Effect of prophylactic treatment with levetiracetam on the incidence of postattenuation seizures in dogs undergoing surgical management of single congenital extrahepatic portosystemic shunts.

Ronan A Mullins,Jean Phillipe Billet,Hilde De Rooster,Michael S Tivers,Davina M Anderson,Robert N White,Kathryn M Pratschke,Laura E Selmic,Ines Gordo,Ameet Singh,Anne Kummeling,Kelley M Thieman Mankin,Carlos Sanchez Villamil,Barbara M Kirby,Melanie Olive,Donald A Yool,Herve Brissot

doi:10.1111/vsu.13141

Abstract

To report the incidence of postattenuation seizures (PAS) in dogs that underwent single congenital extrahepatic portosystemic shunt (cEHPSS) attenuation and to compare incidence of PAS in dogs that either did or did not receive prophylactic treatment with levetiracetam (LEV). Multi-institutional retrospective study. Nine hundred forty dogs. Medical records were reviewed to identify dogs that underwent surgical attenuation of a single cEHPSS from January 2005 through July 2017 and developed PAS within 7 days postoperatively. Dogs were divided into 3 groups: no LEV (LEV-); LEV at ≥15 mg/kg every 8 hours for ≥24 hours preoperatively or a 60 mg/kg intravenous loading dose perioperatively, followed by ≥15 mg/kg every 8 hours postoperatively (LEV1); and LEV at <15 mg/kg every 8 hours, for <24 hours preoperatively, or continued at <15 mg/kg every 8 hours postoperatively (LEV2). Seventy-five (8.0%) dogs developed PAS. Incidence of PAS was 35 of 523 (6.7%), 21 of 188 (11.2%), and 19 of 228 (8.3%) in groups LEV-, LEV1, and LEV2, respectively. This difference was not statistically significant (P = .14). No differences between groups of dogs that seized with respect to investigated variables were identified. The overall incidence of PAS was low (8%). Prophylactic treatment with LEV according to the protocols that were investigated in our study was not associated with a reduced incidence of PAS. Prophylactic treatment with LEV does not afford protection against development of PAS. Surgically treated dogs should continue to be monitored closely during the first 7 days postoperatively for seizures.

Highlights

Prophylactic treatment with LEV according to the protocols that were investigated in our study was not associated with a reduced incidence of postattenuation seizures (PAS)
The main findings of this study are (1) that the overall incidence of PAS was low (8%) and similar to that reported in recent literature[6,7] and (2) that prophylactic treatment with LEV, at either ≥15 mg/kg every 8 hours for ≥24 hours preoperatively or a 60 mg/kg intravenous loading dose perioperatively with continuation postoperatively at ≥15 mg/kg every 8 hours or other less standardized LEV protocols (LEV2), did not result in a reduced incidence of PAS compared with dogs that did not receive any prophylactic LEV
No significant differences were identified between groups of dogs that seized with respect to signalment; shunt morphology; concurrent conditions; incidence of preoperative neurologic signs and seizures; preoperative medical management; method and degree of shunt attenuation; type and timing of PAS; electrolyte, ammonia and glucose concentrations at the time of seizures; and shortterm survival

Summary

Results

Incidence of PAS was 35 of 523 (6.7%), 21 of 188 (11.2%), and 19 of 228 (8.3%) in groups LEV-, LEV1, and LEV2, respectively. This difference was not statistically significant (P = .14). No differences between groups of dogs that seized with respect to investigated variables were identified. Conclusion: The overall incidence of PAS was low (8%). Prophylactic treatment with LEV according to the protocols that were investigated in our study was not associated with a reduced incidence of PAS. Clinical significance: Prophylactic treatment with LEV does not afford protection against development of PAS. Treated dogs should continue to be monitored closely during the first 7 days postoperatively for seizures

| INTRODUCTION

| MATERIALS AND METHODS

Group LEV2

| RESULTS

| DISCUSSION