QUARTERLY BEAT / JULY 2024
NEXT STEP? NEUROLOCALIZATION – YOU DON’T WANT TO SKIP THIS ONE!
DIFFERENTIALS
DEGENERATIVE Lysosomal storage diseases
DEVELOPMENTAL Hydrocephalus, cortical dysplasia, lissencephaly
ANOMOLOUS
Idiopathic
Liver disease, renal disease, mitochondrial encephalopathy, hyponatremia, hypernatremia, hypocalcemia, hypoglycemia, hypoxia...
METABOLIC
WHY NEUROLOCALIZE? NECESSARY TO COME UP WITH YOUR MOST ACCURATE LIST OF DIFFERENTIALS
NEOPLASTIC
Primary or metastatic
NUTRITIONAL
Thiamine deficiency
INFLAMMATORY MUO, SRMA, infectious, feline = limbic encephalitis
Pesticides (metaldehyde, OP'ss, carbamates, pyrethrin...,) Lead, EG, Mycotoxins, Caffeine
TOXIC
TRAUMATIC
TBI, skull fractures
VASCULAR
CVA – ischemic or hemorrhagic
Once you develop your list of differentials, further diagnostics should be discussed with the owner to conceive the best course of action for your patient. Some of these may include:
WHEN TO START AED?
DIANOSTICS
2015 ACVIM CONSENSUS
· Complete blood count and chemistry · Liver function test
· Identifiable structural lesion present or prior history of brain disease or TBI · Acute repetitive seizures or 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 There are many options for anti-seizure medications in our canine and feline patients. When choosing the right AED for your patient, keep in mind that not only do we need to manage the seizures, but we also need to manage the side effects of the medication and owner satisfaction.
· Bile acids · Ammonia
· +/- Thoracic radiographs · +/- Abdominal ultrasound
· MRI · CSF
Once you have diagnosed your patient, you will treat the underlying disease process (if one is identified) that is the cause of the seizures. However, regardless of the underlying cause, in most cases an anti-seizure medication needs to be part of your treatment plan. Below is a chart to help determine when you should initiate anti-seizure medication.
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