Home care for cluster seizures

In addition to new drug options for refractory canine epilepsy, consider home treatment of cluster seizures to alleviate the need for repeated, costly emergency veterinary care. Rectal diazepam (1 mg/kg of the parenteral formulation), administered at the onset of seizures, has been shown to decrease the number of cluster seizure events in dogs with epilepsy over 24 hours.1 It is recommended that the dose be increased to 2 mg/kg in dogs receiving maintenance phenobarbital therapy to account for changes in diazepam elimination when the drugs are administered concurrently.2

I advise owners that they can safely administer rectal diazepam up to three times within a 24-hour period, but if treatment fails to control the seizures, they should seek emergency care for their dogs. Because diazepam is inactivated by light and adheres to plastic, it is best to dispense the drug in the original glass vial and instruct the owner to draw the required amount into a syringe when needed. A rubber catheter or teat cannula is then placed on the syringe to facilitate rectal administration. Suppository forms of diazepam are available, but the pharmacokinetics of these products in dogs has not been evaluated.

Additional doses of maintenance oral antiepileptic drugs, or pulse therapy with one of the newer drugs (in which a medication is administered only during the cluster event), have also been advocated to treat repeated seizures at home, but no published reports have documented the efficacy of such treatments.

REFERENCES

1. Podell M. The use of diazepam per rectum at home for the acute management of cluster seizures in dogs. J Vet Intern Med 1995;9(2):68-74.

2. Wagner SO, Sams RA, Podell M. Chronic phenobarbital therapy reduces plasma benzodiazepine concentrations after intravenous and rectal administration of diazepam in the dog. J Vet Pharmacol Ther 1998;21(5):335-341.