Download our seizure tracking app, print out seizure action plans, or explore other educational materials. The authors thank the owners of three cases, referring veterinarians and colleagues at Veterinary Specialists & Emergency Center for supporting us for the article preparation. After failing to control daily epileptic episodes with PB, LEV, and potassium bromide over the next 10 days, ZNS at 50% reduced dose (5 mg/kg PO q12h) was resumed to confirm the direct association between ZNS and the aggressive episodes as well as to manage seizure episodes. Firocoxib was also prescribed for the joint condition. The trusted provider of veterinary information since 1955, Overview of Systemic Pharmacotherapeutics of the Nervous System, Antiepileptic Drugs Used to Stop Ongoing Seizure Activity, Maintenance Anticonvulsant or Antiepileptic Therapy, Last review/revision Mar 2015 | Modified Nov 2022. (2007) 10:10510. As for type 3 adverse effects, the possibility of affecting thyroid function (especially decrease in total T4) and the changes in blood chemistry profile within the reference range, including the elevation of ALP and Ca and the decrease of total protein and albumin compared with those prior to the administration of ZNS, were observed (7). If azotemia is present, a different AED can be used, or the initial bromide dose can be reduced by half and serum concentrations monitored. Among various ASDs, ZNS has been frequently used in veterinary practice with several adverse effects being reported (2, 7, 1317, 2532). Systematic review of antiepileptic drugs' safety and effectiveness in feline epilepsy. No use, distribution or reproduction is permitted which does not comply with these terms. Daily seizure episodes resolved after ZNS was added. The abrupt episode typically lasted for ~2030 s. 1. by SpencerBhumi Thu Aug 14, 2014 3:08 pm, Return to Treatment & Maintenance Issues for Epileptic Dogs. BMC Vet Res. It has also been used to treat aggressive behavior problems ( see Psychotropic Agents Psychotropic Agents Anxiolytics, antipsychotics, antidepressants, and mood stabilizers used to treat human behavioral disorders are being used more commonly in veterinary medicine as adjuncts to behavioral modification read more ). This sulfonamide-based anticonvulsant restricts the propagation and spread of seizures and suppresses epileptogenic focus activity. by MK's mom Fri Jun 05, 2015 2:01 pm, Return to Treatment & Maintenance Issues for Epileptic Dogs. Generally, monitor your pet for any adverse effects, and that the medication is working. The plan now will be to wean the Zonisamide. Therapeutic monitoring is generally not necessary when using this drug, and there does not appear to be a correlation between serum drug concentration and therapeutic efficacy. The owner reported the same abnormal behavior episodes relapsed within 12 h after re-introduction and gradually deteriorated over the next 3 days. Our case 2 did not have MRI or cerebrospinal fluid analysis to rule out other intracranial structural conditions, which was clinically considered relatively unlikely given stable condition through a long follow-up duration of this case. Nonetheless, the proportional association between ZNS dose and the severity of the clinical signs was shown with multiple dose adjustments in this case. Zonisamide - Zonisamide is a broad-spectrum antiseizure medication that blocks voltage-dependent sodium and T-type calcium channels. (2007) 48:1348. For the most part, people who continue to have seizures despite taking two or more medications at appropriate doses may not benefit by adding medications without removing others. The option that is best for you depends on several factors: In general, it is better to control seizures with a single medication. doi: 10.1111/ane.12016, 20. The abnormal behavior episodes deteriorated along with gradual dose increment of zonisamide and these episodes almost completely disappeared within 5 days after discontinuation of zonisamide. Although some of it is metabolized by the P450 enzyme system, much is excreted unchanged in the urine. doi: 10.1111/jvim.16205, 42. Right now we are not sure which has made the severe change in her behavior. Adverse effects classified as type 4 have not been reported (7). Prior to the referral, this dog had been managed with ZNS starting at 2.5 mg/kg per os (PO) q12h then gradually increased in the dose up to 5 mg/kg q12h with the trough blood concentration at 21.2 g/ml over the 15 months. Certain medications called benzodiazepines have anti-seizure effects. Most people with epilepsy take one or more medicines. A 10-year-old male castrated miniature poodle was referred to Veterinary Specialists and Emergency Center for recent onset of generalized seizure episodes, decreased appetite, and abnormal behavior. Biton V. Clinical pharmacology and mechanism of action of zonisamide. doi: 10.1592/phco.23.1.93.31911, 35. Zonisamide is administered by mouth, as an oral capsule, or it may be compounded into an oral liquid. by SpencerBhumi Wed Aug 13, 2014 5:20 pm, Post Changes in brain serotonin and dopamine levels are considered as a mechanism of ZNS-induced PAE (24, 35, 37) and human patients with a history of psychiatric disorder had significantly greater risk of developing PAE associated with ASDs including ZNS (24, 36, 38, 39). Doing this will keep you safe and help you manage your seizures to the best of your ability. Vet has us on a weaning OFF schedule for the phenobarbital AND immediately starting 50 MG zonisamide twice a day. (1988) 11:33342. What worries me is he is on metronidazole (weaning off per vet), metoclopramide, ranitidine, simethicone and thyroxine, plus the zonisamide. Pets with a hypersensitivity or an allergy to sulfonamide drugs should use zonisamide with caution. Contact your veterinarian if these signs are severe. Due to serious detrimental impact on the family, ZNS was discontinued abruptly as a therapeutic trial with our concern of possible association between the episodic aggression and ZNS. Neuropsychiatr Dis Treat. Walker RM, DiFonzo CJ, Barsoum NJ, Smith GS, Macallum GE. (2012) 60:3579. Introduction. Acute hepatic failure has been reported in cats given diazepam for behavioral problems; thus, a pretreatment chemistry profile should be evaluated before using diazepam, and cats should be watched closely during the first 2 wk of use. Log in 24/7 to access your pets health care information. The regular maintenance dose can be started at the same time as the loading dose or immediately afterward. The phase IV clinical study analyzes which people take Zonisamide and have Drug withdrawal syndrome. Making the decision to stop taking an anti-seizure medication (ASM) can be difficult. For maintenance therapy in dogs, it may be used alone at 0.5 mg/kg, tid, but it is best used as an adjunct to phenobarbital at dosages of 0.10.5 mg/kg/day. Long-time reader, first time asking a question. This dog was managed well with PB (2 mg/kg q12h) and LEV (20 mg/kg q8h) with no observable epileptic or aggressive behavior episodes for 13 months until this dog died of an unrelated condition. An oral loading dosage of 400600 mg/kg of bromide is divided into four doses and given with food over a 1- to 4-day period. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. Epilepsy is a neurological disorder in which the electrical activity of the brain is disturbed causing seizures. (2020) 7:169. doi: 10.3389/fvets.2020.00169, 41. The dose of ZNS was increased to 6.6 mg/kg PO q12h by a referring veterinarian. Zonisamide is available as capsules of 25, 50 and 100 mg . Summary: Drug withdrawal syndrome is found among people who take Zonisamide, especially for people who are male, 50-59 old, have been taking the drug for 1 - 6 months. Therefore, it is important to discuss with your healthcare provider the expected success or failure of weaning off and eliminating anti-seizure medication. Adequate control of seizures in epileptic dogs, therefore, may require higher dosages of clorazepate when coadministered with phenobarbital. Kubota M, Nishi-Nagase M, Sakakihara Y, Noma S, Nakamoto M, Kawaguchi H, et al. Bhatti SFM, de Risio L, Muana K, Penderis J, Stein VM, Tipold A, et al. Use for phrases Platt JE, Opler LA, Platt EM. An MRI and cerebrospinal fluid analysis were both unremarkable. Primidone is a barbiturate that has three metabolites: phenobarbital, primidone, and phenylethylmalonamide. Baulac M. Introduction to zonisamide. Zonisamide, USP is a white to off white crystalline powder, pKa=10.2, and is moderately soluble in water (0.80 mg/mL) and 0.1 N HCl (0.50 mg/mL). Prior to referral, this dog had been on ZNS at the dose of 10 mg/kg PO q12h for presumptive idiopathic epilepsy over the past 3 years and epilepsy had been extremely well-controlled with no seizure episodes witnessed. If you can find something other than KBr try that first, my boy had so many issues from the KBr, but sadly it seemed to be the only drug that gave him a reprieve and also the one that I'm convinced caused the problem that caused his passing. Zonisamide (ZNS) is an antiepileptic drug (AED) approved for adjunct treatment of partial seizures in adults. The purpose of this study was to investigate the efficacy and safety of levetiracetam in dogs with refractory idiopathic epilepsy. Call your provider or find anepilepsy specialist and make an appointment to discuss any changes youd like to make before you make them. However, cats not only have a longer half-life (1520 hr) than dogs but also do not develop a tolerance to the anticonvulsant effects. The link you have selected will take you to a third-party website. A maintenance AED should also be considered if the first seizure episode is protracted or severe, or during an episode of status epilepticus (as a followup to emergency treatment, see Antiepileptic Drugs Used to Stop Ongoing Seizure Activity Antiepileptic Drugs Used to Stop Ongoing Seizure Activity In status epilepticus, treatment is essential to prevent death from hyperthermia, acidosis, hypoperfusion, and hypoxia. This was not the case for me. by SpencerBhumi Mon Jul 01, 2013 5:09 pm, Post J Vet Intern Med. Sci. Other than episodic aggression, the dog remained healthy and happy. doi: 10.1016/j.jfms.2008.01.006, 30. by seebr5640 Sun Jun 30, 2013 1:08 pm, Post Reported type 2 adverse effects include two cases of acute toxic liver injury, three cases with dermatologic lesions, and one case of renal tubular acidosis (1317). Studies suggest that 60% of dogs respond initially; however, after 48 mo, there is a loss of effect in of previous responders because of development of tolerance. doi: 10.1016/j.applanim.2017.11.008, Keywords: episodic abnormal behavior, psychiatric adverse effect, anti-seizure drug, zonisamide, dog, epilepsy, Citation: Kanazono S, Ukai M and Hiramoto A (2021) Abnormal Behavior Episodes Associated With Zonisamide in Three Dogs: A Case Report. Bromide is renally eliminated and thus should not be used in dogs with renal dysfunction without careful monitoring. Bromide can be formulated into a solution of various concentrations (100 mg/mL, 200 mg/mL, 250 mg/mL are convenient ones) or into tablets or capsules. doi: 10.3988/jcn.2007.3.4.175, 4. (2011) 73:15058. After 12 weeks of treatment, 7 out of 10 dogs were seizure-free. Epilepsy Behav. J Vet Med Sci. Tolerance to phenobarbital therapy may develop in dogs treated continually for months to years and may result in decreased seizure control; however, an increase (25%) in the dose usually will result in improved seizure control. by readerofthepack Fri Aug 08, 2014 1:32 pm, Post Zonisamide should not be used in pets that are hypersensitive or allergic to it. It is well absorbed in dogs after oral administration and undergoes both hepatic and renal metabolism. Because the elimination half-life is short in dogs (24 hr), it is probably not an effective anticonvulsant, but a dosage of 510 mg/kg, bid, has been suggested. 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