Subscribe
Share
Share
Embed
Welcome to the Synaptic Tails podcast, where neurology meets practical tips in veterinary care. Hosted by Dr Emma Hancox, a Technical Vet Advisor at Dômes Pharma UK, alongside Dr Mark Lowrie of Movement Referrals.
In each episode, we explore the challenges of managing epilepsy cases in first-opinion practice - sharing clinical insights, lived experience, and practical strategies to support your patients and your team.
Season 1 introduced Dômes Pharma UK’s S.M.A.R.T. Approach to Epilepsy, offering step-by-step support on seizure management. In Season 2, we build on that foundation with even more focused conversations - tackling status epilepticus, seizure mimics, feline epilepsy, adjunctive therapies, and the power of teamwork in chronic care.
Join us as we unravel the complexities of veterinary neurology, share real-world stories, and empower you with knowledge. Together, let’s enhance the health and happiness of our canine and feline companions.
🌐 Learn more about Dômes Pharma UK: https://domespharma.co.uk
Access Vet Resources from Dômes Pharma UK at https://domespharma.co.uk/the-vet-vault/
🌐 Learn more about Movement Referrals: https://www.movementvets.co.uk
Movement Referrals is an independent, specialist veterinary hospital with practices in the North West and Midlands. Our aim is to provide high-quality but efficient Specialist referral services. We concentrate on orthopaedics and neurology, two of the most common reasons for referrals. We offer common referral procedures, such as TPLO, patellar luxation, and spinal surgery, at reasonable prices.
Hello and welcome back to Synaptic Tales.
I'm Emma, your host, and as
always, I'm joined by our
brilliant neurology expert, Mark.
In today's episode, we are diving into
the fascinating world of feline seizures.
Did you know that seizures
in cats are often approached
much differently than in dogs?
Mark, I feel like this is
one of those topics that can
really catch vets off guard.
How true is that?
Well, you're absolutely right, Emma.
I mean, for a long time our understanding
of seizures in cats has been heavily
extrapolated from what we know about dogs.
But I think it's become clear
that cats are not just small dogs.
We've heard that so many times,
but when it comes to neurology,
you know, seizures, their seizures,
the causes and even responses to
treatment can differ significantly.
So it's really vital that
we tailor our approach.
And we've, we've kind of titled this
episode, recognising feline Epilepsy,
which is probably a bit of a stretch
and just us trying to get this
into the SMART acronym in some way.
But it really is true, isn't it?
It's all about how to recognise
these seizures in cats.
Why are they so different?
Well, what's key here is that recognising
these events isn't always straightforward,
yet you'd think it would be.
Owner's descriptions play a crucial role.
And video footage can be a game changer.
I mean, I think, you know, with,
with video footage, not only do we
see the episodes, but sometimes if
a, if a cat isn't moving around,
well owners can actually capture
how that cat looks at home.
The number of times we don't see a cat,
well, you know, it won't move around
and perform for you in the consult room.
So owners can capture
that movement at home.
They're quite uncooperative, aren't they?
Sometimes cats.
They're clever.
They are.
Some might call them the superior species.
So what's the biggest difference when
it comes to cats versus dogs when it
comes to their epilepsy or seizures?
One of the main differences is the
higher prevalence of focal seizures
in cats when we compare that to dogs.
Now this often correlates with
underlying structural brain disease.
So things like tumours and inflammation
of the brain can cause these problems.
But then by contrast, dogs
are more commonly diagnosed
with idiopathic epilepsy when
no structural cause is found.
Another difference is that cats can
display behavioural changes before
or between seizures, such as pacing,
circling, or even bumping into things.
And these can be early signs
of a forebrain disorder.
It sounds like a lot of
detective work with cats.
In dogs, we were talking mainly about
tonic-clonic, generalised seizures.
Is that the same for cats then?
Well, it can be different.
I mean, cats can be really tricky.
So dogs, they have these generalised
seizures, which might be really obvious,
but cats are masters of subtlety.
So, for example, a focal seizure
in a cat might look like a bit of
repetitive blinking, twitching of the
face, or even a behavioural change like
sudden aggression, fear or dilation.
Rapid dilation and
constriction of the pupils.
So-called hippus.
So as I said, it does sound like
quite a lot of detective work
and that I'm assuming the history
then is really crucial and other
neurological signs I think for those.
Oh it definitely is.
So like history taking neurological
exams really important.
But advanced diagnostics like MRI and CSF,
well they're often necessary for cats.
Unlike dogs where, you know,
idiopathic epilepsy might be diagnosed
based on history alone, we usually
need to dig a bit deeper in cats.
I mean we say 98% of dogs with a
normal intrarectal exam in between
their fits that have their first
seizures between six months and six
years would have idiopathic epilepsy.
We don't have that same sort of
stat if you like, for recognising
idiopathic epilepsy in cats.
That's a shame because it's
really nice stat in dogs.
It's really helpful.
And so useful for owners
to make informed decisions.
Yeah, for sure.
So you mentioned structural brain disease.
So what are the main causes
then of seizures in cats?
Like how do you figure
out what's behind them?
You mentioned maybe advanced imaging and
Well, yeah.
So seizures, again, I split them into
intracranial or extracranial causes.
So intracranial causes are the
diseases of the brain, if you like.
So structural issues such as tumours,
inflammatory disease, so so-called
encephalitis or vascular events, we
call them cerebral vascular accidents.
And then the extracranial causes,
they're all the problems in the
blood, the blood going to the brain.
So things would be metabolic, like
hypoglycaemia, hepatic encephalopathy,
or even toxic problems like
exposure to lead or antifreeze.
The process of figuring out the cause
though starts with a, a thorough
history question about changes in
behaviour, appetite, I guess vision.
You'll find that cats that lose vision
might not be jumping up anymore.
They haven't got that
binocular vision they need.
Or even litter box habits.
So potentially toileting in the
house, not in the litter box as
maybe they, they did previously.
Then once we've done the history,
we move on to blood tests.
There are some key things here for cats.
I mean, I'd say it's really important
to do blood pressure measurements.
Now I know that's a bit of a draw with
cats because they're really hard to
do blood pressure measurements for,
they get very stressed in clinics and
it can be a very hard thing to do.
But I do think blood pressure measurements
in cats before performing further
diagnostics is really, really important.
And then sometimes, once we've done all
of that, that's when we consider, well
maybe now we'll go on for advanced imaging
to rule out structural brain disease.
Another thing I'd want to pick
up would be packed cell volume.
So PCV, that's another really
big thing to check in cats.
And we often see it in kind of,
if we see a high PCV, we might
dismiss that as being dehydration
or something along those lines.
But we do see cats then get
quite a high PCV that would then
lead to sludging of the blood.
That in turn can cause seizures.
So I always make sure I've
checked PCV and that it's okay.
Indeed.
Haematocrit as well would be fine.
The other big thing here though is blood
pressure, and I've mentioned this already.
High blood pressure
alone can cause seizures.
When I'm saying high, I mean if you've
got a cat with a blood pressure of
a systolic of around 160 millimetres
of mercury or higher, I would be very
worried that could be the cause for
the neurological signs because there's
this phenomenon called hypertensive
encephalopathy, simply meaning the
high blood pressure is triggering off
neurological signs and if it's well,
generally will cause more problems
in the forebrain than anywhere else.
And the most common sign of
forebrain disease are seizures.
So hence why we see that in
cats, definitely happens in dogs
too, but I'd say it's something
we're more aware of in cats.
So monitoring blood
pressure is so important.
But as I've said, very difficult
in cats as they get stressed and
the blood pressure can rise in the
clinic as a normal stress response.
Yeah.
I feel like you have to put
your medicine hat on here
rather than your neurology hat.
Well, it is true because I,
I've not taught much about
managing the blood pressure.
I don't want to go down that
route because that's not my bag.
But you're right.
But that's exactly what we want to do.
You know, we will want to be lowering
that blood pressure and of course look
for causes as to why the patient's
hypertensive in the first place, whether
it be a primary or secondary reason.
And of course I can imagine that
must influence the, treatment
decisions as well, right?
Oh, absolutely.
So for example, if a metabolic
issue is causing the seizures,
treating that underlying condition
could actually resolve the problem.
On the other hand, structural issues
might require long-term management
with anti-epileptic medications.
I won't go into blood pressure,
but there are a number of reasons
a cat may be hypertensive.
So investigating these causes becomes very
important in the presence of seizures.
It's really interesting.
It's so different from dogs and I
think, you know, the fact that they
have those more focal issues and
then all of these kind of medical
issues that can contribute, it's, it
is so differently, and I think I'm
taking away from this already, that
if I've got a cat who presents with
seizures, I basically need to look
pretty hard for an underlying cause.
So how common is true idiopathic epilepsy?
How common is that in cats?
Does it happen considering in
dogs it's suggested to affect
about one in 130 dogs in the UK?
Do we have that similar stat for cats or?
Well for cats we don't have
an exact statistic as neatly
defined as we do for dogs.
We do know it's less common in
cats, but seizures in cats are much
more likely to have an underlying
structural or metabolic cause.
Things like brain tumours,
inflammation of the brain, vascular
events, hypertension, systemic
conditions, hepatic encephalopathy
and hypoglycaemia are key ones here.
That said, idiopathic epilepsy
in cats does exist, and I don't
want to emphasise too much that
it's not there because it is.
We see it still quite a lot.
Okay.
Particularly in younger cats, the
diagnosis typically one of exclusion,
meaning you've ruled out other
potential causes through your history.
Physical exam, blood work, and imaging.
And often combined with CSF analysis.
So to sum it up, in cats, seizures are
more often a sign of an underlying issue
and idiopathic epilepsy is less common.
But as with all things clinical experience
and further studies will hopefully help
refine our understanding of how often this
truly occurs in the feline population.
It certainly is still quite frequent.
Okay.
So we are ruling out everything else.
Is it worthwhile in cats, even
if you are investigating, putting
them onto anti epileptic drugs
even to try and control the issue?
Or would you prefer to
do all your workup first?
No, I, I think it's often mentioned,
isn't it, that we may be, people
think we shouldn't start phenobarbital
till we know exactly what's going on.
I'd have no worry about starting it
early on for these patients, but for
the same reason as in dogs, you know,
that one seizure will lead to another.
And so early treatment is probably
a very good idea for these patients
to try and stop them worsening and
having a problem down the line.
But I'd add in here as well that
actually one thing that is good about
cats is yes, epilepsy is a progressive
disorder, but it doesn't seem to have
nearly the same problems we do in
dogs refractory epilepsy certainly
happens, but it is far less frequent.
Again, no good reason for this, but,
as a rule, managing seizures in cats is
generally a lot more straightforward.
Okay.
So whilst diagnosis is a little bit
more nuanced and we have to go jump
through a few hoops, when we get down to
treatment, things are much more, much more
straightforward and, and easier to follow.
So when it comes to treating cats, then
obviously there's, to my knowledge,
nothing licensed out there for cats.
So is it the same kind of
recommendations as in dogs?
Are we still looking at that?
A-C-V-I-M triangle?
Phenobarbital at the top?
So yeah, Yeah, exactly.
I mean, like, when it comes to cats,
yes, we have to kind of extrapolate
from dogs and many of the medications
we use in dogs, absolutely fine in cats.
So we would be looking at phenobarbital
to begin with as a first line approach.
We mentioned imepitoin.
It's not something I reach for, so I
haven't used it much, but I, I'm aware
it is something that can be considered.
But I tend to find if we start with
phenobarbital, that's a really good
place to begin if things don't go well
or if we find the seizures aren't that
well controlled, then again, unless,
unless there's severe adverse effects,
we're adding in other medications
to try and manage the epilepsy.
So the second line approach typically
in dogs would be potassium bromide.
Yeah.
But that word needs, well, that drug
needs to be banned from this conversation.
It's not good for cats.
So they develop an allergic, pneumonitis.
So get this really horrible
allergic airway disease that
can be life threatening.
And I have seen patients die from that.
So, Okay.
All I'd say is don't go near bromide.
We'll leave that one alone and
cross that off our list of options.
But if we then go to the next most
commonly used option, it's levetiracetam
and that can be a great drug in cats.
I say all of this, I'm kind
of scooting around the issue
or skirting around the issue.
I. Of the fact that cats still need
to be found and medicated twice
or in, in, with levetiracetam.
They need to be found three
times a day and given this
medication three times a day.
Right.
I struggle medicating my own
cat once a day with a tablet.
I think it's very dedicated owner that
can give levetiracetam three times a day.
I've said in a previous episode that,
you know, giving a dog levetiracetam
twice a day isn't, isn't great.
I do make a bit of an exception for
cats because it is so much harder.
So if twice a day is all the
owner can manage, then so be it.
You know, it's better to do that
than not give another medication.
But that's where I'd be with them.
I'd start with phenobarbital and then
move to levetiracetam as a second option.
Yeah, that makes sense.
And definitely avoid that
potassium bromide in these guys.
Absolutely, go nowhere near it.
Yeah.
There's, just thinking back to our very
first episode, all of the things we
said there about, diazepam, midazolam,
that's still all acceptable for cats
that are in status epilepticus, isn't it?
We can, we can use most of
those without any problem.
Diazepam I would say is
fine in that setting.
I wouldn't ever use it as
oral medication long term.
Of course then you're, you're
worried about, hepatic necrosis
and, and severe problems with that.
But as rectal diazepam, intranasal,
midazolam, these are all good
choices and ones I'd be happy to do.
As I say, you know, cats have
claws and teeth so when they're
fitting it's hard to get near them.
But if you can administer 'em
then brilliant worth doing.
It can be hard to get near them
when they're not fitting as well.
So
I think that's a really.
know about the claws and the teeth.
So when it comes to seizures and
cats, are there any particular
conditions we need to be aware of?
Well, there is one condition, but when I
first heard about it, I actually thought,
well, I'm never going to see one of those.
It sounded a bit made up if I'm honest.
But that wasn't the case at all.
So the condition, well, it's
become known as Feline Audiogenic
Reflex Seizures or FARS for short.
It all started when the charity
International Cat Care contacted me
about several inquiries they'd have
received from owners concerned about
their cats having seizures triggered
by certain high pitched sounds.
Now, initially I thought this was
something new, not well documented, and
honestly I didn't know much about it.
But when the number of queries
kept growing, I realised this was
more than just an odd coincidence.
There was clearly something
here to investigate.
It's so incredible and I kind of hoped
you'd bring this up again because
we, we kind of briefly mentioned
this back in season one and it was
really fascinating to me, but, so I
hope we can delve into it a bit more.
What kind of seizures are
we talking about here?
Well, the seizures are primarily
noise induced, and as such,
they're known as reflex seizures.
They're responding to a stimulus.
There are a few types of seizures that
have been described in these patients.
The first is the one we all know,
so generalised tonic-clonic seizures
where the cat loses awareness.
Collapses may show signs like chomping
of the jaw, paddling of the legs,
and sometimes even passing urine.
These seizures tend to last only
a few minutes, and they're ones
we are probably most used to.
But what I'd say here is when it comes
to feline audiogenic reflex seizures,
these aren't the most common seizure type.
We definitely see them, but they
don't seem to be the most common
thing that that owners and vets see.
The second type, and these were
the most common in our study,
are the myoclonic seizures.
I know we've touched on these in
a previous episode, so they are
still generalised seizures because
they're affecting the whole body.
They're really short, often lasting,
just a fraction of a second.
And they look almost like those funny
episodes we see in cartoons like Tom
and Jerry, where Tom gets jolted by
noise or jumps at the sight of Jerry.
Now, as a result of that feline
Audiogenic reflex seizures were
called Tom and Jerry Syndrome.
They thought that would be quite funny.
But I did a bit of research because
you know, we're all familiar with
Tom and Jerry, and I thought it
would be great to get a little.
Demonstration of what
happens when Tom sees Jerry.
It actually turns out that tom
doesn't jump at the sight of Jerry.
Stop it.
Well, no, that's what we
all thought, wasn't it?
All these years that there's many
episodes we've seen, we've probably
seen the same episode five, 10 times.
Oh my goodness.
It's like the monopoly man doesn't
have a moustache or top hat or
what That thing, what is that?
Well, what's actually happening in these
episodes, and probably why we don't
see Tom and Jerry on the TV anymore is
Jerry spent his whole life attacking
Tom, quite violently hitting him on
the head with a hammer was one of them.
Getting him caught in
numerous mouse traps.
Basically, Tom is persecuted by Jerry
and it's essentially a very large
victim of Jerry's abuse, but there's
no myoclonic seizures in Tom and Jerry.
So it is a bit of a misnomer to
call it Tom and Jerry syndrome,
but the press love a little.
Oh yeah.
A little title like that to use.
I'm not going to lie, I'm
probably going to remember that.
I wonder if it's like, I dunno whether
you, like me doom scroll in the
evening, but I sometimes see these
videos of cats having these like.
Over the top jerking motions almost
to like metronome tickings or things
like that is, would you say that
could potentially look like this?
I think it's very likely to
be this, so you're right.
You know, nowadays some of these
videos get caught on camera and
put on social media and everyone
has a little chuckle about it.
But I think in some of these cases,
these are cats that actually are having
a, an over the top reaction to a noise
that actually can be quite serious.
So definitely these are the sorts
of things we're thinking about here.
Mm-hmm.
It's really interesting.
And then there is another type of
seizure, but you'll be pleased to know
this is one I have mentioned previously.
So it's the absence or atonic seizures.
And these are much rarer.
Now I say that we again don't know
how much rarer because I think owners
don't focus on these quite as much.
They are hard to pick up, but the
cat will seem to sort of zone out
staring blankly for up to maybe 20, 30
seconds without responding to its name.
And these are really easy to miss,
which is why I say they may be a lot
more common than what we've reported.
Yeah.
Fascinates me that it might be
completely under-reported, but, and
it sounds like there's a, a variety
of responses to these sounds and what
kind of noises are triggering them.
Is this like, like loud
fireworks or something like that?
You'd think, wouldn't you?
You'd think firework a loud
bang, something like that.
But actually this is where
it's really fascinating.
So the noises that provoke these
seizures are often high pitched.
Really relatively quiet sounds.
Examples that were given to me were things
like the sound of computer keys, tapping
plastic or paper bags, crinkling, or even
the clink of keys can trigger an episode.
And more unusual triggers include
walking barefoot on a wooden floor or
the sound of a dog's collar jingling.
That's now getting into the Tom and
Jerry territory again, where the, to
the dog inadvertently attacks the cat.
But interestingly, the louder and more
persistent the sounds, the more likely
it is to cause a more severe seizure.
So not necessarily a loud sound like
a firework, but if those keys jingling
get louder and louder, you'll get
this phenomenon of audiogenic kindling
where the myoclonic seizures gather,
they sort of continue to occur.
And then potentially you can provoke a
full generalised tonic-clonic seizure.
So essentially repeated small
noises build up and culminate
in a larger, more severe fit.
That's so fascinating.
And it's almost like you can't do
anything around them if they've
got this problem jingling.
Anything
Well, you say that, don't you
say, you got to make me know,
got to avoid doing this and that.
You can't.
You can't.
But, so it's, it's a great thing
to say to owners, but I feel
pretty helpless to go home and
tiptoe around the house, so, yeah.
Yeah,
absolutely that.
And I think I remember you, you
telling me before that what was a
really surprising finding was actually
many of these cats are actually deaf.
How does that work?
Yeah.
Well that was one of the
paradoxes of our study.
So yes, around half of the cats were
reported by their owners as having hearing
difficulties or being completely deaf.
Now you'd think that would prevent
the seizures, but it doesn't.
The reason we think this might
happen and we don't know, is that
cats have an amazing ability to.
To hear ultrasonic frequencies and
many of the sounds that trigger these
seizures fall within that range.
Even if they're deaf to lower
frequencies, their ultrasonic hearing
is often unaffected, which means
that these sounds still catch their
attention leading to a seizure.
Such an interesting point and
it really highlights how complex
these seizures are and obviously
how complex cats are as well.
Well, another important point is
that this is a condition that affects
older cats with the average age of
onset being around 15 years old.
So amongst that age group, it
seems really quite ubiquitous.
So many cats that get older can
have this, and this is what's really
surprised me, and it's progressive,
so it may start as an occasional
twitch or jerk and then progress to
something far more apparent with age.
Interestingly, many of these cats
also had other long-term conditions
like cardiac or renal disease,
which of course are conditions we
typically associate with aging.
However, we did find enough cats
without these issues that we can
rule out those conditions as a direct
cause of the noise induced seizures.
This really is a syndrome on its own.
So that is interesting because
you talked earlier about high
blood pressure and things like
that in cats causing these issues.
But actually this seems to
be completely separate then.
It really is.
I mean it's different to old age and
I think one of the pitfalls we've all
fallen into in the past is we may have
been presented with these cats in a
routine clinic and because they're older
cats and they might have the occasional
jerk, I know what I would've been like
before I knew about this condition.
I just thought, well, it's it's old age.
It's a cat with renal failure or something
to do with the thyroid or the kidneys.
because that's, I mean, that's my
knowledge of feline medicine is
it's all about you get high blood
pressure, you get chronic renal
failure and you get hyperthyroidism
and they also sort of interlink.
That's it.
Done.
You know, everything you need
to now about feline medicine.
Joking, of course, it's much more,
intricate than that, but, but I think
if you saw a cat having these episodes,
you might put it down to one of them.
And if you do some investigation
in an older cat over the age of 10,
you're probably likely to find these
conditions and you might inadvertently
blame that when actually this is
something completely different.
That's really interesting.
And so are you treating these
in the same way as we would
an idiopathic epileptic cat?
Are we using phenobarbital in these guys?
Well?
that's a really good point
because treatment is an
important part of managing FARS.
So we found that a lot of cats were being
prescribed, anti-epileptic medications.
And of course with what we've
said so far, phenobarbital is
the first medication we reach to.
But actually phenobarbital did help with
the generalised tonic-clonic seizures,
but it seemed to have very little effect
at controlling the myoclonic fits.
So given they were the most prevalent
type of fit, it wasn't really giving
that much benefit to these patients.
Levetiracetam on the other hand,
was much more effective for
both of the seizure types, but
particularly the myoclonic seizures.
And in some cases it actually managed
to get rid of the seizures completely.
What I would say is it seemed to,
help 90% of the cats with myoclonic
seizures and about 70% of the cats
with generalised tonic clonic seizures.
It also seemed to have fewer
side effects than phenobarbital.
So it really is the medication
that I would recommend now, when
faced with this condition.
There's even some evidence
suggesting that levetiracetam
might prevent audiogenic kindling.
So remember that's where one seizure leads
to another and you might crinkle, well
jangle your keys cause the myoclonic fits
to enter a sort of train of fits that lead
to a big generalised tonic-clonic seizure.
So we do think that this might
help in this kindling effect,
potentially slowing or stopping
the progression of the condition.
Hmm.
That is interesting.
So, slight differences there, like
a, a nuanced approach to this one,
particularly if they're myoclonic.
Do you often see that they
stay in those categories?
So if a, a cat initially presents
with the myoclonic episodes, are they,
do they stay like that or do they
progress to kind of generalised or?
This is a really good question.
It's one of the limitations we had in
our study, if I'm honest, because the
cats, we had to include, we had to prove
they were having an epileptic problem.
And when you see a cat with a generalised
tonic-clonic seizure, I think that's
proof in itself that with video footage
of that cat, it's very clear and I think
we could all sit around and agree it
was a generalised tonic-clonic seizure.
So we really had to include
those cats in our study.
If the cat was just having myoclonic.
Episodes we weren't able to include
them in our study because there was some
controversy at the time as to whether they
truly represented an epileptic condition.
Right.
what would be great is to go back through
now and look at cats demonstrating
any of these behaviours in order
to answer the question you've posed
that do these change with time?
And I think they do.
Certainly in our study we found the
generalised tonic-clonic seizures got
more frequent with time, but they really
were a big minority of the overall number
of seizures expressed by these cats.
And myoclonic seizures were well up there
as the number one manifestation of FARS.
It's so interesting and it's, it's
promising news really, that there may
be some more kind of research into this
and finding out these new disorders.
So how common is this then,
considering it's still really
fairly recently recognised?
Well, yeah, I mean, I've said I thought
it was rare when I first heard about it.
I actually thought it was made up, if
I'm honest, to begin with, but I've been
amazed at how frequently this is seen.
The main problem is
whether we recognise it.
I mean, if you have a cat that is over
10 years old, because this always seems
to happen in the second decade of life,
there seems a relatively high chance
that this is occurring for your cat,
even if the episodes are infrequent.
I have a cat myself at home that has
this, but it's really infrequent.
So for my cat at the minute, it's not a
problem and we don't need to treat for it.
But as with many conditions
in veterinary neurology, our
understanding is still evolving.
It's a reminder of how important it is to
keep asking questions and investigating
new possibilities, especially when we
see something unusual or unexpected.
I'd also want to say that when we give
the levetiracetam to these cats, one
thing that owners were really surprised
by is not just the myoclonic seizures
disappearing, but these cats suddenly
seem to have a new lease of life.
Owners would say, I've got my
old cat back, you know, or my
young cat back, I should say.
And it's hard to know why, but I think
the reason is, is myoclonic seizures
being a generalised seizure have a
period of postictal behaviour afterwards.
Now, if you have a five minute
generalised tonic-clonic seizure,
you'd expect a very short period
afterwards of strange behaviour
that which are the postictal signs.
The same is true of myoclonic fits,
but because they're so short, I think
that postictal phase is really short.
Therefore, we don't typically see it.
But these cats that we're having them
frequently, and you can have cats having
them almost all the time, you know,
we're talking sort of five or 10 in a
minute, you know, that sort of frequency.
I believe those cats were
developing a constant postictal.
State and the levetiracetam was
a way of stopping the myoclonic
seizures and lifting them from that
postictal brain fog, if you like.
And it gave them a much
happier outlook on life.
So I do strongly think these cats
benefit from levetiracetam if
they're happening that frequently.
But I go back to my own cat.
My cat does have this,
but very infrequently.
So I think levetiracetam is a bit
of a jump at this stage, given
I maybe see one episode a day.
Whereas these are the cats
that have them all the time.
And I think there's great benefits.
Yeah, definitely.
Or is that just because you don't
want to medicate your cat twice a day?
Or three times a day.
Three times a day.
There is that too.
Can I ask a really annoying question?
This sort of thing always worries me.
Where are
you going now?
I'm just going to go back
to that treatment really.
You know, because I'm a vet
and that's where my brain goes.
I was just thinking with dogs on
phenobarbital, we have to do quite
a lot of monitoring or we want
to do quite a lot of monitoring.
Maybe not so for Levetiracetam,
but do you recommend that in cats?
Do we need to, I know you're not a fan of
measuring liver values, but do we need to
worry about the liver so much with cats?
Do they have that auto induction?
What, what's your sort of
approach to monitoring in cats?
So, yeah, I mean, if we're starting
phenobarbital, I suppose you should always
say that any, well, any, any long-term
medication, we should be doing some
form of blood monitoring to have a look.
But I think it's a really good
point to bring up because there
are some, some key differences.
In dogs, we worry about the liver a lot
and I think probably more than we need to,
but the liver is always , at the forefront
of our focus on what we're doing.
Now, if you read through the side
effects of phenobarbital and cats,
they're very similar to dogs.
You know, you've got ataxia,
nausea, weight gain, weight loss,
polydipsia, polyuria, all of that.
But one thing you'll not notice on the
side effects list is hepatic problems.
So problems with the liver, and
for some reason cats are really
tolerant to phenobarbital.
So I'm not saying don't measure the
liver, or don't monitor the liver
because I think we should with any
chronic medication, and that goes
with any medication we reach for.
But I don't think there's a
particular focus on that here.
And I've yet to see, and I, I
believe there's not been any reports
of cats developing liver disease
following phenobarbital treatments.
So that's something I would reassure
you of that that's less concerning.
You know, you've jinxed yourself now.
I'm going to see one tomorrow.
You absolutely are, yeah.
He's on its way.
Phoning the practice right now.
And the other blood test, of
course is the serum concentrations,
you know, measuring them.
And we said the reason why we do
that in dogs is that auto induction.
So where dogs get tolerant
to the medication with time.
So we need to put more medication
into the dog to achieve the
same serum concentration.
But again, in cats that isn't a big thing.
We don't seem to see
that same auto induction.
So I'm not going to say we don't
want to check serum concentrations
because we definitely do, but
I'm not quite as focused on it
in the same way as I am in dogs.
The advantage of all of this means that
when you come to prescribe phenobarbital
in cats, we're not really having to ask
owners to come back nearly as much as we
do with dogs, which is another benefit
because we know cats in a practice.
That's also something we
want to avoid as much as we
Yeah.
If we can manage them
distantly all the better.
Yeah, definitely.
It's been really useful, this
podcast, or this episode.
I think my main take home message
really from this episode is: don't
treat cats like small dogs, really.
They're very different when
it comes to their seizures.
I'm really looking for that underlying
cause and not forgetting about those
audiogenic seizures, particularly in
those older cats, often, probably a
bit more common than we might think.
Would you say that's fair?
Oh, absolutely.
So old cats that twitch don't just
have bad kidneys and hyperthyroidism,
they may have this epilepsy syndrome.
So do keep it in mind.
Perfect.
Well, I think that's all we've got
time for today, although I think
we could probably carry on chatting
all day to be honest on this.
It's been really fascinating.
I think I will definitely question
my own approach to any seizuring
cat from now on, that's for sure.
So sorry to say, but next time is our
final episode in this series already.
I know where have it.
Where's the time going?
So next time we'll hopefully be putting
all of this together and looking at a
team approach to epilepsy and how everyone
can get involved, not just us vets.
See you then.
Looking forward to it.
Same.
Bye.