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For over 150 years, antiepileptic drugs are the main treatment option for epilepsy, but how to best use each drug remains challenging for many clinicians. We will focus on treatment of idiopathic epilepsy. Idiopathic epilepsy has been defined by the International Veterinary Epilepsy Task Force by recurrent epileptic seizures (more than two unprovoked epileptic seizures at least 24 hours apart), unremarkable inter-ictal neurological examination and routine diagnostic tests with age at epileptic seizure onset of between six months and six years (Tier I confidence level). An unremarkable MRI of the brain and cerebrospinal fluid is necessary for the diagnosis of idiopathic epilepsy in dogs outside the aforementioned age frame and improves the confidence level of diagnosis (Tier II) within the aforementioned age-frame. Idiopathicepilepsy should not be seen as one single disease, but rather a variety of brain diseases in which the lesion was not identified on routine diagnostics. It is likely that idiopathic epilepsy represents a complex interplay between genetic predisposition and intrinsic and extrinsic environmental factors. Therefore, it is not surprising that dogs with idiopathic epilepsy will vary in their response to treatment. We will focus on current first-line anti-epilepticdrug treatment and how to use each individual drug appropriately. We will also discuss what can be expected from an antiepileptic drug in terms of efficacy, treatment of co-morbidities such as neurobehavioural disorders, and the impact of epilepsy and treatment on quality of life.
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