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Alternative drugs to phenobarbital in canine epileptic patients

02 May 2021
Clinical
20 mins read
02 May 2021
Volume 26 · Issue 5

Abstract

Epilepsy is one of the most common chronic neurological diseases in companion animals. The first choice for anti-epileptic drugs has consistently been phenobarbital. However, the presence of side effects or contraindications for its use, or poor control of seizures in some canine patients, may require the replacement of phenobarbital, or the addition of more anti-epileptic drugs to the treatment protocol. This article describes the indications, mechanism of action, pharmacokinetics, recommended doses and adverse effects of anti-epileptic drugs whic can be used in place of phenobarbital. A review of the current literature and the administration of each anti-epileptic drug in veterinary practice is also presented. Bromide and imepitoin are overall good options for adjunctive or alternative anti-epileptic medications. However, the pros and cons of each drug need to be considered, in order to choose the most suitable therapeutic protocol for each case. Pharmaco-resistant epilepsy occurs when seizure activity fails to be controlled with two or more anti-epileptic drugs. In the latter situation, some more recently studied alternative anti-epileptic drugs can be considered, such as levetiracetam, gabapentin, pregabalin, zonisamide, felbamate and topiramate. Non-medical options include a medium chain triglyceride oil enriched diet, and cannabidiol.

Epilepsy is a chronic pathological condition of the brain, characterised by recurrent seizures in association with an enduring alteration of the brain (Berendt et al, 2015). The true prevalence of epilepsy in dogs is unknown, but has been estimated to be 0.6–0.75% of the general dog population (Berendt et al, 2015).

Seizures are the clinical manifestation of an excessive, synchronous and uninterrupted discharge of a group of neurons, which causes uncontrollable electrical activity in the cerebral cortex.

Abnormal neuronal activity may be caused by a variety of underlying aetiologies. An extracranial disturbance of metabolic, nutritional or toxic nature might cause reactive seizures in a normal brain, but structural epilepsy is caused by intracranial lesions affecting the brain, which can initially be caused by infections, inflammations, neoplasia, vascular accidents and trauma. No definitive causes have yet been found in dogs suffering from benign idiopathic epilepsy, although a genetic component may be involved. However, if a structural cause is suspected, despite remaining obscure, the disease is defined as unknown epilepsy (Berendt et al, 2015). A study among dogs undergoing magnetic resonance imaging (MRI) for investigation of epilepsy reported the presence of structural lesions in 45% of dogs, and a presumed diagnosis of idiopathic epilepsy in 53.8% of dogs (Hall et al, 2020).

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antiepileptic drug
monotherapy
polytherapy
refractory epilepsy