Canine Epilepsy Website

Owner expectations and monitoring response

Expectations
It is important to manage the client's expectations. If they start treatment with unrealistic hopes of what can be achieved they will be more likely to become disillusioned and treatment failure will result.

Instructions to owners
The owner must fully understand the implications of the disease before starting treatment. It is important that the owner knows what to expect in terms of response to treatment and is aware of the possibility of status epilepticus and how to manage it. Commitments from the owner include keeping a seizure diary and being willing to schedule appointments at least once a year (with further contact between times as necessary)

You may want to print these owner factsheets to give to your clients:		About epilepsy
		Living with an epileptic dog

*Important messages for client*
•	Dogs with primary epilepsy are normal animals with lower seizure threshold.
•	The aim of anticonvulsant treatment is not to cure epilepsy but to “control” it.
•	Side-effects of anticonvulsant treatments are occasionally worse than the seizures themselves.
•	Mild side-effects are common when first starting treatment with anticonvulsant drug.
•	Therapeutic effects and side-effects are related to serum level and not oral dosage of the anti-epileptic drug.
•	Oral anticonvulsant drugs may take a long time to be effective, so seizure control may not be immediate.
•	Client must keep accurate record of witnessed or suspected seizures.
•	Client must be willing to bring their dog or cat in for periodic examination.
•	Client should seek immediate veterinary care for any seizure lasting longer than 10 minutes or for clusters of seizures without recovery between.
•	Client should not alter the treatment without veterinary advice.
•	Skipping doses or stopping drugs abruptly can precipitate seizures.

Serum Monitoring Scheme

*Phenobarbitone* Therapeutic and toxic effects of phenobarbitone are related to serum concentrations and not the quantity of drug administered orally. Therapeutic monitoring of serum phenobarbitone concentration can be helpful in determining the optimal dose.

*Monitoring should be performed:*
•	When steady state blood levels are reached after starting treatment or after changing oral dosage (12 to 15 days in dogs). This provides a baseline to guide further changes in doses according to clinical circumstances.
•	If seizure frequency increases.
•	Every 3 to 6 months to verify that blood concentrations are maintained in the therapeutic range.
•	If drug-related side-effects are suspected.
•	If drugs are added that might interfere with phenobarbitone’s pharmacokinetics (corticosteroids, cimetidine, chloramphenicol).

Recommended therapeutic range in dogs is 20 to 35 ug/ml (65-194µmol/l). Most dogs will “respond” (reduction in frequency, intensity and severity of the seizures with minimal side-effects) when the serum level of phenobarbitone is within this range. However, some dogs might need to be in the upper limit of this range while others might need to be below the lower limit. This therapeutic range is only an indication of changes required in the oral dosage.

Monitoring of serum bromide concentration should be performed:
•	When steady state blood levels are reached after starting treatment or after changing oral dosage (3 to 6 months in dogs). This provides a baseline to guide further changes in doses according to clinical circumstances.
•	If seizure frequency increases.
•	Every 6 to 12 months to verify that blood concentrations are maintained in the therapeutic range.
•	If drug-related side effects are suspected.

Recommended oral dosage in dogs is 30 mg/kg once daily. Therapeutic serum concentrations are 880 to 3000 mg/ml as a solitary agent and 810 to 2400 mg/ml in combination with phenobarbitone.