Treatment in canine epilepsy – a systematic review

Abstract

BackgroundVarious antiepileptic drugs (AEDs) are used for the management of canine idiopathic epilepsy (IE). Information on their clinical efficacy remains limited. A systematic review was designed to evaluate existing evidence for the effectiveness of AEDs for presumptive canine IE. Electronic searches of PubMed and CAB Direct were carried out without date or language restrictions. Conference proceedings were also searched. Peer-reviewed full-length studies describing objectively the efficacy of AEDs in dogs with IE were included. Studies were allocated in two groups, i.e. blinded randomized clinical trials (bRCTs), non-blinded randomized clinical trials (nbRCTs) and non-randomized clinical trials (NRCTs) (group A) and uncontrolled clinical trials (UCTs) and case series (group B). Individual studies were evaluated based on the quality of evidence (study design, study group sizes, subject enrolment quality and overall risk of bias) and the outcome measures reported (in particular the proportion of dogs with ≥50% reduction in seizure frequency).ResultsTwenty-six studies, including two conference proceedings, reporting clinical outcomes of AEDs used for management of IE were identified. Heterogeneity of study designs and outcome measures made meta-analysis inappropriate. Only four bRCTs were identified in group A and were considered to offer higher quality of evidence among the studies. A good level of evidence supported the efficacy of oral phenobarbital and imepitoin and fair level of evidence supported the efficacy of oral potassium bromide and levetiracetam. For the remaining AEDs, favorable results were reported regarding their efficacy, but there was insufficient evidence to support their use due to lack of bRCTs.ConclusionsOral phenobarbital and imepitoin in particular, as well as potassium bromide and levetiracetam are likely to be effective for the treatment of IE. However, variations in baseline characteristics of the dogs involved, significant differences between study designs and several potential sources of bias preclude definitive recommendations. There is a need for greater numbers of adequately sized bRCTs evaluating the efficacy of AEDs for IE.

The Evidence Behind the Treatment of Canine Idiopathic Epilepsy

“…Precisely, based on the controlled studies, direct AED comparisons include: Tipold et al (2014) showed that monotherapy with imepitoin in dogs with newly diagnosed epilepsy was almost similarly effective and potentially more tolerated than phenobarbital. The same result was reported within other studies investigated in the systematic review by Charalambous et al (2014).…”

“…Munana et al At this point it is worth mentioning that the international veterinary epilepsy task force (IVETF) recently published a consensus statement (Bhatti et al 2015) for treatment suggestions based mainly on current published evidence as provided and analyzed in this knowledge summary and in the systematic review by Charalambous et al (2014) and it was additionally supported and adjusted by expert's opinions.…”

Comparing the effects of first‐line antiepileptic drugs on the gait of dogs with idiopathic epilepsy

“…There is currently a lack of objective data regarding AED adverse-effect profiles (Charalambous and others 2014), hampering objective choice of AEDs based on both efficacy and adverse-effect profile. As such, there is a strong need for more objective studies of the adverse effects of drugs including PB and imepitoin.…”

2015 ACVIM Small Animal Consensus Statement on Seizure Management in Dogs

“…These studies, however, were noted to carry a higher degree of bias 8. By allowing a decrease in the use of drugs metabolized by the liver, potassium bromide treatment also may decrease the frequency of hepatotoxicity.…”