An update on the prophylactic use of peri-operative levetiracetam in dogs undergoing portosystemic shunt attentuation
This is an interesting snippet of recently-published information from Utrecht which I hadn’t seen until today:
‘Postligation seizure syndrome (PLS) is described in 5-18% of the dogs postoperative to ligating the extrahepatic shunt and is mostly seen within 72 hours after surgery(1). Scientific literature claims a preventative effect of a preoperative treatment with levetiracetam, an anti-epilepticum. The aim of this study is to investigate if preventative treatment with levetiracetam shows a significant decrease of PLS after operatively narrowing an extrahepatic shunt in dogs in the University clinic of companion animals in Utrecht (UKG). A total of 162 dogs have been used and did receive levetiracetam or no anticonvulsant medication before undergoing occlusion of an extrahepatic shunt. This is a retrospective study of the population of dogs that came into the UKG from the end of 2013 until the end of 2017 and went for surgery with preoperative levetiracetam(n=41) compared with a similar control group(n=121) existing out of dogs which were operated without preoperative levetiracetam between 2005 and 2013. Before the dogs went for surgery different characteristics were recorded. Results: Levetiracetam was administered to 25% (41/162) of the dogs. Three dogs of the levetiracetam treatment group (7.3%) developed post ligation syndrome, in comparison only two dogs of the control group developed post ligation syndrome (1.7%). The Fisher exact test with a P-Value of smaller than .05 shows that there is no significant difference between the untreated and LEV-treated group comparing the incidence of post ligation syndrome. Conclusion and Clinical Importance: Pretreatment with levetiracetam of dogs undergoing occlusion of an extrahepatic shunt does not decrease the incidence of postoperative seizures and status epilepticus. Furthermore, treatment with levetiracetam did not give a better prognosis for dogs with PLS‘
Although, statistically, there was no difference between the levetiracetam and non-levetiracetam groups, my non-statistical observation is that there was a tendency for levetiracetam to be associated with a higher risk of post-ligation neurological signs. That accords with our own findings and reinforces our decision not to use levetiracetam as a default treatment…at least until further data emerges.