Neurologist Matthew Green
CVS Neurologist Furthers Understanding Of Management Of Canine Generalised Epileptic Seizures
1 year ago 
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Research undertaken by CVS neurologist, Matthew Green at Dovecote Veterinary Hospital[1], has provided insights into the approach to initial management of epileptic dogs in first opinion practice in the UK.
His study explored data collected as part of the Small Animal Veterinary Surveillance Network (Savsnet) at the University of Liverpool[2]. In total, clinical records concerning 3,150,713 consultations (917,373 dogs) were collected and analysed from 224 UK veterinary practices. This included the management of canine generalised epileptic seizures in 517 dogs up to 6 years of age.
Green’s resulting peer-reviewed paper The approach to initial management of canine generalised epileptic seizures in primary-care veterinary practices in the United Kingdom concluded that the majority (98%) of dogs presenting for a single epileptic seizure were not started on long-term therapy; in accordance with the approach recommended by the International Veterinary Epilepsy Task Force (IVETF). However, management of cluster seizures in primary care practice appears to be one area that could be improved.
Key findings from the study included:
- Sixty-seven dogs (13.0%) received anti-seizure drugs at first presentation. Prescription of anti-seizure drugs were significantly more likely in dogs presenting with cluster seizures.
- Phenobarbital and imepitoin were the most frequently chosen anti-seizure drugs.
- Eighty-six dogs were presented with cluster seizures; less than half of these were prescribed anti-seizure drugs, most frequently imepitoin (n= 19) and phenobarbital (n=17). Imepitoin was frequently selected in the treatment of cluster seizures despite no authorisation for this purpose.
- Presentation for a single epileptic seizure occurred in 321 dogs; seven were prescribed anti-seizure drugs. Primary care clinicians rarely prescribed anti-seizure drugs following a single epileptic seizure in accordance with International Veterinary Epilepsy Task Force recommendations.
- Of the dogs presenting with a single seizure and at least 6-month follow-up (n=165), 33 (20%) did not have subsequent seizures recorded.
The paper also reported on the factors potentially associated with prescription and choice of anti-seizure drugs (ASDs). This paper reported that dogs presented for cluster seizures (more than one epileptic seizure in a 24-hour period) were more likely to be prescribed ASDs, or to be referred to a specialist, than dogs without cluster seizures. Unlike phenobarbital, it is noted that the market authorisation for Imepitoin does not include the treatment of cluster seizures; however, Imepitoin was more frequently prescribed than phenobarbital in response to cluster seizures. Veterinarians should be aware that the use of Imepitoin for cluster seizures should be considered as “off-licence” has additional implications for obtaining informed consent. Additionally, more than half of dogs with cluster seizures were not prescribed any ASDs. Given that the presence of cluster seizures is typically considered an indication to start long-term therapy by the IVETF, this may be one aspect of seizure management that could be improved in primary care practice. Dogs that were neutered or microchipped were more likely to be started on ASDs following the initial presentation, perhaps suggesting that owners who take part in regular and preventative healthcare prior to the onset of their dog’s seizures could be more willing to start therapy in the earlier stages of the disease. These findings may ultimately contribute to improved cohesion in the management of canine epileptic seizures between primary care and referral institutions.
Lead author, Matthew Green, said: “We believe this research contributes to an improved understanding of the current management strategies for canine epilepsy in general practice and how this compares to the current guidelines advised by the IVETF. Given the prevalence of epileptic seizures within the UK canine population, as well as the large proportion of dogs that will be managed entirely within general practice without referral to a neurologist, it is vital to ensure that the level of care being provided is optimal. We therefore hope that this research ultimately supports and guides general practitioners in their approach to canine epilepsy, thereby improving the quality of life of affected dogs and their owners.”
The peer-reviewed paper describing the management of canine generalised epileptic seizures in 517 dogs, has been published in The Journal of Small Animal Practice – The approach to initial management of canine generalised epileptic seizures in primary-care veterinary practices in the United Kingdom[3]. The research was also undertaken by CVS neurologists Mark Lowrie and Laurent Garosi.
CVS Group operates across small animal, farm animal, equine, laboratories and crematoria, with 473 veterinary practices and referral centres in the UK, the Republic of Ireland and the Netherlands. In the last five years the company has invested nearly £80 million in its sites, facilities and equipment, in addition to industry leading training and support, to give the best possible care to animals.
[1] https://dovecoteveterinaryhospital.co.uk/
[2] and was funded through a grant from PetSavers
[3] https://onlinelibrary.wiley.com/doi/epdf/10.1111/jsap.13543?saml_referrer
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