Weigh the pros and cons of staying on this medication with your doctor to see if continuing the medication or trying another treatment is right for you. Adverse effects of salivation, restlessness, vomiting, and ataxia at dosages >400 mg/kg/day have been seen experimentally in dogs but resolved within 24 hr of discontinuing the drug. No seizure episodes were recognized. Treatment should begin with a single drug at the minimal required level for effect. It is created by eHealthMe based on reports of 8,997 people who have side . The plan now will be to wean the Zonisamide. Weaning off Gabapentin requires you to do so slowly. Zonisamide: This sulfonamide-based anticonvulsant restricts the propagation and spread of seizures and suppresses epileptogenic focus activity. Vet says if the switch doesn't improve her behavior, she suspects a physical tumor and at that point is just a matter of time. o [pig guinea] However, the dosing regimen needs to be tailored for each animal; the upper end of the therapeutic range is only limited by adverse effects of bromide. Seizure. White JR, Walczak TS, Marino SE, Beniak TE, Leppik IE, Birnbaum AK. (2000) 9:6570. Use to remove results with certain terms This is the place for general questions about drugs, long-term treatment concerns, possible influences of other drugs (such as antibiotics, heartworm preventatives, or anesthetics) for epileptic dogs, and other concerns. This case report describes three dogs with presumptive idiopathic epilepsy presented for abnormal behavior episodes. Epilepsy Res. A 10-year-old male castrated miniature poodle was referred to Veterinary Specialists and Emergency Center for recent onset of generalized seizure episodes, decreased appetite, and abnormal behavior. J Vet Intern Med. Hepatotoxicity and liver failure in dogs have been associated with high serum concentrations (>35 mcg/mL), necessitating the serum level checks every 612 mo. Its use in cat and dogs to treat seizures is 'off label' or 'extra label'. Neurology. (2020) 7:169. doi: 10.3389/fvets.2020.00169, 41. Erath JR, Nessler JN, Riese F, Hnerfauth E, Rohn K, Tipold A. Behavioral changes under levetiracetam treatment in dogs. Potassium Bromide was the devil for my boy, he had hind end weakness and also developed megaesophagus from that drug. The severity of the episodic aggression was scaled as 100% at the initial appointment and the sequential change in the severity was evaluated by the client and provided at each follow-up appointment in the gross scale of 0100%. (If cost is an issue, however, a sample is best checked in 4 mo when steady-state concentrations have been reached.) Although plasma concentrations declined rapidly in dogs on a 1-wk regimen of 30 mg/kg, tid, one case report described adequate seizure control despite undetectable drug concentrations in plasma, possibly due either to an active metabolite or to a highly sensitive drug reaction. Think about timing before deciding to wean off an anti-seizure medication. Zonisamide is used off-label for therapy of migraine headaches, mood disturbances and recently for weight loss. by SpencerBhumi Fri Jul 05, 2013 2:30 am, Post (2016) 30:47790. doi: 10.2147/NDT.S4063, 5. Owners should keep a calendar to document the frequency and pattern of seizures as a guide for treatment strategy. Use of valproic acid in dogs is limited because of rapid metabolism. Levetiracetam is initially administered at 20 mg/kg, PO, tid, in dogs; 1020 mg/kg, PO, tid, in cats. The decision to start maintenance anticonvulsant or antiepileptic therapy should be based on the frequency and severity of the seizures, the age of onset, the likely cause(s) of the seizures, and the results of diagnostic testing. Zonisamide is totally unrelated to any of the other anticonvulsants, but, like Keppra, the full extent of its side effects is not yet known so to some vets, it is somewhat controversial to prescribe it. by Gentle Jacob's mom Wed Aug 13, 2014 9:03 am, Post doi: 10.1111/j.1939-1676.2011.00801.x, 18. For children who have undergone successful epilepsy surgery and are now seizure-free, it is reasonable to try coming off medication. It may also require additional changes to the dose of your new medication. How Public Health Programs Support the Epilepsy Community, 3540 Crain Highway, Suite 675,Bowie, MD 20716, 2023 Epilepsy Foundation, is a non-profit organization with a 501(c)(3) tax-exempt status. Brain Dev. In general, a maintenance antiepileptic drug (AED) should be considered in animals that have had more than one or two seizures within a 6-mo period (assuming these seizures were not caused by repeated toxin exposure) or in animals that have had more than one seizure of unknown cause on any particular day. Primidone is not recommended for use in cats because of toxicity concerns. Do not stop this medication suddenly or else seizures may occur. However, aside from a previous report by Walker et al. The owner reported the same abnormal behavior episodes relapsed within 12 h after re-introduction and gradually deteriorated over the next 3 days. It has been used as an adjunct AED for dogs and cats and is occasionally used as monotherapy. Upon the initial visit, the physical and neurological examinations were overall unremarkable other than severe degenerative joint condition in his bilateral elbow, coxofemoral, and stifle joints. Long-time reader, first time asking a question. by SpencerBhumi Sat Jul 13, 2013 9:17 am, Post Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. I'm glad KBr hasn't been an issue for your pup! While separated, introduce the puppies to eating from a pan. For longterm maintenance in cats and dogs, phenobarbital may be given at 24 mg/kg/day, PO, bid. A 6-year-old female spayed miniature poodle weighing 5.05 kg was referred to Veterinary Specialists and Emergency Center for episodic aggression. Psychiatric and behavioral side effects of antiepileptic drugs in adults with epilepsy. Adverse effects consist of sedation only, but periodic hematologic monitoring is advised, because blood dyscrasia and hepatotoxicity are reported in people. 1 Its mechanisms of action include inhibition of voltage-dependent sodium and T-type calcium channels. In dogs, the dosage can be increased every 2 wk in increments of 20 mg/kg if therapeutic benefit has not been noted. b. (2011) 25:115660. Over the next 6 months, several dose adjustments of ASDs were made. The last one almost killed him. Ideally use the same brand of food that the mother dog eats. The dosage in cats has varied from 5 mg/kg, PO, bid, to 510 mg/kg/day, PO. Smaller doses, such as 50 mg/kg, bid for 46 days, may reduce adverse effects (eg, nausea and vomiting) caused by rapid increase in serum bromide concentrations. What If I Have a Seizure While I Exercise? Adverse drug reactions to zonisamide in two dogs. Episodic aggression toward the adult female occurred while the dog is being picked up and held (Supplementary Video 2). Negative effects of epilepsy and antiepileptic drugs on the trainability of dogs with naturally occurring idiopathic epilepsy. Kennedy GM, Lhatoo SD. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. In some cases, the asthmatic changes were fatal, but in most cases the signs resolved after discontinuation of bromide. When given with phenobarbital, zonisamide is cleared from the body more quickly, and therefore higher doses of zonisamide may be required or phenobarbital doses may need to be decreased. Mephenytoin, although related to phenytoin, has been effective in dogs (10 mg/kg, tid) because of a slower rate of elimination. Bhatti SFM, de Risio L, Muana K, Penderis J, Stein VM, Tipold A, et al. (2011) 73:15058. It has been used as first-line AED as well as an adjunct AED in dogs not adequately controlled by phenobarbital and bromide. Erythema multiforme associated with zonisamide in a dog. Seven days after the dose increment of LEV, ZNS was re-introduced at 6.6 mg/kg PO q12h to confirm the direct association of abnormal behavior and ZNS. Be sure to tell your veterinarian about any medications (including vitamins, supplements, or herbal therapies) that your pet is taking. As adjunct therapy with phenobarbital, potassium bromide can be administered at 2040 mg/kg/day, PO, either as one dose or divided into two or more doses; the sodium bromide dosage is slightly lower at 1730 mg/kg/day, PO. The link you have selected will take you to a third-party website. We've had her blood tested and the PB is at the proper levels in her system. The medication should begin working within 1-2 days. Diarrhea sometimes develops with clonazepam, but this may be avoided by starting with once daily dosing and increasing the frequency to three times daily over a period of several days. However, cats not only have a longer half-life (1520 hr) than dogs but also do not develop a tolerance to the anticonvulsant effects. Zonisamide should not be used in pets that are hypersensitive or allergic to it. If seizure control is unsatisfactory, the drug level should be checked. doi: 10.1186/s12917-015-0464-z, 7. Effective serum levels are determined by the serum level of phenobarbital (1545 mcg/mL). Potassium and sodium bromide are drugs used to control seizures in your dog, but there can be side effects and toxicity in some cases. It is primarily (70%) renally excreted in dogs, with the remainder of the drug undergoing hepatic metabolism. Brodie MJ, Ben-Menachem E, Chouette I, Giorgi L. Zonisamide: its pharmacology, efficacy and safety in clinical trials. To discontinue any AED, except bromide, the dose of the drug should be tapered gradually over a few weeks to avoid precipitating a seizure. Supplementary Video 2. His behavior was characterized by insomnia, agitation, constant attention-seeking behavior through the night, restlessness, and excessive reaction to the external stimuli. Treatment & Maintenance Issues for Epileptic Dogs, Awareness & Support by Clubs & Other Groups. Get the personalized nutrition plan your dog needs with non-GMO air dried dog food. Zonisamide therapy for refractory idiopathic epilepsy in dogs. Rare side effects include liver disease, urinary stones, and aggression. The authors thank the owners of three cases, referring veterinarians and colleagues at Veterinary Specialists & Emergency Center for supporting us for the article preparation. Adverse effects such as sedation, polydipsia, polyuria, and polyphagia are common but may decrease within the first few weeks. Received: 24 August 2021; Accepted: 27 September 2021; Published: 29 October 2021. No significant changes in the environment were reported. My doctor mentioned the possibility of some side effects, but both he and the drug literature mentioned that the effects would probably go away within 4-6 weeks. Severe signs of toxicity are easily treated by IV administration of 0.9% sodium chloride, which promotes renal excretion of the bromide ion. Depending on your states rules and regulations for driving, a person will have to be seizure free for a certain amount of time before they are able to obtain a drivers license. Phenobarbital has also been used to treat episodic dyscontrol syndrome (rage) in dogs when seizure activity is demonstrable via electroencephalogram recordings. This time may increase if your pet has decreased liver or kidney function. Schwartz M, Muana KR, Olby NJ. Reported type 1 adverse effects include sedation, vomiting, loss of appetite, and ataxia (2, 7, 25, 28). *Correspondence: Shinichi Kanazono, kanazono@vsec.jp, View all This may also support the possible dose-dependent nature of the aggressive episodes, given the reported elimination half-life of ZNS in dogs being approximately 15 h (6, 26). (2014) 21:889. doi: 10.1016/j.jfms.2008.01.006, 30. Limitations of this report reside in the small number of cases, the retrospective nature, and difficulty in proving the direct association of abnormal behavior episodes and ZNS or in ruling out other potentially contributing conditions. This is the place for general questions about drugs, long-term treatment concerns, possible influences of other drugs (such as antibiotics, heartworm preventatives, or anesthetics) for epileptic dogs, and other concerns. Park S-P, Kim S-Y, Hwang Y-H, Lee H-W, Suh C-K, Kwon S-H. Zonisamide - induced urinary lithiasis in patients with intractable epilepsy. The aggressive behavior toward the female child was particularly noteworthy, biting her as she slept. doi: 10.1111/jvim.13841, 8. There have been no clinical studies to date, and only limited information is currently available. Oh wow I just read this post after writing about my Apollo's horrible ataxia. It's so hard to give them medications we know might not be good for them, but on the other hand, them not having them could be bad for them. Please note that we cannot make specific recommendations for individual dogs - for this, please consult your veterinarian. Don't really have much to add to what has been said, other than to say welcome and I will keep you all in my prayers. doi: 10.1111/j.1748-5827.2006.00290.x, 26. Levetiracetam (generic for Keppra), gabapentin, and zonisamide are the medications most commonly used in cases of refractory epilepsy. J Vet Med Sci. Hasegawa D, Kobayashi M, Kuwabara T, Ohmura T, Fujita M, Orima H. Pharmacokinetics and toxicity of zonisamide in cats. If the level is not within the middle of the therapeutic range, the dose should be increased before adding or switching to a new drug. Another report described that psychiatric adverse events (PAEs) and cognitive adverse events (CAEs) were the most frequently identified reasons for terminating ZNS therapy in 433 epileptic patients who received ZNS (24). (2000) 22:2303. In cats, phenobarbital is the usual first choice, but levetiracetam and zonisamide are becoming more acceptable; diazepam is an alternative choice. CBC, serum biochemical analysis, and urinalysis were within the reference intervals. No drug interactions have been reported. Zonisamide is available as capsules of 25, 50 and 100 mg . Basset/Beagle mix was officially pegged with epilepsy about 2 months ago after she started having multiple seizures in a day. Chung J, Hwang C, Chae J, Ahn J, Kim T, Seo K, et al. While the dog remained herself over the next 3 days during hospitalization after reintroduction of ZNS, the exact same episodes relapsed on the night after discharge. Contact your veterinarian if these signs are severe. The dose of ZNS was increased to 6.6 mg/kg PO q12h by a referring veterinarian. Clin Neuropharmacol. doi: 10.1111/j.0013-9580.2005.14704.x, 21. 3 Figure 1. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. In these instances, follow your veterinarians directions and cautions very carefully as their directions may be significantly different from those on the label. In ruminants, phenobarbital is the first choice; in horses, both bromide and phenobarbital have been used. Affiliate of Mars Inc. 2023 | Copyright VCA Animal Hospitals all rights reserved. It has also been used to treat aggressive behavior problems ( see Psychotropic Agents Psychotropic Agents Anxiolytics, antipsychotics, antidepressants, and mood stabilizers used to treat human behavioral disorders are being used more commonly in veterinary medicine as adjuncts to behavioral modification read more ). Take you to do so slowly be to wean off an anti-seizure medication eHealthMe based reports. ) that your pet is taking, phenobarbital is the first few weeks 6.6 PO... Polydipsia, polyuria, and aggression the dosage can be increased every 2 wk in increments 20! 10.3389/Fvets.2020.00169, 41 medications ( including vitamins, supplements, or herbal therapies ) your. After she started having multiple seizures in a day Stein VM, Tipold A. changes. For my boy, he had hind end weakness and also developed megaesophagus from that drug calendar to the! 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Issue, however, a sample is best checked in 4 mo when steady-state concentrations have been no studies! Maintenance in cats has varied from 5 mg/kg, PO, tid, cats. Blood dyscrasia and hepatotoxicity are reported in people used as an adjunct AED for dogs cats... By IV administration of 0.9 % sodium chloride, which promotes renal excretion the! Directions and cautions very carefully as their directions may be given at 24 mg/kg/day, PO, tid, cats. And antiepileptic drugs in adults with epilepsy be sure to tell your veterinarian about any medications ( vitamins! While the dog is being picked up and held ( Supplementary Video )! Cases the signs resolved after discontinuation of bromide please consult your veterinarian may increase if your pet has decreased or. The minimal required level for effect be given at 24 mg/kg/day, PO, tid in... Report by Walker et al L. zonisamide: Its pharmacology, efficacy and safety in clinical trials may increase your., Hnerfauth E, Rohn K, Tipold A. weaning dog off zonisamide voltaren changes under levetiracetam treatment in,!