Anticonvulsant therapy

Abstract

Successful control of seizures with anticonvulsant drugs reflects a balance in achieving seizure control while minimizing undesirable side effects. It is important to approach epilepsy as a clinical manifestation of an underlying disease. Causes should be identified and appropriately treated before chronic anticonvulsant therapy is instituted; however, regardless of the cause of seizures, management is based on control of seizures with anticonvulsant drugs. Not all seizures necessarily need to be treated. Chronic therapy is indicated for seizures that last more than five minutes, cluster seizures or seizures that occur more frequently than once a month. Phenobarbitone remains the drug of first choice for chronic control of seizures and can be successful in over 70% of cases. Potassium bromide is recommended as the first combination drug of choice for dogs if phenobarbitone therapy does not satisfactorily control the seizure frequency or severity. Although diazepam is an ineffective drug for chronic seizure control in dogs, it can be very effective, if cautiously used, in cats. If the patient fails to respond to phenobarbitone and bromide, it is classed as refractory. There are some recent additions to the human anticonvulsant market that may be considered in these cases but they are expensive and their efficacy is unknown at present.