Dawn Boothe, Phd, DVM, DACVIM/Internal Medicine, DACVCP (Clinical Pharmacology)
Course Open: April 20-July 2, 2022
Real Time Sessions (RTS): Wednesdays, April 27, May 4, 18, 25, June 1, 8, 15, and 22, 2022; 9:00-11:00 pm ET (USA) World Clock Converter
Total CE Credit: 16
RACE Category: 16 hours Medical Skip to Enrollment Course Information:
The primary purpose of this course is to improve the ability of participants to manage seizure patients by providing an in-depth understanding of how various anticonvulsants work and how to use this information to make decisions regarding which anticonvulsant to use for a given patient and when to alter the dose, add or change the drug. The course will include a discussion of seizure definitions and classification, formulating a diagnostic plan for the seizure patient based on signalment and history, and general principles of seizure management. Neurophysiology and seizure pathophysiology will be discussed as it pertains to anticonvulsant action. Use and therapeutic drug monitoring of the most commonly used anticonvulsants in the canine and feline species including Phenobarbital, Bromide, Zonisamide, Levetiracetam, Gabapentin, Pregabalin and Imepitoin will be covered and current knowledge of the potential use of cannabinoids for seizure control will be discussed. Case examples will be provided to illustrate the principles of seizure management. Management of patients with cluster seizures and status epilepticus will be included. Learning Objectives:
Upon completion of the course, the participant should be able to
- Given seizure phenotype:
- differentiate a seizure from other episodic events
- determine if the seizure is a generalized seizure or a focal seizure
- Given signalment and history:
- determine the likely etiologic classification of an individual seizure patient.
- recommend an appropriate diagnostic plan.
- recommend an appropriate treatment plan.
- Use the principles of seizure management to:
- accurately assess anticonvulsant efficacy.
- decide when and how to add, load and discontinue the common anticonvulsants in any given patient.
- Identify the major excitatory and inhibitory neurotransmitters and their role in seizure pathophysiology.
- Understand the role of Na+, K+, Cl- and Ca++ in neurotransmission.
- Relate this pathophysiology to the pharmacodynamics of commonly
and less commonly used antiseizure medications:
- Benzodiazepines, Phenobarbital, Bromide, Zonisamide, and Levetiracetam as major antiseizure medications
- Gabapentin/Pregabalin, Imepitoin
- Cannabidiol
- Describe the role of therapeutic drug monitoring in achieving therapeutic success
- Given the disposition (pharmacokinetics) of the different anticonvulsant drugs:
- Anticipate the characteristics which might represent the “ideal” antiseizure medication
- Predict the role of transport proteins and drug metabolizing enzymes in establishing plasma drug concentrations
- Describe the relationship between drug elimination half-life and dosing interval of a drug
- Impact on “fluctuate” or “accumulate”
- Impact on dosing interval and time to steady-state
- Impact on approach to therapeutic drug monitoring
- Impact on adjusting dosing regimens in response to therapeutic failure
- Relate route of antiseizure drug elimination to risk of adverse events, likelihood of drug or diet interactions, and impact of disease on response
- Given the pharmacodynamics and pharmacokinetics (disposition) of a drug, predict:
- the relative risk of the drug in causing adverse events
- how disease or other patient factors might impact the safety of that drug
- predict the most appropriate anticonvulsant combination for refractory patients
- Maximize the use of therapeutic drug monitoring to
- identify individual patient therapeutic range to the various antiseizure medications
- adjust dosing regimens in response to disease, changes in drug disposition, and
- in response to therapeutic failure
- in response to drug interactions
- Regarding cannabinoids and epilepsy:
- describe the physiology of endocannabinoids as it relates to seizures
- Identify the sources of phytocannabinoids
- Delineate the challenges of using “dietary supplements” as a source of cannabidiol
- Support or refute the evidence of medical cannabinoids for control of epilepsy in humans and animals
- Support or refute the evidence of safety of medical cannabinoids for control of epilepsy in humans or animals
- Predict the role of cannabidiol in the treatment refractory epilepsy.
- Regarding long term clinical management of epilepsy:
- Recognize those patients that are most likely to have reactive seizures or structural epilepsy based on signalment, history, physical, neurological and laboratory examination results.
- List the general categories of diseases which can cause reactive seizures or structural epilepsy
- Describe the circumstances upon which long term antiseizure therapy should be implemented
- Determine criteria upon which one drug might be chosen over another
- Delineate a monitoring program for the patient based on the chosen drug (both clinical pathology and drug monitoring)
- Determine at what point a patient is determined to be refractory to monotherapy with the first-choice drug
- Identify the most appropriate add-on anticonvulsant for the patient and re-adjust the monitoring program for that patient accordingly
- Regarding short term management of cluster seizures and status epilepticus:
- Discriminate between cluster seizures and status epilepticus.
- Delineate antiseizure medications and their various routes of administration for specific treatment of cluster seizures.
- Describe a logical approach to the treatment of status epilepticus.
- Identify the signs of cerebral edema and the appropriate drugs for attempting to counteract it.
Accreditation: This course is approved for 16 hours of continuing education credit by RACE for veterinarians. (RACE 20-903163) Course Agenda: Week 1 (Real Time Session April 27, 2022): Principles of Seizure Management
Presenter: Anne Elizabeth Katherman
This session will focus on seizure definitions, classification of seizures by etiology and phenotype, and developing an appropriate diagnostic and treatment plan based on etiologic classification. An introduction to the principles of seizure management including drug selection, judging efficacy, adding, loading and weaning off anticonvulsants will be included. Week 2 (Real Time Session May 4, 2022): Neurophysiology and Seizure Pathophysiology
Presenter: Anne Elizabeth Katherman
This session will cover the roles of Na+, K+, Cl- and Ca++ in neuronal depolarization, repolarization and transmission, the major excitatory and inhibitory neurotransmitters and their receptors, and factors effecting neuronal hyperexcitability and hyper synchronization. The site and mechanism of action of Phenobarbital, Bromide, Levetiracetam and Imepitoin and the proposed site and mechanism of action for Zonisamide will be introduced. **** BREAK - May 11, 2022 - No Real Time Session **** Week 3 (Real Time Session May 18, 2022): Introduction to Antiseizure Therapy: Principles of Therapy
Presenter: Dawn Boothe
This session will introduce the rationale behind antiseizure medications, and the challenges in using them safely and effectively based on general disposition considerations. The relationship between half-life and dosing interval as it relates to the design of the dosing regimen and the use of therapeutic drug monitoring to enhance therapeutic success will be addressed. Week 4 (Real Time Session May 25, 2022): Antiseizure Medications and Long-Term Management of Epilepsy
Presenter: Dawn Boothe
This session will apply the principles learned in the first session to the most commonly used antiseizure medications, including Benzodiazepines (short term management), Phenobarbital, Bromide, Zonisamide, and Levetiracetam as major antiseizure medications. Gabapentin/Pregabalin and Imepitoin will be briefly discussed. Week 5 (Real Time Session June 1, 2022): Cannabinoids and Epilepsy
Presenter: Dawn Boothe
Medical cannabinoids are the hottest new therapeutic intervention for just about anything. But is their efficacy for treatment of epilepsy real? Are they safe? This session will describe the role of endocannabinoids in neuronal physiology as it relates to seizures and describe the evidence of cannabidiol as a safe and effective antiseizure medication for refractory epilepsy. Challenges as they relate to regulations and quality product will be discussed. Week 6 (Real Time Session June 8, 2022): Case-Based Seizure Management; The Uncomplicated Patient
Presenters: Anne Elizabeth Katherman and Dawn Boothe
This session will consist of a series of seizure cases and poll questions for participants to practice what they have learned in the preceding sessions regarding initial classification, diagnostic recommendations, seizure management and therapeutic drug monitoring. Week 7 (Real Time Session June 15, 2022): Case-Based Seizure Management; The Complicated and Refractory Patient
Presenters: Anne Elizabeth Katherman and Dawn Boothe
This session will consist of a series of seizure cases and poll questions which will provide participants practical experience with managing patients on multiple anticonvulsants and those which are refractory to anticonvulsant medication. Emphasis will be placed on considering adverse drug reactions and drug interactions. Week 8 (Real Time Session June 22, 2022): Cluster Seizures and Status Epilepticus
Presenters: Anne Elizabeth Katherman and Dawn Boothe
This session will cover the definitions and pathophysiology of cluster seizures and status epilepticus and discuss diagnostic recommendations, supportive measures and the use of short and long-term anticonvulsant medication in such patients. Successful completion (scoring 80% or better) on the end-of-course test is required to earn a certificate of completion for the course. To learn more about the requirements for earning a CE certificate, please refer to Receiving Your CE Credit and Course Completion Certificate. Course Materials: Course materials will be available in the course library prior to each Real Time Session.
Required Textbook(s): There is no required textbook for this course.
Enrollment is closed.
Tuition: Member $368 ($331 early bird special if enrolled by April 6, 2022)
Non-Member $519 ($467 early bird special if enrolled by April 6, 2022)
Prices are listed in US dollars. *To ensure participants are ready and prepared for classes, enrollment will close on April 27, 2022 at 5 pm ET (USA) or when the maximum number of participants is reached. *For more information on how online CE works, see the Participant Resource Center.- Enrollment qualifications: VIN CE courses are open to VIN member and non-member veterinarians. Veterinarians enrolling in a VSPN CE course must be a VIN member. Veterinary support staff must be a VSPN member to enroll in a VSPN CE or a VIN CE course open to VSPN member enrollment.
- Each enrollee must be able to receive emails from @vspn.org and @vin.com addresses. Email is our major form of communication with participants; personal emails are highly recommended rather than clinic/hospital email addresses.
- For further assistance call 800-846-0028 ext. 797 or email CEonVIN. Please include the course title, your full name, and contact information in your correspondence.
VIN Education Director VIN CE Services: CEonVIN
800-846-0028 or 530-756-4881; ext. 797
or direct line to VIN/VSPN from the United Kingdom: 01 45 222 6154
or direct line to VIN/VSPN from Australia: 02 6145 2357