Prophylactic, Chronic or Maintenance Therapy
The cornerstone of treatment for seizures is the use of a chronic therapy designed to lower the chance of a pet having a seizure. We are striving to find a balance bewteen adequate seizure control and medication side effects. These medications are given daily, regularly and over a long period of time. Choosing a drug to stop seizures is kind of like choosing an antibiotic when you do not know what the infection is. Your veterinarian will pick the medication that is the most efficacious, safe, easiest to give and lowest cost. They also tend to pick the medication they have the most experience and therefore comfort with. Regardless, it is a trial and error process. About 75% of all dogs with seizures will have their seizures adequately controlled with one medication (higher in cats). Many medications and combinations of medications can be used. The general guideline is to use a medication, in increasing amounts if necessary until you either gain adequate seizure control, the patient develops a negative side effect or such a large amount of the medication has been used that more is unlikely to result in any more benefit. Once a medication is failed we move on to other medications. We try to only make changes to one medication at a time in order to avoid confusion as to results or side effects.
A bridge medication is a drug that is temporarily used to gain an “edge” over seizures. In this situation, most of the time the patient’s seizures are well controlled by the chronic medication (see above) but there might be a time when the patient is a little extra susceptible to having a seizure or another circumstance may develop which requires an extra amount of temporary medication to “get over the hump”. Another example might be when waiting for a chronic medication to reach adequate blood levels, or if a particular trigger might be anticipated (such as a visit to the groomer or visiting family members). During this time of increased seizure susceptibility, a temporary medication can be used to gain a little more seizure control and then withdrawn once the threat has subsided.
A potential lifesaving medication can be given during a seizure or at the first indication a seizure is about to occur in order to stop or prevent a seizure from occurring. Generally, these are the same drugs a veterinarian may give in the hospital through an injection into the blood stream but they are delivered in the home through an alternative route such a rectally, squirted up the nose or applied to mucus membranes in the mouth. They will take some time to reach the brain (usually 5-15 minutes) but can help to lessen a potentially dangerous seizure or break the cycle in cases of cluster seizures and status epilepticus (a really long seizure). Pulse medications have been shown to significantly reduce the number of emergency room visits due to extensive seizure activity. They are generally very safe and effective.