Abstract
BackgroundVarious antiepileptic drugs (AEDs) are used for the management of canine idiopathic epilepsy (IE). Information on their clinical efficacy remains limited. A systematic review was designed to evaluate existing evidence for the effectiveness of AEDs for presumptive canine IE. Electronic searches of PubMed and CAB Direct were carried out without date or language restrictions. Conference proceedings were also searched. Peer-reviewed full-length studies describing objectively the efficacy of AEDs in dogs with IE were included. Studies were allocated in two groups, i.e. blinded randomized clinical trials (bRCTs), non-blinded randomized clinical trials (nbRCTs) and non-randomized clinical trials (NRCTs) (group A) and uncontrolled clinical trials (UCTs) and case series (group B). Individual studies were evaluated based on the quality of evidence (study design, study group sizes, subject enrolment quality and overall risk of bias) and the outcome measures reported (in particular the proportion of dogs with ≥50% reduction in seizure frequency).ResultsTwenty-six studies, including two conference proceedings, reporting clinical outcomes of AEDs used for management of IE were identified. Heterogeneity of study designs and outcome measures made meta-analysis inappropriate. Only four bRCTs were identified in group A and were considered to offer higher quality of evidence among the studies. A good level of evidence supported the efficacy of oral phenobarbital and imepitoin and fair level of evidence supported the efficacy of oral potassium bromide and levetiracetam. For the remaining AEDs, favorable results were reported regarding their efficacy, but there was insufficient evidence to support their use due to lack of bRCTs.ConclusionsOral phenobarbital and imepitoin in particular, as well as potassium bromide and levetiracetam are likely to be effective for the treatment of IE. However, variations in baseline characteristics of the dogs involved, significant differences between study designs and several potential sources of bias preclude definitive recommendations. There is a need for greater numbers of adequately sized bRCTs evaluating the efficacy of AEDs for IE.
Highlights
Various antiepileptic drugs (AEDs) are used for the management of canine idiopathic epilepsy (IE)
Many of these previous reports do not use an objective measurement of efficacy, e.g. a% reduction in seizure frequency in a proportion of dogs of a study population after a specific period of treatment; instead they are based on subjective observations, e.g. ‘improvement in seizure control’ or ‘change in seizure frequency’
Description of studies By 10 August 2014, the search strategy had identified a total of 156 unique citations; 142 from the electronic searches of PubMed and CAB Abstracts and manual searches from the publications’ reference lists, and 14 from manual searching of major conference proceedings
Summary
Various antiepileptic drugs (AEDs) are used for the management of canine idiopathic epilepsy (IE). Information on their clinical efficacy remains limited. Individual studies were evaluated based on the quality of evidence (study design, study group sizes, subject enrolment quality and overall risk of bias) and the outcome measures reported (in particular the proportion of dogs with ≥50% reduction in seizure frequency). Clinical information on the grounds of their efficacy remains limited, with most evidence derived from non-blinded non-randomized uncontrolled trials and case series [6]. Many of these previous reports do not use an objective measurement of efficacy, e.g. a% reduction in seizure frequency in a proportion of dogs of a study population after a specific period of treatment; instead they are based on subjective observations, e.g. Many of these previous reports do not use an objective measurement of efficacy, e.g. a% reduction in seizure frequency in a proportion of dogs of a study population after a specific period of treatment; instead they are based on subjective observations, e.g. ‘improvement in seizure control’ or ‘change in seizure frequency’
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