QUARTERLY BEAT / DECEMBER 2025
CONTROLLING THE EPILEPTIC PATIENT In 2015, the ACVIM published a Consensus on seizure management in dogs and I follow those same guidelines for when to start an AED in cats. The consensus states that an AED should be started if:
frustrations early on, it will increase our overall ability to help these patients in the long-term. I often get asked what is considered good seizure control and the answer is that it is very case dependent. If I see a patient that has been having seizures once a week and I can get their frequency down to 1 seizure every 1-2 months, I am happy. On the flip side, if I have a patient that is only having seizures every 2-3 months but their seizures last up to 5 minutes and they are dangerously aggressive to the owner in the post-ictal state, then I will not be satisfied and I will strive for better seizure control. I find that it is good information to let the owners know that as long as we get good seizure control, which 44% of cats with EUC will have good control with phenobarbital, then the overall life-expectancy of their beloved pet shouldn’t be altered. AED OPTIONS When you start a patient on anti-seizure or anti-epileptic medications, we have three goals:
• Identifiable structural lesion present or prior history of brain disease or TBI • Acute repetitive seizures or status epilepticus (SE) (ictal >5 minutes or >3 or more generalized seizures within a 24-hours period) • >2 or more seizure events within a 6-month period • Prolonged, severe or unusual postictal periods
If an underlying disease for the patient is found – i.e., inflammatory brain disease – then treating the underlying disease in conjunction with AED’s is needed. If epilepsy of unknown cause is diagnosed, it is important for the owners to understand that there is no cure. We do our best to control the frequency, duration, and severity of seizures with AEDs. Treatment is normally started with one anticonvulsant medication and other medications are added if needed. I try and “max out” the current AED that a patient is receiving prior to adding in a 2nd AED as long as the patient is handling the medication well. When I am considering if I have “maxed out” a drug, I am considering the patients drug blood level, blood work, side effects, owners’ ability to handle the side effects, and cost. For example, though levetiracetam is a great medication to choose for cats, most owners have a very difficult time giving a medication three times a day. A frustrated owner of an epileptic patient is not something that we want, though out of fear and uncertainty it often does come with the territory. That being said, if we can provide as much information and minimize their concerns and
1. Seizure control 2. Side effects 3. Owner satisfaction
Below is a chart of the most commonly used feline AED’s, the recommended starting dose of these AED’s, drug blood level monitoring, and side effects. Once I have chosen the AED for the patient, I normally start at the listed dose and make further dosage adjustments based on the drug blood levels and side effects. Remember, every seizure case is different, and you should expect that you are going to need to adjust your treatment plan many times until you find what works for them.
MOST COMMON SIDE EFFECTS IN CATS
DRUG
DOSE (PO)
MONITORING
2 Weeks after starting and after dose change, then q6m 10–20 µ g/dl
Behavioral (hyperexcitability), lethargy, ataxia, facial itching, ALT elevation
PHENOBARBITAL
1–2mg/kg q12–24hrs
REGULAR: 20–60mg/kg x 8hrs XR: 30mg/kg x 12hrs
Not well established, proposed 5–45 µ g/ml
LEVETIRACETAM
Sedation
Under investigation, but currently use human ranges of 2–5mg/L
PREGABALIN
1–4mg/kg q12hrs
ATAXIA (Start low)
Sulfonamide based, sedation, inappetence
10–40 µ g/ml
ZONISAMIDE
5–10mg/kg q12–24hrs
TOPIRAMATE
5–10mg/kg q12hrs
Lethargy, inappetence
REFERENCES
1. Pakozdy A, Halasz P, Klang A. Epilepsy in cats: Theory and practice. J Vet Intern Med. 2014;28:255-263. 2. Podell M, Volk HA, Berendt M, et al. 2015 ACVIM small animal consensus statement on seizure management in dogs. J Vet Intern Med. 2016;30:477-490. 3. Wahle AM, Bruhschwein A, Matiasek K et al. Clinical characterization of epilepsy of unknown cause in cats. J Vet Intern Med. 2014;28:182-188.
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