VIN NEUR100-0420: Seizure Management: Depolarization, Repolarization, and What we can do about it

The lectures for this course will be presented in an audio format using a webinar platform.

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Presenters: Anne Elizabeth Katherman, DVM, MS, DACVIM/Neurology
Dawn Boothe, Phd, DVM, DACVIM/Internal Medicine, DACVCP (Clinical Pharmacology)
Course Open: April 7-May 29, 2020
Real Time Sessions (RTS): Tuesday, April 14, 21, 28, May 5, 12, and 19, 2020; 9:00-11:00 pm ET (USA)
Course RTS Times in Your Area: World Clock Converter

Level and Prerequisites: This intermediate course will be open to veterinarians actively interested in seizure management.
VIN CE Course: Open to veterinarians. This course has been submitted for RACE approval for veterinarians.

Course Information:
The primary purpose of this course is to provide 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 or change the drug. The course will include a discussion of seizure pathophysiology, general principles of seizure management, drug monitoring and a discussion of the most commonly used anticonvulsants in the canine and feline species. Case examples will be provided to illustrate the principles of seizure management. Management of patients with cluster seizures and status epilepticus will be included and alternatives for anticonvulsants which are currently difficult to obtain will be discussed. The course will also include an overview of the diagnostic workup for patients with secondary seizures. Phenobarbital, Potassium Bromid, Zonisamide, Keppra, Keppra XR, Gabapentin, Pregabalin, and Imepitoin will be discussed.

Week 1 (Real Time Session April 14, 2020): Seizure Pathophysiology and Principles of Seizure Management
Presenter: Anne Elizabeth Katherman, DVM, MS, DACVIM/Neurology
Format: Audio
Objectives: Upon completion of this session, the participant should be able to
  • Identify the major excitatory and inhibitory neurotransmitters
  • Identify the location of action for each anticonvulsant
  • Explain how each anticonvulsant works
  • List the important factors for judging anticonvulsant efficacy
  • List the principles for adding and discontinuing anticonvulsants

Week 2 (Real Time Session April 21, 2020): Introduction to Anticonvulsants and How They Work
Presenter: Dawn Boothe, Phd, DVM, DACVIM/Internal Medicine, DACVCP
Format: Audio
Objectives: Upon completion of this session, the participant should be able to
  • Given the half-life and dosing interval of a drug:
    • determine if the drug will “fluctuate” or “accumulate”,
    • describe the best approach to monitoring;
    • choose an appropriate response to modification of the dosing regimen in a patient that has failed therapy
  • Implement a monitoring program based on an understanding of when and why anticonvulsant monitoring can be helpful in making decisions regarding addition or changes to anticonvulsant medication.
  • Given the mechanism of action and the disposition of a drug, predict:
    • the relative risk of the drug in causing adverse events and how disease or other patient factors might impact the safety of that drug
    • the relative risk of drug interactions
    • predict the most appropriate anticonvulsant combination.
  • Given a new “human” drug, identify the reasons why this drug should or should not be used without scientific studies in the target species.

Week 3 (Real Time Session April 28, 2020): Introduction to Anticonvulsants and How They Work - continued
Presenter: Dawn Boothe, Phd, DVM, DACVIM/Internal Medicine, DACVCP
Format: Audio
Objectives: Upon completion of this session, the participant should be able to
  • Factors that might impact oral absorption and drug distribution
  • Predict whether or not the drug is likely to cause adverse events and how to monitor and respond to these adverse events
  • Predict clinically relevant drug interactions and how to prevent or respond to them
  • Establish an individualized monitoring program for that drug for the patient
  • Describe the circumstances upon which the patient will be declared refractory to monotherapy with that drug
  • Identify the most appropriate add-on anticonvulsant for the patient and re-adjust the monitoring program for that patient accordingly

Week 4 (Real Time Session May 5, 2020): Uncomplicated Case Based Seizure
Presenter: Anne Elizabeth Katherman, DVM, MS, DACVIM/Neurology
Dawn Boothe Phd, DVM, DACVIM/Internal Medicine, DACVCP
Format: Audio
Objectives: Upon completion of this session, the participant should be able to
  • Design and implement a safe and effective anti-epileptic treatment course for the anti-epileptic naïve patient. This includes:
    • Identify the major excitatory and inhibitory neurotransmitters
    • Choosing an appropriate anticonvulsant for the patient based on presentation, patient factors (i.e., signalment) and client considerations (including cost of drug and monitoring)
    • Prescribe an initial dosing regimen
    • Design and implement a monitoring program for the patient, based on clinical signs, clinical pathology and therapeutic drug monitoring
    • For therapeutic drug monitoring program with a focus on when, and how
    • Determine if and when a patient has failed the initial drug
    • Choose the most appropriate approach to failure
    • Identify key concepts to transmit to the client that will proactively minimize emerging adverse events (including therapeutic failure) in the patient

Week 5 (Real Time Session May 12, 2020): Complicated Case Based Seizure Management - continued
Presenter: Anne Elizabeth Katherman, DVM, MS, DACVIM/Neurology
Dawn Boothe Phd, DVM, DACVIM/Internal Medicine, DACVCP
Format: Audio
Objectives: Upon completion of this session, the participant should be able to
  • Design and implement a safe and effective anti-epileptic treatment course for the complicated anti-epileptic naïve patient. This includes all of the objectives in week 4, with an added emphasis of:
    • Choosing the most appropriate add-on antiepileptic
    • Identifying the risk of adverse drug events and drug interactions between combination antiepileptics
    • Designing therapeutic interventions that might be proactively or after the fact implemented to reduce the risk of adverse events
    • Modify a monitoring program as needed for combination therapy
    • Determine when a patient has failed each stepwise modification of an antiepileptic drug regimen
    • Identify non-traditional medications that might support the refractory epileptic.

Week 6 (Real Time Session May 19, 2020): Seizure Pathophysiology and Principles of Seizure Management
Presenter: Anne Elizabeth Katherman, DVM, MS, DACVIM/Neurology
Format: Audio
Objectives: Upon completion of this session, the participant should be able to
  • Understand the difference between cluster seizures and status epilepticus.
  • Develop knowledge of the anticonvulsant options for specific treatment of cluster seizures.
  • Follow a logical approach to the treatment of status epilepticus.
  • Know the signs of cerebral edema and the appropriate drugs for attempting to counteract it.
  • Recognize those patients that are most likely to have secondary seizures based on signalment, history, physical, neurological and laboratory examination results.
  • List the general categories of diseases which can cause secondary seizures.

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.

About the Presenters:
Anne Elizabeth Katherman serves as a Veterinary Information Network neurology consultant. In addition she develops continuing education courses on neurology topics for VIN, does research for the VIN Drug Formulary and is the associate editor for the neurology chapters in the VIN online textbook Associate. Dr. Katherman did her residency training at Purdue and Auburn Universities. Dr. Katherman lives in Hampton, Virginia. Dr. Katherman previously owned a Neurology and Neurosurgery specialty practice in Yorktown and Virginia Beach, Virginia, worked in both specialty and general practices in Washington DC, Maryland and Virginia and was an assistant professor at the Virginia Maryland Regional College of Veterinary Medicine. She has served on various ACVIM committees and has been a reviewer for the JACVIM.

Dawn Boothe graduated from Texas A&M University (TAMU) in 1977 and 78 (BS), and a Doctor of Veterinary Medicine in 1980. After an internship at Auburn University, she returned to TAMU to complete an MS in Physiology a residency in small animal internal medicine (becoming board certified in 1985), and a PhrMA Fellowship and PhD in Veterinary Clinical Pharmacology (1989). She is among the first class of diplomates in the American College of Veterinary Clinical Pharmacology (1991). In 1990, she joined TAMU in the Department of Veterinary Physiology and Pharmacology, reaching Professor in 2003. She then joined the departments of Anatomy, Physiology and Pharmacology and Clinical Sciences at Auburn University’s College of Veterinary Medicine as Professor. She directs the Clinical Pharmacology Laboratory, serving over 4000 national and international veterinary practices. She actively teaches in the 1st through 4th veterinary students, and has mentored over 31 graduate students or Clinical Pharmacology Residents. Dr. Boothe has received over $1.7M research funding as principle investigator, has authored or coauthored over 125 peer-reviewed scientific publications, 2 text books and over 60 book chapters. Major awards include a University Achievement Award in Teaching at Texas A&M University, the Jack Mara Scientific Achievement Award for Scientific Achievement (national), and at AU, graduate student mentor awards (University and College level) and the Zoetis Award for Excellence in Research. She most recently was recognized by Auburn University with an Alumni Professorship.

Total CE Credit: 12

Tuition: Member $276 ($248 early bird special if enrolled by March 24, 2020)
Non-Member $413 ($312 early bird special if enrolled by March 24, 2020)
Prices are listed in US dollars.

*To ensure participants are ready and prepared for classes, enrollment will close on April 14, 2020 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.

To Enroll:
  1. 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.
  2. 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.
  3. Each person is individually responsible for his/her own registration. To ensure that all information received is secure and correct, please do not enroll for a course on behalf of another individual.
  4. For further assistance call 800-846-0028 ext. 797 or email . Please include the course title, your full name, and contact information in your correspondence.
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"This program (RACE program number to be determined) has been submitted for approval by AAVSB RACE to offer a total of 12 CE Credits, with a maximum of 12 CE Credits being available to any individual veterinarian. This RACE approval is for the subject matter categories of: Medical, using the delivery method of Interactive-Distance: (Web-based, Teleconference or Audio-Conference). This approval is valid in jurisdictions which recognize AAVSB RACE; however, participants are responsible for ascertaining each board's CE requirements."

Course withdrawal and refund policy: A complete refund of the paid course price will be issued when your withdrawal request is received prior to the listed start date of the course. If you wish to withdraw after the start date please contact the VIN office 800-846-0028 ext. 797 to discuss eligibility for a pro-rated refund.

*For more information on VIN's upcoming CE courses, check the VIN Course Catalog.

Katherine James, DVM, PhD, DACVIM (SAIM)
VIN Education Director

VIN CE Services:
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