Researchers from Ghent University (UGhent), Austria Veterinary Medicine School (Austria VetMed) and the Royal Veterinary College (RVC) have published the first systematic review of the evidence for the efficacy and safety of all anti-epileptic drugs (AEDs) in feline epilepsy.

The aim of the study was to assess the efficacy and adverse effect profile of each individual AED by analysing all available data published and then evaluating how reliable it was.

The researchers gathered, screened and assessed all the information published in peer-reviewed journals and publications. The individual studies were then evaluated based on the quality of evidence, study design, study group sizes, subject enrolment quality and overall risk of bias, as well as the efficacy and safety outcome measures.

Lead-author, Marios Charalambous from Ghent University, said: "We recruited systematic methods to combine, compare and summarise the results of independent studies and, therefore, create more objective and reliable conclusions based on the current evidence. It was a time-consuming, demanding and challenging process, and we hope we provided the clinicians now with essential information which they can use for daily practice." 

The researchers found that much of the evidence for the medical treatment of feline epilepsy was based on below-par reporting of efficacy and adverse effect, worse than what was formerly reported in dogs.

The lack of good quality evidence led authors to conclude that it would be: "...rather inaccurate to make definite statements on which one [AED] should be considered as a first or second choice in terms of both efficacy and safety profile. However, if clinicians focus on AED’s efficacy, phenobarbital can be used as first-choice monotherapy and if they focus on AED’s safety, imepitoin or levetiracetam can be used." 

Holger Volk, Head of the Department Clinical Science and Services and Professor of Veterinary Neurology and Neurosurgery at the RVC, said: "Not only does this study offer a new perspective on the management of feline epilepsy, but also highlights the importance of the need for trials which provide high quality evidence in order to have more reliable and objective results about the efficacy and safety of the AEDs in feline epilepsy."

The study was published in BMC Veterinary Research (https://doi.org/10.1186/s12917-018-1386-3).