Podell M
College of Veterinary Medicine, Ohio State University, Columbus 43210, USA.
Clin Tech Small Anim Pract. 1998 Aug;13(3):185-92. doi: 10.1016/S1096-2867(98)80040-6.
Successful treatment of seizure disorders in small animals requires proper patient assessment, understanding the principles of antiepileptic drug (AED) therapy, designing a strategy for pharmacotherapy, and plans for emergency treatment. Several levels of assessment are needed in managing an epileptic patient to include the diagnosis, effectiveness of therapy, and health-related quality of life assessments. Three levels of diagnosis are important in determining the appropriate AED therapy: 1) confirmation that an epileptic seizure has occurred, and if so, the seizure type(s) manifested; 2) diagnosis of the seizure etiology; and 3) determination of an epileptic syndrome. Monotherapy is the initial goal of treating any cat or dog with epilepsy to reduce possible drug-drug interactions and adverse effects. Unfortunately, many of the AEDs useful in people cannot be prescribed to small animals either due to inappropriate pharmacokinetics (too rapid of an elimination), and potential hepatotoxicity. Thus, the most commonly used AEDs in veterinary medicine are from the same mechanistic category, that of enhancing inhibition of the brain. Antiepileptic drugs can be classified into three broad mechanistic categories: 1) enhancement of inhibitory processes via facilitated action of gamma amino-butyric acid (GABA); 2) reduction of excitatory transmission; and 3) modulation of membrane cation conductance. Pharmacotherapy strategies should be designed based on the decision when to start treatment, choice of the appropriate AED, and proper AED monitoring and adjustment. Information is presented for the current AEDs of choice, phenobarbital and bromide. Additional guidelines are provided for administration of newer AEDs, felbamate and gabapentin. All owners should be aware that emergency therapy may be necessary if recurrent or severe seizures occur in their pet. A rapid, reliable protocol is presented for the emergency management of seizuring cats and dogs in the hospital and at home. Home treatment with per rectal administration of diazepam in the dog has proven to be an effective means of reducing seizure frequency and owner anxiety. Treating each animal as an individual, applying the philosophy that seizure prevention is better than intervention, and consulting specialists to help formulate or revise treatment plans will lead to improved success in treating seizure disorders in the cat and dog.
成功治疗小动物的癫痫疾病需要对患者进行恰当评估，理解抗癫痫药物（AED）治疗的原则，制定药物治疗策略以及紧急治疗计划。在管理癫痫患者时需要进行几个层面的评估，包括诊断、治疗效果以及与健康相关的生活质量评估。在确定合适的AED治疗方案时，三个层面的诊断很重要：1）确认癫痫发作已经发生，如果发生了，明确发作的类型；2）诊断癫痫发作的病因；3）确定癫痫综合征。单一疗法是治疗任何患有癫痫的猫或狗的初始目标，以减少可能的药物相互作用和不良反应。不幸的是，许多对人类有用的AED由于不合适的药代动力学（消除过快）和潜在的肝毒性，不能用于小动物。因此，兽医学中最常用的AED属于同一机制类别，即增强对大脑的抑制作用。抗癫痫药物可分为三大机制类别：1）通过促进γ-氨基丁酸（GABA）的作用增强抑制过程；2）减少兴奋性传递；3）调节膜阳离子电导。药物治疗策略应根据何时开始治疗的决定、合适AED的选择以及适当的AED监测和调整来设计。文中介绍了当前的首选AED苯巴比妥和溴化物的相关信息。还提供了关于新型AED非氨酯和加巴喷丁给药的额外指导方针。所有宠物主人都应意识到，如果他们的宠物出现反复发作或严重的癫痫发作，可能需要进行紧急治疗。文中给出了在医院和家中对癫痫发作的猫和狗进行紧急处理的快速、可靠方案。经证实，在家中给狗直肠给药地西泮是减少癫痫发作频率和主人焦虑的有效方法。将每只动物视为个体，秉持预防癫痫发作优于干预的理念，并咨询专家以帮助制定或修订治疗计划，将提高猫和狗癫痫疾病的治疗成功率。
