When SHOULD you start anticonvulsant medications?

I am, again, teaching this week at the AVC! (Prince Edward Island) We covered complex seizures in this Advanced Neurology course so I thought I'd share a few notes from that discussion...
Enjoy!

Following the recommendations of the International Veterinary Epilepsy Task Force I suggest the following guidelines:

Two or more seizures within 6 months
History of status epilepticus (one seizure longer than 3 min) or cluster seizures (cluster seizures meet the definition in the point above)
Post ictal signs are severe or lasting longer than 24 hours (ex: aggression)
Seizure frequency or duration is progressing in the last 3 interictal periods. (ex: 12 months apart, then 8 months then 6 months)

Medications are selected based on the metabolic status of the patient, seizure pattern and client constraints (administration frequency, cost, bias). Phenobarbital and bromide are considered first line treatments by the IVETF and are recommended for most forms of seizures in dogs. Phenobarbital could be considered a first line drug for cats as well (Bromide is a big NO-NO for cats). The level of evidence available to make these recommendations is, at the time of writing, more complete than for the other anticonvulsant drugs. I use the following table to as a guide for starting or changing anticonvulsant drugs; hopefully you find it useful also. Remember that these are guidelines and many animals need manipulation of their seizure control life-long.

Subscribe to TidBit Tuesdays at barnesveterinaryservices.com and see the entire post, including Table 1 which includes reasoning for when to use each anticonvulsant for dogs and cats.

Do you have a patient with seizures that you think might benefit from a neurology consult? Feel free to schedule at https://barnesveterinaryservices.com OR email me directly! Thanks for reading; I hope you are staying warm!