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Help for Pets with Epilepsy

Status epilepticus is most often defined as a single seizure lasting 5 minutes or longer, or 2 or more seizures without recovery in between. Generalized status epilepticus constitutes a medical emergency. Urgent and aggressive treatment is needed early in the process, within 30 minutes before permanent brain damage can occur. The goals of treatment are to stop the seizures, support systemic organ functions, and protect brain function.
 
Historically, owners of dogs at risk for episodes of status epilepticus were given diazepam (the generic of Valium®) in solution to administer rectally. This would allow 30-45 minutes of control to allow the owner to administer oral antiepileptic drugs. Access to the rectum is difficult during seizures, and research has shown that medications work more quickly when administered as a nasal spray compared to the same dose given rectally. However, because diazepam is a relatively weak member of the class of drugs known as benzodiazepines, adequate doses can present a risk of aspiration pneumonia after intranasal administration (ie, the volume of liquid required to give an adequate dose of drug can’t be absorbed by the nose, so it can run down the throat and enter the lungs, leading to pneumonia). Therefore, veterinary neurologists began to explore intranasal use of more potent benzodiazepines. Midazolam and lorazepam can both be administered intranasally in smaller volumes and have a more rapid onset of action. Both midazolam and lorazepam are stable when dispensed in light-protected plastic syringes (unlike diazepam) and may be repackaged in patient-specific doses.  Our compounding pharmacists can prepare patient-specific doses of intranasally administered benzodiazepines equipped with ready-to-administer mucosal atomizer devices to facilitate rapid administration and promote better CNS (central nervous system) penetration of drug across nasal mucosa (lining of the nose), which is required to stop seizures.

Approximately 25-30% of dogs with idiopathic epilepsy don’t respond to standard doses of the traditional anticonvulsant drugs phenobarbital and potassium bromide. Most anticonvulsants must be given 3-4 times a day. Zonisamide is a drug approved for human use in the United States and has been used to manage both focal and generalized seizures in dogs and cats. Zonisamide is well-tolerated and is typically administered every 12 hours. Because doses of zonisamide for dogs and cats are relatively low compared to available human capsule strengths, it must frequently be compounded into a liquid dosage form or into smaller capsules for animals.

Ask our compounding pharmacist for more information about how customized medications can help owners to rapidly help pets with status epilepticus, and provide options to simplify the administration of daily anticonvulsant medications.
 

References

AJVR 2000 61:6, 651-654
Proceedings of the American College of Veterinary Internal Medicine, 2003.
AJVR 2012 73:4, 539-545
Pediatr Dent. 1998 Sep-Oct; 20(5):321-6.
Proceedings of the American College of Veterinary Internal Medicine, June, 2014.
J Vet Med Sci. 2011 Nov; 73(11):1505-8.


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