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Seizure Control: |
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Status epilepticus (continuous or cluster seizures) in dogs and cats may be interrupted by diazepam, given at 0.5 mg/kg (not to exceed 10 mg at one time), IV. Sodium pentobarbital to effect, not to exceed 3-15 mg/kg, IV, may also be used, followed by phenobarbital at 2-4 mg/kg, IM, every 6 hr. Diazepam given at 0.1-2 mg/kg/hr, IV, may be used to control persistent status epilepticus. Oral anticonvulsants should be resumed as soon as
possible if currently being given. |
| Recommended maintenance anticonvulsant therapy in dogs and cats is phenobarbital at 2-4 mg/kg, PO, bid-tid as needed to control seizures or to maintain serum levels at 25-30 µg/mL. Dogs can be treated with potassium bromide (KBr), 22 mg/kg, bid with food until the serum level is 1,500-4,000 µg/mL 3 mo after initiation of therapy. Phenobarbital is good for animals with seizures multiple times weekly as it may become clinically effective in 72 hr,
whereas KBr may take several weeks. KBr bypasses the liver so it is better than phenobarbital in animals with liver disease. Phenobarbital and KBr may be given in combination. KBr may cause asthma in cats. Since KBr is not commercially available, it may be prepared by a compounding pharmacist by mixing chemical grade KBr crystals in water at a concentration of 125 mg/mL or 250 mg/mL. Once the effective dose is obtained, the crystals may be packed in gelatin capsules. Because KBr
is toxic to people, owners are advised to wear gloves while medicating the dog. KBr serum levels are affected by the salt content of the diet, so the diet should be consistent. KBr has proved more efficacious in dogs with cluster seizures than phenobarbital. Other oral anticonvulsants are rarely used because of side effects, ineffectiveness, or expense. Diazepam at 0.5-1 mg/kg, PO, bid, may be used in cats with uncontrolled seizures on phenobarbital; it is not an
effective oral anticonvulsant in dogs. A compounding pharmacist can prepare rectal suppositories containing diazepam 0.5-2 mg/kg for use at home in dogs with cluster seizures. Acupuncture may be useful to control seizures in all species. |
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Acute Spinal Cord Injury: |
| Acute spinal cord injury from trauma, intervertebral disk herniation, or fibrocartilaginous embolization resulting in paraplegia must be treated aggressively in dogs to ensure the best chance for recovery. Methylprednisolone sodium succinate or prednisolone sodium succinate is given at 30 mg/kg, IV, followed by 15 mg/kg in 2 and 6 hr, then 2.5 mg/kg/hr as a constant IV infusion. Dexamethasone is not rapid-acting enough to use. Oral famotidine at 0.5-1 mg/kg, sid
or bid, cimetidine at 5-10 mg/kg, bid, or misoprostol at 3 µg/kg, bid, can be used to protect the GI tract. For maximum benefit, decompressive spinal surgery should be performed as soon as possible, usually within 24 hr, when indicated. |
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| Anti-inflammatory Drugs: |
| For control of CNS inflammation in dogs and cats unassociated with a virus or other agent, either prednisone at 2 mg/kg or dexamethasone at 0.2 mg/kg may be given PO, sid. Oral famotidine at 0.5-1 mg/kg, sid or bid; cimetidine at 5-10 mg/kg, bid; or misoprostol at 3 µg/kg, bid, is given to prevent GI irritation. If GI ulcers develop and melena is detected, sucralfate (500 mg for cats and dogs <20 kg;
1 g for dogs >20 kg), PO, tid-qid, is given 2 hr apart from other drugs. Phenylbutazone, carprofen, etodolac, or aspirin should never be given in conjunction with steroids as GI ulceration is common. The dosages of all steroids given should be slowly tapered; abrupt withdrawal should be avoided. Prednisone can be used as longterm maintenance therapy on alternate days to avoid complete suppression of adrenal function. |
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| Antiedema Drugs: |
| After cranial surgery and in animals with brain tumors or head injuries causing a declining neurologic status, 20% mannitol, 1-2 g/kg, may be given slowly IV. Mannitol is not given in spinal cord injuries. Use of methylprednisolone sodium succinate as described above for acute spinal cord injury reduces edema as well. |
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| Muscle Relaxants: |
| Diazepam at 0.5 mg/kg or methocarbamol at 40 mg/kg, PO, tid-qid, relieves muscle spasms from intervertebral disk protrusion and other sources of nerve root irritation. |
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| Antimicrobial Therapy: |
| Refer to discussions of specific infections for antimicrobial therapy recommendations. |
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| Nursing Care: |
| Animals with paraplegia and quadriplegia need intensive nursing care. The animal should be maintained on padding and turned every 4-6 hr to avoid decubital ulcers. The bladder must be expressed or catheterized every 6-8 hr. Urine must be monitored for evidence of cystitis. The skin must be kept clean and free of urine and feces to prevent dermatitis. Quadriplegic animals may need to be hand fed nutritious food and given plenty of water. Manual extension and flexion of joints
and muscle massage will help delay contractures and muscle atrophy in paralyzed limbs. |
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