Neurologist In Sydney?

[DeltaCharlie]

Hi all,

I was just wondering if anyone has any recommendations for a canine neurologist in Sydney? My young girl has reached the point where we need to seek advice beyond what a run of the mill vet can provide. Her seizure clusters are getting much worse and I am receiving conflicting information in regards to medication schedules etc and am having drugs pushed onto me that all my research is suggesting will not be appropriate and could in fact make her worse. I would rather start dealing with someone who deals with seizure disorders on a daily basis and has experience to draw on when advising new medications etc.

I have heard that Georgina Child is very good, I believe she works out of SASH and also consults for Sydney Uni? I will try and make some calls tomorrow to find out consult prices etc but thought I would ask for opinions here first :)

TIA

[Xyz]

Definately Georgina. Hope you get some good results.

What medications is she currently on just out of interest?

[Jumabaar]

Georgina is quite amazing.

That being said all the internal medicine specialists (at ARH, SASH and USYD) deal with seizure disorders and are typically very up to date with the meds available as it is relatively common.

[_PL_]

Agreed! Georgina is fantastic :)

[DeltaCharlie]

She is a 14kg dog. Currently on 75mg phenobarb twice a day and 375mg keppra three times a day with diazepam used during clusters. She is also on 0.3 thyroxine twice a day for hypothyroidism. Her bloods were last tested in April so will be looking to test them again in the next few weeks. She is currently on day 5 of a cluster so I want to wait until all the loading doses are out of her system before we retest her. One vet is pushing for pexion which is fairly new in Australia but everything I am reading suggests that it won't help in her case and could actually make her worse as it is linked to increased seizure activity. I would rather try zonisamide as a 3rd drug if we need to as everything seems much more positive with it and it will work well with her current meds but the vet really wants to try the pexion. I will be speaking with my local vet (who is awesome and has dealt with her seizures from the start) tomorrow and will gauge her feelings. She has been off all week so I haven't had a chance to talk with her yet.

[Jumabaar]

I have Chinese herbs, Zonisaminde and Potassium Bromide for my Boof. It holds him most of the time but transitioning from Summer to Winter is a struggle.

I know Pheno can impact on the Zonisamide levels (decrease them) which is a downside of using them together and why we are using the KBr instead of Pheno.

J Vet Pharmacol Ther. 2008 Jun;31(3):259-64. doi: 10.1111/j.1365-2885.2008.00955.x.

Pharmacokinetics of zonisamide and drug interaction with phenobarbital in dogs.

Orito K1, Saito M, Fukunaga K, Matsuo E, Takikawa S, Muto M, Mishima K, Egashira N, Fujiwara M.

Author information

Abstract

The purposes of the present study were to elucidate the pharmacokinetics of zonisamide, determine the presence of a drug interaction with phenobarbital, and evaluate how long any interaction lasted after discontinuation of phenobarbital in dogs. Five dogs received zonisamide (5 mg/kg, p.o. and i.v.) before and during repeated oral administration of phenobarbital (5 mg/kg, bid, for 30-35 days). Zonisamide (5 mg/kg, p.o.) was also administered 8, 10, and 12 weeks after discontinuation of phenobarbital. Blood was sampled until 24 h after each zonisamide administration and serum concentrations of zonisamide were determined. Repeated phenobarbital decreased the maximum serum concentration, area under the serum concentration vs. time curve, apparent elimination half-life, and bioavailability of zonisamide. Total clearance increased. Time to maximum serum concentration and volume distribution were not changed. The maximum serum concentration and area under the serum concentration vs. time curve of zonisamide continued to be low until 10 weeks after the discontinuation of phenobarbital. They were restored to the same serum concentration as before phenobarbital administration 12 weeks after the discontinuation of phenobarbital. These data suggested that repeated administration of a clinical dose of phenobarbital enhanced the clearance of zonisamide and the enhanced clearance lasted at least 10 weeks after the discontinuation of phenobarbital. Caution may be necessary when zonisamide is given with phenobarbital and when antiepileptic therapy is changed from phenobarbital to zonisamide.

[DeltaCharlie]

I have Chinese herbs, Zonisaminde and Potassium Bromide for my Boof. It holds him most of the time but transitioning from Summer to Winter is a struggle.

I know Pheno can impact on the Zonisamide levels (decrease them) which is a downside of using them together and why we are using the KBr instead of Pheno.

J Vet Pharmacol Ther. 2008 Jun;31(3):259-64. doi: 10.1111/j.1365-2885.2008.00955.x.

Pharmacokinetics of zonisamide and drug interaction with phenobarbital in dogs.

Orito K1, Saito M, Fukunaga K, Matsuo E, Takikawa S, Muto M, Mishima K, Egashira N, Fujiwara M.

Author information

Abstract

The purposes of the present study were to elucidate the pharmacokinetics of zonisamide, determine the presence of a drug interaction with phenobarbital, and evaluate how long any interaction lasted after discontinuation of phenobarbital in dogs. Five dogs received zonisamide (5 mg/kg, p.o. and i.v.) before and during repeated oral administration of phenobarbital (5 mg/kg, bid, for 30-35 days). Zonisamide (5 mg/kg, p.o.) was also administered 8, 10, and 12 weeks after discontinuation of phenobarbital. Blood was sampled until 24 h after each zonisamide administration and serum concentrations of zonisamide were determined. Repeated phenobarbital decreased the maximum serum concentration, area under the serum concentration vs. time curve, apparent elimination half-life, and bioavailability of zonisamide. Total clearance increased. Time to maximum serum concentration and volume distribution were not changed. The maximum serum concentration and area under the serum concentration vs. time curve of zonisamide continued to be low until 10 weeks after the discontinuation of phenobarbital. They were restored to the same serum concentration as before phenobarbital administration 12 weeks after the discontinuation of phenobarbital. These data suggested that repeated administration of a clinical dose of phenobarbital enhanced the clearance of zonisamide and the enhanced clearance lasted at least 10 weeks after the discontinuation of phenobarbital. Caution may be necessary when zonisamide is given with phenobarbital and when antiepileptic therapy is changed from phenobarbital to zonisamide.

From most people I have spoken to it seems the zoni levels need to be doubled if the dog is also on pb. It also impacts on her thyroxine dosage. She is currently being tested for the abcb1 gene as part of a research study. If she carries this mutation it will change the drugs protocol as it means she is resistant to pb and other similar drugs. Current research suggests that 40% of bcs are unfortunately. If she is resistant to it then she will be weaned off and something will need to take its place as a primary. We are trying to avoid KBr at this point as she is such an active dog, it will be a last resort.

ETA which Chinese herbs are you using?

Edited July 12, 2015 by DeltaCharlie

[Danois]

I have seen Georgina in the past - admittedly with a cat but found her good.