Karen Kline, DVM, MS, DACVIM (Neurology), shares common anticonvulsants for patients with seizures, and offers advice for veterinarians conducting a neurologic examination

Anticonvulsants for cats and dogs

In this pre-Fetch dvm360 conference interview, Karen Kline, DVM, MS, DACVIM (Neurology) shares what she believes are some of the most important things to keep in mind when it comes to the neurologic examination of patients with seizures. In the interview, she also talks about what some common anticonvulsants for cats and dogs are.

Below is the interview transcript. It has been lightly edited for clarity.

Karen Kline, DVM, MS, DACVIM (Neurology): 

The most important thing is thinking about the age and the signalment of the patient, but also what their neurologic exam and physical exams are like, because that can help you to determine what the next steps are going to be, diagnostically and treatment wise. But also talking to owners about realistic expectations when they're managing their seizure patients. So I think those are some of the most important topics.

The most common anticonvulsants are phenobarbital and potassium bromide. Those are dog anticonvulsants. In the cat, many times we'll use phenobarbital as well. We've heard of other drugs like Keppra and zonisamide and topiramate and pregabalin. We also have heard about the use of dietary changes and so forth. But the most commonly used drug [is] going to be phenobarbital, and it's still a tried-and-true drug that that is very useful in our patients species-wide.

Videos

Christopher Shapley, DVM, CVA, CVCH, CVFT, talks about his multimodal approach for dogs with certain neurological diseases, and why it works

Treating neurologic diseases with herbal formulations and acupuncture

on a lecture presented at the Fetch dvm360 conference in Long Beach, California earlier this winter, Christopher Shapley, DVM, CVA, CVCH, CVFT, talked about his multi modal approach for treating neurological diseases in dogs. He explained the benefits of using herbal formulations in these patients, emphasizing that in patients who cannot walk, combining it with electroacupuncture therapy is what yields success.

Christopher Shapley, DVM, CVA, CVCH, CVFT: 

I think my specialty within my specialty are neurologic dogs, so dogs that have had disc protrusion, disc herniation, a flare up of intervertebral disc disease. And what I'll do is…if they're unable to walk, we use a form of electroacupuncture, again, to help kind of jump start the nerves.

And with that, I always combine herbal formulations. And a lot of these herbal formulations have been used in human medicine dating back to the 1200s. So any down dog, I will basically utilize herbs and herbal formulations that are reducing inflammation, reducing pain, and we're increasing blood flow, and not just everywhere in the body, but these herbal formulations are targeted specifically for the spine or the cervical region, depending on where the lesion is.

So I feel like, and I've always used the adage that you know, if we're not using herbs along with acupuncture, and if we're not using acupuncture along with herbs, we're not going to have any success. So again, any of my, you know, intervertebral disc disease, or disc herniation dogs—I [am] actually [treating] multiple patients right now—and usually within a few weeks, we're able to get them up and walking again. They're not exactly running around doing zoomies, but they're up, they're mobile, they're able to get up on the couch, they're able to go outside to relieve themselves. And again, I attribute it to that multimodal approach, or that combining of the acupuncture and the herbal formulations.

Alternative approaches to treating neurologic diseases in dogs

The FDA posted warning letters to firms selling unapproved drugs, claiming that the drugs control and treat seizures in dogs and cats. Each of the products named in the warning letters are not FDA-approved or conditionally approved, therefore the safety of the products have not been verified by the FDA for safety, effectiveness, or manufacturing methods.

The warning letters went to the following companies

Doc Ackerman’s– Epilepsy and Seizure Formula

: SeizureGuard Plus and Life Span Arthritis & Mobility Advanced Enzyme Therapy

: Bully Baum No Seize, Can-B-Gone - Cancer Oil Extract, and Brain & Neurological

: Dog Seizure and Epilepsy Supplement and Blood Support for Dogs

: Vet Select Nuroplex Capsules and Vet Select Nuroplex - 2oz homeopathic Spray

 each of the unapproved products were sold on the firm’s websites, Amazon shops, and social media pages without prescriptions or other veterinary oversight.

 Drugs used to treat and control seizures are not safe for use except under supervision of a licensed veterinarian due to their specialized training and experience.

Currently, the FDA has conditionally approved 2 animal drugs to treat idiopathic epilepsy in dogs under expanded conditional pathway, 

. The pathway is used for drugs that are intended to treat serious and life-threatening diseases or address an unmet health need. The FDA also stated that veterinarians have the option for treatment in the form of extralabel use, such as prescribing drugs intended for human use in animals or prescribing an animal drug for use in a different species of animal.

 Veterinary professionals or clients are encouraged by the FDA to report any animal adverse events to the FDA’s Center for Veterinary Medicine.

All products approved by the FDA carry a statement on the label stating their approval and include the products' new animal drug application, abbreviated new animal drug application (for generic animal drugs), or Conditional Approval number.

Any veterinary clients that have been administering any of the unapproved drugs included in the warning letters should consult a licensed veterinarian to gain an accurate diagnosis and receive appropriate treatment. Clients can safely dispose of the medications if they are on the FDA flush list, and if not, follow FDA instructions to discard the medication in the trash.

The FDA asked the firms to respond to the sent warning letters within 15 days of receipt to explain how they will address the violations listed in the warning letters. If the companies fail to do so, it may result in legal action taken by the FDA, including seizing the products and/or a court order requiring the company to stop the distribution and manufacturing of the unapproved numbers.

Suspected unapproved drugs or devices can be reported to the FDA through FORM FDA 1932a “Veterinary Adverse Experience, Lack of Effectiveness or Product Defect Report" as well as to report adverse events for any approved or unapproved drug or animal device.

FDA Warns Six Sellers of Unapproved Seizure Drugs for Animals. News release. U.S. Food and Drug Administration. January 7, 2025. Accessed January 7, 2025. 

https://www.fda.gov/animal-veterinary/cvm-updates/fda-warns-six-sellers-unapproved-seizure-drugs-animals?utm_medium=email&utm_source=govdelivery

FDA. Disposal of Unused Medicines: What You Should Know. US Food and Drug Administration. Updated September 3, 2024. Accessed January 7, 2025. https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know

FDA. How to Report Animal Drug and Device Side Effects and Product Problems. US Food and Drug Administration. Updated September 3, 2024. Accessed January 7, 2025. 

https://www.fda.gov/animal-veterinary/report-problem/how-report-animal-drug-and-device-side-effects-and-product-problems

Articles

The unapproved drugs claim to treat and control seizures in canine and feline patients 

FDA issues warning to multiple firms selling unapproved seizure medication 

Craig A Clifford, DVM, MS, DACVIM (Oncology) talks about Laverdia-CA1, as well as indolent lymphoma in this interview with dvm360

About the novel drug for canine lymphoma

Earlier this winter, Craig A Clifford, DVM, MS, DACVIM (Oncology), sat down with 

 to talk about his lecture on canine lymphoma, presented at the Fetch dvm360 conference in Long Beach, California. In this interview, Clifford focuses on the new drug for treating lymphoma in dogs: Laverdia-CA1. He talks about how the drug is given, its efficacy against T cell lymphoma, and why it is a game-changer for the primary care physician. Clifford also discusses what indolent lymphoma is and what to do after an indolent lymphoma diagnosis. 

Below is a partial transcript. It has been lightly edited for clarity.

Craig A Clifford, DVM, MS, DACVIM (Oncology): 

So we're going to be discussing with “Canine Lymphoma” a couple of things. One, going back to what I had said previously, the idea of immunophenotyping and why it's important, and why that should be done by the primary care but most of the lecture is going to focus on the new novel drug called Laverdia-CA1, and this is an oral anticancer drug. It's not on the same level as what we call chemotherapy, where I think of chemotherapy as like a shotgun. When chemotherapy enters the body, it kills all cells that are growing. Now, cancer generally grows faster than most cells, so that's [what] it preferentially kills, but clearly other cells that grow, such as hair, such as immune system cells, and GI tract cells can be affected by it and that's why we see those adverse events.

[Laverdia-CA1] is a much more targeted drug, and the data suggests that this drug will work for dogs with lymphoma. The beauty of it, it is an oral medication, so if we were tasked with, you and I, the idea of creating the perfect drug for a primary care doctor, the first thing we'd want is something that's going to be oral—so we're not having to give injections, place catheters—and something that's convenient. This is given twice a week, with 3 days off in between: that's incredibly convenient.

We also want something that doesn't have a lot of side effects, and the side effect profile is very favorable. Based upon the studies that have been done, no dogs have been taken off the study due to severity of adverse events, so it means that it's a safe drug. The final thing we want is it's got to work, and clearly this drug does. We know for the average dog, it may hold the disease for about 3 months or so. So it's not meant to be a silver bullet, a cure-all for lymphoma. More likely in the future, oncologists will be combining it with other agents in other types of protocols, but to me, knowing that 80% of lymphomas are left untreated, this gives the primary care a game changer—something else that they can utilize, other than just prednisone.

I’ve noticed an uptick in no-shows for procedures. How can we get clients to arrive on time for surgeries?

Surgical and dental services account for 10.9% of hospital revenue.

 No-show clients are a serious headache, risking lost revenue and putting extra stress on teams. Missing procedures also has consequences on patients’ health. Try these 8 strategies:

Never tell clients they can “drop off” pets on the morning of procedures. Pet owners may assume they can hand you the leash or cat carrier and go. You also risk random arrivals with everyone showing up at once or at the end of check-in time.

Schedule admission appointments every 10 to 15 minutes such as 8 AM, 8:10 AM, etc. Prioritize check-ins based on the length of procedures:

 Long procedures of 60 or more minutes such as orthopedic surgeries, C-sections, and abdominal exploratory surgeries.

 Medium procedures of 45 to 59 minutes such as spays on large dogs, ear resection, and enucleation.

 Short procedures of 44 or fewer minutes such as feline spay/neuter, small tumor removal, and dewclaw removal.

Set expectations when scheduling procedures. Say, “<Pet name>’s admission appointment begins at <time, date>. For 10 to 15 minutes, you will meet with a technician who will answer your questions and confirm how to reach you on the day of the procedure. We will text/email you reminders as the date nears, including presurgical instructions and an anesthetic consent form to review and return in advance.”

“Begins” communicates “Be here, be ready”—not down the street at Starbucks…unless you’re getting lattes for the entire staff. Let clients know that important instructions and medical forms are part of the confirmation process.

This is especially important if you’re booking procedures weeks in advance. Text and email up to 5 procedure confirmations. Each confirmation serves a purpose.

Include a calendar invite in the first confirmation. Calendar invitations, called .ics files, are saved in a universal calendar format used by several email and calendar programs, including Google Calendar, Microsoft Outlook, and Apple Calendar.

 Calendar invites can lower no-show rates up to 25 percent, especially among working professionals.

Buttons increase click-through rates by 15% over hyperlinks.

 Use buttons for important call-to-action requests such as “confirm” or “Reschedule/cancel.” 

Five days before the procedure, give clients the last chance to reschedule or cancel. With advanced notice, you can easily fill empty slots. Keep a waitlist or call clients with upcoming procedures to see if they want their pets to be seen sooner. If you can’t fill empty surgical slots, the doctor could start afternoon appointments earlier.

3. Perform preanesthetic testing before procedure days.

Let’s say the doctor diagnoses a pet’s dental disease during today’s checkup and discusses the need for treatment. The technician explains services and fees in the treatment plan. The client agrees and books the procedure for next week. Collect samples for the preanesthetic test today.

Doing preanesthetic testing on the day of diagnosis has 3 advantages:

Clients pay for lab tests today and are financially committed to showing up on the day of the procedure.

You may choose whether to do in-house testing or send it to the reference lab.

Increases clients’ perception of value because the dental treatment cost will be lower when they prepay lab work today.

Rolling Hills Veterinary Service in Bethel, Ohio, cut surgery check-in time in half by automatically sending and collecting digital forms by text and email through Otto.

 Forms write back to patient records in its practice information management software, saving administrative time for client service representatives (CSRs).

Because clients have invested 10 minutes of personal time answering patient health questions and authorizing consent, they are more likely to show up for procedures. Your anesthetic consent form will confirm clients’ preferred contact method, give consent, offer additional services such as nail trim and microchip, current medications, the last time the pet was fed, allergies and health concerns, and payment policies. Download an anesthetic consent form at 

https://www.dvm360.com/view/anesthesia-surgery-and-treatment-consent-form

Clients at VCA Sheridan Animal Hospital & Veterinary Specialists of Western New York in Buffalo get an admission process sheet when scheduling. Instructions explain what to do or not do 10 days before the pet’s procedure, the day before, what to bring, and what to expect on procedure day. Download the admission process sheet at 

If pets take medications that must be given with food, veterinarians should set protocols on medication administration and fasting. Include special instructions for patients with diabetes.

Have cancellation, no-show, and late policies that you communicate upfront during the confirmation process. Clients need to know how far in advance procedures must be cancelled or rescheduled, what happens if they no-show, and how you’ll handle late arrivals. When sending procedure confirmations, include hyperlinks and buttons where clients can click to access policies. Include policies on your online booking webpage and new client registration form. Get a free sample of cancellation, no-show, and late policies at 

7. Call clients who haven’t responded 2 days prior.

Expect most clients to confirm digitally and complete online anesthetic consent forms. Abigail Fulton, a CSR and veterinary assistant at Rolling Hills Veterinary Service, says 65% to 75% of clients confirm digitally. She noted that staff can focus more of their time on face-to-face interactions with clients coming into the clinic, rather than speaking on the phone.

If clients don’t confirm or submit forms, call them. Say, “We have reserved a surgical/dental procedure for <pet name> with an admission appointment on <date, time>. We need your confirmation and anesthetic consent form today by <time>. This will help our medical team prepare for your pet’s procedure. I am resending the text/email. If we do not receive confirmation and the consent form by <time> today, this surgical/dental procedure will be released to another patient in need. Please call/text/email us today.”

Requesting deposits for procedures can prevent no-shows—but don’t use the term “deposit.” Check state laws on deposits and partial payments (

). In New Jersey, businesses must visibly post refund policies. If you don’t, you are liable to give clients cash refunds or credits for up to 20 days after purchase.

Clients also may assume they will get money back if you say “deposit.” Use the term “surgical reservation fee” or “prepayment.”

Explain the payment when booking procedures. Say, “We have scheduled <pet name>’s procedure on <date>. Your admission appointment will be at <time>. You will receive a text/email confirmation and an invoice for your surgical reservation fee of $___. Use the link to pay online. This amount will be applied to the procedure. If you need to change the surgery date, notify us at least X days/hours in advance for it to be refund eligible. We will send presurgical instructions and an anesthetic consent as the date nears.” If fees aren’t refund eligible, explain, “This surgical reservation fee is nonrefundable.”

Take payments through your practice app, text-to-pay links, online payments, or swipe cards if booking procedures in-person. Never take credit card numbers over the phone and manually process payments. Card-not-present transactions are usually more expensive than card-present transactions because they have a higher risk of fraud and chargebacks.

 The average rate for card-not-present transaction increases to 2.25% to 2.65%.

When you set clear expectations and provide timely reminders, you’ll resolve your no-show problem.

Need a script for a client conversation? 

Submit your scenario to info@csvets.com for consideration in future columns.

Best known as the “Queen of Scripts,” Wendy Myers knows the right words will lead clients to accept your medical advice, driving patient and practice health. As founder of Communication Solutions for Veterinarians, she teaches practical skills through online courses, conferences, and onsite consulting. Wendy’s experience as a partner in a specialty and emergency hospital helped her understand issues that owners and managers face. Learn how Wendy can train your team at 

2024 Veterinary Industry Benchmark Report. iVET360. Accessed December 2, 2024. 

Calendar Invites. InEvent FAQ. Accessed December 2, 2024. 

https://faq.inevent.com/l/en/in-event-registration/calendar-invites

Dean S. 8 Solutions to Patient No-Shows and Missed Appointments. Keona Health. Accessed December 2, 2024. 

https://www.keonahealth.com/resources/8-solutions-to-patient-no-shows-missed-appointments

How Otto Flow helped Rolling Hills cut time spent on confirmation calls and surgery check-ins in half. Otto. Accessed December 2, 2024. 

https://otto.vet/how-otto-flow-helped-rolling-hills-cut-time-spent-on-confirmation-calls-and-surgery-check-ins-in-half/

Hilst H. Consumer Returns and Refund Laws by State. FindLaw. Accessed December 2, 2024. 

https://www.findlaw.com/consumer/consumer-transactions/customer-returns-and-refund-laws-by-state.html

Rej M. Card present vs card not present transactions. Merchant Cost Consulting. Accessed December 2, 2024. 

https://merchantcostconsulting.com/lower-credit-card-processing-fees/card-present-vs-card-not-present-transactions/

Scripts for confident client conversations

How Do I Say…? : Reducing surgery no-shows

Common linear foreign bodies include string, yarn, carpet, cloth material, or leashes. Linear foreign bodies present a unique challenge as they can trail down the intestines which will result in intestinal plication and the string material can start to act as a saw on the mesenteric border of the intestines. This can result in perforation, bowel death, and septic peritonitis. Clinical signs can include anorexia, vomiting, lethargy, regurgitation, ptyalism, abdominal pain, dehydration and, as in this case study, the offending foreign object may be protruding from the anus.

Rusty, a 6-year-old orange tabby, found some sparkly string which he decided might be tasty. The owner witnessed him ingest the string 2 days prior to presentation. He had passed a few bits of string in his stools, but on this particular day, he had approximately 4 cm of string protruding from his anus and Rusty became anorexic and painful.

Rusty's radiographs confirming intestinal plication with no free air and normal serosal detail within the abdomen. (Image courtesy of Heather Timmermans)

Physical examination revealed normal vital signs with mild dehydration and palpation of the intestines revealed they were bunched and painful. No string was found in the oral cavity under the tongue.

Abdominal radiographs confirmed intestinal plication with no free air and normal serosal detail within the abdomen. The stomach contained a soft tissue opacity in the pylorus and a heterogenous mix of gas and soft tissue opacity within the fundus.

Blood work revealed a normal complete blood count, mild hyperglycemia at 275 mg/dL (reference range 70-150), and mild hypokalemia at 3.3 mmol/L (reference range 3.7-5.8). The hyperglycemia was attributed to stress and pain and the hypokalemia was attributed to anorexia and gastrointestinal

GI) obstruction. Intravenous fluids were started to rehydrate him prior to surgery.

Rusty was placed in dorsal recumbency, and his abdomen was sterilely prepped. He received 22 mg/kg cefazolin IV perioperatively. A 10 blade was used to make a ventral midline incision from the xyphoid process to just caudal to the umbilicus. The intestines were plicated from the pylorus to the large bowel.

Rusty's stomach exteriorized from the abdomen

The stomach was exteriorized from the abdomen and packed off with sterile moistened lap sponges. A stab incision was made into the stomach and a hemostat was used to exteriorize the wadded string from the pylorus. The string was cut caudal to the wad of string. The intestinal plication was immediately improved. The stomach was closed with 3-0 monoweb in a double inverting pattern. The intestines were gently manipulated into more normal positioning. Evaluation of the mesenteric side of the intestines revealed no evidence of perforation nor necrosis. Gentle traction on the string from the rectum did not result in movement of the linear foreign body so the distal jejunum was isolated outside of the abdomen and packed off with sterile lap sponges. A stab incision was made into the distal jejunum, the string was exteriorized and cut.

The orad portion of the string was able to be gently removed from the jejunal incision. The caudal portion of the string was able to be removed with rectal manipulation caudally. The jejunal incision was closed in a simple interrupted pattern with 3-0 monoweb. The abdomen was closed with 2-0 monoweb in a simple continuous pattern, the subcutaneous tissues were closed with 3-0 monoweb in a simple continuous pattern and then an intradermal pattern. The skin was closed with 3-0 monoweb in a cruciate pattern. Recovery from anesthesia was uneventful.

Rusty was continued on intravenous fluids for the remainder of the day. He received maropitant for nausea and Zorbium topically for pain control. After a couple of days of ileus, which was treated with Mirataz ointment, oral Cerenia, and gentle syringe feeding, his appetite returned to normal. He was back to his normal self by suture removal.

Objects can get caught around the base of the tongue, knot up in the stomach, and become lodged in the pylorus or further down in the gastrointestinal tract 