Vet.Emerg., Jun/22: Suspected benzo withdrawal-associated seizures in 3 dogs...

The full title of this case report from the Journal of Veterinary Emergency and Critical Care is "Suspected benzodiazepine withdrawal-associated seizures in 3 young dogs undergoing mechanical ventilation".

https://pubmed.ncbi.nlm.nih.gov/35708738/

Abstract

Objective: To describe new onset of generalized seizures in 3 young dogs following cessation of a benzodiazepine-containing sedation protocol to facilitate mechanical ventilation (MV) for hypoxemia.

Series summary: Three dogs under 5 months of age underwent MV due to severe hypoxemia. All 3 dogs were sedated with a constant rate infusion of benzodiazepines as part of their sedation protocol to facilitate MV. All 3 dogs had an acute onset of generalized seizures within 36 hours of sedation cessation and weaning from MV. All 3 dogs' seizures were successfully managed with a slow, tapering course of benzodiazepines. One dog was additionally treated with levetiracetam at the time of initial seizure activity, which was discontinued 1 year following discharge and absence of ongoing seizure activity. All 3 dogs were discharged successfully with no reports of ongoing seizures or neurologic deficits after discharge.

New or unique information provided: Young dogs managed with benzodiazepines to facilitate MV may have acute onset of generalized seizures following cessation, which can be successfully managed with short-term benzodiazepine therapy. The 3 cases in this series demonstrated a positive outcome and were successfully managed following acute onset of generalized seizure activity post-MV.

Interesting find, Lapis2. Thank you.

Here’s a link to the full paper:

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/vec.13221

Per the Discussion section:

“All seizures were controlled with re-institution of benzodiazepine boluses and constant rate infusions that were slowly tapered.”

Here’s how the authors operationalized ‘slowly tapered’ in the 3 cases:

Case 1: The midazolam infusion was continued at 0.2 mg/kg/h for 10 hours and then slowly weaned over the following 31 hours before discontinuing.

Case 2: Following the second seizure, a continuous infusion of midazolam was initiated at 0.3 mg/kg/h. The infusion was continued at this rate for 24 hours, slowly weaned over the next 12 hours, and discontinued after a total of 36 hours.

Case 3: The dog was placed on a midazolam constant rate infusion at 0.25 mg/kg/h that was slowly weaned over the subsequent 24 hours.