Status epilepticus in dogs and cats, part 2: treatment, monitoring, and prognosis

Objective - To discuss current anticonvulsant drug options and advances in treatment of status epilepticus (SE) and to review the prognosis associated with SE. Treatment - When treating a patient with SE, the main goals are to halt seizure activity, prevent further seizures, identify the cause of the seizures, and manage any complications. The veterinary literature indicates that benzodiazepines are the most common class of drugs used for the initial treatment of SE. Although many anticonvulsant drugs are currently available for treatment of SE, there is a lack of evidence demonstrating clear benefit to the use of specific therapeutics for benzodiazepine-refractory SE. Several multicenter, randomized, and placebo-controlled clinical trials are currently investigating the efficacy of new drugs, such as fosphenytoin, for use in canine SE. Another active area of research is the investigation of nonpharmacologic methods of seizure treatment including percutaneous vagal nerve stimulation and transcranial ultrasonic neuromodulation. Monitoring - Electroencephalography (EEG) is underutilized in the management of veterinary seizure disorders. However, recent advances in EEG technology may allow for earlier and proactive therapeutic interventions in epileptic patients, provide objective data collection regarding treatment efficacy, and yield insight into the neurologic status of patients with SE. Most importantly, use of EEG in patients with SE will lead to increased recognition of nonconvulsive seizures and nonconvulsive SE. Prognosis - Mortality associated with SE is as high as 25% in dogs due to direct and indirect causes of death. Dogs with seizure disorders have a decreased lifespan compared to the general population, and epileptic dogs with SE have a significantly abbreviated lifespan compared to epileptics that do not experience SE. In people, nonconvulsive SE has a higher morbidity and mortality than convulsive SE, regardless of patient age or underlying diagnosis.