Phenobarbital - experiences?

[Antonio65]

I went online to check what studies have been carried out on its effectiveness on Cats and it’s only been studied once back in 2014 which involved 30 cats and found it was 50% effective” it also lowers the effectiveness of any other prescribed medications.All studies are reported to the US National Library of Medicine btw. So what ever side effects your reporting your vet doesn’t have a lot to go by.
I don’t feel qualified to suggest anything - phenobarbital given to cats sounded a bit odd.

This is what the neurologist and the other vets told me. There are fewer studies on cats than on dogs, but they reckon that it might work just the same.
The package shows a dog on the label, but it happens often for other drugs, when the manufacturer has to apply for authorization

I am not even sure that my cat needs this drug, but I want to give it a try and see if she stops having her moments when she seems confused and lost in our home for a few days. She acts this way for a week or so, then she resumes her usual habits for ten days to two weeks, then again. But she also has longer moments of normalcy.
The neurologist is adamant it is a focal epilepsy, and he prescribed this drug.

 

[Antonio65]

Update

We're well into the eighth week of treatment.

Things seem to be rather settled. Freya is fine, alert, has a good appetite, and is quite playful, though she keeps losing balance when she quickly changes direction when she chases her toys. She seems also a little slower at catching them when I throw them at her, and she often misses them. We have a simple wooden stair to help them reach the window sill. They have always used it with no problem at all. In the last couple weeks Freya has tumbled down the steps a few times, and she fell on the floor from the top step once.

This is a photo of Giada (L) and Freya (R) on the stair to the window sill. Freya tumbled down a few times, also she fell from the top step, as high as the sill, about 3 feet from the floor (tiled).

Again, since Thursday (it's always a Thursday, isn't it?) it seems her poops are softer and not properly shaped.
But what's absolutely annoying is that since three days ago she started meowing and howling, randomly in the day, at walls, doors, windows, at the top of her voice, and there's nothing I can do to stop her. She paces from door to window, from room to room, meowing out loud. And yesterday she darted out the door to the yard and wouldn't go back inside. Something she did only twice last year, but I can't remember if she was meowing out loud in those periods.

 

[NekoM]

That sounds really positive, phenobarbital is known to occasionally affect vision, which may be slowing her coordination slightly, but if she’s active and eating she’s staying healthy. Has your Vet been monitoring her eyesight? If not this is a link I’ve used before on how to do a simple home vision test for a cat. It’s a side effect that’s worth checking occasionally.
How to Test a Cat's Vision

 

[Kflowers]

Looking at the kitties' window ladder, I'm wondering if you could make a little wall/gate to go over the open end at the top. If the problem is her depth perception that would let Freya know absolutely when she was at the edge and would keep her from stepping off the upper step. It would also keep both of them from doing the "sitting here, stretching, fell off of the whatever" that cats will do from time to time. You wouldn't need anything heavy or fancy, just a couple of strips of light wood. If the side pieces aren't thick enough for nails/screws you can buy L shaped brackets to attach to the side pieces and the covering piece.

 

[Antonio65]

That sounds really positive, phenobarbital is known to occasionally affect vision, which may be slowing her coordination slightly, but if she’s active and eating she’s staying healthy. Has your Vet been monitoring her eyesight? If not this is a link I’ve used before on how to do a simple home vision test for a cat. It’s a side effect that’s worth checking occasionally.
How to Test a Cat's Vision

Thanks, I didn't know about phenobarbital affecting vision, though only occasionally. I didn't find any mention to that in any page I found before starting the therapy.
Well, I haven't run the 7 steps in the link you provided, Freya is sleeping now, but I am quite sure that she would pass them all. She can see the tiniest midge on the ceiling, she watches the birds on the tree outside the window, or tries to catch the pointer of the mouse on my PC, so I guess that she is able to see small object, even slowly moving like the cursor on the PC monitor.
But what you say is interesting in that during the first of the two specialist visits with the neurologist, he ran some quick tests in the room and concluded that Freya had a poor sight only because she didn't react to the threat test (Step 2 in your link), while I was sure she can see better that I can.
My vet didn't check Freya's eyesight on the last visit, but I will ask her to do it next month, when the vaccines boosters are due.

My Rainbow Bridge cat Lola had partially lost her sight due to a BP surge, but she regained her sight and lost it again several times in her last year of life. This thing would puzzle all the ophthalmologists we saw, and one of them was a highly regarded professor. According to them, Lola was totally blind due to a dual retina detachment, but I had evidence that she could see perfectly, though not everyday. She could see the people walking across the street behind a closed window, and would follow them with her eyes. She was able to avoid obstacles that I would put before her steps. She could navigate a room she had never seen before.
Then, there were days when she would walk into the table legs, or other object that had always been there.
So, after those experiences, what ophthalmologists say does not impress me much

Nonetheless, I will try most, if not all, the steps in your link. Thanks!

 

[Antonio65]

Looking at the kitties' window ladder, I'm wondering if you could make a little wall/gate to go over the open end at the top. If the problem is her depth perception that would let Freya know absolutely when she was at the edge and would keep her from stepping off the upper step. It would also keep both of them from doing the "sitting here, stretching, fell off of the whatever" that cats will do from time to time. You wouldn't need anything heavy or fancy, just a couple of strips of light wood. If the side pieces aren't thick enough for nails/screws you can buy L shaped brackets to attach to the side pieces and the covering piece.

Actually this was something that I've had in mind for years, especially when my sweet Lola was using the ladder. Lola had become very weak due to a disease, and wasn't able to jump right onto the sill from the floor, so I built that ladder. Lola went to the Bridge 6 years ago, but the ladder stayed there, and even young kittens that I fostered years ago would use it.

No cat, not even Lola who was weak, elderly, blind, etc, had ever fallen from the top step. So, even if the project for a guard around it was in my mind, I thought it would have been useless... until now.
Rather than a lack of depth perception, I would say that Freya has an occasional lack of balance. It only happened once that he fell from the top, and she rarely goes up there, she usually stops on the second to last step because it's closer to the radiator and its warm air when it's on.
What happened at least three times so far is that she tumbled down from her favorite step, probably while she was trying to change position.

The reason why the ladder has a guard on the outer side is that Lola had fallen once, on a day when she was weaker than her usual during her disease. The original design had no guard.

So, what is concerning me is that she seems to have a certain lack of balance on quick changes of direction or position, and I wonder if this is a consequence of the medicine.

She stopped meowing and yowling at 3:30 pm, after I took her our on her leash for a few minutes.

 

[Antonio65]

Update.

We're close to the end of the ninth week of treatment, we're going to start the tenth week on Thursday.

This last week went by quite quietly, with no particular signs from Freya. She's been eating and using the litter box regularly, no weird moments.
She's still a slow eater, she takes twice as long to finish the same amount of canned food, and she's still losing some bits from her mouth every now and then. In the last three days it seems she has a bit less appetite, in that she isn't finishing her meals, or, like the past two nights, she doesn't even want to eat at all, though she eats well three hours later. Hopefully, this slight lack of appetite isn't the prelude of a period of what I think is a heat, like I witnessed in the past.

Yesterday we had an appointment for their rabies vaccine boosts, so I had the chance to speak with the vet rather than calling her on the phone to update her. Of course, the vet who was following me in the last three or four months wasn't there, it seems she's been moved to another clinic, another vet that I know well took her place, but she had to be filled in...
She said that from what I told her, and from the long vocalization that Freya had about a week ago, she thinks this might well be a sign of heat. She proposed me to have an implant of deslorelin done to suppress these heat cycles. I told the vet that the last time I spoke with one of them, they told me that Freya couldn't be in heat, because she had been spayed before and the LH test came back negative (but she tested positive 6 months earlier). I told her that I am against it, I do not want chemicals into my cat especially if we don't know if they are of any help, she said that this is the only way to fix this problem, a problem that according to the other vet doesn't even exist!
See? This is what I can't stand. Each vet has a different opinion and approach to the same issue.
Can't trust any of them anymore!

 

[Margot Lane]

Just catching up on this thread all at once: what a brave and loving pet owner you are! I can’t imagine how much all this is costing you, but perhaps things are more affordable in Italy than the US. Can you catch me up on one thing I am not seeing and that is, when you are allowed to stop the phenobarbital? Or is it more of wait and see weekly approach? The only thing I can add of any help, if it is, is that my sister suffers from Grand Mal seizures, and she wants the exact same thing Freya wants afterwards: comfort and reassurance. She says when she comes out of them, she has no idea who she is, where she is or what has happened, and all she wants is a calm voice telling her everything is OK. (So that is probably what Freya would tell you, if she could). Just a suggestion on the deslorelin, you could approach it thusly: if this phenobarbital does no good in the long run, why not try this other approach and see?

 

[Kflowers]

This is terrible. Really there is no other word for the vets alternating their diagnose and insisting they are the only ones who are right and your cat must have this or that. Is there any way you could go to the clinic where the last vet who suggested the phenobarbital is now practicing? I'm not saying change vets, but I think it might help if you could talk to her and have her test to see if what she suggested is helping or not.

Not that tests seem to be that effective. Perhaps I don't understand these things, but it seems to me that either the hormone they are testing for is there or not. Unless the hormone is suppressed totally except when a cat is in heat. Is that possible? And, if it is, why hasn't anyone told you that before?

 

[Antonio65]

Just catching up on this thread all at once: what a brave and loving pet owner you are! I can’t imagine how much all this is costing you, but perhaps things are more affordable in Italy than the US. Can you catch me up on one thing I am not seeing and that is, when you are allowed to stop the phenobarbital? Or is it more of wait and see weekly approach? The only thing I can add of any help, if it is, is that my sister suffers from Grand Mal seizures, and she wants the exact same thing Freya wants afterwards: comfort and reassurance. She says when she comes out of them, she has no idea who she is, where she is or what has happened, and all she wants is a calm voice telling her everything is OK. (So that is probably what Freya would tell you, if she could). Just a suggestion on the deslorelin, you could approach it thusly: if this phenobarbital does no good in the long run, why not try this other approach and see?

First of all, let me say that I'm so sorry for your sister, I know how hard it is. Yes, calm, a sweet approach and some loving words are of help after those terrible minutes!
Is your sister on the same drug as Freya is? How is it working for her? Is the drug able to control most of her seizures?

To answer your question, according to what the vets told me at the beginning of this path, there should be no end to this therapy, it's a life-long therapy, or at least until it is considered necessary.
My opinion is still that Freya might not have any epilepsy. In the last two years, she had some weird episodes, when she mostly showed to be lost in the house, distracted, confused. She never had any of the classic seizures as we know them. And she only showed this behavior, she only had these "blank periods", from late March/April, to October, both in 2021 and 2022. This is strange, isn't it?
Right now we can't tell if the drug is working, because we are in those 5 months when nothing happened in the past two years either.

This weekly update, this kind of a journal, is just for those who want to listen and learn something from my experience.

As for the deslorelin, as far as I have understood, it is something put under the skin, and this implant releases this drug that suppresses the hormones. Once it is implanted, in can't be removed. So, I wouldn't like to have something in my cat that doesn't stop working when I want to.

The costs aren't that high.
Vet visits, tests, scans, drugs are really inexpensive here compared to what one could pay in the US.
The Phenoleptil (the drug I'm giving Freya) comes in a package of 100 tablets, for €10. Those 100 tablets are nearly 7 months worth of therapy.
A vet visit is around €40, a specialist neurologist visit is €100, a complete blood work is €80.

 

[Antonio65]

This is terrible. Really there is no other word for the vets alternating their diagnose and insisting they are the only ones who are right and your cat must have this or that. Is there any way you could go to the clinic where the last vet who suggested the phenobarbital is now practicing? I'm not saying change vets, but I think it might help if you could talk to her and have her test to see if what she suggested is helping or not.

To be honest, I'm quite glad for getting rid of the vet who had been following my case in the last few months. She looked a little "messy" in my opinion. She would say things that then she would correct, and the worst thing was that she seemed not to listen to and memorize words.
The clinic where I go to is part of a chain of clinics. This vet was coming from one of the other clinics in the same chain, only 8 miles away, and she got back to that clinic. Her place was taken by this senior vet that I knew already from another practice, so I feel more comfortable now.

Not that tests seem to be that effective. Perhaps I don't understand these things, but it seems to me that either the hormone they are testing for is there or not. Unless the hormone is suppressed totally except when a cat is in heat. Is that possible? And, if it is, why hasn't anyone told you that before?

From what I have read, the LH is always present when a cat or dog has been correctly and fully spayed (LH test > 1 ng/ml), but it is suppressed when the pet is in heat. If Freya had been correctly spayed, then why was the test positive (LH < 1 ng/ml) in May 2022?
There can be a mistake somewhere.

 

[Antonio65]

UPDATE - 200 days

Yesterday was the 200th day since I started the treatment with Phenobarbital to my Freya.
The medicine was prescribed by a neurologist following a diagnosis of a possible focal epilepsy of idiopathic nature, though my Freya never showed any classic signs of that disease. Her main issues were that she would cyclically show moments when she was kind of lost in the house, she couldn't remember where her dishes were, she couldn't recognize her name or us, she didn't want to play, she was confused. These episode could last from three or four days to over a week, and would repeat about twice a month between April and October, then nothing in winter time.

Since the beginning of the therapy she didn't show any of these weird symptoms anymore, but she hadn't been showing them in the couple of months before we started either.
According to the leaflet in the package, she should have had an increased appetite, thirst and urination. It was just the opposite, a reduced appetite, thirst as usual, urination as usual.
According to the leaflet, the patient could experience apathy or lethargy as well, but these would be limited to the first days of administration. Actually, Freya has been less active on average, even after nearly 7 months. Of course she plays a lot, but she's less constant, and on average she's lazier.
She even showed a couple of adverse reactions that weren't mentioned on the leaflet, and that my vets didn't know about, but I found something about them on the web.
From my experience, I can say that the manufacturer is a liar, and I reported these "lies" to my vets.

Freya has become a slow eater too, she takes several minutes to eat up all her meal, and most times she doesn't finish it. It's as if the meal takes her so much time that she gets bored and gives up.
She's not purring anymore, and I'm quite sure she stopped purring after the beginning of the therapy. She's still loving and affectionate, but not purring at all.
Her eyes have different expression, sometimes it seems to me that her eyes are void of expression, she nearly looks like she's stoned.
One thing that I noticed is that, very often, she howls and meows out loud at walls and closed doors, especially in the evening.
Another thing I think I have noticed is that she's become more repetitive and compulsive on certain actions and behaviors. For instance, she stubbornly tries to squeeze under a piece of furniture or under the sofa, even if it's clear that she will never manage to crawl under them, or she jumps on the chair, then onto the table, then leaps to the counter, jumps down at the end of it and repeats the whole process for even half an hour, and this especially happens at 1 pm.
She's been throwing up stomach juices a few times, and I can't remember she used to do this before. Yesterday she threw up juices 20 minutes after taking the tablet, so I guess she didn't take it at all.

All of the above can't be related to an excessive dosage of the med because we ran a test for assessing the level of phenobarbital in her blood, and it was close to the minimum (18 µg/ml in a range of 15-35 µg/ml).
The dosage is one quarter of a 25mg tablet, twice daily.

This morning I opened the new package of tablets (each package holds 100 tablets, so it lasts 200 days).
I decided I will keep giving her these tablets for a whole year. The vet wanted me to administer them to Freya at least 6 months, I will go on till Christmas. Then I will talk to the vets and ask them if they agree with suspending the therapy and see if Freya is fine all the same.

 

[Kflowers]

This: "she jumps on the chair, then onto the table, then leaps to the counter, jumps down at the end of it and repeats the whole process for even half an hour," struck an old memory. Long ago when we had a pregnant cat, in the evenings she would go to the end of the bed race to the head of the bed, leap up, hit the wall and slither down between the headboard and the wall. Then she would do it again and again. When she had the kittens she stopped doing.

I'm not saying anything here except what you described reminded me of this very strange and alarming time in her life. I'm not saying it has anything to do with Freya. I'm only mentioning it because you are in an unknown place with her and the spacing out she does. Make of this what you will. It probably means nothing.

 

[Antonio65]

I am sure Freya is not pregnant but it surely has something to do with her mind condition and I noticed this only in the last two or three months.

 

[Kflowers]

Not pregnant is good. We never found out why ours did the run and crash thing. The whole business with Freya's spaying is beyond madding. I know the only thing keeping you from running around the house screaming is the noise would bother the girls. I hope you do have somewhere you can go and just scream.

 

[Adnil95]

Hello,
I’m new here and was reading this tread in order to search for experiences of phenobarbital usage in cats.
First, let me say that I’m sorry for all that happened to you and Freya. I was reading your experience and I can say that I definitely understand the vet frustration - I am experiencing the same in the last month! Thank you for the experience documentation.
Currently my cat Salem is on the same drug that Freya is (Phenoleptil) and takes the same dosage.
But I will post a bit of a background of Salem’s experience:
A month ago, suddenly our 3 year old female cat Salem came running from the balcony inside and was meowing and repetitively scratching her ear. I called the vet next day to set up an appointment because I though an insect bit her or flew in her ear.
The next day something strange happened: she had an episode of “throwing up” of only saliva.
I reported to the vet that immediately told me she had an episode of epilepsy (the ears were clear, she is in optimal health) and immediately wanted me to start on phenobarbital.

I told him that, even though it’s possibile, we should still ran some tests maybe it’s a digestive issue: he didn’t want to.
So I return home, in look for another clinic in order to get a second opinion. Meanwhile Salem looks more voracious but overall, still herself. The “throwing up” - sciallorea - happens again and soon we notice that it happens after she heats (I give them meals three times a day, no free feeding).
After getting in contact with another clinic
they agree to run some test but in the meantime, because of her past experience with tonsillitis and a presumed super early catching of feline asthma, she administers an antibiotic and cortisol. Later that day, we had a terrible experience of a grand mal seizure.
I contact the vet, they tell me to come the morning after to run complete blood work. In the meantime, scialorrea episodes were more frequent, 7-8 times a day, and we had experience a second grand mal seizure. Salem seemed a bit nervous about these episodes and continued to scratch and kick herself obsessively, even causing herself an injury in her ear and a bald spot behind her ear. Luckily she didn’t loose her appetite.

Vet told me that they suspect an HE hepatic encelopathy due to a possibile congenital portosistemical hepatic shunt. They advised me to switch immediately to hepatic food, administer lactulose in order to reduce the ammonia in her brain and to start phenobarbital, lowest dosage (1/4 tablet) once a day to see the effects and meanwhile wait for the result of bloodwork.
We started everything but nothing seemed to work actually, she still experienced some generalized partial seizures 7-8 times a day.
Vets refer me to another clinic to do en abdominal ecography.
I drove an hour to this clinic and the Vet there wanted to start from zero and run more tests. We caught the grand mal seizure on video and he did not have a doubt about that being a seizure. Since Salem was not getting better, we’ve upped the dosage in the meantime waiting for results of blood work and the availability for an ecography: he told me if we wanted to let her stay there for days, I declined and asked how should I manage possibile grand mal seizures (diazepam prescribed that I have available if needed). Salem did not experience grand mal seizures but general partial ones, still at least 4-5 a days.

The vet told us that phenobarbital levels need time to work, at least 48h on the right dosage which is tricky to find in cats. He advise us to remain on lactulose and hepatic food. He advise us to also give a cardiac ecography, abdominal one and blood test to assess post prandial bile acids and possibile parasite infections.

We wait 4 days to have the cardiac and abdominal and all exams.
Meanwhile Salems appetite becomes voracious, she starts to even try to eat her toys, she seems progressively less and less herself. Void-like eyes, hiding behavior, aggressive behavior towards other cats, no affection at all.

We do all the tests, bloodwork results come back, indicating and inflammation but nothing out of the ordinary. We have to wait for other blood test results and meanwhile we get the ecography ones. They only gave me results without any debriefing whatsoever, the doctor that was working on our cause wasn’t working so I had to wait. On the report there were no portosystemical shunts detected, some hepatic lesions. Cardiomyopathy detected but “nothing to highlight” (how can a specialist say “cardiomyopathy” and “nothing to highlight” in the same sentence??). Meanwhile Salem was frightened, she seem not to recognize me anymore, generalized partial seizures 4-5 times a day.

Next days results came in and all of the presumed problems were in fact negative.I was frustrated after spending practically 1k and scared for my Salem. The vet told me that he would talk to the specialist about the cardiomyopathy and let me know (still waiting) and about hepatic lesions they don’t know (???). He is now convinced that she had idiopathic epilepsy and advise me to wait further to let phenobarbital work.

14 days after starting Phenoleptil, 2 quarters of 25 mg a day (every 12 hours) magically Salem started to become slowly herself - today, after one month she did not experience any seizure apart from a strange brief episode where she was afraid for a few seconds and vocalized just now that I’m writing this (her generalized partial seizures always ended with howls). I was still advised to do an MRI but I have the same doubts even though I would like to rule out other neurological damages.

Phenobarbital experience so far:

First week no improvement. Salem stil herself.
Second week from 7-8 to 4-5 seizures, grand mal seizure absence. Salems was not herself.
Third week Salem start to emerge as herself again, immediate reduction from 4-5 to 2 episodes her first day getting better and 0 seizures. Ataxia, she is wobbly, unable to climb as she used to (she climbs everywhere and generally likes to stay up), the obsessive licking and scratching stopped. I worry she will not be able to experience space the same again but I’m happy she is seizure free. She has appetite and eats normally, no more aggressiveness, start to be more affectionate. Still hides in some moments.
Fourth week Salem returned completely to normal, no more ataxia, started to climb again, no more hiding and she returned to purring. Her appetite grew a bit more.

What to do next: we would like to still have the MRI scan done in September (now it’s impossibile to book something, vet’s are also on holidays). The vet that is following us said that he does not think it’s urgent right now, he is happy that the therapy is working (I since returned to normal food and no lactulose) and that we should assess her phenobarbital levels in her blood perhaps even scanning the thyroid all in the same session of the MRI scan because it will require general anesthesia.
He also said that he hopes for us that it is a “reversible epilepsy” (never heard of something like this) and perhaps after all exams we could try to reduce gradually the dose to see what happens - this was my plan until this evening when the mini-seizure (perhaps focal seizure?) occured.

How is Freya now?
I’m writing this just to give you also my experience on phenobarbital even though it is not same and for someone maybe like me, in search of experience and not vet advice (clearly they are not sure how to approach this, the guidelines are as always based on dog-researched even tho it is not the same species!)

 

[Antonio65]

Hello,
I’m new here and was reading this tread in order to search for experiences of phenobarbital usage in cats.

Hi Adnil95 , welcome to TCS.

I'm sorry to read what happened to your Salem. Though it's clear that she has epilepsy due to the recurrence of several episodes of seizure or grand mal seizure, I wonder how your first vet was able to diagnose an epilepsy from only one episode that you told him.
Before my neurologist decided to start a therapy with Phenoleptil, it took several visits and loads of blood work and tests.

Your Salem did show some scary episode, with grand mal seizure, unlike my Freya that would just have those weird moments when she didn't recognize the place, us and her name. Freya had nothing that, in my opinion, could pose a risk to her life. That's why I was hesitant about starting the therapy.

Anyway I am aware of what a grand mal seizure is and looks like. My previous cat Lola (in my avatar) had two episodes in the last year of her life, probably related to her severe health issues at that time.
Same thing happened to a senior cat I had found on a major road, very likely abandoned, and that I brought home with me. She only lived with me 10 days, and on her last day she had a very scary episode. So I know what these seizure look like, and my Freya never had anything like that.

I'm sorry that you and Salem had to go through such an ordeal to try and find a diagnosis and an answer to the issue.
And that despite the therapy and upping the dosage, Salem still hasn't found her balance point. I think I have searched the web far and wide, but there is very little info on the use and effects of phenobarbital on cats. As you have seen, dogs are more mentioned in these studies, as always.

I see you are based in northern Italy, just like me, though I don't know what clinics and vets you saw and talked to. There's no need you disclose this info here. What surprises me is that you found little cooperative vets, it seems, when I know that over here up in the north, vets tend to be very open and cooperative with patients.

Phenobarbital experience so far:
First week no improvement. Salem stil herself.
Second week from 7-8 to 4-5 seizures, grand mal seizure absence. Salems was not herself.
Third week Salem start to emerge as herself again, immediate reduction from 4-5 to 2 episodes her first day getting better and 0 seizures. Ataxia, she is wobbly, unable to climb as she used to (she climbs everywhere and generally likes to stay up), the obsessive licking and scratching stopped. I worry she will not be able to experience space the same again but I’m happy she is seizure free. She has appetite and eats normally, no more aggressiveness, start to be more affectionate. Still hides in some moments.
Fourth week Salem returned completely to normal, no more ataxia, started to climb again, no more hiding and she returned to purring. Her appetite grew a bit more.

Your experience in the first 4 weeks of treatment is slightly different from mine, as you might have read.
With my Freya, the first week went as nothing happened. The second week was bad, she was much less active, apathetic and rather weak, she wasn't able to jump onto the sofa. The third week was when Freya had a few episodes when she would scratch wildly and almost endlessly. I found out it was a rare side effects of the phenobarbital, not mentioned in the leaflet. Your Salem would scratch herself to blood before the therapy started.
In the fourth week Freya was quite herself again, she showed and increased activity and energy, and was more interested in food.

What to do next: we would like to still have the MRI scan done in September (now it’s impossibile to book something, vet’s are also on holidays). The vet that is following us said that he does not think it’s urgent right now, he is happy that the therapy is working (I since returned to normal food and no lactulose) and that we should assess her phenobarbital levels in her blood perhaps even scanning the thyroid all in the same session of the MRI scan because it will require general anesthesia.
He also said that he hopes for us that it is a “reversible epilepsy” (never heard of something like this) and perhaps after all exams we could try to reduce gradually the dose to see what happens - this was my plan until this evening when the mini-seizure (perhaps focal seizure?) occured.

I gave up the idea of having an MRI done, because it wouldn't fix the issue anyway. Should the MRI find nothing, we wouldn't know what to do with Freya's problem. Should the MRI find any physical issue in her brain, would it be treatable? Of course no. So I think it's quite useless.
And I also think that it could be a little risky.
Freya had a late spaying because the vets didn't trust the anesthesia for the surgery on a cat with such problems. So why should I put the same cat at risk with a heavier scan?

is Freya now?
I’m writing this just to give you also my experience on phenobarbital even though it is not same and for someone maybe like me, in search of experience and not vet advice (clearly they are not sure how to approach this, the guidelines are as always based on dog-researched even tho it is not the same species!)

Freya is fine, we're in the eighth month of therapy. She didn't have any more episodes of weird behavior, but she's visibly less active than she was before last December, she's slower, I'd say, and it can even happen that she falls on a side when I gently move her aside, as she doesn't have the strength to stand.
As I said, I will give her these two quarters of tablet daily until the end of the year, then I will contact my neurologist again and ask him to prepare a plan to slowly discontinue the therapy and see what happens.
If Freya shows some weird behavior again, then we'll know she needs the med, otherwise we could evaluate it carefully.

All the best to you and your Salem.

 

[Antonio65]

UPDATE - 260 days

Things are still stable after 260 days, no weird behavorial episodes occurred since the beginning of the therapy.
What I'm noticing in these past two or three weeks is an increased trend to vomit stomach juices in the early morning, between 6 am and 8 am, so I'm wondering if the use of this drug can expose Freya to a form of gastritis.
It doesn't seem to me she's lacking her appetite, though there have been some scattered days when she didn't want to eat as usual.

This morning Freya vomited just 4 minutes after she took her pill, a few minutes before she had her breakfast. I'm giving her the pills at 8 am and 8 pm sharp, so it can happen that in the morning she might have already have or have not had her meal when she takes the pill.
This was the fourth time in 260 days that Freya threw up after taking the pill. When this happens, I do not give her another pill to compensate for the lost one.

The informative leaflet in the package does not mention any gastric issues, but we know that those leaflets always hide or don't tell the whole truth.

In a week or two I will have Freya thoroughly checked in order to assess any other issues deriving from the use of this drug that might give liver diseases.

 

[Antonio65]

The blood works for Freya are completely clear, no consequences to her liver after 9 months of treatment.
The vet agreed that if no episodes have occurred in 6 to 8 months, then it is wise to review the need of the med, so at the end of the year I will have a new consult with the neurologist to prepare a plan to slowly suspend the phenobarbital for a certain time and see what happens next.

 

[Antonio65]

UPDATE - 300 days

October 17th was the 300th day of therapy. I've been consistent for 300 days, never skipped a dose on my part, but Freya threw up the pill two or three times so far.
Freya is still doing fine, no weird behavior episodes whatsoever.

What I noticed about 10 days ago, though, was that she would throw up stomach juices every morning at around 6 am, and after that she had a poor appetite. I was afraid it was a gastritis, but I think I haven't found any article on the web that links a gastritis to the phenobarbital.
If anyone has more info of this, I would appreciate the input. Thanks!