Clinical Observations Associated with Phenobarbital Serum Monitoring to Manage Epilepsy in a California Sea Lion with Domoic Acid Toxicosis

Abstract

The marine algal toxin domoic acid is an important threat to marine mammal health, and exposure can lead to both acute neurologic signs and a chronic epileptic syndrome in California sea lions (Zalophus californianus). Phenobarbital has been used for several decades to manage seizures, although reports are limited correlating dosing, serum monitoring and clinical efficacy in this species. This report details serum monitoring over 33 months in an 8-year-old male sea lion. Seizure control was achieved when phenobarbital concentrations were above 18 μg/mL, and sedation and ataxia were noted when concentrations were above 35 μg/mL. There was no clinically significant difference between phenobarbital concentrations resulting from once-daily versus twice-daily dosing. Serum levels remained detectable as far as 101 days after administration, and remained stable during periods of prolonged anorexia, although dramatic decreases in serum concentrations were noted immediately after normal eating resumed. For this animal, a serum phenobarbital target range of 20–30 μg/mL was achievable with a dose of 1.5 mg/kg once daily followed by therapeutic monitoring, and this is a reasonable recommended concentration and initial dose for clinicians treating this species. Long-term seizure control may be difficult to achieve with anti-epileptic drugs such as phenobarbital alone, and further research is needed to make novel options useful for clinical management of biotoxin-related neurologic disease in this aquatic species.