously have to stick to the cascade for food safety reasons, which sometimes does compromise animal welfare or means an animal needs to be euthanised. In companion animals this is not of concern. I make my choice/choices of active ingredient based on clinical judgement, and follow the cascade if possible, but if for one reason or another (dosage, application, antibiotic sensitivity, clinical safety) this would compromise animal welfare then, well, I don't. Would anyone use Advantix on a cat when all cat flea preparations were unavailable for some reason, just because it is licensed for the same indication for a different species? Definitely not!

Re: anticonvulsivant therapy

Martin Atkinson — Fri, 27 Mar 2015 10:37:51 GMT

[quote user="Michael Woodhouse"]

I think you will find if there is a licensed veterinary medicine for another species it must be used as first choice under the cascade. Or do you guys just ignore that?

[/quote]My primary concern is the welfare of my patients and the efficacy of the medication. If this goes against the cascade then I would tell the inspector to stuff it up a part of his anatomy where the light of day will not see it again and be prepared to defend that stance.

Sorry, can't say anything more constructive on the OP but feel better for having got that off my chest!

Re: anticonvulsivant therapy

verena roustan — Fri, 27 Mar 2015 10:18:14 GMT

Did somebody ever used Levetiracetam then?

They don't say much about this medication in the Formulary or the Nelson&Couto SA medecine book...

Or do you know who I could call to get dome advices about that?

Many thanks for all your answers x

Re: anticonvulsivant therapy

Hannah Wynne Richards — Fri, 27 Mar 2015 09:50:56 GMT

Since BSAVA formulary says "Do not use" then as far as I'm concerned that deals with the lagality.

Wynne

Re: anticonvulsivant therapy

Alex Gough — Fri, 27 Mar 2015 09:43:47 GMT

[quote user="Michael Woodhouse"]

I think you will find if there is a licensed veterinary medicine for another species it must be used as first choice under the cascade. Or do you guys just ignore that?

[/quote]

I think this is a great example of why you shouldn't blindly follow the cascade. You are wrong to say that a licensed veterinary medicine for another species MUST be used as first choice under the cascade. You wouldn't prescribe the Pardale, (licensed paracetamol for dogs) to a cat. Clinical considerations trump everything else, and I have no problem using an unlicensed drug as my first line choice, even if there is another drug licensed for that use, in that species, for that condition, if I consider my choice to be clinically superior. Talk to cardiologists about Hypercard, and whether they think that should be the first line treatment for HCM in cats.

Products are licensed based on the information available at the time, and they stay licensed, even when the science moves on, and better products become available through human channels.

I know not everyone agrees with this reasoning, but it is legally perfectly acceptable, provided you can clinically justify your choice, and the client gives informed consent.

Re: anticonvulsivant therapy

Andrew Kent — Fri, 27 Mar 2015 08:20:10 GMT

[quote user="Michael Woodhouse"]

I think you will find if there is a licensed veterinary medicine for another species it must be used as first choice under the cascade. Or do you guys just ignore that?

[/quote]

Whilst KBr can work in cats it causes significant side effects in about 50% of cases, most commonly a frequently fatal inflammatory lung disease. That's why if you look in the BSAVA formulary under KBr it says for cats "do not use"

I would be happy that gives a good enough reason not to use it under the cascade.

That doesn't mean it couldn't be used - but there are better options and the owners would have to give very informed consent before use. For me I might consider it as a last resort if a client couldn't afford other options and the clients understood the risks.

Andy

Re: anticonvulsivant therapy

Clive Ansell — Fri, 27 Mar 2015 07:42:00 GMT

Are there any reports, of or has anyone used off label, Pexion in cats?

Re: anticonvulsivant therapy

Glenn Hodgson — Fri, 27 Mar 2015 07:37:36 GMT

We inherited a cat on bromide. Left him on it as he was well. Lab always gave dire warnings each time we tested blood concentrations. He did well on iT.

Would be very canny about starting a new cat on it though.

Re: anticonvulsivant therapy

Michael Woodhouse — Fri, 27 Mar 2015 00:04:54 GMT

I think you will find if there is a licensed veterinary medicine for another species it must be used as first choice under the cascade. Or do you guys just ignore that?

Re: anticonvulsivant therapy

Stephen Courtney — Thu, 26 Mar 2015 21:42:52 GMT

Gabapentin may be an option also?

Re: anticonvulsivant therapy

Stephen Courtney — Thu, 26 Mar 2015 21:42:25 GMT

I think andy has the right of it. It might be worth phoning a neurologist and asking for advice - if i remember rightly keppra ( leva whotsit) only works for a while so treating for a period then stopping, then restarting is the way to go. /haven't had to use it for a while.

in the bad old days I used diazepam as a first choice anticonvulsant in cats and never had a problem, but would be reluctant to try that now without having exhausted alternatives and had a very frank chat with he owner that included written consent

Re: anticonvulsivant therapy

Andrew Kent — Thu, 26 Mar 2015 19:16:44 GMT

Im afraid I would disagree with Michael - I would urge against using KBr in cats as it can cause fatal side effects.

I would probably go for levetiracetam as my second choice drug.

Andy

Re: anticonvulsivant therapy

verena roustan — Thu, 26 Mar 2015 19:00:41 GMT

Thanks Michael, that was my main concern

Did somebody ever tried anything else? or would recommend it better than KBr?

Re: anticonvulsivant therapy

Michael Woodhouse — Thu, 26 Mar 2015 18:50:08 GMT

KBr

http://www.ncbi.nlm.nih.gov/pubmed/12387381

I used it once and seemed to really help. I never saw side effects, but the linked paper suggests they are common.