Levetiracetam as an adjunct to phenobarbital treatment in cats with suspected idiopathic epilepsy

Bailey, Kerry Smith; Dewey, Curtis W.; Boothe, Dawn M.; Barone, Georgina; Kortz, Gregg D.

doi:10.2460/javma.232.6.867

Cited by 44 publications

(69 citation statements)

References 18 publications

(19 reference statements)

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“…A similar rate was reported for bromide, however associated with more adverse events including idiosyncratic allergic pneumonitis [25]. The only available data on levetiracetam as add-on therapy to phenobarbital reported 25–30% seizure freedom [26]. Our study demonstrated a rate of seizure freedom with imepitoin treatment similar to that previously reported for phenobarbital in cats.…”

Section: Discussionsupporting

confidence: 89%

Imepitoin is well tolerated in healthy and epileptic cats

et al. 2017

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Background: Epilepsy in the cat is a serious medical condition. To date there are no licensed treatments for feline epilepsy and no well-controlled clinical studies on the efficacy or safety of antiepileptic drugs in cats. The aim of this study was to collect tolerability data and first exploratory efficacy data of imepitoin in both healthy and epileptic cats. Results: In two tolerability studies, 30 healthy cats received imepition twice daily in doses of 0, 30, 40 or 80 mg/kg bodyweight for 30 days. No serious adverse events were observed in any of the dose groups. In the imepitoin treated groups, emesis was observed in some animals temporarily and intermittently mainly in the second and third weeks of treatment. In a small, single-arm, open label, uncontrolled clinical trial eight cats suffering from idiopathic epilepsy were treated with imepitoin twice daily at doses of 30 mg/kg bodyweight for 30 days. Four of these cats (50%) achieved seizure freedom for at least 8 weeks under treatment. Adverse events, mostly lethargy, decreased appetite and emesis, were often mild and transient. Conclusion: In summary, imepitoin was well tolerated in healthy and epileptic cats and showed in a pilot trial indication for efficacy in treating feline epilepsy.

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Section: Discussionsupporting

confidence: 89%

Imepitoin is well tolerated in healthy and epileptic cats

et al. 2017

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“…Its novel mechanism of action coupled with minimal reported adverse effects makes it an appealing drug for seizure control in cats . Pharmacokinetics of intermediate‐release levetiracetam (IRL)‐administered PO in cats support a 20–25 mg/kg dosage, but the short elimination half‐life of 2.95 ± 0.95 hours necessitates a q8h dosing regimen, decreasing owner compliance . An extended‐release formulation of levetiracetam is specially formulated to result in a lower maximal drug concentration ( C max ), a longer time to maximal concentration ( T max ) and less fluctuation in serum concentrations in humans when compared to IRL .…”

mentioning

confidence: 99%

Pharmacokinetics of Single Oral Dose Extended‐Release Levetiracetam in Healthy Cats

Barnard

Heller

Boothe

2017

Veterinary Internal Medicne

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BackgroundRepeated PO dosing of anti‐epileptic drugs may contribute to poor compliance in treated cats. Intermediate‐release levetiracetam has been used safely in cats, but must be given q8h to maintain serum concentrations in the therapeutic interval for humans (5–45 μg/mL). Approved extended‐release levetiracetam (XRL) for human use may require less frequent dosing, but the large dosing unit has limited its use in cats.HypothesesIn healthy cats, serum levetiracetam concentration will remain above 5 μg/mL for at least 24 hours after administration of a single dose of XRL PO and will be well tolerated.Animals7 healthy cats.MethodsExtended‐release levetiracetam (500 mg) was administered PO. Blood was collected and neurologic examination findings recorded at scheduled times over 30 hours. Serum levetiracetam concentration was quantitated by an immunoassay validated in cats. Data were subjected to noncompartmental analysis. Descriptive statistics were reported.ResultsThe median dosage of 86.2 mg/kg, (range, 80–94.3) achieved a mean maximum concentration (C max) of 89.8 ± 25.8 μg/mL at 4.9 ±1.57 hours. Serum levetiracetam was >5 μg/mL in all cats by 90 minutes. Mean concentrations were 43.7 ± 18.4 and 4.9 ± 3.4 μg/mL at 12 and 24 hours, respectively. The half‐life was 4.1 ± 1.0 hours. The drug was well tolerated.Conclusions and Clinical ImportanceA single 500 mg PO dose of XRL safely maintained serum levetiracetam concentration ≥5 μg/mL in healthy cats for at least 21 hours. Clinical efficacy studies in epileptic cats receiving XRL are indicated; however, monitoring should be implemented for individual cats.

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“…1 Causes of seizures and treatment options for cats are historically poorly described in the veterinary literature; however, there is a wealth of recently published clinical research focusing on feline seizures. 2,3,4,5,6,7 Underlying causes of seizures in cats are similar to those identified in dogs, although incidence varies between the two species, as do clinical manifestations of seizure activity. The goals of this article are to review recent veterinary literature related to feline seizures, with a focus on seizure classification, clinical manifestations, diagnostics, and treatment options.…”

Section: Introductionmentioning

confidence: 79%

“…7 LEV is well tolerated in cats, and the only adverse effects noted in a small clinical study were mild self-limiting inappetence and lethargy. 7 LEV is available in generic forms as an oral solution, oral tablet, and injectable preparation. The starting dose for LEV in cats is the same as for dogs, at 20 mg/kg orally.…”

Section: 40mentioning

confidence: 94%

“…Commonly reported causes of structural epilepsy in cats include infectious etiologies such as feline infectious peritonitis (FIP) or toxoplasmosis, noninfectious inflammatory disease (with neoplasms with meningioma and lymphoma being the most common), and ischemic or hemorrhagic infarcts. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] "Reactive seizures" are seizures occurring secondary to a systemic, toxic, or metabolic abnormality in the absence of an identifiable intracranial disease process. Because these seizures do not result from an intracranial cause, they are not classified as epilepsy even if they occur repeatedly.…”

Section: Classification and Seizure Etiologymentioning

confidence: 99%

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Seizures and epilepsy in cats

Moore¹

2014

VMRR

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Seizures are a common presenting complaint in cats, although causes and options for the treatment of seizures in this species have been historically poorly described in the veterinary literature. Seizure manifestation in cats may be different than what is typically seen in dogs, but the underlying causes of seizure activity are the same. These include primary epilepsies, structural epilepsies, and reactive seizures. Although primary epilepsy was once believed to be rare in cats, we now commonly appreciate this syndrome, albeit at a lower frequency than in dogs. Because of this, a complete diagnostic work-up is recommended for all cats presenting for initial evaluation of seizures. Symptomatic treatment of seizures in cats is similar to dogs, with only a few limitations related to species-specific antiepileptic drug toxicities. The goal of this review is to summarize the recent veterinary literature related to feline seizures, with a focus on seizure classification, clinical manifestation, diagnostic evaluation, and treatment options.

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Levetiracetam as an adjunct to phenobarbital treatment in cats with suspected idiopathic epilepsy

Cited by 44 publications

References 18 publications

Imepitoin is well tolerated in healthy and epileptic cats

Imepitoin is well tolerated in healthy and epileptic cats

Pharmacokinetics of Single Oral Dose Extended‐Release Levetiracetam in Healthy Cats

Seizures and epilepsy in cats

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