Pheno-barb, Keppra and Prednisone ok altogether for my dog for seizures ?

[aronel344]

My 6 year old australian shepherd cross started having seizures starting in April of this year (he had 1) and in June, he had a cluster of about 12 in a 24 hour period and was hospitalized for 2 days.  Since then, he has been on Pheno-barbital and was doing well until this last weekend when he had another seizure, followed by another within a couple of hours.  We took him back to the emergency hospital and he was released the next morning without having any more seizures in the night., now they have added Keppra to his phenobarbital and after a visit with an animal neurologist, who believes my dog has a tumor based on some exercises he put him through, and added prednisone to the mix, I feel all of this is excessive and unsafe for my dog but he's never had any medical conditions before so I don't know what is 'normal' in doggie meds - are pheno-barbital, Keppra and Prednisone commonly prescribed together for seizures?

[shannon781]

One last comment; I assume your vet has done blood work and other testing to rule out the underlying cause for the seizures. If he/she is left with brain tumor on the list, the only way to confirm this (if this is the only location in the body that the cancer is) is to have an MRI done. This can cost upwards of $2000 and only available at specialty clinics, so the management without knowing what type of cancer is present is steroids (pred) to bring down inflammation. Your vet is only to trying to cover all the bases!

[shannon781]

Yes, the prednisone doesn't help with seizures directly, but it does decrease inflammation throughout the body and the central nervous system if there is something like a tumor putting pressure in the brain. The phenobarbital is a very widely used anti-seizure medication. It is highly metabolized by the liver and over time, cause liver enzymes to rise. Keppra (levetiracetam) is mostly excreted by the kidneys are is one of the safest drugs speaking in terms of therapeutic vs. toxic blood concentrations. Other drugs include zonisamide, potassium bromide, etc. A large percentage of dogs respond to one anti-seizure medication. For some, one is not enough and they need 2, 3, or 4 others! (I have seen it). It is not excessive to have more than one drug. Each drug works on a different receptor in the brain. The more ways a seizure can be prevented, the more likely the dog is to not have them. We start off giving one and hope they respond, but may need more. They can occasionally have breakthrough seizures, but as long as it is no more than 1 or 2 every 30 days, the dog is considered well controlled. As far as "unsafe", it is true that these are drugs. Even safe drugs can have potential side effects. You must weigh these side effects against the benefit of controlling seizures. In short, this is a common practice to combine all of these drugs and they are not "unsafe" combinations in theory. Hope this helps!