Definition and classification of epilepsy in dogs and cats: basic physiological knowledge of epilepsy (can be understood series) IVETF definition of epilepsy; seizures, reactive seizures, epilepsy, persistent epilepsy, cluster epilepsy; IVETF classi...
Definition and classification of epilepsy in dogs and cats: basic physiological knowledge of epilepsy (can be understood series) IVETF definition of epilepsy; seizures, reactive seizures, epilepsy, persistent epilepsy, cluster epilepsy; IVETF classification of epilepsy: focal epilepsy and systemic epilepsy; idiopathic epilepsy and structural epilepsy.
Diagnosis of epilepsy in dogs and cats: The importance of medical history investigation: Diagnosis process: Like vomiting, epilepsy seizures are just symptoms! The most common cause of reactive seizures and the examinations that may be required; screening of structural epilepsy; diagnostic criteria for idiopathic epilepsy.
Diagnosis: Blood routine, biochemical, combinatorial examination of coagulation and urine analysis should be checked in animals with epilepsy. For suspected liver disease, it can be assessed whether epilepsy caused by liver problems can be assessed through clinical phenomena, disorders or biochemical indicators (e.g., hypoproteinemia, low cholesterol, low urea nitrogen, low sugar, abnormal liver enzymes), bile acids or free ammonia levels. If an animal is using antiepileptic drugs, the drug levels of AEDs in the serum should be detected, which is necessary than the level of calming in the serum.
Blood pressure tests and blood oxygen tests are encouraged, especially in recent times when severe epilepsy or respiratory distress is shown. Imaging and cerebrospinal fluid examinations are also recommended in epilepsy animals without etiology unless there is obvious metabolic problems or epilepsy caused by toxic substances. MRI is the preferred imaging, and CT is also useful in diagnosis. Many forebrain injuries are visual on CT, even if there are only very few changes. If there is no evidence of increased intracranial pressure (eg, severe midline metastasis, cerebrospinal decapitation, infarct hydrocephalus) or tumor damage in the imaging intermediates, cerebrospinal fluid collection can be found.
Pathological examinations found: Physical examinations and histopathology rarely find the cause of epilepsy. Any cause of prolonged epilepsy, whatever causes it, can lead to edema and neuronal necrosis, especially in the hippocampus and temporal lobe.
Treatment: The first goal of treatment is to tissue epilepsy seizures and prevent subsequent relapses of epilepsy. After each rapid antiepileptic drug is administered, the condition of the sick animal must be observed. If serum biochemistry shows potential metabolic problems such as hypoglycemia or low calcium, correct them immediately. If the diseased animal has continuous convulsions or at least twice within 24 hours, the dosage of anti-epileptic drugs should be increased. If epilepsy caused by poisoning or metabolic diseases has been eliminated, the amount of anti-epileptic should be gradually reduced after a few weeks. Animals with intracranial structural abnormalities, spontaneous epilepsy, or unresolved metabolic diseases require continued use of maintenance doses of antiepileptic drugs unless the underlying cause has been determined to be resolved.
Drug selection:
Emergency: If the diseased animal is in epilepsy, if the animal does not inject 0.5 mg/kg of diazepam intravenously with antiepileptic drugs, if the p450 inducer such as phenobarbital is being used, the diazepamation amount is 1 mg/kg. In order to avoid not being able to find the intravenous medicine immediately, sometimes the dose is twice that of the intravenous medicine. Midazolam can be chosen instead of diazepam. For dogs with slow vacuolar response or only partial response, antiepileptic drugs can be added to control them. In addition to valerate phenobarbital, it is the next option and can be injected intravenously. Propofol or other fast-acting antiepileptic drugs can be used first when phenobarbital has not yet worked. Recently, the new anti-epilepsy, like levetiracetam, can be administered intravenously, which is a safe choice for dogs and cats.
The following is a short list of some first aid drugs.
Dimmobilization mechanism: GABA receptor agonist (hepatic metabolism). Side effects: sedation, excitement, liver disease (appears after oral administration of cats). Dosage is 0.5 ml/kg (1 mg/kg when phenobarbital is used) and dosage is intravenous; CRI 0.2~2 mg/kg/h (0.2~0.5/kg/h classical initial amount); dental (double intravenous injection). When the animal has not corrected the ion imbalance, both stabilizing CRI and injection must be used to maintain the body's sedation and prevent the next epilepsy. Intravenous continuous infusion is the last thing that needs to be stopped.
midazolam, mechanism: GABA receptor agonist (hepatic metabolism). Dosage: 0.1~0.3mg/kg,IV,IM,SQ.
Phenobarbital, mechanism: GABA receptor agonist half-life 24 to 72 hours (hepatic metabolism). Side effects: polyuria, thirst, excessive eating, behavioral changes, liver disease (especially > in blood levels; 35-40 micrograms/mL), bone marrow malignant fluid (usually within 1 month of initial treatment), skin disease, dysfunction, hypothyroxine. If the dose is given intravenously, cardiovascular inhibition and hypotension will occur. Dosage: Starting 12 to 16 mg/kg. After the remaining drug was used for more than 24 hours, a dose of 6 mg/kg was injected intravenously in relatively stable animals. It takes 20 minutes for the best results, so other medications may be needed to control the epilepsy during this time. If you encounter stubborn epilepsy, the maximum dose per day is 30 mg/kg/d, but only 16 mg/kg can be used at a time.
Other drug selection, propofol mechanism: short-acting anesthetics (hepatic and systemic microparticle metabolism). Side effects: sedation, cardiopulmonary inhibition, hypotension, Hyendz body production (continuous occurrence of cats). Dosage: 2 to 8 mg/kg per dose; CRI 0.1 to 0.6 mg/kg/min.
pentobarbital, dosage 1 to 3 mg/kg, followed by repeated doses or 3 to 10 mg/kg/h CRI. Although pentobarbital can reduce the extent of convulsions, some authors still suspect its ability to inhibit neuronal activity related to epilepsy.
In this chapter, valbubarbital is not praised by the author.
Other options, levetiracetam is a potent antiepileptic drug and it can be used for intravenous injection. Anesthesia can be induced and maintained with isoflurane or continuous intravenous intravenous drips with propofol or phenobarbital. These animals require intubation and assisted breathing.
Maintenance therapy: Antiepileptic drugs in veterinary drugs evolve at a very fast pace. While many veterinarians will consider traditional drugs like phenobarbital and potassium bromide preferred drugs, other authors prefer expensive new drugs that have fewer side effects and do not require very strict monitoring and are better or the same as those of traditional drugs. Potassium bromide can cause adverse lung infections in cats, so it is not recommended for cats. Validosis is used as a maintenance drug for anti-epileptics in cats, but many authors do not recommend it because it has been reported that Validosis may cause severe irreversible liver disease in cats. Some animals cannot control the condition by using an anti-epileptic drug, and at this time, two or even three combinations of treatment should be used. When using traditional drugs for treatment, be sure to make sure the blood level is within the appropriate range before adding dosage.
Many new drugs are administered orally. New drug, Zonesamide (Zonegram)
mechanism: blocking calcium and sodium ion channels; enhancing the release of GABA. The half-life is 15 hours. Liver metabolism. Side effects: ataxia, vomiting, lethargy and dry eye. Tracking and monitoring: CBC and biochemistry once every six months. The blood concentration of zonisamide is not often used. Dosage: 4 to 10 mg/kg PO twice a day for dogs. If other drugs that induce liver microscopic enzyme have been used, the dose of the drug should be used to the maximum amount. Not recommended for cats.
levetiracetam (Keppra) mechanism: calcium ion and glycine channel blockers. The elimination half-life in dogs is 4 hours, but the most effective effect occurs when blood drug concentration is low. Extrahepatic hydrolysis urine excretion. Side effects: Very safe.
At high doses, ataxia, drooling, gastrointestinal symptoms occur. Tracking: CBC and biochemistry once every 6 months. Dosage: The first dose of dog is 20mg/kgPO 3 times a day. An increase of 10 to 20 mg/kg can be later. You can inject slowly intravenously at 20 mg/kg.
is used in cats in the same amount. Neurontin mechanism: increase synthetic GABA levels and block calcium ion channels. Kidney (main pathway) and liver metabolism. The elimination half-life in dogs is 3 to 4 hours, although the significant effect occurs at the low peak of drug concentration. Side effects: mild ataxia and sedation. Tracking: The gabapentin level is not widely used and the effect is not clear in humans. Dosage: 30 to 60 mg/kg/d, administered to the dog three to four separate times. 5 to 10 mg/kg PO2 to three times a day to cats. Do not use liquids and add styphon, because there is xylitol.
Traditional medicine, phenobarbital: Tracking: After changing the dose or if the effect of controlling epilepsy is poor, blood concentration needs to be observed 14 to 21 days after medication. In dogs, if the medication is started, biochemical, CBC, and bile acid examinations are recommended. It is recommended to retest the biochemical test every 6 months, add the level of pentine and bile acid quality. Dosage: The starting amount in dogs is 2 to 3 mg/kg twice a day, when the control effect is controlled. When the control effect is poor, gradually increase the amount. The treatment level of blood concentrations are generally 15 μg/ml to 35 μg/ml in most dogs and 15 to 30 μg/ml in most cats.
Potassium bromide, mechanism: GABA receptor agonist, half-life of 20 to 30 elimination half-life (renal metabolism). Side effects: polyuria, thirst, excessive eating, gastrointestinal diseases, behavioral changes, pancreatitis, skin diseases, ataxia (especially the hind limbs) and chlorine concentrations in the blood biochemistry are misassessed. It is prohibited in cats because it may cause fatal pneumonia in cats; it is also prohibited in animals with kidney and heart disease. Tracking: The blood drug concentration should be tested 3 months after the first dose or the dose is changed. Less than 6 months to 1 year, biochemical, routine urine and bromide concentrations in the blood must be tested. If you can try not to change the variety of food, because the salt concentration can change the concentration of the drug in the blood. Dosage: Young animals should be given continuously for 5 days, 100 mg/kg per day. In an emergency, the total dose at a time can exceed the total dose of a day and can be administered rectally, but gastrointestinal symptoms can be frequent. Maintenance amount is 30 to 40 mg/kg PO per day. When the dose increases, partial administration is recommended (100 mg/kg and new dose/day for 5 consecutive days). Diuresis with 0.9% NaCl will quickly reduce blood drug concentration. The drug concentration level during treatment is 1 to 3 mg/ml.
Prevention/Interaction: AEDs are compound drugs, so any listed prevention and impact are a small part of the problem that can occur. Generally speaking, whether acepromazine can cause epilepsy remains to be investigated, but some practitioners believe that it is necessary to pay attention to the use in dogs with epilepsy problems. Any medication that lowers the epilepsy threshold should be avoided. Any drug metabolized by the liver cytochrome p450 pathway used with phenobarbital must be changed or increased.
