Keppra/Levetiracetam (generic)

Keppra: Keppra is an excellent long term anti convulsive treatment that has the added benefit of being associated with an exceptionally low incidence of toxicity. The draw back of Keppra at this time remains its high cost. Therefore, in most cases, Keppra is reserved for use in dogs as an additional anticonvulsant to be used in cases where seizure suppression has become refractory to doses of phenobarbital and potassium bromide that are approaching the maximum. It also may be a better choice than potassium bromide for additional anticonvulsant therapy for cats in cases where phenobarbital alone does not adequately control seizures.

Update

Brady has been on his new medicine, Keppra, for 6 days now and is tolerating it well, which is wonderful news. It is always scary to add another drug since the reaction to it is always unknown in your own dog. He's doing well and his motor skills are good. He hasn't been ataxic and is doing his normal everyday routine, which involves his long morning walk and daily ball playing. He can run after the ball as normal, without any tumbling over or losing his balance.He can go up and down the stairs, jump on the bed, jump up on us, etc.; all is done normally without any wobbliness or loss of balance.

One thing I have noticed is that his water consumption has gone up again; this is definitely a side effect of phenobarbital. It seemed that his love of water had diminished somewhat, but once again his water intake is up. Not a big deal whatsoever, just something I noticed. With the possibilities of side effects, this is one we can definitely live with.

Our Decision and Next Plan of Action

Per Dr. Katherman's recommendation, we have decided to add Keppra to Brady's cocktail of medication.

Keppra must be given 3 times per day. His dose will be 375 mg three times daily for a total dose of 1125mg daily, in addition to the other medications.

Zonisamide is being decreased from 250mg to 225 mg twice per day, for a total of 450 mg daily.

Phenobarbital will remain the same. The dose for that is 64.8mg twice per day, for a total of 129.60mg daily.

Potassium Bromide will remain the same as well. That dose is 2ml three times per day, for a daily total of 6ml=600mg.

This new medication schedule began on Monday morning, March 8, 2010.

Blood work results are in

On Friday, March 5th, Dr. Katherman called with Brady's blood work results. The Zonisamide levels were on the high end of the therapeutic range; thus being higher than what she prefers to see it. So even with the Zonisamide being on the high side, we still haven't gained the seizure control that we'd like. Potassium Bromide levels were low so there is plenty of room to increase that drug if needed. However, the Zonisamide must be decreased since it can cause problems in the long term if it remains at the current dose.

At the present time, our choice would be either to increase Potassium Bromide or to bring on another AED (anti-epileptic drug). If we choose to increase Potassium Bromide, it will take another 4 months until it reaches a steady state or efficacy. Also, rear end weakness and ataxia will be a very real possibility. The other choice would be to add Keppra, which has very minimal side effects and is fast acting. Per Dr. Katherman's recommendation, the rational choice at this time would be to add Keppra to the mix.