Abstract
Limited information is available on the long-term follow-up and seizure recurrence in dogs with reactive seizures due to suspected exogenous toxicity. The purpose of this study was to report the long-term follow-up of 13 dogs referred to a single referral hospital, diagnosed with reactive seizures and treated with a standardized levetiracetam protocol. All dogs received a loading levetiracetam dose of 60 mg/kg/IV once, followed by a maintenance dose of 20 mg/kg every 8 h as part of an open-label clinical study. Levetiracetam was withdrawn after a 6-months seizure-free period by reducing levetiracetam to 20 mg/kg every 12 h for a 4-week seizure-free period, followed by levetiracetam 20 mg/kg every 24 h for a 4-week seizure-free period, before levetiracetam treatment was stopped. No adverse effects of the treatment were reported. No dogs experienced any seizures after discharge or after levetiracetam withdrawal. Median follow-up time from time of discharge was of 78 months (=6 years 6 months). The result of this study supports the use of levetiracetam for treatment of reactive seizures due to exogenous substance intoxication. Moreover, our results do not support the need for long-term antiepileptic treatment in cases of reactive seizures due to exogenous intoxication.
Highlights
Reactive seizures (RS) have been defined as seizures “occurring as a natural response from the normal brain to a transient disturbance in function which is reversible when the cause or disturbance is rectified” [1]
The decision to continue the LEV for 6 months following the initial presentations was based on current guidelines on initiation of antiseizure drugs (ASD) treatment in dogs with idiopathic epilepsy, which include the presence of 2 or more epileptic seizures within a 6-month period and the presence of status epilepticus and cluster seizures, as well as other criteria [15]
In the 13 dogs reported in this study the choice of ASD could be considered further complicated by the knowledge that the signalment of the dogs included in the study could be suggestive of idiopathic epilepsy
Summary
Reactive seizures (RS) have been defined as seizures “occurring as a natural response from the normal brain to a transient disturbance in function (metabolic or toxic in nature) which is reversible when the cause or disturbance is rectified” [1]. Reported prevalence of RS in dogs varies widely among the few studies available in the veterinary literature, ranging from 6.3 to 13.6%. Treatment of RS involves the use of antiseizure drugs (ASD) and treatment of the intrinsic underlying etiology when known [2,3,4,5,6] Levetiracetam (LEV) is a pyrrolidine derivative and is widely used in human medicine for various seizure types. It is not licensed, it is commonly used due to is safety profile [7], lack of hepatic metabolism (unlike most ASD), and minimal drug interactions. Levetiracetam was reported superior to placebo in a randomized, double-masked, placebo-controlled trial for the treatment of cluster seizure and status epilepticus when administered intravenously (IV).
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