Seizure disorders are commonly encountered in small animal practice. The goal of this book is to provide a comprehensive, evidence-based resource to assist in the successful management of recurrent seizures in dogs and cats. Practical information on every aspect of seizure management is presented and is supported with a review of the available literature. The book’s format is designed to provide a logical, clinically relevant approach to the seizure patient, with in-depth information on the broad range of topics involved in the diagnosis and treatment of seizure disorders in dogs and cats. The first five chapters describe the clinical and diagnostic approach to the seizure patient, and include thorough descriptions of seizure classification with video case examples, canine idiopathic epilepsy, the genetics of epilepsy, feline epilepsy and quality of life. There are separate chapters devoted to advanced imaging and electroencephalography, both of which contain numerous images to complement the discussion of the material. The remaining chapters focus on epilepsy treatment and include a review of general treatment guidelines and pharmacological principles, as well as a comprehensive review of antiseizure drugs, adjunctive therapies for drug-resistant epilepsy, and the management of cluster seizures and status epilepticus in dogs and cats. The 19 book chapters are authored by veterinary specialists from around the globe. Algorithms are included throughout the book, and each chapter contains a summary of key points, providing easy access to information to support clinical decision making and patient care. Our aim was to create a comprehensive reference that would be of value to primary care veterinarians, veterinary students, interns, residents, and veterinary specialists alike.
Authors:
Luisa De Risio
DVM (Hons), PhD, PGCert Vet Ed, FHEA, Dipl. ECVN, FRCVS, RCVS and EBVS® European Specialist in Veterinary Neurology
Luisa De Risio is a Diplomate of the European College of Veterinary Neurology (ECVN), Fellow of the Royal College of Veterinary Surgeons (RCVS), RCVS and EBVS European Specialist in Veterinary Neurology and ECVN Secretary. She is one of the founding members of the International Veterinary Epilepsy Task Force (IVETF), the Chair of the IVETF diagnosis working group and co-chair of the IVETF treatment working group. Luisa has coauthored a textbook on canine and feline epilepsy, contributed chapters to other veterinary books, published widely in peer-reviewed journals and lectured at numerous continuing education and scientific meetings. She has worked at the Animal Health Trust (2005–2019) as Head of Neurology/Neurosurgery and Head of Clinical Research and joined Linnaeus Veterinary limited, UK, in 2020 as Clinical Research & Excellence Director. Luisa has been awarded the Postgraduate Certificate in Veterinary Education by the Royal Veterinary College, she is a Fellow of the Higher Education Academy (FHEA) and Honorary Professor in Veterinary Neurology at Nottingham Trent University.
Karen R. Muñana
DVM, MS, Dipl. ACVIM (Neurology)
Karen Muñana is a practicing board-certified veterinary neurologist. She is Professor of Neurology and Neurosurgery at North Carolina State University College of Veterinary Medicine, USA. She received her Bachelor of Science degree from the University of California at Berkeley and her Doctor of Veterinary Medicine from the University of California at Davis. She completed a neurology and neurosurgery residency training program and Master of Science degree at Colorado State University. Her research focuses on canine epilepsy and commonly involves clinical trials in which a new treatment or diagnostic tool is evaluated in epileptic pets. She is a member of the International Veterinary Epilepsy Task Force (IVETF) and has served on two American College of Veterinary Internal Medicine consensus panels on seizure management. She has published chapters and articles in numerous textbooks and peer-reviewed scientific journals and has been an invited speaker at national and international veterinary meetings.
Contributors:
Sofie F.M. Bhatti
DVM, PhD
Head of Clinical Neurology, Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Belgium.
Karin Borges
PhD
Associate Professor, School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St. Lucia, Australia.
Marios Charalambous
DVM, PhD, Dipl. ACVIM (Neurology), Dipl. ECVN, FHEA, MRCVS
Clinical and Research Associate, Clinic for Small Animals, Department of Neurology, University of Veterinary Medicine Hannover, Germany.
Andrea Fischer
Dr. med. vet., Dipl. ECVN, Dipl. ACVIM (Neurology), EBVS® European Specialist of Veterinary Neurology
Professor of Veterinary Neurology and Head of the Neurology Service, Small Animal Medicine Clinic, Centre for Clinical Veterinary Medicine, LMU University of Munich, Germany.
Kari Foss
DVM, MS, Dipl. ACVIM (Neurology)
Assistant Professor, Neurology & Neurosurgery, Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois, USA.
Devon Hague
DVM, Dipl. ACVIM (Neurology)
Clinical Associate Professor, Neurology & Neurosurgery, Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, Illinois, USA.
Daisuke Hasegawa
DVM, PhD, DAiCVIM (Neurology)
Professor, Veterinary Clinical Neurology and Veterinary Radiology, Nippon Veterinary and Life Science University, Tokyo, Japan.
Fiona M.K. James
DVM, MSc, DVSc., ACVIM (Neurology)
Associate Professor, Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Canada.
Borbala A. Lörincz
Dr. med. vet., PhD
University of Veterinary Medicine, Vienna, Austria.
Stephanie McGrath
DVM, MS, Dipl. ACVIM (Neurology)
Associate Professor, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, USA.
Elliott S. Neal
BAdvSc (Hons), Research Assistant
School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St. Lucia, Australia.
Rowena M.A. Packer
BSc (Hons), PhD, PGCert (VetEd), FHEA
Lecturer in Companion Animal Behaviour and Welfare Science and BBSRC Research Fellow, Royal Veterinary College, UK.
Akos Pakozdy
Dr. med. vet., PhD, Dipl. ECVN, EBVS® European Specialist in Veterinary Neurology
University of Veterinary Medicine, Vienna, Austria.
Mark G. Papich
DVM, MS, Dipl. ACVCP
Professor of Clinical Pharmacology, College of Veterinary Medicine, North Carolina State University, USA.
Edward (Ned) E. Patterson
DVM, PhD, Dipl. ACVIM (SAIM)
Professor of Medicine and Genetics, University of Minnesota College of Veterinary Medicine, St. Paul, USA.
Michael Podell
MSc, DVM, Dipl. ACVIM (Neurology)
Chief Medical Officer, MedVet, Columbus, USA.
Miyoko Saito
DVM, PhD, DAiCVIM (Neurology)
Associate Professor, Head of Neurology Service, Lab. Small Animal Surgery (Neurology), Azabu University, Kanagawa, Japan.
Fabio Stabile
DVM, MRCVS, PhD, Dipl. ECVN, RCVS, EBVS® European Specialist in Veterinary Neurology
Senior Consultant in Neurology and Neurosurgery, Southfields Veterinary Specialists, Linnaeus Veterinary Ltd, UK.
Andrea Tipold
Dr med. vet., Dipl. ECVN, EBVS® European Specialist in Veterinary Neurology
Professor of Veterinary Neurology, Dept. of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany.
Luc Van Ham
DVM, PhD, Dipl. ECVN
Professor of Veterinary Neurology and Neurosurgery, Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Belgium.
Weizhi Xu
MSc, PhD student
School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St. Lucia, Australia.
Table of contents:
01 The Clinical and Diagnostic Approach to the Seizure Patient....... 1
Luisa De Risio, Karen R. Muñana
Terminology........................................................................... 1
Phases associated with a seizure................................... 4
Disorders that can mimic seizures and discriminators ............................................................... 5
Systematic diagnostic approach to the patient with seizure disorders.................................................... 8
02 Canine Idiopathic Epilepsy.................... 33
Andrea Fischer
Types of epileptic seizures................................................ 34
Diagnostic approach .......................................................... 38
Breed-related differences ................................................. 39
and lifespan in canine idiopathic epilepsy .................................................................................. 63
03 Quality of Life Issues in Canine Epilepsy................................................................. 77
Rowena MA Packer
What is quality of life?........................................................ 77
Impact of epilepsy on canine QoL.................................. 78
Impact of epilepsy on caregiver quality of life.............. 85
04 Genetics of Epilepsy in Dogs and Cats................................................................ 93
Edward (Ned) E. Patterson
Genetic or suspected genetic idiopathic epilepsy in dogs................................................................ 93
Structural epilepsies in dogs ............................................ 96
L-2-Hydroxyglutaric aciduria.............................................. 97
Genetic counseling for breeding dogs with epilepsy ...................................................................... 100
Feline epilepsy genetics .................................................... 100
05 Feline Epilepsy................................................ 103
Akos Pakozdy, Borbala A. Lörincz
Prevalence of seizure disorders in cats......................... 103
Terminology........................................................................... 103
Diagnostic approach to seizure disorders in cats....... 104
Antiseizure treatment of feline epilepsy......................... 110
Outcome of feline epilepsy................................................ 112
06 Advanced Diagnostic Imaging in Epilepsy........................................................... 117
Daisuke Hasegawa
Conventional MRI................................................................ 118
Structural MRI for diagnosis of epilepsy........................ 129
Advanced and functional imaging................................... 133
Imaging findings of structural epilepsies ....................... 140
Degenerative diseases....................................................... 140
07 Electroencephalography.......................... 155
Fiona M.K. James
How does EEG work? ....................................................... 156
How to record EEG? .......................................................... 158
How to interpret EEG?....................................................... 164
How to report EEG?........................................................... 175
Where to learn more on EEG?........................................ 176
08 Fundamental Principles of Pharmacokinetics for Antiseizure Medications............................... 185
Mark G. Papich
Important definitions............................................................ 185
Principles of drug disposition in animals....................... 185
Drug elimination (elimination half-life, t½)....................... 188
Drug distribution (volume of distribution)....................... 190
Drug clearance..................................................................... 192
Drug absorption................................................................... 194
09 Principles of Antiseizure Drug Use... 201
Karen R. Muñana, Luisa De Risio
Initiating therapy................................................................... 201
Choosing an appropriate antiseizure drug.................... 204
Devising a rational treatment plan .................................. 207
Drug resistance.................................................................... 213
Epilepsy remission ............................................................. 214
10 Phenobarbital.................................................... 219
Fabio Stabile, Luisa De Risio
Mechanism of action ......................................................... 219
Pharmacokinetics ............................................................... 219
Efficacy .................................................................................. 221
Clinical use ........................................................................... 223
Adverse effects and drug interactions............................ 229
11 Potassium Bromide...................................... 239
Michael Podell
Mechanism of action ......................................................... 239
Pharmacokinetics................................................................ 239
Efficacy................................................................................... 240
Clinical use............................................................................ 241
Adverse effects and drug interactions............................ 243
12 Levetiracetam................................................... 247
Karen R. Muñana
Mechanism of action .......................................................... 247
Pharmacokinetics................................................................ 248
Efficacy................................................................................... 249
Clinical use ........................................................................... 252
13 Imepitoin................................................................ 257
Andrea Tipold
Mechanism of action .......................................................... 257
Pharmacokinetics................................................................ 258
Efficacy................................................................................... 258
Clinical use ........................................................................... 261
Adverse effects and drug interactions............................ 262
14 Zonisamide......................................................... 267
Daisuke Hasegawa, Miyoko Saito
Mechanism of action .......................................................... 267
Pharmacokinetics................................................................ 268
Clinical use ........................................................................... 271
Adverse effects and drug interactions ........................... 273
15 Other Antiseizure Drugs .......................... 279
Kari Foss, Devon Hague
Clorazepate and Clonazepam ......................................... 281
Felbamate.............................................................................. 282
Gabapentin .......................................................................... 283
Topiramate............................................................................. 284
Pregabalin.............................................................................. 286
Rufinamide ............................................................................ 287
Lacosamide........................................................................... 287
Brivaracetam......................................................................... 288
16 Cannabidiol in Canine Epilepsy......... 291
Stephanie McGrath
Mechanism of Action ......................................................... 291
Pharmacokinetics................................................................ 293
Efficacy .................................................................................. 295
Clinical use............................................................................ 296
Adverse effects and drug interactions............................ 296
17 Dietary Management of Canine Epilepsy ............................................................... 301
Elliott S. Neal, Weizhi Xu, Karin Borges
Pathophysiology and mechanism of action.................. 301
“Pharmacology and pharmacokinetics” of ketogenic diets and medium chain triglycerides............. 305
Efficacy................................................................................... 306
Manipulations of macronutrients – practical considerations for the treatment of dogs with epilepsy.. 309
18 Neurostimulation for Canine Epilepsy................................................................. 313
Sofie F.M. Bhatti Contributors: Marios Charalambous, Luc Van Ham
Vagus nerve stimulation .................................................... 314
Transcranial magnetic stimulation .................................. 318
Conclusions........................................................................... 321
19 Management of Status Epilepticus and Cluster Seizures in Dogs and Cats.................................... 325
Marios Charalambous Contributor: Sofie F.M. Bhatti
Status epilepticus ................................................................ 325
Cluster seizures ................................................................... 340
