QUARTERLY BEAT / JULY 2024
INCREASE INHIBITION
DECREASE EXCITATION
PRE-SYNAPTIC Ca CHANNEL
GABA-R
SVA2
VG-Na CHANNEL
GLUTAMATE-R
* * * *
PHENOBARBITAL
KBR
*
LEVETIRACETAM
* *
*
ZONISAMIDE
*
TOPIRAMATE
PREGABALIN
When it comes to choosing an anti-seizure medication, your main goals will be to either increase inhibition or decrease excitation in the brain. Below is a list of the most common AEDs and their main mechanism of action.
When it comes to focal seizures, I prefer to use either pregabalin or levetiracetam, but of course there are other AED options as well. Please see the chart below for AED options for your patients.
DOSE
SIDE EFFECTS
MONITORING / OTHER TID BITS
Sedation Weakness Ataxia Disorientation
2-4 mg/kg PO Q12hrs (d) 1-4 mg/kg PO Q12hrs (c)
Monitoring under investigation, currently use human recommendations of serum concentration of 2–5 mg/L *Great for neuropathic pain – 2 mg/kg PO q12hrs
PREGABALIN
*can do q8hrs in refractory cases *start low, especially in cats
Polydpsia Flatulence
5–45 ug/ml
20 mg/kg PO q8hrs with regular levetiracetam 30 mg/kg PO q12hrs with extended release levetiracetam
*Intravenous use for status patients or cluster seizures *Patients commonly defecate XR capsules - doesn't affect efficacy *Cannot split XR tablets for every day use, but if using in emergent situation for immediate use you can (extra dose post seizure, etc)
LEVETIRACETAM
Sedation
*Increase dose if patient on phenobarbital
I understand how stressful and confusing managing seizure patients can be. Hopefully this will provide you with some guidance. And don’t forget, you can always reach out with questions!
carpentier@mnveterinaryneurology.com
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