- A definition of refractory epilepsy is not established for dogs, but it is generally agreed that an animal with frequent or severe seizures or intolerable side effects despite appropriate antiepileptic drug (AED) therapy is considered refractory to treatment.3
- Levetiracetam and zonisamide are increasingly the drugs of choice for monotherapy by some neurologists. A recent study found no reduction in monthly seizure frequency when levetiracetam was used as a sole agent.4 However, little additional information is available in the veterinary literature on the efficacy of these medications as sole agents.
- Some AEDs (eg, levetiracetam, zonisamide) have a reported “honeymoon effect,” with dogs developing tolerance over time.
- Gabapentin and pregabalin are not known efficacious AEDs but anecdotally may help with seizure control in patients tolerant to other medications.
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