1 00:00:00,050 --> 00:00:02,539 Hello and welcome back to Synaptic Tales. 2 00:00:02,870 --> 00:00:05,780 I'm Emma, your host, and as always, I'm joined by our 3 00:00:05,780 --> 00:00:07,849 brilliant neurology expert, Mark. 4 00:00:08,479 --> 00:00:12,590 In today's episode, we are diving into the fascinating world of feline seizures. 5 00:00:13,129 --> 00:00:15,469 Did you know that seizures in cats are often approached 6 00:00:15,469 --> 00:00:16,939 much differently than in dogs? 7 00:00:17,330 --> 00:00:19,789 Mark, I feel like this is one of those topics that can 8 00:00:19,789 --> 00:00:21,590 really catch vets off guard. 9 00:00:21,740 --> 00:00:22,490 How true is that? 10 00:00:22,925 --> 00:00:24,215 Well, you're absolutely right, Emma. 11 00:00:24,305 --> 00:00:28,295 I mean, for a long time our understanding of seizures in cats has been heavily 12 00:00:28,295 --> 00:00:30,845 extrapolated from what we know about dogs. 13 00:00:31,504 --> 00:00:34,355 But I think it's become clear that cats are not just small dogs. 14 00:00:34,385 --> 00:00:37,474 We've heard that so many times, but when it comes to neurology, 15 00:00:37,565 --> 00:00:41,465 you know, seizures, their seizures, the causes and even responses to 16 00:00:41,465 --> 00:00:43,385 treatment can differ significantly. 17 00:00:43,865 --> 00:00:46,775 So it's really vital that we tailor our approach. 18 00:00:47,780 --> 00:00:53,360 And we've, we've kind of titled this episode, recognising feline Epilepsy, 19 00:00:53,690 --> 00:00:57,169 which is probably a bit of a stretch and just us trying to get this 20 00:00:57,169 --> 00:00:58,970 into the SMART acronym in some way. 21 00:00:58,970 --> 00:01:01,039 But it really is true, isn't it? 22 00:01:01,039 --> 00:01:03,919 It's all about how to recognise these seizures in cats. 23 00:01:03,979 --> 00:01:04,970 Why are they so different? 24 00:01:05,675 --> 00:01:10,295 Well, what's key here is that recognising these events isn't always straightforward, 25 00:01:10,475 --> 00:01:11,795 yet you'd think it would be. 26 00:01:12,215 --> 00:01:14,475 Owner's descriptions play a crucial role. 27 00:01:14,985 --> 00:01:17,525 And video footage can be a game changer. 28 00:01:17,525 --> 00:01:21,035 I mean, I think, you know, with, with video footage, not only do we 29 00:01:21,035 --> 00:01:24,995 see the episodes, but sometimes if a, if a cat isn't moving around, 30 00:01:24,995 --> 00:01:28,145 well owners can actually capture how that cat looks at home. 31 00:01:28,595 --> 00:01:32,285 The number of times we don't see a cat, well, you know, it won't move around 32 00:01:32,285 --> 00:01:33,755 and perform for you in the consult room. 33 00:01:34,295 --> 00:01:36,605 So owners can capture that movement at home. 34 00:01:37,010 --> 00:01:38,570 They're quite uncooperative, aren't they? 35 00:01:38,570 --> 00:01:39,620 Sometimes cats. 36 00:01:39,680 --> 00:01:40,120 They're clever. 37 00:01:41,270 --> 00:01:41,540 They are. 38 00:01:42,170 --> 00:01:44,300 Some might call them the superior species. 39 00:01:46,700 --> 00:01:51,140 So what's the biggest difference when it comes to cats versus dogs when it 40 00:01:51,140 --> 00:01:52,880 comes to their epilepsy or seizures? 41 00:01:53,405 --> 00:01:57,364 One of the main differences is the higher prevalence of focal seizures 42 00:01:57,364 --> 00:01:59,584 in cats when we compare that to dogs. 43 00:02:00,334 --> 00:02:04,114 Now this often correlates with underlying structural brain disease. 44 00:02:04,114 --> 00:02:08,884 So things like tumours and inflammation of the brain can cause these problems. 45 00:02:09,874 --> 00:02:13,519 But then by contrast, dogs are more commonly diagnosed 46 00:02:13,519 --> 00:02:17,299 with idiopathic epilepsy when no structural cause is found. 47 00:02:18,799 --> 00:02:23,569 Another difference is that cats can display behavioural changes before 48 00:02:23,780 --> 00:02:28,910 or between seizures, such as pacing, circling, or even bumping into things. 49 00:02:28,910 --> 00:02:32,540 And these can be early signs of a forebrain disorder. 50 00:02:32,989 --> 00:02:35,539 It sounds like a lot of detective work with cats. 51 00:02:36,079 --> 00:02:40,819 In dogs, we were talking mainly about tonic-clonic, generalised seizures. 52 00:02:40,819 --> 00:02:42,169 Is that the same for cats then? 53 00:02:42,934 --> 00:02:44,254 Well, it can be different. 54 00:02:44,254 --> 00:02:46,144 I mean, cats can be really tricky. 55 00:02:46,504 --> 00:02:50,644 So dogs, they have these generalised seizures, which might be really obvious, 56 00:02:50,764 --> 00:02:53,194 but cats are masters of subtlety. 57 00:02:53,539 --> 00:02:57,349 So, for example, a focal seizure in a cat might look like a bit of 58 00:02:57,349 --> 00:03:02,599 repetitive blinking, twitching of the face, or even a behavioural change like 59 00:03:02,599 --> 00:03:04,909 sudden aggression, fear or dilation. 60 00:03:04,909 --> 00:03:08,009 Rapid dilation and constriction of the pupils. 61 00:03:08,309 --> 00:03:09,479 So-called hippus. 62 00:03:10,769 --> 00:03:13,529 So as I said, it does sound like quite a lot of detective work 63 00:03:13,529 --> 00:03:17,369 and that I'm assuming the history then is really crucial and other 64 00:03:17,759 --> 00:03:19,439 neurological signs I think for those. 65 00:03:19,649 --> 00:03:20,459 Oh it definitely is. 66 00:03:20,459 --> 00:03:23,819 So like history taking neurological exams really important. 67 00:03:23,939 --> 00:03:29,579 But advanced diagnostics like MRI and CSF, well they're often necessary for cats. 68 00:03:30,119 --> 00:03:33,599 Unlike dogs where, you know, idiopathic epilepsy might be diagnosed 69 00:03:33,599 --> 00:03:37,949 based on history alone, we usually need to dig a bit deeper in cats. 70 00:03:38,039 --> 00:03:42,659 I mean we say 98% of dogs with a normal intrarectal exam in between 71 00:03:42,659 --> 00:03:45,419 their fits that have their first seizures between six months and six 72 00:03:45,419 --> 00:03:48,089 years would have idiopathic epilepsy. 73 00:03:48,629 --> 00:03:52,659 We don't have that same sort of stat if you like, for recognising 74 00:03:52,679 --> 00:03:54,239 idiopathic epilepsy in cats. 75 00:03:54,539 --> 00:03:56,699 That's a shame because it's really nice stat in dogs. 76 00:03:57,119 --> 00:03:58,049 It's really helpful. 77 00:03:58,229 --> 00:04:00,629 And so useful for owners to make informed decisions. 78 00:04:00,659 --> 00:04:01,499 Yeah, for sure. 79 00:04:02,129 --> 00:04:04,409 So you mentioned structural brain disease. 80 00:04:04,409 --> 00:04:07,679 So what are the main causes then of seizures in cats? 81 00:04:07,679 --> 00:04:09,659 Like how do you figure out what's behind them? 82 00:04:09,659 --> 00:04:11,130 You mentioned maybe advanced imaging and 83 00:04:12,554 --> 00:04:12,854 Well, yeah. 84 00:04:12,854 --> 00:04:17,444 So seizures, again, I split them into intracranial or extracranial causes. 85 00:04:17,444 --> 00:04:20,924 So intracranial causes are the diseases of the brain, if you like. 86 00:04:21,174 --> 00:04:25,554 So structural issues such as tumours, inflammatory disease, so so-called 87 00:04:25,554 --> 00:04:30,264 encephalitis or vascular events, we call them cerebral vascular accidents. 88 00:04:30,984 --> 00:04:33,384 And then the extracranial causes, they're all the problems in the 89 00:04:33,384 --> 00:04:35,274 blood, the blood going to the brain. 90 00:04:35,274 --> 00:04:40,284 So things would be metabolic, like hypoglycaemia, hepatic encephalopathy, 91 00:04:40,674 --> 00:04:44,304 or even toxic problems like exposure to lead or antifreeze. 92 00:04:46,734 --> 00:04:50,244 The process of figuring out the cause though starts with a, a thorough 93 00:04:50,244 --> 00:04:55,614 history question about changes in behaviour, appetite, I guess vision. 94 00:04:55,734 --> 00:04:58,674 You'll find that cats that lose vision might not be jumping up anymore. 95 00:04:58,704 --> 00:05:00,474 They haven't got that binocular vision they need. 96 00:05:01,104 --> 00:05:02,544 Or even litter box habits. 97 00:05:02,544 --> 00:05:06,409 So potentially toileting in the house, not in the litter box as 98 00:05:06,409 --> 00:05:08,149 maybe they, they did previously. 99 00:05:09,129 --> 00:05:12,124 Then once we've done the history, we move on to blood tests. 100 00:05:12,424 --> 00:05:13,894 There are some key things here for cats. 101 00:05:13,894 --> 00:05:18,064 I mean, I'd say it's really important to do blood pressure measurements. 102 00:05:19,084 --> 00:05:22,534 Now I know that's a bit of a draw with cats because they're really hard to 103 00:05:22,534 --> 00:05:25,414 do blood pressure measurements for, they get very stressed in clinics and 104 00:05:25,414 --> 00:05:26,824 it can be a very hard thing to do. 105 00:05:27,304 --> 00:05:30,604 But I do think blood pressure measurements in cats before performing further 106 00:05:30,604 --> 00:05:32,734 diagnostics is really, really important. 107 00:05:33,814 --> 00:05:37,144 And then sometimes, once we've done all of that, that's when we consider, well 108 00:05:37,144 --> 00:05:41,074 maybe now we'll go on for advanced imaging to rule out structural brain disease. 109 00:05:42,514 --> 00:05:45,424 Another thing I'd want to pick up would be packed cell volume. 110 00:05:45,424 --> 00:05:48,814 So PCV, that's another really big thing to check in cats. 111 00:05:48,814 --> 00:05:52,054 And we often see it in kind of, if we see a high PCV, we might 112 00:05:52,054 --> 00:05:55,504 dismiss that as being dehydration or something along those lines. 113 00:05:55,954 --> 00:05:59,854 But we do see cats then get quite a high PCV that would then 114 00:05:59,854 --> 00:06:01,444 lead to sludging of the blood. 115 00:06:01,774 --> 00:06:04,054 That in turn can cause seizures. 116 00:06:04,234 --> 00:06:07,594 So I always make sure I've checked PCV and that it's okay. 117 00:06:07,864 --> 00:06:08,194 Indeed. 118 00:06:08,194 --> 00:06:09,724 Haematocrit as well would be fine. 119 00:06:10,804 --> 00:06:13,984 The other big thing here though is blood pressure, and I've mentioned this already. 120 00:06:13,984 --> 00:06:17,044 High blood pressure alone can cause seizures. 121 00:06:17,644 --> 00:06:20,704 When I'm saying high, I mean if you've got a cat with a blood pressure of 122 00:06:20,704 --> 00:06:25,444 a systolic of around 160 millimetres of mercury or higher, I would be very 123 00:06:25,444 --> 00:06:28,564 worried that could be the cause for the neurological signs because there's 124 00:06:28,564 --> 00:06:33,634 this phenomenon called hypertensive encephalopathy, simply meaning the 125 00:06:33,634 --> 00:06:38,224 high blood pressure is triggering off neurological signs and if it's well, 126 00:06:38,284 --> 00:06:41,644 generally will cause more problems in the forebrain than anywhere else. 127 00:06:41,644 --> 00:06:44,524 And the most common sign of forebrain disease are seizures. 128 00:06:44,644 --> 00:06:47,764 So hence why we see that in cats, definitely happens in dogs 129 00:06:47,764 --> 00:06:51,574 too, but I'd say it's something we're more aware of in cats. 130 00:06:52,414 --> 00:06:55,144 So monitoring blood pressure is so important. 131 00:06:55,819 --> 00:06:59,419 But as I've said, very difficult in cats as they get stressed and 132 00:06:59,599 --> 00:07:02,539 the blood pressure can rise in the clinic as a normal stress response. 133 00:07:02,599 --> 00:07:02,989 Yeah. 134 00:07:03,769 --> 00:07:07,779 I feel like you have to put your medicine hat on here 135 00:07:07,779 --> 00:07:09,969 rather than your neurology hat. 136 00:07:10,299 --> 00:07:12,669 Well, it is true because I, I've not taught much about 137 00:07:12,669 --> 00:07:13,719 managing the blood pressure. 138 00:07:13,719 --> 00:07:16,389 I don't want to go down that route because that's not my bag. 139 00:07:17,349 --> 00:07:17,739 But you're right. 140 00:07:17,739 --> 00:07:18,819 But that's exactly what we want to do. 141 00:07:18,819 --> 00:07:21,249 You know, we will want to be lowering that blood pressure and of course look 142 00:07:21,249 --> 00:07:24,639 for causes as to why the patient's hypertensive in the first place, whether 143 00:07:24,639 --> 00:07:26,229 it be a primary or secondary reason. 144 00:07:26,799 --> 00:07:29,959 And of course I can imagine that must influence the, treatment 145 00:07:29,959 --> 00:07:31,159 decisions as well, right? 146 00:07:31,264 --> 00:07:31,954 Oh, absolutely. 147 00:07:31,954 --> 00:07:35,194 So for example, if a metabolic issue is causing the seizures, 148 00:07:35,644 --> 00:07:38,554 treating that underlying condition could actually resolve the problem. 149 00:07:39,064 --> 00:07:42,784 On the other hand, structural issues might require long-term management 150 00:07:42,784 --> 00:07:44,944 with anti-epileptic medications. 151 00:07:45,694 --> 00:07:48,304 I won't go into blood pressure, but there are a number of reasons 152 00:07:48,304 --> 00:07:50,044 a cat may be hypertensive. 153 00:07:50,044 --> 00:07:54,424 So investigating these causes becomes very important in the presence of seizures. 154 00:07:55,774 --> 00:07:56,674 It's really interesting. 155 00:07:56,674 --> 00:08:00,334 It's so different from dogs and I think, you know, the fact that they 156 00:08:00,334 --> 00:08:04,834 have those more focal issues and then all of these kind of medical 157 00:08:04,834 --> 00:08:10,414 issues that can contribute, it's, it is so differently, and I think I'm 158 00:08:10,414 --> 00:08:13,984 taking away from this already, that if I've got a cat who presents with 159 00:08:13,984 --> 00:08:17,884 seizures, I basically need to look pretty hard for an underlying cause. 160 00:08:18,604 --> 00:08:22,924 So how common is true idiopathic epilepsy? 161 00:08:23,464 --> 00:08:24,754 How common is that in cats? 162 00:08:24,754 --> 00:08:28,564 Does it happen considering in dogs it's suggested to affect 163 00:08:28,564 --> 00:08:31,054 about one in 130 dogs in the UK? 164 00:08:31,414 --> 00:08:33,474 Do we have that similar stat for cats or? 165 00:08:33,934 --> 00:08:36,709 Well for cats we don't have an exact statistic as neatly 166 00:08:36,709 --> 00:08:38,119 defined as we do for dogs. 167 00:08:38,299 --> 00:08:43,279 We do know it's less common in cats, but seizures in cats are much 168 00:08:43,279 --> 00:08:46,639 more likely to have an underlying structural or metabolic cause. 169 00:08:46,909 --> 00:08:49,849 Things like brain tumours, inflammation of the brain, vascular 170 00:08:49,849 --> 00:08:53,479 events, hypertension, systemic conditions, hepatic encephalopathy 171 00:08:53,479 --> 00:08:55,369 and hypoglycaemia are key ones here. 172 00:08:56,239 --> 00:09:00,209 That said, idiopathic epilepsy in cats does exist, and I don't 173 00:09:00,209 --> 00:09:03,099 want to emphasise too much that it's not there because it is. 174 00:09:03,099 --> 00:09:04,709 We see it still quite a lot. 175 00:09:04,709 --> 00:09:04,739 Okay. 176 00:09:05,229 --> 00:09:10,419 Particularly in younger cats, the diagnosis typically one of exclusion, 177 00:09:10,569 --> 00:09:13,539 meaning you've ruled out other potential causes through your history. 178 00:09:13,899 --> 00:09:15,999 Physical exam, blood work, and imaging. 179 00:09:16,659 --> 00:09:18,969 And often combined with CSF analysis. 180 00:09:19,449 --> 00:09:24,009 So to sum it up, in cats, seizures are more often a sign of an underlying issue 181 00:09:24,459 --> 00:09:27,099 and idiopathic epilepsy is less common. 182 00:09:27,549 --> 00:09:32,289 But as with all things clinical experience and further studies will hopefully help 183 00:09:32,499 --> 00:09:36,969 refine our understanding of how often this truly occurs in the feline population. 184 00:09:37,299 --> 00:09:39,456 It certainly is still quite frequent. 185 00:09:40,134 --> 00:09:40,464 Okay. 186 00:09:41,154 --> 00:09:42,834 So we are ruling out everything else. 187 00:09:43,194 --> 00:09:48,744 Is it worthwhile in cats, even if you are investigating, putting 188 00:09:48,744 --> 00:09:51,834 them onto anti epileptic drugs even to try and control the issue? 189 00:09:51,834 --> 00:09:54,524 Or would you prefer to do all your workup first? 190 00:09:54,854 --> 00:09:58,184 No, I, I think it's often mentioned, isn't it, that we may be, people 191 00:09:58,184 --> 00:10:01,034 think we shouldn't start phenobarbital till we know exactly what's going on. 192 00:10:01,454 --> 00:10:05,294 I'd have no worry about starting it early on for these patients, but for 193 00:10:05,294 --> 00:10:08,114 the same reason as in dogs, you know, that one seizure will lead to another. 194 00:10:08,444 --> 00:10:12,704 And so early treatment is probably a very good idea for these patients 195 00:10:12,704 --> 00:10:15,944 to try and stop them worsening and having a problem down the line. 196 00:10:16,544 --> 00:10:19,874 But I'd add in here as well that actually one thing that is good about 197 00:10:19,874 --> 00:10:23,984 cats is yes, epilepsy is a progressive disorder, but it doesn't seem to have 198 00:10:23,984 --> 00:10:28,364 nearly the same problems we do in dogs refractory epilepsy certainly 199 00:10:28,364 --> 00:10:30,734 happens, but it is far less frequent. 200 00:10:31,054 --> 00:10:35,434 Again, no good reason for this, but, as a rule, managing seizures in cats is 201 00:10:35,434 --> 00:10:36,994 generally a lot more straightforward. 202 00:10:37,204 --> 00:10:37,534 Okay. 203 00:10:37,684 --> 00:10:41,044 So whilst diagnosis is a little bit more nuanced and we have to go jump 204 00:10:41,044 --> 00:10:44,394 through a few hoops, when we get down to treatment, things are much more, much more 205 00:10:44,394 --> 00:10:46,224 straightforward and, and easier to follow. 206 00:10:47,694 --> 00:10:52,524 So when it comes to treating cats, then obviously there's, to my knowledge, 207 00:10:52,524 --> 00:10:54,504 nothing licensed out there for cats. 208 00:10:54,504 --> 00:10:58,434 So is it the same kind of recommendations as in dogs? 209 00:10:58,434 --> 00:10:59,754 Are we still looking at that? 210 00:11:00,034 --> 00:11:01,694 A-C-V-I-M triangle? 211 00:11:02,234 --> 00:11:03,284 Phenobarbital at the top? 212 00:11:03,284 --> 00:11:04,449 So yeah, Yeah, exactly. 213 00:11:04,609 --> 00:11:07,429 I mean, like, when it comes to cats, yes, we have to kind of extrapolate 214 00:11:07,429 --> 00:11:12,199 from dogs and many of the medications we use in dogs, absolutely fine in cats. 215 00:11:12,199 --> 00:11:16,759 So we would be looking at phenobarbital to begin with as a first line approach. 216 00:11:17,059 --> 00:11:18,539 We mentioned imepitoin. 217 00:11:18,559 --> 00:11:22,609 It's not something I reach for, so I haven't used it much, but I, I'm aware 218 00:11:22,609 --> 00:11:24,259 it is something that can be considered. 219 00:11:24,859 --> 00:11:28,369 But I tend to find if we start with phenobarbital, that's a really good 220 00:11:28,789 --> 00:11:33,139 place to begin if things don't go well or if we find the seizures aren't that 221 00:11:33,139 --> 00:11:36,109 well controlled, then again, unless, unless there's severe adverse effects, 222 00:11:36,109 --> 00:11:39,469 we're adding in other medications to try and manage the epilepsy. 223 00:11:40,339 --> 00:11:43,729 So the second line approach typically in dogs would be potassium bromide. 224 00:11:43,729 --> 00:11:43,789 Yeah. 225 00:11:44,599 --> 00:11:47,359 But that word needs, well, that drug needs to be banned from this conversation. 226 00:11:47,419 --> 00:11:48,739 It's not good for cats. 227 00:11:48,739 --> 00:11:52,079 So they develop an allergic, pneumonitis. 228 00:11:52,109 --> 00:11:54,689 So get this really horrible allergic airway disease that 229 00:11:54,689 --> 00:11:55,709 can be life threatening. 230 00:11:55,739 --> 00:11:57,599 And I have seen patients die from that. 231 00:11:57,599 --> 00:11:57,929 So, Okay. 232 00:11:58,679 --> 00:12:00,179 All I'd say is don't go near bromide. 233 00:12:00,179 --> 00:12:03,029 We'll leave that one alone and cross that off our list of options. 234 00:12:03,869 --> 00:12:08,099 But if we then go to the next most commonly used option, it's levetiracetam 235 00:12:08,579 --> 00:12:10,619 and that can be a great drug in cats. 236 00:12:11,519 --> 00:12:14,069 I say all of this, I'm kind of scooting around the issue 237 00:12:14,069 --> 00:12:15,599 or skirting around the issue. 238 00:12:15,599 --> 00:12:20,369 I. Of the fact that cats still need to be found and medicated twice 239 00:12:20,369 --> 00:12:22,629 or in, in, with levetiracetam. 240 00:12:22,649 --> 00:12:24,779 They need to be found three times a day and given this 241 00:12:24,779 --> 00:12:26,009 medication three times a day. 242 00:12:26,009 --> 00:12:26,099 Right. 243 00:12:26,609 --> 00:12:29,899 I struggle medicating my own cat once a day with a tablet. 244 00:12:30,479 --> 00:12:34,274 I think it's very dedicated owner that can give levetiracetam three times a day. 245 00:12:35,234 --> 00:12:39,444 I've said in a previous episode that, you know, giving a dog levetiracetam 246 00:12:39,464 --> 00:12:40,904 twice a day isn't, isn't great. 247 00:12:41,534 --> 00:12:45,014 I do make a bit of an exception for cats because it is so much harder. 248 00:12:45,014 --> 00:12:47,654 So if twice a day is all the owner can manage, then so be it. 249 00:12:47,654 --> 00:12:50,234 You know, it's better to do that than not give another medication. 250 00:12:50,714 --> 00:12:52,304 But that's where I'd be with them. 251 00:12:52,304 --> 00:12:56,264 I'd start with phenobarbital and then move to levetiracetam as a second option. 252 00:12:56,954 --> 00:12:57,944 Yeah, that makes sense. 253 00:12:58,274 --> 00:13:00,679 And definitely avoid that potassium bromide in these guys. 254 00:13:00,849 --> 00:13:02,029 Absolutely, go nowhere near it. 255 00:13:02,489 --> 00:13:02,689 Yeah. 256 00:13:02,754 --> 00:13:07,354 There's, just thinking back to our very first episode, all of the things we 257 00:13:07,354 --> 00:13:13,114 said there about, diazepam, midazolam, that's still all acceptable for cats 258 00:13:13,114 --> 00:13:14,704 that are in status epilepticus, isn't it? 259 00:13:14,854 --> 00:13:17,254 We can, we can use most of those without any problem. 260 00:13:17,305 --> 00:13:20,454 Diazepam I would say is fine in that setting. 261 00:13:20,575 --> 00:13:23,395 I wouldn't ever use it as oral medication long term. 262 00:13:23,395 --> 00:13:25,875 Of course then you're, you're worried about, hepatic necrosis 263 00:13:25,875 --> 00:13:27,345 and, and severe problems with that. 264 00:13:27,765 --> 00:13:32,015 But as rectal diazepam, intranasal, midazolam, these are all good 265 00:13:32,015 --> 00:13:33,695 choices and ones I'd be happy to do. 266 00:13:33,995 --> 00:13:36,395 As I say, you know, cats have claws and teeth so when they're 267 00:13:36,395 --> 00:13:37,685 fitting it's hard to get near them. 268 00:13:37,685 --> 00:13:40,146 But if you can administer 'em then brilliant worth doing. 269 00:13:40,760 --> 00:13:43,145 It can be hard to get near them when they're not fitting as well. 270 00:13:43,145 --> 00:13:43,505 So 271 00:13:43,630 --> 00:13:44,360 I think that's a really. 272 00:13:44,520 --> 00:13:45,365 know about the claws and the teeth. 273 00:13:45,800 --> 00:13:49,760 So when it comes to seizures and cats, are there any particular 274 00:13:49,760 --> 00:13:51,710 conditions we need to be aware of? 275 00:13:52,490 --> 00:13:56,330 Well, there is one condition, but when I first heard about it, I actually thought, 276 00:13:56,390 --> 00:13:58,070 well, I'm never going to see one of those. 277 00:13:58,640 --> 00:14:00,890 It sounded a bit made up if I'm honest. 278 00:14:01,010 --> 00:14:02,180 But that wasn't the case at all. 279 00:14:02,180 --> 00:14:06,740 So the condition, well, it's become known as Feline Audiogenic 280 00:14:06,770 --> 00:14:09,680 Reflex Seizures or FARS for short. 281 00:14:10,850 --> 00:14:14,060 It all started when the charity International Cat Care contacted me 282 00:14:14,060 --> 00:14:17,180 about several inquiries they'd have received from owners concerned about 283 00:14:17,180 --> 00:14:21,350 their cats having seizures triggered by certain high pitched sounds. 284 00:14:22,340 --> 00:14:26,660 Now, initially I thought this was something new, not well documented, and 285 00:14:26,660 --> 00:14:28,520 honestly I didn't know much about it. 286 00:14:29,420 --> 00:14:32,480 But when the number of queries kept growing, I realised this was 287 00:14:32,480 --> 00:14:34,880 more than just an odd coincidence. 288 00:14:35,240 --> 00:14:37,160 There was clearly something here to investigate. 289 00:14:38,225 --> 00:14:42,245 It's so incredible and I kind of hoped you'd bring this up again because 290 00:14:42,245 --> 00:14:45,965 we, we kind of briefly mentioned this back in season one and it was 291 00:14:46,265 --> 00:14:50,045 really fascinating to me, but, so I hope we can delve into it a bit more. 292 00:14:50,375 --> 00:14:52,715 What kind of seizures are we talking about here? 293 00:14:53,345 --> 00:14:57,575 Well, the seizures are primarily noise induced, and as such, 294 00:14:57,575 --> 00:14:59,045 they're known as reflex seizures. 295 00:14:59,045 --> 00:15:01,265 They're responding to a stimulus. 296 00:15:02,015 --> 00:15:05,795 There are a few types of seizures that have been described in these patients. 297 00:15:05,845 --> 00:15:09,475 The first is the one we all know, so generalised tonic-clonic seizures 298 00:15:09,505 --> 00:15:11,095 where the cat loses awareness. 299 00:15:11,335 --> 00:15:15,775 Collapses may show signs like chomping of the jaw, paddling of the legs, 300 00:15:15,985 --> 00:15:17,635 and sometimes even passing urine. 301 00:15:18,355 --> 00:15:21,055 These seizures tend to last only a few minutes, and they're ones 302 00:15:21,055 --> 00:15:23,245 we are probably most used to. 303 00:15:23,905 --> 00:15:27,145 But what I'd say here is when it comes to feline audiogenic reflex seizures, 304 00:15:27,145 --> 00:15:29,365 these aren't the most common seizure type. 305 00:15:29,395 --> 00:15:32,095 We definitely see them, but they don't seem to be the most common 306 00:15:32,095 --> 00:15:34,535 thing that that owners and vets see. 307 00:15:36,125 --> 00:15:39,715 The second type, and these were the most common in our study, 308 00:15:39,805 --> 00:15:41,455 are the myoclonic seizures. 309 00:15:41,905 --> 00:15:45,025 I know we've touched on these in a previous episode, so they are 310 00:15:45,025 --> 00:15:48,145 still generalised seizures because they're affecting the whole body. 311 00:15:48,820 --> 00:15:52,450 They're really short, often lasting, just a fraction of a second. 312 00:15:52,990 --> 00:15:56,650 And they look almost like those funny episodes we see in cartoons like Tom 313 00:15:56,650 --> 00:16:01,960 and Jerry, where Tom gets jolted by noise or jumps at the sight of Jerry. 314 00:16:02,830 --> 00:16:07,660 Now, as a result of that feline Audiogenic reflex seizures were 315 00:16:07,660 --> 00:16:09,023 called Tom and Jerry Syndrome. 316 00:16:09,173 --> 00:16:10,403 They thought that would be quite funny. 317 00:16:11,273 --> 00:16:13,343 But I did a bit of research because you know, we're all familiar with 318 00:16:13,343 --> 00:16:15,143 Tom and Jerry, and I thought it would be great to get a little. 319 00:16:15,623 --> 00:16:18,323 Demonstration of what happens when Tom sees Jerry. 320 00:16:18,983 --> 00:16:22,043 It actually turns out that tom doesn't jump at the sight of Jerry. 321 00:16:22,113 --> 00:16:22,973 Stop it. 322 00:16:23,023 --> 00:16:24,773 Well, no, that's what we all thought, wasn't it? 323 00:16:24,803 --> 00:16:27,173 All these years that there's many episodes we've seen, we've probably 324 00:16:27,173 --> 00:16:29,183 seen the same episode five, 10 times. 325 00:16:29,438 --> 00:16:30,098 Oh my goodness. 326 00:16:30,098 --> 00:16:33,668 It's like the monopoly man doesn't have a moustache or top hat or 327 00:16:33,668 --> 00:16:35,108 what That thing, what is that? 328 00:16:35,483 --> 00:16:38,753 Well, what's actually happening in these episodes, and probably why we don't 329 00:16:38,753 --> 00:16:43,613 see Tom and Jerry on the TV anymore is Jerry spent his whole life attacking 330 00:16:43,613 --> 00:16:47,483 Tom, quite violently hitting him on the head with a hammer was one of them. 331 00:16:47,583 --> 00:16:49,713 Getting him caught in numerous mouse traps. 332 00:16:50,223 --> 00:16:55,473 Basically, Tom is persecuted by Jerry and it's essentially a very large 333 00:16:55,473 --> 00:17:00,723 victim of Jerry's abuse, but there's no myoclonic seizures in Tom and Jerry. 334 00:17:00,723 --> 00:17:03,573 So it is a bit of a misnomer to call it Tom and Jerry syndrome, 335 00:17:03,663 --> 00:17:05,073 but the press love a little. 336 00:17:05,598 --> 00:17:06,168 Oh yeah. 337 00:17:07,053 --> 00:17:07,773 A little title like that to use. 338 00:17:07,823 --> 00:17:09,183 I'm not going to lie, I'm probably going to remember that. 339 00:17:10,508 --> 00:17:15,698 I wonder if it's like, I dunno whether you, like me doom scroll in the 340 00:17:15,698 --> 00:17:19,228 evening, but I sometimes see these videos of cats having these like. 341 00:17:20,098 --> 00:17:25,748 Over the top jerking motions almost to like metronome tickings or things 342 00:17:25,748 --> 00:17:28,793 like that is, would you say that could potentially look like this? 343 00:17:28,913 --> 00:17:31,163 I think it's very likely to be this, so you're right. 344 00:17:31,163 --> 00:17:34,313 You know, nowadays some of these videos get caught on camera and 345 00:17:34,523 --> 00:17:36,803 put on social media and everyone has a little chuckle about it. 346 00:17:36,803 --> 00:17:39,353 But I think in some of these cases, these are cats that actually are having 347 00:17:39,353 --> 00:17:43,463 a, an over the top reaction to a noise that actually can be quite serious. 348 00:17:43,463 --> 00:17:46,493 So definitely these are the sorts of things we're thinking about here. 349 00:17:46,573 --> 00:17:47,265 Mm-hmm. 350 00:17:47,265 --> 00:17:48,075 It's really interesting. 351 00:17:48,720 --> 00:17:52,750 And then there is another type of seizure, but you'll be pleased to know 352 00:17:52,750 --> 00:17:54,550 this is one I have mentioned previously. 353 00:17:54,550 --> 00:17:57,580 So it's the absence or atonic seizures. 354 00:17:58,060 --> 00:17:59,410 And these are much rarer. 355 00:17:59,530 --> 00:18:03,190 Now I say that we again don't know how much rarer because I think owners 356 00:18:03,190 --> 00:18:04,720 don't focus on these quite as much. 357 00:18:04,720 --> 00:18:08,830 They are hard to pick up, but the cat will seem to sort of zone out 358 00:18:08,860 --> 00:18:13,240 staring blankly for up to maybe 20, 30 seconds without responding to its name. 359 00:18:13,960 --> 00:18:17,050 And these are really easy to miss, which is why I say they may be a lot 360 00:18:17,050 --> 00:18:18,880 more common than what we've reported. 361 00:18:19,365 --> 00:18:19,655 Yeah. 362 00:18:20,515 --> 00:18:24,280 Fascinates me that it might be completely under-reported, but, and 363 00:18:24,280 --> 00:18:28,690 it sounds like there's a, a variety of responses to these sounds and what 364 00:18:28,690 --> 00:18:30,190 kind of noises are triggering them. 365 00:18:30,190 --> 00:18:33,760 Is this like, like loud fireworks or something like that? 366 00:18:34,000 --> 00:18:34,630 You'd think, wouldn't you? 367 00:18:34,630 --> 00:18:37,150 You'd think firework a loud bang, something like that. 368 00:18:37,390 --> 00:18:39,160 But actually this is where it's really fascinating. 369 00:18:39,160 --> 00:18:42,520 So the noises that provoke these seizures are often high pitched. 370 00:18:42,880 --> 00:18:45,130 Really relatively quiet sounds. 371 00:18:45,540 --> 00:18:49,170 Examples that were given to me were things like the sound of computer keys, tapping 372 00:18:49,709 --> 00:18:55,239 plastic or paper bags, crinkling, or even the clink of keys can trigger an episode. 373 00:18:56,139 --> 00:18:59,489 And more unusual triggers include walking barefoot on a wooden floor or 374 00:18:59,489 --> 00:19:01,319 the sound of a dog's collar jingling. 375 00:19:01,619 --> 00:19:04,349 That's now getting into the Tom and Jerry territory again, where the, to 376 00:19:04,529 --> 00:19:06,389 the dog inadvertently attacks the cat. 377 00:19:07,259 --> 00:19:11,999 But interestingly, the louder and more persistent the sounds, the more likely 378 00:19:11,999 --> 00:19:14,099 it is to cause a more severe seizure. 379 00:19:14,789 --> 00:19:18,449 So not necessarily a loud sound like a firework, but if those keys jingling 380 00:19:18,449 --> 00:19:22,559 get louder and louder, you'll get this phenomenon of audiogenic kindling 381 00:19:22,559 --> 00:19:27,629 where the myoclonic seizures gather, they sort of continue to occur. 382 00:19:27,689 --> 00:19:31,779 And then potentially you can provoke a full generalised tonic-clonic seizure. 383 00:19:32,269 --> 00:19:35,869 So essentially repeated small noises build up and culminate 384 00:19:35,869 --> 00:19:37,639 in a larger, more severe fit. 385 00:19:37,719 --> 00:19:38,964 That's so fascinating. 386 00:19:38,964 --> 00:19:42,534 And it's almost like you can't do anything around them if they've 387 00:19:42,534 --> 00:19:44,124 got this problem jingling. 388 00:19:44,339 --> 00:19:44,459 Anything 389 00:19:44,679 --> 00:19:46,249 Well, you say that, don't you say, you got to make me know, 390 00:19:46,369 --> 00:19:47,589 got to avoid doing this and that. 391 00:19:47,619 --> 00:19:48,189 You can't. 392 00:19:48,249 --> 00:19:48,849 You can't. 393 00:19:48,849 --> 00:19:51,579 But, so it's, it's a great thing to say to owners, but I feel 394 00:19:51,579 --> 00:19:54,160 pretty helpless to go home and tiptoe around the house, so, yeah. 395 00:19:54,259 --> 00:19:54,549 Yeah, 396 00:19:54,549 --> 00:19:55,419 absolutely that. 397 00:19:55,469 --> 00:19:58,924 And I think I remember you, you telling me before that what was a 398 00:19:58,924 --> 00:20:04,774 really surprising finding was actually many of these cats are actually deaf. 399 00:20:05,104 --> 00:20:06,274 How does that work? 400 00:20:06,504 --> 00:20:06,634 Yeah. 401 00:20:06,634 --> 00:20:08,839 Well that was one of the paradoxes of our study. 402 00:20:09,199 --> 00:20:13,399 So yes, around half of the cats were reported by their owners as having hearing 403 00:20:13,399 --> 00:20:16,399 difficulties or being completely deaf. 404 00:20:17,119 --> 00:20:19,939 Now you'd think that would prevent the seizures, but it doesn't. 405 00:20:20,719 --> 00:20:24,589 The reason we think this might happen and we don't know, is that 406 00:20:24,589 --> 00:20:26,989 cats have an amazing ability to. 407 00:20:26,989 --> 00:20:30,814 To hear ultrasonic frequencies and many of the sounds that trigger these 408 00:20:30,814 --> 00:20:33,034 seizures fall within that range. 409 00:20:33,634 --> 00:20:38,674 Even if they're deaf to lower frequencies, their ultrasonic hearing 410 00:20:38,674 --> 00:20:42,394 is often unaffected, which means that these sounds still catch their 411 00:20:42,394 --> 00:20:44,704 attention leading to a seizure. 412 00:20:45,514 --> 00:20:49,594 Such an interesting point and it really highlights how complex 413 00:20:49,594 --> 00:20:52,474 these seizures are and obviously how complex cats are as well. 414 00:20:53,104 --> 00:20:56,164 Well, another important point is that this is a condition that affects 415 00:20:56,254 --> 00:21:00,754 older cats with the average age of onset being around 15 years old. 416 00:21:01,234 --> 00:21:05,284 So amongst that age group, it seems really quite ubiquitous. 417 00:21:05,644 --> 00:21:09,394 So many cats that get older can have this, and this is what's really 418 00:21:09,394 --> 00:21:13,504 surprised me, and it's progressive, so it may start as an occasional 419 00:21:13,504 --> 00:21:18,244 twitch or jerk and then progress to something far more apparent with age. 420 00:21:19,264 --> 00:21:23,434 Interestingly, many of these cats also had other long-term conditions 421 00:21:23,434 --> 00:21:27,604 like cardiac or renal disease, which of course are conditions we 422 00:21:27,604 --> 00:21:29,524 typically associate with aging. 423 00:21:30,544 --> 00:21:33,964 However, we did find enough cats without these issues that we can 424 00:21:33,964 --> 00:21:38,104 rule out those conditions as a direct cause of the noise induced seizures. 425 00:21:38,824 --> 00:21:40,984 This really is a syndrome on its own. 426 00:21:42,604 --> 00:21:45,694 So that is interesting because you talked earlier about high 427 00:21:45,694 --> 00:21:49,504 blood pressure and things like that in cats causing these issues. 428 00:21:49,504 --> 00:21:51,484 But actually this seems to be completely separate then. 429 00:21:51,934 --> 00:21:52,474 It really is. 430 00:21:52,474 --> 00:21:55,624 I mean it's different to old age and I think one of the pitfalls we've all 431 00:21:55,624 --> 00:21:58,984 fallen into in the past is we may have been presented with these cats in a 432 00:21:58,984 --> 00:22:03,214 routine clinic and because they're older cats and they might have the occasional 433 00:22:03,214 --> 00:22:06,514 jerk, I know what I would've been like before I knew about this condition. 434 00:22:06,514 --> 00:22:07,804 I just thought, well, it's it's old age. 435 00:22:07,804 --> 00:22:12,864 It's a cat with renal failure or something to do with the thyroid or the kidneys. 436 00:22:12,864 --> 00:22:15,334 because that's, I mean, that's my knowledge of feline medicine is 437 00:22:15,384 --> 00:22:18,384 it's all about you get high blood pressure, you get chronic renal 438 00:22:18,384 --> 00:22:21,204 failure and you get hyperthyroidism and they also sort of interlink. 439 00:22:21,624 --> 00:22:22,134 That's it. 440 00:22:22,134 --> 00:22:22,404 Done. 441 00:22:22,404 --> 00:22:24,324 You know, everything you need to now about feline medicine. 442 00:22:24,954 --> 00:22:28,174 Joking, of course, it's much more, intricate than that, but, but I think 443 00:22:28,174 --> 00:22:31,564 if you saw a cat having these episodes, you might put it down to one of them. 444 00:22:31,564 --> 00:22:35,854 And if you do some investigation in an older cat over the age of 10, 445 00:22:35,854 --> 00:22:38,764 you're probably likely to find these conditions and you might inadvertently 446 00:22:38,764 --> 00:22:41,319 blame that when actually this is something completely different. 447 00:22:42,154 --> 00:22:43,084 That's really interesting. 448 00:22:43,924 --> 00:22:47,584 And so are you treating these in the same way as we would 449 00:22:47,734 --> 00:22:49,984 an idiopathic epileptic cat? 450 00:22:49,984 --> 00:22:52,054 Are we using phenobarbital in these guys? 451 00:22:52,198 --> 00:22:52,318 Well? 452 00:22:52,318 --> 00:22:54,688 that's a really good point because treatment is an 453 00:22:54,688 --> 00:22:56,548 important part of managing FARS. 454 00:22:56,548 --> 00:23:02,528 So we found that a lot of cats were being prescribed, anti-epileptic medications. 455 00:23:02,588 --> 00:23:05,798 And of course with what we've said so far, phenobarbital is 456 00:23:05,798 --> 00:23:07,478 the first medication we reach to. 457 00:23:08,138 --> 00:23:12,608 But actually phenobarbital did help with the generalised tonic-clonic seizures, 458 00:23:12,608 --> 00:23:16,328 but it seemed to have very little effect at controlling the myoclonic fits. 459 00:23:16,568 --> 00:23:20,498 So given they were the most prevalent type of fit, it wasn't really giving 460 00:23:20,498 --> 00:23:22,478 that much benefit to these patients. 461 00:23:23,468 --> 00:23:27,038 Levetiracetam on the other hand, was much more effective for 462 00:23:27,038 --> 00:23:30,788 both of the seizure types, but particularly the myoclonic seizures. 463 00:23:30,818 --> 00:23:35,468 And in some cases it actually managed to get rid of the seizures completely. 464 00:23:35,828 --> 00:23:39,778 What I would say is it seemed to, help 90% of the cats with myoclonic 465 00:23:39,778 --> 00:23:44,778 seizures and about 70% of the cats with generalised tonic clonic seizures. 466 00:23:45,038 --> 00:23:48,308 It also seemed to have fewer side effects than phenobarbital. 467 00:23:48,428 --> 00:23:51,538 So it really is the medication that I would recommend now, when 468 00:23:51,538 --> 00:23:52,708 faced with this condition. 469 00:23:53,848 --> 00:23:57,158 There's even some evidence suggesting that levetiracetam 470 00:23:57,178 --> 00:23:59,668 might prevent audiogenic kindling. 471 00:23:59,668 --> 00:24:03,568 So remember that's where one seizure leads to another and you might crinkle, well 472 00:24:03,628 --> 00:24:07,918 jangle your keys cause the myoclonic fits to enter a sort of train of fits that lead 473 00:24:07,918 --> 00:24:09,868 to a big generalised tonic-clonic seizure. 474 00:24:10,378 --> 00:24:13,468 So we do think that this might help in this kindling effect, 475 00:24:13,798 --> 00:24:17,368 potentially slowing or stopping the progression of the condition. 476 00:24:19,693 --> 00:24:19,753 Hmm. 477 00:24:19,753 --> 00:24:20,263 That is interesting. 478 00:24:20,263 --> 00:24:23,443 So, slight differences there, like a, a nuanced approach to this one, 479 00:24:23,443 --> 00:24:25,183 particularly if they're myoclonic. 480 00:24:25,813 --> 00:24:29,083 Do you often see that they stay in those categories? 481 00:24:29,083 --> 00:24:33,733 So if a, a cat initially presents with the myoclonic episodes, are they, 482 00:24:34,093 --> 00:24:38,653 do they stay like that or do they progress to kind of generalised or? 483 00:24:39,133 --> 00:24:40,213 This is a really good question. 484 00:24:40,343 --> 00:24:43,973 It's one of the limitations we had in our study, if I'm honest, because the 485 00:24:43,973 --> 00:24:48,713 cats, we had to include, we had to prove they were having an epileptic problem. 486 00:24:49,493 --> 00:24:53,033 And when you see a cat with a generalised tonic-clonic seizure, I think that's 487 00:24:53,033 --> 00:24:57,473 proof in itself that with video footage of that cat, it's very clear and I think 488 00:24:57,473 --> 00:25:00,293 we could all sit around and agree it was a generalised tonic-clonic seizure. 489 00:25:00,983 --> 00:25:03,833 So we really had to include those cats in our study. 490 00:25:04,433 --> 00:25:06,803 If the cat was just having myoclonic. 491 00:25:07,133 --> 00:25:10,553 Episodes we weren't able to include them in our study because there was some 492 00:25:10,553 --> 00:25:14,813 controversy at the time as to whether they truly represented an epileptic condition. 493 00:25:15,083 --> 00:25:15,413 Right. 494 00:25:15,729 --> 00:25:19,719 what would be great is to go back through now and look at cats demonstrating 495 00:25:19,719 --> 00:25:22,629 any of these behaviours in order to answer the question you've posed 496 00:25:22,629 --> 00:25:24,309 that do these change with time? 497 00:25:24,759 --> 00:25:25,719 And I think they do. 498 00:25:25,719 --> 00:25:28,839 Certainly in our study we found the generalised tonic-clonic seizures got 499 00:25:28,839 --> 00:25:33,099 more frequent with time, but they really were a big minority of the overall number 500 00:25:33,099 --> 00:25:35,259 of seizures expressed by these cats. 501 00:25:35,289 --> 00:25:40,509 And myoclonic seizures were well up there as the number one manifestation of FARS. 502 00:25:41,199 --> 00:25:45,819 It's so interesting and it's, it's promising news really, that there may 503 00:25:45,819 --> 00:25:49,909 be some more kind of research into this and finding out these new disorders. 504 00:25:50,359 --> 00:25:54,589 So how common is this then, considering it's still really 505 00:25:54,589 --> 00:25:56,039 fairly recently recognised? 506 00:25:56,524 --> 00:25:59,944 Well, yeah, I mean, I've said I thought it was rare when I first heard about it. 507 00:26:00,364 --> 00:26:04,624 I actually thought it was made up, if I'm honest, to begin with, but I've been 508 00:26:04,654 --> 00:26:07,264 amazed at how frequently this is seen. 509 00:26:07,804 --> 00:26:10,084 The main problem is whether we recognise it. 510 00:26:10,954 --> 00:26:14,404 I mean, if you have a cat that is over 10 years old, because this always seems 511 00:26:14,404 --> 00:26:18,874 to happen in the second decade of life, there seems a relatively high chance 512 00:26:18,874 --> 00:26:22,924 that this is occurring for your cat, even if the episodes are infrequent. 513 00:26:23,314 --> 00:26:27,214 I have a cat myself at home that has this, but it's really infrequent. 514 00:26:27,214 --> 00:26:30,784 So for my cat at the minute, it's not a problem and we don't need to treat for it. 515 00:26:31,444 --> 00:26:34,774 But as with many conditions in veterinary neurology, our 516 00:26:34,774 --> 00:26:36,454 understanding is still evolving. 517 00:26:36,844 --> 00:26:41,254 It's a reminder of how important it is to keep asking questions and investigating 518 00:26:41,254 --> 00:26:46,624 new possibilities, especially when we see something unusual or unexpected. 519 00:26:47,464 --> 00:26:51,514 I'd also want to say that when we give the levetiracetam to these cats, one 520 00:26:51,514 --> 00:26:54,694 thing that owners were really surprised by is not just the myoclonic seizures 521 00:26:54,694 --> 00:26:58,654 disappearing, but these cats suddenly seem to have a new lease of life. 522 00:26:59,434 --> 00:27:01,624 Owners would say, I've got my old cat back, you know, or my 523 00:27:01,624 --> 00:27:03,004 young cat back, I should say. 524 00:27:03,424 --> 00:27:06,994 And it's hard to know why, but I think the reason is, is myoclonic seizures 525 00:27:07,384 --> 00:27:11,494 being a generalised seizure have a period of postictal behaviour afterwards. 526 00:27:12,244 --> 00:27:14,884 Now, if you have a five minute generalised tonic-clonic seizure, 527 00:27:15,244 --> 00:27:18,464 you'd expect a very short period afterwards of strange behaviour 528 00:27:18,484 --> 00:27:20,194 that which are the postictal signs. 529 00:27:21,094 --> 00:27:24,754 The same is true of myoclonic fits, but because they're so short, I think 530 00:27:24,754 --> 00:27:26,554 that postictal phase is really short. 531 00:27:26,554 --> 00:27:28,384 Therefore, we don't typically see it. 532 00:27:29,104 --> 00:27:32,254 But these cats that we're having them frequently, and you can have cats having 533 00:27:32,254 --> 00:27:36,934 them almost all the time, you know, we're talking sort of five or 10 in a 534 00:27:36,934 --> 00:27:38,944 minute, you know, that sort of frequency. 535 00:27:39,604 --> 00:27:42,074 I believe those cats were developing a constant postictal. 536 00:27:42,629 --> 00:27:45,869 State and the levetiracetam was a way of stopping the myoclonic 537 00:27:45,869 --> 00:27:49,589 seizures and lifting them from that postictal brain fog, if you like. 538 00:27:50,009 --> 00:27:52,319 And it gave them a much happier outlook on life. 539 00:27:52,319 --> 00:27:57,929 So I do strongly think these cats benefit from levetiracetam if 540 00:27:58,019 --> 00:27:59,309 they're happening that frequently. 541 00:27:59,369 --> 00:28:00,479 But I go back to my own cat. 542 00:28:00,479 --> 00:28:02,789 My cat does have this, but very infrequently. 543 00:28:02,789 --> 00:28:06,149 So I think levetiracetam is a bit of a jump at this stage, given 544 00:28:06,149 --> 00:28:08,429 I maybe see one episode a day. 545 00:28:09,329 --> 00:28:12,029 Whereas these are the cats that have them all the time. 546 00:28:12,089 --> 00:28:13,504 And I think there's great benefits. 547 00:28:13,574 --> 00:28:14,414 Yeah, definitely. 548 00:28:14,864 --> 00:28:18,194 Or is that just because you don't want to medicate your cat twice a day? 549 00:28:18,509 --> 00:28:19,379 Or three times a day. 550 00:28:19,409 --> 00:28:20,294 Three times a day. 551 00:28:20,344 --> 00:28:21,184 There is that too. 552 00:28:22,909 --> 00:28:24,349 Can I ask a really annoying question? 553 00:28:25,354 --> 00:28:26,604 This sort of thing always worries me. 554 00:28:26,604 --> 00:28:26,784 Where are 555 00:28:26,784 --> 00:28:27,464 you going now? 556 00:28:27,949 --> 00:28:30,109 I'm just going to go back to that treatment really. 557 00:28:30,479 --> 00:28:32,639 You know, because I'm a vet and that's where my brain goes. 558 00:28:32,969 --> 00:28:36,719 I was just thinking with dogs on phenobarbital, we have to do quite 559 00:28:36,719 --> 00:28:39,419 a lot of monitoring or we want to do quite a lot of monitoring. 560 00:28:39,979 --> 00:28:44,419 Maybe not so for Levetiracetam, but do you recommend that in cats? 561 00:28:44,419 --> 00:28:48,979 Do we need to, I know you're not a fan of measuring liver values, but do we need to 562 00:28:48,979 --> 00:28:50,989 worry about the liver so much with cats? 563 00:28:51,199 --> 00:28:53,029 Do they have that auto induction? 564 00:28:53,029 --> 00:28:54,999 What, what's your sort of approach to monitoring in cats? 565 00:28:55,599 --> 00:28:58,839 So, yeah, I mean, if we're starting phenobarbital, I suppose you should always 566 00:28:58,839 --> 00:29:03,339 say that any, well, any, any long-term medication, we should be doing some 567 00:29:03,339 --> 00:29:05,199 form of blood monitoring to have a look. 568 00:29:05,589 --> 00:29:07,569 But I think it's a really good point to bring up because there 569 00:29:07,569 --> 00:29:09,429 are some, some key differences. 570 00:29:10,389 --> 00:29:15,159 In dogs, we worry about the liver a lot and I think probably more than we need to, 571 00:29:15,429 --> 00:29:18,388 but the liver is always , at the forefront of our focus on what we're doing. 572 00:29:18,988 --> 00:29:21,778 Now, if you read through the side effects of phenobarbital and cats, 573 00:29:22,408 --> 00:29:23,728 they're very similar to dogs. 574 00:29:23,758 --> 00:29:27,478 You know, you've got ataxia, nausea, weight gain, weight loss, 575 00:29:27,478 --> 00:29:29,398 polydipsia, polyuria, all of that. 576 00:29:30,268 --> 00:29:35,008 But one thing you'll not notice on the side effects list is hepatic problems. 577 00:29:35,008 --> 00:29:38,398 So problems with the liver, and for some reason cats are really 578 00:29:38,398 --> 00:29:40,288 tolerant to phenobarbital. 579 00:29:40,288 --> 00:29:44,743 So I'm not saying don't measure the liver, or don't monitor the liver 580 00:29:44,743 --> 00:29:47,743 because I think we should with any chronic medication, and that goes 581 00:29:47,743 --> 00:29:49,303 with any medication we reach for. 582 00:29:50,023 --> 00:29:52,213 But I don't think there's a particular focus on that here. 583 00:29:52,213 --> 00:29:55,423 And I've yet to see, and I, I believe there's not been any reports 584 00:29:55,423 --> 00:29:58,303 of cats developing liver disease following phenobarbital treatments. 585 00:29:58,303 --> 00:30:02,618 So that's something I would reassure you of that that's less concerning. 586 00:30:02,953 --> 00:30:04,363 You know, you've jinxed yourself now. 587 00:30:04,363 --> 00:30:05,483 I'm going to see one tomorrow. 588 00:30:05,573 --> 00:30:06,753 You absolutely are, yeah. 589 00:30:06,833 --> 00:30:07,388 He's on its way. 590 00:30:07,418 --> 00:30:08,738 Phoning the practice right now. 591 00:30:09,758 --> 00:30:13,778 And the other blood test, of course is the serum concentrations, 592 00:30:13,778 --> 00:30:14,738 you know, measuring them. 593 00:30:15,398 --> 00:30:18,248 And we said the reason why we do that in dogs is that auto induction. 594 00:30:18,248 --> 00:30:20,918 So where dogs get tolerant to the medication with time. 595 00:30:20,918 --> 00:30:23,618 So we need to put more medication into the dog to achieve the 596 00:30:23,618 --> 00:30:25,688 same serum concentration. 597 00:30:26,348 --> 00:30:28,208 But again, in cats that isn't a big thing. 598 00:30:28,268 --> 00:30:31,148 We don't seem to see that same auto induction. 599 00:30:31,178 --> 00:30:35,348 So I'm not going to say we don't want to check serum concentrations 600 00:30:35,348 --> 00:30:38,198 because we definitely do, but I'm not quite as focused on it 601 00:30:38,198 --> 00:30:40,418 in the same way as I am in dogs. 602 00:30:41,078 --> 00:30:44,308 The advantage of all of this means that when you come to prescribe phenobarbital 603 00:30:44,308 --> 00:30:47,738 in cats, we're not really having to ask owners to come back nearly as much as we 604 00:30:47,738 --> 00:30:51,638 do with dogs, which is another benefit because we know cats in a practice. 605 00:30:51,908 --> 00:30:54,128 That's also something we want to avoid as much as we 606 00:30:54,503 --> 00:30:55,013 Yeah. 607 00:30:55,028 --> 00:30:57,068 If we can manage them distantly all the better. 608 00:30:57,563 --> 00:30:58,823 Yeah, definitely. 609 00:30:59,763 --> 00:31:03,193 It's been really useful, this podcast, or this episode. 610 00:31:03,543 --> 00:31:07,788 I think my main take home message really from this episode is: don't 611 00:31:07,788 --> 00:31:09,978 treat cats like small dogs, really. 612 00:31:10,038 --> 00:31:12,498 They're very different when it comes to their seizures. 613 00:31:12,858 --> 00:31:17,028 I'm really looking for that underlying cause and not forgetting about those 614 00:31:17,448 --> 00:31:21,318 audiogenic seizures, particularly in those older cats, often, probably a 615 00:31:21,318 --> 00:31:22,818 bit more common than we might think. 616 00:31:22,818 --> 00:31:23,523 Would you say that's fair? 617 00:31:24,123 --> 00:31:24,873 Oh, absolutely. 618 00:31:24,873 --> 00:31:29,543 So old cats that twitch don't just have bad kidneys and hyperthyroidism, 619 00:31:30,093 --> 00:31:32,373 they may have this epilepsy syndrome. 620 00:31:32,373 --> 00:31:33,693 So do keep it in mind. 621 00:31:34,473 --> 00:31:35,133 Perfect. 622 00:31:35,643 --> 00:31:38,553 Well, I think that's all we've got time for today, although I think 623 00:31:38,553 --> 00:31:41,043 we could probably carry on chatting all day to be honest on this. 624 00:31:41,223 --> 00:31:42,453 It's been really fascinating. 625 00:31:42,833 --> 00:31:45,853 I think I will definitely question my own approach to any seizuring 626 00:31:45,853 --> 00:31:47,393 cat from now on, that's for sure. 627 00:31:48,353 --> 00:31:53,963 So sorry to say, but next time is our final episode in this series already. 628 00:31:54,143 --> 00:31:55,073 I know where have it. 629 00:31:55,223 --> 00:31:56,183 Where's the time going? 630 00:31:56,633 --> 00:32:00,083 So next time we'll hopefully be putting all of this together and looking at a 631 00:32:00,083 --> 00:32:04,763 team approach to epilepsy and how everyone can get involved, not just us vets. 632 00:32:05,003 --> 00:32:05,573 See you then. 633 00:32:05,746 --> 00:32:06,586 Looking forward to it. 634 00:32:06,751 --> 00:32:07,041 Same. 635 00:32:07,421 --> 00:32:07,641 Bye.