Abstract
BackgroundUnderstanding the efficacy and safety profile of antiepileptic drugs (AEDs) in feline epilepsy is a crucial consideration for managing this important brain disease. However, there is a lack of information about the treatment of feline epilepsy and therefore a systematic review was constructed to assess current evidence for the AEDs’ efficacy and tolerability in cats. The methods and materials of our former systematic reviews in canine epilepsy were mostly mirrored for the current systematic review in cats. Databases of PubMed, CAB Direct and Google scholar were searched to detect peer-reviewed studies reporting efficacy and/or adverse effects of AEDs in cats. The studies were assessed with regards to their quality of evidence, i.e. study design, study population, diagnostic criteria and overall risk of bias and the outcome measures reported, i.e. prevalence and 95% confidence interval of the successful and affected population in each study and in total.ResultsForty studies describing clinical outcomes of AEDs’ efficacy and safety were included. Only two studies were classified as “blinded randomised controlled trials”. The majority of the studies offered high overall risk of bias and described low feline populations with unclear diagnostic criteria and short treatment or follow-up periods. Individual AED assessments of efficacy and safety profile showed that phenobarbital might currently be considered as the first choice AED followed by levetiracetam and imepitoin. Only imepitoin’s safety profile was supported by strong level of evidence. Imepitoin’s efficacy as well as remaining AEDs’ efficacy and safety profile were supported by weak level of evidence.ConclusionsThis systematic review reflects an evidence-based assessment of the published data on the AEDs’ efficacy and safety for feline epilepsy. Currently, phenobarbital is likely to be the first-line for feline epileptic patients followed by levetiracetam and imepitoin. It is essential that clinicians evaluate both AEDs’ effectiveness and tolerability before tailoring AED to the individual patient. Further studies in feline epilepsy treatment are by far crucial in order to establish definite guidelines for AEDs’ efficacy and safety.
Highlights
Understanding the efficacy and safety profile of antiepileptic drugs (AEDs) in feline epilepsy is a crucial consideration for managing this important brain disease
Search strategy Studies evaluating or describing the effectiveness and safety of an AED in cats were searched. As it was described in our previous systematic reviews [8, 15], studies were assessed based on four inclusion criteria adapted for feline patients, i.e. type of study, case definition, treatment and outcome
Final electronic searches were carried out on 21 June 2017 with no date or language restrictions and the same databases were searched with the same search strategies as it was described before [8, 15], i.e. Pub Med, CAB Abstracts, Google Scholar and searching of articles, proceedings and textbooks to identify reference lists of published papers and proceedings of relevant scientific conferences such as the annual American College of Veterinary Internal Medicine forum and the European College of Veterinary Neurology Symposium
Summary
Understanding the efficacy and safety profile of antiepileptic drugs (AEDs) in feline epilepsy is a crucial consideration for managing this important brain disease. There is a lack of information about the treatment of feline epilepsy and a systematic review was constructed to assess current evidence for the AEDs’ efficacy and tolerability in cats. Databases of PubMed, CAB Direct and Google scholar were searched to detect peer-reviewed studies reporting efficacy and/or adverse effects of AEDs in cats. Guidelines with regards to AEDs’ efficacy and safety have been established in canine epilepsy [13, 14] based on previous systematic reviews and meta-analysis [8, 15].
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