In dogs undergoing extrahepatic portosystemic shunt attenuation, does pretreatment with levetiracetam reduce postoperative seizure incidence?



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PICO question

In dogs undergoing surgical attenuation of a congenital extrahepatic portosystemic shunt, does pretreatment with levetiracetam reduce the incidence of post attenuation seizures?


Clinical bottom line

Category of research question


The number and type of study designs reviewed

Four papers were critically reviewed. All were retrospective cohort studies

Strength of evidence


Outcomes reported

In one paper levetiracetam was found to reduce the risk of post-attenuation seizures. In the remaining three papers no difference was found between the frequency of post-attenuation seizures and the use of levetiracetam


That prophylactic levetiracetam is not indicated for the use of preventing post-attenuation seizures in dogs surgically treated for extrahepatic portosystemic shunts


How to apply this evidence in practice

The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.

Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.


Open Access Peer Reviewed


Fryer, K.J., Levine, J.M., Peycke, L.E., Thompson, J.A. & Cohen, N.D. (2011). Incidence of Postoperative Seizures with and without Levetiracetam Pretreatment in Dogs Undergoing Portosystemic Shunt Attenuation. Journal of Veterinary Internal Medicine. 25(6), 1379–1384. DOI:

Gommeren, K., Claeys, S., De Rooster, H., Hamaide, A. & Daminet, S. (2010). Outcome from status epilepticus after portosystemic shunt attenuation in 3 dogs treated with propofol and phenobarbital. Journal of Veterinary Emergency and Critical Care. 20(3), 346–351. DOI:

Hardie, E.M., Kornegay, J.N. & Cullen, J.M. (1990). Status Epilepticus after Ligation of Portosystemic Shunts. Veterinary Surgery. 19(6), 412–417. DOI:

Matushek, K.J., Bjorling, D. & Mathews, K. (1990). Generalized motor seizures after portosystemic shunt ligation in dogs: five cases (1981–1988). Journal of the American Veterinary Medical Association. 196(12), 2014–2017.

Mullins, R.A., Sanchez Villamil, C., de Rooster, H., Kummeling, A., White, R.N., Thieman Mankin, K.M., Tivers, M.S., Yool, D.A., Anderson, D.M., Pratschke, K.M., Gordo, I., Brissot, H., Singh, A., Olive, M., Billet, J.P., Selmic, L.E. & Kirby, B.M. (2018). Effect of prophylactic treatment with levetiracetam on the incidence of postattenuation seizures in dogs undergoing surgical management of single congenital extrahepatic portosystemic shunts. Veterinary Surgery. 48(2), 164–172. DOI:

Otomo, A., Singh, A., Jeong, J., Dobberstein, R., Lundhild, A., Peter, E., Brisson, B., Oblak, M. & Milovancev, M. (2020). Long‐term clinical outcomes of dogs with single congenital extrahepatic portosystemic shunts attenuated with thin film banding or ameroid ring constrictors. Veterinary Surgery. 49(3) 436–444. DOI:

Packer, R., Nye, G., Porter, S.E. & Volk, H.A. (2015). Assessment into the usage of levetiracetam in a canine epilepsy clinic. BMC Veterinary Research. 11(1), 25. DOI:

Strickland, R., Tivers, M.S., Adamantos, S.E., Harcourt-Brown, T.R., Fowkes, R.C. & Lipscomb, V.J. (2018). Incidence and risk factors for neurological signs after attenuation of single congenital portosystemic shunts in 253 dogs. Veterinary Surgery. 47(6), 745–755. DOI:

Tisdall, P.L.C., Hunt, G.B., Youmans, K.R. & Malik, R. (2000). Neurological dysfunction in dogs following attenuation of congenital extrahepatic portosystemic shunts. Journal of Small Animal Practice. 41(12), 539–546. DOI:

Vol. 7 No. 3 (2022): The third issue of 2022

Section: Knowledge Summaries

Categories :  Small Animal  /  Dogs  /  Cats  /  Rabbits  /  Production Animal  /  Cattle  /  Sheep  /  Pig  /  Equine  /  Exotics  /