Zonisamide discontinuation due to psychiatric and cognitive adverse events: a case-control study. If primidone is switched to phenobarbital, one grain of phenobarbital can be substituted for 250 mg primidone. Depending on a childs seizure frequency, it is also a good idea to consider stopping seizure medication well before teens are at the age where driving becomes a possibility. Already have a myVCA account? All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. In that situation, many healthcare providers recommend waiting at least 6-12 months after surgery before reducing medication. (2014) 10:257. doi: 10.1186/s12917-014-0257-9, 33. Rare side effects include liver disease, urinary stones, and aggression. Epilepsia. Use of valproic acid in dogs is limited because of rapid metabolism. doi: 10.1111/j.1365-2885.2008.00993.x, 27. The clinical signs in our cases were similar to PAE in humans, which seriously and negatively affected the caregivers' quality of life. Although some of it is metabolized by the P450 enzyme system, much is excreted unchanged in the urine. Zonisamide was prescribed with the gradual dose increment plan potentially up to 13.7 mg/kg q12h if needed based on his seizure frequency. BMC Vet Res. A 2-week telephone follow-up revealed this dog was exhibiting unusual behavior episodes of abrupt barking during sleep without obvious external stimuli. Here, we report three dogs with abnormal behavior episodes associated with ZNS. Epilepsy Res. A 50:50 mixture of milk replacer and water is recommended. University of Veterinary Medicine Hannover, Germany, University of Veterinary Medicine Vienna, Austria, Cave Veterinary Specialists, United Kingdom. Potassium Bromide was the devil for my boy, he had hind end weakness and also developed megaesophagus from that drug. In dogs, phenobarbital and bromide are considered first-line maintenance AEDs, but levetiracetam and zonisamide are often used as well. Front. Download our seizure tracking app, print out seizure action plans, or explore other educational materials. Our consideration for keeping the pheno are 1) it is still the necessary drug to re-load Spencer with to control bad clusters, 2) its main side effect (hunger) is manageable and 3) liver damage (enzymes) is being monitored & is acceptable for the moment " with Milk Thistle supplement. The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fvets.2021.763822/full#supplementary-material. 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). But, taking them daily may cause drowsiness, dizziness and loss of balance, and other side effects. I'm glad KBr hasn't been an issue for your pup! (2015) 11:116. Your options may include increasing the dose of your current medication, replacing it with a different medication, or adding a different medication while continuing to take your current medication. Using this medicine while you are pregnant can harm your unborn baby. If excessive sedation occurs, a lower dose should be used initially and gradually increased. This case series reports the occurrence of reversible behavior changes associated with zonisamide in three dogs with no pre-existing behavior problems prior to administration of zonisamide. In human medicine, there were several reports of psychiatric and behavioral side effects associated with ZNS (1, 24, 3336). Cardiovascular defects were prominent in both rats and dogs. Ashkenazi A, Benlifer A, Korenblit J, Silberstein SD. Systematic review of antiepileptic drugs' safety and effectiveness in feline epilepsy. Feeding. Dogs receiving concurrent drug therapy known to induce hepatic microsomal enzymes (ie, phenobarbital) require nearly twice the dosage of zonisamide to achieve and maintain serum concentrations than dogs receiving zonisamide alone. If you decide to switch to a different medication, youll need to take both for a while to see how helpful the new medication is and how well you tolerate it. Doses may be doubled in early stages and increased by 25%50% in later stages. Zonisamide therapy for refractory idiopathic epilepsy in dogs. This medication may be given with or without food, however, if your pet vomits or acts sick after receiving it, give this medication with food or a small treat. Taking multiple medications can reduce quality of life because of side effects, drug interactions, and cost. Our low carb, nutrient-dense recipes are the easiest way to feed your dog fresh homemade food on the budget you choose. Brief exposure to temperatures between 15C (59F) and 30C (86F) is permitted. doi: 10.5326/0400285, 31. Diarrhea sometimes develops with clonazepam, but this may be avoided by starting with once daily dosing and increasing the frequency to three times daily over a period of several days. However, aside from a previous report by Walker et al. Epilepsy Behav. Zonisamide (Oral Route) Side Effects Drug information provided by: Merative, Micromedex Along with its needed effects, a medicine may cause some unwanted effects. If you have a seizure, you may be unable to drive yourself to school or work for some time. For some people with epilepsy, the benefits of taking a benzodiazepine every day outweigh the risks. 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. by seebr5640 Tue Jul 02, 2013 9:08 am, Post This pyrrolidine-based anticonvulsant has an unknown mechanism of action. Zonisamide. Smaller doses, such as 50 mg/kg, bid for 46 days, may reduce adverse effects (eg, nausea and vomiting) caused by rapid increase in serum bromide concentrations. The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. This was not the case for me. Chronic migraine. Moore RA, Wiffen PJ, Derry S, Lunn MPT. Felbamate is a dicarbamate AED that exerts its anticonvulsant effects through multiple mechanisms, including potentiating GABA-mediated neuronal inhibition, inhibiting voltage-sensitive neuronal calcium and sodium channels, and blocking N-methyl-d-aspartatemediated neuronal excitation. by Gentle Jacob's mom Wed Aug 13, 2014 9:03 am, Post Zaccara G, Specchio LM. Because diazepam has a rapid onset of action that prevents the spread read more ). After 12 weeks of treatment, 7 out of 10 dogs were seizure-free. It is typically used twice daily in dogs, usually as a supplement to phenobarbital. Give her 3/4 of the regular dose for a few weeks, then a half dose for a few weeks, then a 1/4 dose for a few weeks. The severity of episodic aggression was determined based on the client's oral description at each follow-up; 100% at the initial presentation. But, taking them daily may cause drowsiness, dizziness and loss of balance, and other side effects. Zonisamide (brand name: Zonegran) is an anticonvulsant (antiseizure) medication that is either used as an initial therapy for epilepsy or as an add-on drug for difficult to control seizures. doi: 10.1186/s12917-015-0464-z, 7. In dogs not on drugs that induce hepatic microsomal enzymes, the dosage is 5 mg/kg, PO, bid. Neuropsychiatr Dis Treat. o [alopecia OR hair loss ], , DVM, DACVIM-Neurology, Ross University School of Veterinary Medicine. They are effective at stopping prolonged seizures or clusters of seizures. A review article reported the most common adverse effects pertained to the CNS were ataxia, dizziness, somnolence, agitation, and anorexia (36). (2020) 7:169. doi: 10.3389/fvets.2020.00169, 41. Given the history and unremarkable clinicopathological analyses results, ZNS dose was reduced to 4.5 mg/kg PO q12h without any changes in LEV and glycerine to avoid multiple variables at one time for assessing the clinical response to the medication adjustment. If seizure control is unsatisfactory, the drug level should be checked. Looking for a convenient way to access your pets health records, refill prescriptions, view upcoming appointments and more? For me, the side effects of Zonegran far outweighed the positive. Platt JE, Opler LA, Platt EM. The last one almost killed him. Brain Dev. These include the drugs clonazepam, clobazam, diazepam, lorazepam, and clorazepate. Keep us posted on how she's doing. They are usually given to people with epilepsy only when other anti-seizure medications havent helped. (2016) 12:79. doi: 10.1186/s12917-016-0703-y, 3. With limited available evidence supporting its efficacy in the veterinary field, this medication has been widely used for anti-seizure purpose in dogs and in humans (27). Critical differences are that 1) the dog's body adapts to zonisamide pretty quickly -- maybe 2 weeks -- and the ataxia goes away, and 2) the dose of zonisamide doesn't have to increase continually. b. Other potential type II adverse effects include one case with keratoconjunctivitis sicca and one case with polyarthropathy, although the direct relationship was not confirmed in these cases (7). J Vet Pharmacol Ther. If seizures do recur, it is likely that they will be controlled again with medication. Weaning off Gabapentin requires you to do so slowly. Serum concentrations should be checked periodically. Severe signs of toxicity are easily treated by IV administration of 0.9% sodium chloride, which promotes renal excretion of the bromide ion. In cats, side effects may include inappetence (lack of appetite), diarrhea, vomiting, incoordination while walking, and sleepiness. At this point, ZNS dose was 10 mg/kg q12h. While the dog remained herself over the next 3 days during hospitalization after reintroduction of ZNS, the exact same episodes relapsed on the night after discharge. Start your dog's personalized plan today. Collinet A, Sammut V. Suspected zonisamide-related anticonvulsant hypersensitivity syndrome in a cat. Common adverse effects include transient GI distress, alopecia, sedation, and vomiting. Phenobarbital has a long record of safety, efficacy, low cost, and convenience in regard to monitoring serum concentrations. This is the place for general questions about drugs, long-term treatment concerns, possible influences of other drugs (such as antibiotics, heartworm preventatives, or anesthetics) for epileptic dogs, and other concerns. (2006) 68:S39. Pancratitis can be dealt with, I hope your vet comes thru for you and your pup. (2000) 9:6570. 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. J Am Anim Hosp Assoc. Read More If the level is not within the middle of the therapeutic range, the dose should be increased before adding or switching to a new drug. doi: 10.1016/S0387-7604(00)00118-2, 23. Biton V. Clinical pharmacology and mechanism of action of zonisamide. Phenobarbital is used to treat your dog if they have epilepsy or other seizures. Don't really have much to add to what has been said, other than to say welcome and I will keep you all in my prayers. Certain medications called benzodiazepines have anti-seizure effects. Current indications include adjunctive therapy for partial seizures in adults. Zonisamide (ZNS) is an antiepileptic drug (AED) approved for adjunct treatment of partial seizures in adults. Seven days after the discontinuation of ZNS, the owner reported those frequent abnormal behavior episodes almost completely disappeared within 5 days after discontinuation of ZNS except for occasional gesture curling up the upper lip during the sleep for a few seconds. 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