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Table 2 Details of feline population size, seizure frequency, treatment time, doses of AED(s), seizure frequency reduction after AED initiation, 95% CI for the successful and affected cases and evidence statements for each study

From: Systematic review of antiepileptic drugs’ safety and effectiveness in feline epilepsy

References

Wagner [38]

Volk et al. [36]

Boothe et al. [21]

Boothe et al. [21] (retrospective part)

Bertolani et al. [37]

Volk et al. [28]

Klang et sl. [39]

Carnes et al. [42]

Bailey et al. [40]

Lowrie et al. [26]

Dewey et al. [41]

Cuff et al. [30]

Barnard et al. [43]

AED evaluated

Potassium Bromide

LEV

2nd AED

-

-

-

PB (12)

-

-

PB

-

PB (12)

 

PB (4)

PB

-

3rd AED

-

-

-

-

-

-

LEV

-

-

 

-

-

 

4th AED

-

-

-

-

-

-

Gabapentin

-

-

 

-

-

-

No of cats

26

9

7

17

7

5

1

10 (non-epileptic cats)

12 (10 completed the efficacy analysis)

34 (28 completed the efficacy analysis)

4 (3 had presumed IE)

1

7 (non-epileptic cats)

Age of cats at seizure onset (years)

NA

mean 4.1

NA

mean 8.6

median 3; mean 3.2; range 1-8

NA

4

NA

median 2; range 0.25-16

median 16; range 10-19

NA

10

NA

Period of treatment or follow-up (months)

range 1.75-14

mean 13.63

2

mean 12.5

median 8; mean 18; range 1-96

NA

0.75

1 day

median 9; mean 12; range 6-24

3

Minimum 3 months

2

0.06

Dose of AED(s) (mg/kg)

NA

mean 16.5 PO BID

15 PO BID

12 PO BID

NA

NA

PBr 100 (total dose) PO BID; PB: 30 (total dose) PO BID; LEV: 50 (total dose) PO TID; gabapentin 100 (total dose) PO TID

20 mg/kg PO or IV SID (only one single dose)

PB: median 3.02; range 0.75-4.9 PO BID; LEV: median 23.6; range 17.2-34.7 PO TID

median 62.5; range 60-93.75 PO SID

20 mg/kg PO TID

PB: 4.5 PO BID; LEV 50 PO TID

500 mg PO single dose (extended release)

Serum levels of AED(s)

NA

mean 1.15 mg/ml

mean 1.1 mg/ml

PBr: mean 1.5 mg/ml. PB: range, 13-47 μg/ml

NA

NA

NA

median 26.77; mean 25.54; range 13.22-37.11 μg/ml

PB: median 29; range 5.6-75 μg/ml; LEV: median 25.5 μg/ml

NA

PB: mean 35.8 μg/ml; LEV: mean, 16.5; range: 6.9–24.3 μg/ml

NA

89.7 + /−25.7 μg/ ml

Pre-treatment SF (seizures/month or year)

NA

mean 4/month (recorder over a period of 6-12 months)

NA

NA

NA

NA

NA

NA

median 2.1; range 0.8-42.4/month (recorder over a period of median 4.5; range 0.3-46 months)

65/month

NA

continuous

NA

Post-treatment SF (seizures/month or year)

NA

0.52/month

NA

NA

NA

NA

NA

NA

median 0.42; range 0-1.25/month

NA

NA

0 (recorded over a period of 2 months)

NA

No of cats that were failures

NA

1/9 (11%)

NA

-

NA

0

NA

NA

0%

0/28 (0%)

1/4 (25%)

-

NA

No of cats with >0% - <50% reduction in SF

NA

-

NA

8/15 (53%)

NA

0

NA

NA

3/10 (30%)

0/28 (0%)

3/4 (75%)

-

NA

No of cats with ≥50% - <100% reduction in SF

NA

3/9 (33%)

NA

-

NA

0

NA

NA

4/10 (40%)

14/28 (50%)

0

-

NA

No of cats with 100% reduction in SF

NA

5/9 (56%)

NA

7/15 (47%) (available for 15 cats only and 3/7 were receiving also PB)

NA

5/5 (100%)

NA

NA

3/10 (30%)

14/28 (50%)

0

1/1 (100%)

NA

95% CI of successfully treated cases

NA

56-98%

NA

25-70%

NA

100%

NA

NA

40%-90%

100%

0%

100%

NA

Prevalence of adverse effects

11/26 (42%)

6/9 (67%)

0%

8/17 (47%)

NA

4/5 (80%)

NA

10/10 (100%)

2/12 (17%)

5/34 (18%)

2/4 (50%)

NA

0%

95% CI of cases that developed adverse effects

26-61%

35-88%

0%

26%-70%

NA

38-96%

NA

100%

4-45%

6-30%

15-85%

NA

0%

Body system affected and adverse effects

Respiratory (cough(11), dyspnea(2))

Respiratory (cough(6)), dermatological (dermatitis/bromoderma(1))

NA

Respiratory (cough (6)), GI (vomiting (1)), Neurological (sedation/ataxia (2)), weight gain (1), PD (1)

Respiratory (cough(7), dyspnea(2), tachypnea (2))

Respiratory (cough, dyspnea)

Respiratory (cough, tachypnea)

GI (hypersalivation)

Neurological (sedation(1)), GI (anorexia(2))

Neurological (sedation (4), ataxia (2), GI (anorexia (3)), PD (1)

ClinPath (increased ALP(2))

NA

NA

Most common adverse effects

Cough

Cough

NA

Cough

Cough

Cough

NA

hypersalivation (after PO administration only)

anorexia

sedation, anorexia

increased ALP

NA

NA

Adverse effect type

II

II

NA

I & II

II

II

II

I

I

I

I

NA

NA

Proportion of specific adverse effects for each AED based on all study reports

Type I: sedation, ataxia, vomiting, weight gain and PD (1/7; 14%)

Type I: sedation (2/5; 40%), anorexia (2/5; 40%), ataxia (1/5; 20%), hypersalivation (1/5; 20%), elevated serum ALP (1/5; 20%) and PD (1/5; 20%)

Type II: cough (6/7; 86%), dyspnea (3/7; 43%), tachypnea (2/7; 29%), dermatitis/bromoderma (1/7; 14%)

One study reported that there were no adverse effects.

Proportion of specific adverse effects for each AED based on the total affected population

Cough (35/72; 49%), dyspnea (9/72; 12%), tachypnea (3/72; 4%), sedation (2/72; 3%), ataxia (2/72; 3%), dermatitis/bromoderma (1/72; 1%), vomiting (1/72; 1%), weight gain (1/72; 1%) and PD (1/72; 1%)

Hypersalivation (10/67; 15%), sedation (5/67; 7%), anorexia (5/67; 7%), ataxia (2/67; 3%), elevated serum ALP (2/67; 3%) and PD (1/67; 1%)

Overall level of evidence supporting the efficacy and safety profile of an AED

Weak level of evidence for potassium bromide’s efficacy and safety profile

Weak level of evidence for levetiracetam’s efficacy and safety profile

  1. AED(s) anti-epileptic drug(s), BID bis in die (twice daily), CI confidence interval, GI gastrointestinal, IE idiopathic epilepsy, LEV Levetiracetam, m month(s), NA Not Available, PB phenobarbital, PD polydipsia, PU polyuria, PP polyphagia, PBr potassium bromide, PO per os, SID semel in die (once daily), TID ter in die (three times daily), w week(s), y year(s)