Starting Phenobarbital for Feline Seizures
May 8, 2014 7:52 AM   Subscribe

My feisty darling Banana had two grand mal seizures on Monday morning and has since had a complete neuro workup including MRI that have essentially ruled out everything except idiopathic epilepsy. He's been on phenobarbital since Monday evening - first by IV in the hospital, and then starting Tuesday night 15mg twice a day at home. And he is a sad little zombie.

All the vets have told me to expect sedation during the first couple of weeks, but I have no idea if this level of sedation is normal. He's eating, drinking, and using the litter box, but other than that he's essentially living under the bed and will have nothing to do with us, which is heartbreaking as he has always been an extremely affectionate cat who demands attention and love almost every waking second. Occasionally he will emerge from the bed and hobble around the house staring at nothing for a few minutes but he immediately goes back to sleep, either under the bed or in some out of the way location that is not a normal sleeping spot for him.

Is this normal? Will it go away?

I'm working closely with a lot of vets right now, both general and neurologist, so what I'm looking for mostly are personal experiences. Did your cat actually become himself again while treated with this medicine? I miss my buddy.
posted by something something to Pets & Animals (9 answers total)
Best answer: Your vet is right. This is probably one of the oldest seizure drugs out there. They used to give it to people for the same reason (before MUCH better drugs became available.)

You/animals build up a resistance to it after a few weeks though. Let your cutie do what he do, and after a few weeks he should be feeling a lot better.

He may feel kind of yukky, so if he wants to lounge on the sofa with you, just keep a hand on him so that he feels safe sleeping.

If he doesn't get used to it after the first few weeks, re-visit the vet for an adjustment. All meds need adjusting, especially for brain stuff.

Hang in there. He's so freaking cute!
posted by Ruthless Bunny at 7:58 AM on May 8, 2014 [5 favorites]

Best answer: Cute kitty! A friend has a cat with epilepsy. He's been on meds for 8 years, now, and if you didn't know, you wouldn't know. He does have to have a different cocktail every now and again as his drug combo loses effectiveness. Each time he readjusts, he goes through something similar.
posted by clarkstonian at 8:29 AM on May 8, 2014 [2 favorites]

Best answer: It's perfectly normal for cats to hide and generally hate life for several days after an inpatient hospital stay, even without the phenobarb. Give him at least a week or 10 days, then check with the vet if it persists. They will be very experienced with adjusting the dosage to fit your cat's needs.
posted by Rock Steady at 9:57 AM on May 8, 2014 [3 favorites]

Best answer: Disclaimer: My experience with seizures is with a dog. But I will say phenobarbital is one of the oldest drugs used, and has the harshest side effects. I would advise talking to your vets about a more modern anti-seizure drug. We use Zonisamide on our dog Daisy, along with Potassium Bromide (a much safer alternative to phenobarb) in solution. I have also heard good things about Khepra, although I believe it is more expensive than zonisamide.

Also, you should know that when any mammal's brain has a seizure, the neural circuits get a little "scrambled" (not a medical term) and it is easier for that animal to have more seizures. Our own epileptic dog was also like a zombie for a month or so after her six grand mal seizures in 48 hours, but in the three years since she has recovered.

Practical information: For an 80 lb English Bulldog, a month's supply of zonisamide is cheapest in the USA from Costco pharmacy, and runs us around $25. The Potassium Bromide comes from an online pharmacy called Wedgewood, and is about $30 for 2-4 months supply. You would probably pay much less for a smaller cat. Of course if the seizures aren't from epilepsy, then the medication expenses aren't really applicable. Best of luck with your pet!
posted by seasparrow at 1:48 PM on May 8, 2014

Best answer: I can't recall if our cat got especially dopey when he started on the phenobarbital(about the same dosage). He was always pretty docile to begin with, but the drugs did make him a bit moreso as an ongoing baseline. As Rock Steady mentioned part of it may also be readjusting from the visit itself, and more of it general fogginess from the multiple seizures. Give it more time and see if he starts coming out of it. If it continues, you may just need a slightly lower dosage.

Since you just started, it's likely they'll adjust the dosage after a while anyway, to find a minimum that still controls the seizures. Ask about effects on the liver, if it hasn't come up. Ours gets Denamarin as a safeguard.

Something your vet might also neglect to mention is that changing the dose sometimes changes the "nature" of the seizures when they do happen; we ended up finding this out from the pharmacist. There was a period where such an adjustment resulted in the cat not locking up as much, so instead of seizing more or less in place, he'd turn into a hissing, screeching rage monster running around the house if we didn't pin him down fast enough. It sucked. So, if the dose does change, pay a little extra attention for a while after and talk to the vet if anything "interesting" surfaces.
posted by Su at 2:25 PM on May 8, 2014

Best answer: I’m Su's boyfriend, can second what he says about Jcksn's seizures.

Jcksn definitely goes through a dopey period when his meds get changed up. it takes 2-4 weeks for the phenobarb to get to therapeutic levels, so ymmv. anywhere in that period will be normal. he comes out of it afterwards.

if Banana ever ceases the meds, it'll be the same 2-4 wks to get everything out of his system.

our vet also recommended Denamarin twice a week to maintain effects on the liver. you can buy it on Amazon for substantially cheaper than locally. ask your vet if you're interested.

we've just begun switching Jcksn to a new drug called Zonegran (generic: zonisamide) which is also effective on seizures, but seems to let more of his natural mood come through where the phenobarb dampens things.

this is kinda tangential, but if you have a smartphone, an IFTTT account, and a Google account it works really well for charting Banana's (via spreadsheet) seizures over time.

hit me up (email in my profile) if you need to talk about seizure cleanup, keeping Banana happy afterwards, or whatever. we've been doing this for five years now. it gets easier.

good luck!
posted by patricking at 2:38 PM on May 8, 2014

Best answer: another thing I wanted to add, but forgot: Banana could possibly be hiding to feel safe from the seizures. chances are he can feel them coming on. Jcksn can definitely sense when his are coming, and it scares him senseless; i've read accounts from other folks whose companions have similarly seemed "spooked." if this is Banana's first experience with a seizure, stands to reason he could be extra freaked out at so many things changing so suddenly.
posted by patricking at 6:10 PM on May 8, 2014 [1 favorite]

Best answer: We had a dog on pheno for seizures, and she was logey after taking it. She got used to it after a few weeks. The seizures themselves, before the pheno, also made her logey, sometimes for several days.

(Amusing anecdote: My mother accidentally gave the dog a baby aspirin and took the dog's pheno one morning before work. She realized her mistake when she was falling asleep standing up at work, but didn't think too much of it, so she called the vet when she got home to make sure it was ok that the dog got an aspirin. The vet said, "Wait, wait... you took a dog's pheno dosage AND DROVE A CAR? AND WORKED? Don't do that again. Don't worry about the aspirin.")
posted by xyzzy at 9:08 PM on May 8, 2014

Response by poster: Thank you all! You're all the best!

I'm updating this thread with more information because the rarity of feline epilepsy makes the internet not all that useful on this topic, and maybe some future googler will see it: He is definitely showing signs of returning to normal on the 5th day of medication. Still super tired and a bit wobbly, but at least he's purring and seeking out affection, and in the middle of the night he went hunting for dish towels and drug one upstairs, which is classic Banana behavior. I am so relieved and hopeful he'll be back to his normal self soon and that we can keep the epilepsy under control.

(Also it is so cute to see internet strangers referring to my cat as Banana in conversation. Somehow his name doesn't seem hilarious to me until I hear it from an outside source.)
posted by something something at 7:19 AM on May 9, 2014 [1 favorite]

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