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. 2018 Mar 2;14(1):64.
doi: 10.1186/s12917-018-1386-3.

Systematic review of antiepileptic drugs' safety and effectiveness in feline epilepsy

Marios Charalambous  1 , Akos Pakozdy  2 , Sofie F M Bhatti  3 , Holger A Volk  4
Affiliations

Systematic review of antiepileptic drugs' safety and effectiveness in feline epilepsy

Marios Charalambous et al. BMC Vet Res. .

Abstract

Background: Understanding the efficacy and safety profile of antiepileptic drugs (AEDs) in feline epilepsy is a crucial consideration for managing this important brain disease. However, there is a lack of information about the treatment of feline epilepsy and therefore a systematic review was constructed to assess current evidence for the AEDs' efficacy and tolerability in cats. The methods and materials of our former systematic reviews in canine epilepsy were mostly mirrored for the current systematic review in cats. Databases of PubMed, CAB Direct and Google scholar were searched to detect peer-reviewed studies reporting efficacy and/or adverse effects of AEDs in cats. The studies were assessed with regards to their quality of evidence, i.e. study design, study population, diagnostic criteria and overall risk of bias and the outcome measures reported, i.e. prevalence and 95% confidence interval of the successful and affected population in each study and in total.

Results: Forty studies describing clinical outcomes of AEDs' efficacy and safety were included. Only two studies were classified as "blinded randomised controlled trials". The majority of the studies offered high overall risk of bias and described low feline populations with unclear diagnostic criteria and short treatment or follow-up periods. Individual AED assessments of efficacy and safety profile showed that phenobarbital might currently be considered as the first choice AED followed by levetiracetam and imepitoin. Only imepitoin's safety profile was supported by strong level of evidence. Imepitoin's efficacy as well as remaining AEDs' efficacy and safety profile were supported by weak level of evidence.

Conclusions: This systematic review reflects an evidence-based assessment of the published data on the AEDs' efficacy and safety for feline epilepsy. Currently, phenobarbital is likely to be the first-line for feline epileptic patients followed by levetiracetam and imepitoin. It is essential that clinicians evaluate both AEDs' effectiveness and tolerability before tailoring AED to the individual patient. Further studies in feline epilepsy treatment are by far crucial in order to establish definite guidelines for AEDs' efficacy and safety.

Keywords: adverse effects; antiepileptic drugs; comprehensive review; efficacy; epilepsy; feline.

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Conflict of interest statement

Ethics approval and consent to participate

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Competing interests

HV is a member of the editorial board of the journal.

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Figures

Fig. 1
Fig. 1
Proportion of specific adverse effects for phenobarbital. Each adverse effect represents the percentage of cats that were affected by this with regards to the overall combined population for phenobarbital. The blue and red bars indicate type I and II adverse effects, respectively
Fig. 2
Fig. 2
Proportion of specific adverse effects for potassium bromide. Each adverse effect represents the percentage of cats that were affected by this with regards to the overall combined population for potassium bromide. The blue and red bars indicate type I and II adverse effects, respectively
Fig. 3
Fig. 3
Proportion of adverse effects for levetiracetam. Each adverse effect represents the percentage of cats that were affected by this with regards to the overall combined population for levetiracetam. The blue bars indicate type I adverse effects
Fig. 4
Fig. 4
Proportion of specific adverse effects for imepitoin. Each adverse effect represents the percentage of cats that were affected by this with regards to the overall combined population for imepitoin. The blue bars indicate type I adverse effects
Fig. 5
Fig. 5
Pyramid of AEDs’ efficacy hierarchy based on the quality of evidence and outcomes assessment
Fig. 6
Fig. 6
Pyramid of AEDs’ safety hierarchy based on the quality of evidence and outcomes assessment
See this image and copyright information in PMC

References

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