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 | ||||