2015 ACVIM Small Animal Consensus Statement on seizure management in dogs Podell, M.; Volk, H. A.; Berendt, Mette; Löscher, W.; Muñana, K.; Patterson, E. E.; Platt, S. R. Published in: Journal of Veterinary Internal Medicine DOI: 10.1111/jvim.13841 Publication date: 2016 Document version Publisher's PDF, also known as Version of record Document license: CC BY-NC Citation for published version (APA): Podell, M., Volk, H. A., Berendt, M., Löscher, W., Muñana, K., Patterson, E. E., & Platt, S. R. (2016). 2015 ACVIM Small Animal Consensus Statement on seizure management in dogs. Journal of Veterinary Internal Medicine, 30(2), 477-490. https://doi.org/10.1111/jvim.13841 Download date: 28. Sep. 2021 ACVIM Consensus Statement J Vet Intern Med 2016;30:477–490 Consensus Statements of the American College of Veterinary Internal Medicine (ACVIM) provide the veterinary community with up-to-date information on the pathophysiology, diagnosis, and treatment of clinically important animal diseases. The ACVIM Board of Regents oversees selection of relevant topics, identification of panel members with the expertise to draft the statements, and other aspects of assuring the integrity of the process. The statements are derived from evidence-based medicine whenever possible and the panel offers interpretive comments when such evidence is inadequate or contradictory. A draft is prepared by the panel, followed by solicitation of input by the ACVIM membership which may be incor- porated into the statement. It is then submitted to the Journal of Veterinary Internal Medicine, where it is edited before publication. The authors are solely responsible for the content of the statements. 2015 ACVIM Small Animal Consensus Statement on Seizure Management in Dogs M. Podell, H.A. Volk, M. Berendt, W. Loscher,€ K. Munana,~ E.E. Patterson, and S.R. Platt This report represents a scientific and working clinical consensus statement on seizure management in dogs based on cur- rent literature and clinical expertise. The goal was to establish guidelines for a predetermined, concise, and logical sequential approach to chronic seizure management starting with seizure identification and diagnosis (not included in this report), reviewing decision-making, treatment strategies, focusing on issues related to chronic antiepileptic drug treatment response and monitoring, and guidelines to enhance patient response and quality of life. Ultimately, we hope to provide a foundation for ongoing and future clinical epilepsy research in veterinary medicine. Key words: Cerebrospinal fluid; Dogs; Epilepsy; Magnetic resonance imaging; Neurologic disorder. pileptic seizures are a common neurologic disorder Ein dogs characterized by a wide spectrum of clinical Abbreviations: signs and consequences. Variable short- and long-term AED antiepileptic drugs morbidity effects occur caused both by the disease and ESVN/ECVN European Society and College of Veterinary Neurology its treatment. Survivability often is dependent more on ACVIM American College of Veterinary Internal Medicine quality of life and financial issues than actual disease MRI magnetic resonance imaging CT computer tomography CSF cerebrospinal fluid CNS central nervous system From the Medvet Chicago, Medical and Cancer Centers for Pets, ACTH adrenocorticotrophic hormone Chicago, IL (Podell); Department of Neurosurgery, Pritzker School of Medicine, The University of Chicago, Chicago, IL (Podell); t4 thyroxine Department of Clinical Sciences and Services, Small Animal MCT medium chain triglyceride Medicine and Surgery Group, The Royal Veterinary College, QOL quality of life Hatfield, Hertfordshire, UK (Volk); Department of Veterinary and Clinical Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark (Berendt); manifestations.1,2 As such, the burden is on the clinician Department of Pharmacology, Toxicology and Pharmacy, to balance the variable outcome measures of seizure University of Veterinary Medicine, Hannover, Germany (Lo¨scher); Center for Systems Neuroscience, Hannover, Germany (Lo¨scher); control and owner perception of patient quality of life. Department of Clinical Sciences, College of Veterinary Medicine, Epilepsy is a heterogeneous disease process compli- North Carolina State University, Raleigh, NC (Munana);~ cated by the inability to obtain a definitive diagnosis for Department of Veterinary Clinical Sciences, University of all patients as a consequence of the challenges of limited Minnesota College of Veterinary Medicine, St. Paul, MN diagnostic testing because of financial constraints, unpre- (Patterson); Department of Small Animal Medicine & Surgery, dictability of disease progression, and gaps in scientific College of Veterinary Medicine, University of Georgia, Athens, GA 3–5 (Platt). knowledge of disease pathophysiology. Lack of unifor- Corresponding author: M. Podell, Medvet Chicago, Medical and mity of accepted definitions for seizure type, diagnosis, Cancer Centers for Pets, 3123 N. Clybourn, Chicago, IL 60618; and treatment are being addressed but are complicated e-mail: [email protected]. by wide variations in treatment strategies between pri- Submitted January 4, 2016; Revised January 18, 2016; mary and specialty clinicians alike. Furthermore, a rela- Accepted January 18, 2016. tively small database of strong evidence-based clinical © Copyright 2016 The Authors. Journal of Veterinary Internal studies exists for the ever-changing number of antiepilep- Medicine published by Wiley Periodicals, Inc. on behalf of the Ameri- can College of Veterinary Internal Medicine. tic drugs (AED) designed for human use. As a result, This is an open access article under the terms of the Creative many primary care clinicians are left to treat epilepsy Commons Attribution-NonCommercial License, which permits use, with lack of uniform, scientifically based guidelines. distribution and reproduction in any medium, provided the original The International Veterinary Epilepsy Task Force work is properly cited and is not used for commercial purposes. recently published collaborative consensus statements DOI: 10.1111/jvim.13841 478 Podell et al on epilepsy classification3, diagnostic approaches,6 treat- have been identified in epileptic people, including a ment,7 and therapeutic outcome measures.4 These diagnosis of current or previously defined cerebral papers have created a working foundation for the lesions or trauma, presence of interictal EEG epileptic advancement of veterinary epileptology. discharges (up to 90% recurrence rate) and a history of The purpose of this paper was to build on previous marked postictal adverse effects.13,14 Evidence-based work by providing a scientific and working clinical con- guidelines from several international groups are well sensus statement on seizure management in dogs based established for people based on risk-benefit ratio and on current literature coupled with clinical expertise. The predictability factors of drug effect.15–17 From these goal is to establish guidelines for a predetermined, con- guidelines, several commonalities exist in guiding clini- cise, and logical sequential approach to seizure manage- cal practice including confirmation of an epileptic sei- ment starting with seizure identification and diagnosis zure event and seizure type, obtaining a definitive (not included in this report), reviewing decision-making, diagnosis, knowledge that recurrent seizure activity is treatment strategies, focusing on issues related to correlated with poorer long-term treatment success, chronic AED treatment response and monitoring, and and the influence of treatment on quality-of-life concluding with guidelines to enhance patient response (QOL) factors.18 Thus, the decision to treat is a and quality of life. Ultimately, we hope to provide a reflection of the treatment goals to decrease or elimi- foundation for ongoing and future clinical epilepsy nate epileptic events, decrease seizure severity, avoid research in veterinary medicine. adverse effects, and decrease seizure-related mortality and morbidity.7,19,20 Methodology Although similar information is not as readily avail- able for dogs, extrapolation can provide rational treat- The consensus was reached based on the available ment guidelines. Overwhelming evidence exists in published evidence in the peer-reviewed literature, people that there is no benefit to starting treatment including proceedings of Annual Congresses of the after a single unprovoked event.14 The earlier AED European Society and College of Veterinary Neurology treatment is started; however, the better the potential (ESVN ⁄ ECVN) and the American College of Veteri- outcome may be for seizure control.21–23 Recurrent nary Internal Medicine (ACVIM). Aside from searching epileptic seizures can increase epileptogenesis and drug the standard electronic databases Pub Med (www.ncbi. resistance in a subgroup of patients.24,25 Prolonged nlm.nih.gov/PubMed), CAB Abstracts (www.cabdirect. and acute repetitive seizures can increase patient mor- org), and Web of Science (http://wok.mimas.ac.uk), bidity and require prolonged hospitalization with asso- search strategies included reference lists of published ciated financial burden. Comparable information is not papers and proceedings of the aforementioned relevant available for dogs. scientific conferences. Studies were included following The panel recommendations to initiate AED treat- modified criteria previously laid out in detail.8 and ment are summarized as follows: (i) Identifiable struc- included any