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] |
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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 |