CS - Seizures

Question 1

What drugs are licensed for first line use in idiopathic epilepsy?

Answer 1

• phenobarbital

- imepitoin

Question 2

First licensed drug for dogs with epilepsy

Answer 2

phenobarbital

Question 3

FIrst line drug - cats - epilepsy

Answer 3

• phenobarbital

Question 4

First line drug - cats -status epilepticus

Answer 4

diazepam (you can keep cats long-term on this, not dogs nowadays d/t a few case failures. Diazepam reaches brain within seconds, phenobarbitone takes 22 minutes)

Question 5

First line drug - horse - epilepsy

Answer 5

phenobarbital (thi sis not licensed first line but is accepted first line)

Question 6

In dogs given phenobarbitone, when do you check serum phenobarbitone levels?

Answer 6

1st time to check = 14 days

Question 7

When do you check canine KBr serum levels for 1st time?

Answer 7

60-90 days (thus difficult to titrate as takes a long time to build up)

Question 8

When do you need to check canine imepitoin serum levels?

Answer 8

Never - it has a 2.5 hour half life discrepancy b/w serum and EC fluid in brain. It also has a wide therapeutic margin so relatively safe if more given.

Question 9

Side effects - dogs - phenobarbitone

Answer 9

• sedation
• PU / PD
• polyphagia
• liver toxicity (v high dose)
• wobbly (worst in first 2 weeks)
• ataxia (worst in first 2 weeks)
• do haematology for blood dyscrasias

Question 10

Side effects - dogs - KBr

Answer 10

• similar to phenobarbitone except no blood dyscrasias with KBr
• ataxia may be worse than phenobarbitone
• pancreatitis
• bromide toxicity (if 3-4 x daily dose for several days)

Question 11

Side effects - dog - imepitoi

Answer 11

• polyphagia
• sedation
• ataxia (?)
• hyeracitve (often transient)

Question 12

Side effects - cat - diazepam

Answer 12

• severe liver necrosis/ acute hepatotoxicosis

Question 13

Side effects - cat - KBr

Answer 13

feline asthma

Question 14

What is the licensed 2nd line (add on) drug to phenobarbital in dogs?

Answer 14

KBr

Question 15

What is the licensed 2nd line (add on) drug to imepitoin in dogs?

Answer 15

leveteracitam (although this example is more a case of personal preference than official recommendation)

Question 16

Can idiopathic epilepsy patients have focal seizures?

Answer 16

Yes - but they will be symmetrical

Question 17

How do you differentiate a propofol twitch from a seizure?

Answer 17

Move the animal about, twitching stops with propofol-induced twitching, not seizure-induced twitching

Question 18

What part of forebrain can explain marked obtundation?

Answer 18

thalamus (gate of consciousness). Interestingly if you have a thalamus lesion, animals can look very obtunded but when you stimulate them, they wake up and look a lot more alert. With lesions affecting brainstem, this usually doesn’t occur to same level (you can see some improvement in mentation but only minimal)

Question 19

What type of urine crystals are seen in HE?

Answer 19

ammonium biurate crutals

Question 20

How can you dx heavy metal poisoning (lead)?

Answer 20

• measure lead blood levels

- CYTOLOGY: basophilic staining of RBCs

Question 21

Dx - glucose metabolism problems such as glycogen storage diseases (rare)

Answer 21

• measure blood glucose level

- liver biopsy

Question 22

Dx - mitochondriopathies (rare)

Answer 22

• high lactate levels in blood/ CSF

Question 23

Features - uraemic encephalopathy

Answer 23

• older animals
• not associated with food
• normally associated with high BP
• biochem/urine should be helpful

Question 24

Dx - storage diseases

Answer 24

• WBC cytology

- liver/ mm biopsies

Question 25

What diagnostic tests can confirm HE?

Answer 25

• bile acid stimulation (more sensitive and more specific for a PSS)
• ammonia (only if in-house test available and you put blood straight on ice
• ultraasound: large liver, small kidneys, PSS