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Table 4 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 Hasegawa et al. [50] Brewer et al. [49] Ukai et al. [51] Cautela et al. [52] Pellegrini et al., [53] Zoran et al., [54] Dreimann [55]
AED evaluated Zonisamide   Pregabalin Valproic acid
2nd AED - PB (5) -   - - -
3rd AED - - -   - - -
4th AED - - -   - - -
No of cats 6 (non-epileptic cats) 5 8 6 (non-epileptic cats) 8 (non-epileptic cats) 1 (non-epileptic cat) 6 (non-epileptic cats)
Age of cats at seizure onset (years) NA NA median 8.75; range 6.75 -11.5 NA NA NA NA
Period of treatment or follow-up (months) 2.1 3 0.75 NA 0.12-0.25 NA 0.5
Dose of AED(s) (mg/kg) 20 PO SID mean 11.54; range 6.14-17 PO SID 2.5 PO BID for a week, then 5 PO BID 4 PO (one dose only) range 25- 130 intraperitoneally TID < 111 PO at once 40 PO and IV BID
Serum levels of AED(s) median 52.9; mean 56.9 μg/mL Zonisamide: mean 19.44; range 8.8-38.6 mcg/ml; PB: NA median 5.9 (2.1–8.3) for a week, then 13.45 (11.9–24.4) range 2.8-8.2 μg/mL <5 μg/ml 3.4 μg/ml 50-150 μg/ml
Pre-treatment SF (seizures/month or year) NA NA NA NA NA NA NA
Post-treatment SF (seizures/month or year) NA NA NA NA NA NA NA
No of cats that were failures NA 0 NA NA NA NA NA
No of cats with >0% - <50% reduction in SF NA 2/5 (40%) NA NA NA NA NA
No of cats with ≥50% - <100% reduction in SF NA 3/5 (60%) NA NA NA NA NA
No of cats with 100% reduction in SF NA 0 NA NA NA NA NA
95% CI of successfully treated cases NA 23%-88% NA NA NA NA NA
Prevalence of adverse effects 3/6 (50%) 2/5 (40%) 0% 4/6 (67%) >4/8 (>50%) NA 6/6 (100%)
95% CI of cases that developed adverse effects 19-81% 12%-77% 0% 30-90% NA NA 100%
Body system affected and adverse effects Neurological (sedation, ataxia) GI (vomiting, diarrhea, anorexia) Neurological (sedation (1)), GI (anorexia (1)) 0% Neurological (sedation) Neurological (sedation, ataxia, drowsiness, head tremor), GI (anorexia) Neurological (hyperactivity), dermatological (alopecia) Neurological (sedation), GI (vomiting, anorexia)
Most common adverse effects NA NA NA NA Sedation, drowsiness, head tremor, anorexia NA NA
Adverse effect type I I   I I I & II I
Proportion of specific adverse effects for each AED based on all study reports Type I: sedation (2/3; 67%), anorexia (2/3; 67%), ataxia (1/3; 33%), vomiting (1/3; 33%) and diarhoea (1/3; 33%) Type I: sedation Type I: sedation (2/3; 67%), anorexia (2/3; 67%), ataxia (1/3; 33%), drowsiness (1/3; 33%), head tremor (1/3; 33%), hyperactivity (1/3; 33%) and vomiting (1/3; 33%)
Type II: alopecia (1/3; 33%)
Proportion of specific adverse effects for each AED based on the total affected population Sedation (4/19; 21%), anorexia (4/19; 21%), ataxia (3/19; 16%), vomiting (3/19; 16%) and diarrhea (3/19; 16%) NA Sedation (>10/15; 67%), anorexia (>10/15; 67%), ataxia (>4/15; 27%), drowsiness (>4/15; 17%), head tremor (>4/15; 17%), vomiting (6/15; 40%), hyperactivity (1/15; 7%) and alopecia (1/15; 7%)
Overall level of evidence supporting the efficacy and safety profile of an AED Weak level of evidence for zonisamide’s efficacy and safety profile Absent and weak level of evidence for pregabalin’s efficacy and safety profile Absent and weak evidence for valproic acid’s safety profile and efficacy respectively
  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); year(s); y