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Controlling cluster seizures in springer
also see Seizure1
also see Seizure2
also see Seizure control
also see Epilepsy
also see Neurological Problems
also see Seizures with other disorders
also see Differentials
Controlling cluster seizures in Springer
Question: Dr. Mike,
I came across your web site some time ago when I was researching
some problems my dog was having. I think
you provide a wonderful service to pet owners and now I've become
a subscriber. I have a 14 year old female
springer spaniel who is again having problems. I noticed
that she was moving her head in an up and down
motion with a fixed stare, her teeth clinched together while
the rest of her body remained still. I thought that it
might be some kind of seizure. I recorded a video of what
was occurring and took Brandy to my vet. My vet
ran blood work and the results were glucose 92, Bun 28 (H) expected
20 - 20, creatinine 0.7, sodium 148,
potassium 5.3 (H) expected 3.5 - 5.1, chloride 102, NA/K 27,
calcium 10.2, phosphorus 5.3 (H) expected 2.9 - 5.0 with a note that
test result falsely elevated by condition of the sample, total protein
6.3, albumin 2.4 (L) expected 2.6 - 4.0, globulin 3.9, total
bilirubin 0.2, alk phosphatase 366 (H) expected 20 - 130, ast 14, alt 29,
ggt 6, ck 31, amylase 1,078, lipase 267, cholesterol 241, osmolality
299, IGM negative, IGG negative, hemogram - WBC 9.1, RBC 5.84,
HGB 15.4, HCT 45.2, MCV 77.4 (H), MCH 26.4 (H), MCHC 34.1, platelet count
unable to report due to excessive clumping but estimate appears
to e at least 200,000/CU. MM. or Greater. RBC morphology normal,
Differential - segs 78, bands 0, lymphs 16, monos 3, eosinophils 3, basophils
0, ABS Segs 7.0, ABS Bands 0.0, ABS Lymphocytes 1.4, ABS Monocytes
0.2, ABS Eosinophils 0.2, ABS Basophils 0.0. Erchichia and valley
fever were also negative. My vet said that her blood work indicated
she was quite healthy for her age except for being low on protein.
My vet wanted me to take her to a specialist whom she consulted with and
the specialist wanted to do a cat scan on her, but due to the
excessive cost of $900 to $1500 for the cat scan I am unable
to take her. My vet put Brandy on phenobarbital, 30 mg twice a day.
Brandy is also on etogesic 1/4 of a 300 mg tablet once a day
for arthritis and she also has hip dysplasia. She is on hydroxyzine
25 mg 1 pill a day for allergies and CNM hypoallergenic dog
food. Since all of this started I've not been giving her the
hydroxyzine which hasn't really affected her much at this time of year.
The phenobarbital has left her complete drugged and the seizures
have not stopped. She can't get up from the floor by herself and
when she is up she usually falls back down. Two weeks
later my vet increased the phenobarbital to 1 1/2 pills twice a day since
the seizures were not stopping. This only made the problem
worse. Since I was having problems getting the dog up
and about, my vet decided to do blood work early checking the level of
the phenobarbital in her system. This came back at 24 which
was between the level of 15 and 45. I was told that the phenobarbital
level could be increased based on this test. I didn't want
to do that since the dog isn't mobile at all. I then asked my vet
to do a thyroid test on her which I was told wasn't necessary but
it was done anyway. The test came back with a low thyroid
reading at a -.5. Brandy is now on thyrotabs .3 mg twice a day.
She has been on this medication for 11 days. The seizures
have slowed down, but have not stopped. Brandy was having from 8
to 10 a day, but now is at 5 or below. I know that the
phenobarbital could have given a false reading on the thyroid test, but
she has improved since taking it. I had to take Brandy
in for more blood work a week ago because I was having trouble
getting her to eat. This blood work was to check on her kidneys and
liver. The kidneys were good, but the level of
the alk phosphatase was 384 with normal listed at 186. Now I'm being
told that her liver could be failing due to the phenobarbital.
Is this test accurate? Would the phenobarbital cause an elevated
level in liver enzymes? The phenobarbital the dog is
taking has been reduced back to 30 mg twice a day based on this blood
work. I was also told that potassium bromide is processed through
the liver so that won't work. I thought that potassium bromide
was processed through the kidneys. Which is correct? Is there
any seizure medication that is not processed through the liver?
From looking at other areas in your web site you mentioned a bile test.
Can you tell me what is involved in that test? I have to take
the dog in on Monday for more blood work. I've been told not
to feed her that morning. My vet wants to check the phenobarbital,
thyroid, liver, etc. again. I know that I'm grabbing at straws,
but I truly want to help Brandy and the seizures have been slowing down.
Yesterday she didn't have any. I apologize for the long e-mail, but
I wanted to make sure I gave you all of the information. I
would really appreciate any help you can give me. Thanks, Vicky
Answer: Vicky-
There are three things that I have to remember to put in this note,
so I am going to put them in now,
before I forget. The first is that the rise in alkaline phosphatase
after administration of phenobarbital is
normal and should not be viewed as a symptom of liver failure unless
there are other supporting
signs, such as a rise in ALT levels, increases in bilirubin or abnormal
bile acid response test results.
The second thing is that phenobarbital does not exert much antiseizure
activity for the first two to
three weeks of use but it does cause a lot of side effects during that
time, such as the weakness and
incoordination that you have been seeing. Potassium or
sodium bromide takes about a month (with
a loading dose) or about 2 to 3 months (without a loading dose) to
have stable enough serum levels
to exert a continuous anti-seizure effect and it also causes many of
the same signs as phenobarbital
with initial use. The last thing is that bromide does not commonly
cause liver damage or kidney
damage.It is usually thought to be non-toxic to these organs. It is
excreted in the urine and it is pretty
much unchanged when it is excreted.
Control of cluster seizures on an immediate basis can sometimes be obtained
using diazepam (Valium
Rx). We dispense the injectable form of this medication to the
client but advise that it be given
rectally, mixed with a lubricating jelly. It seems to sting a little
when it is administered but most pets
tolerate it well enough that it can be used at home. This makes it
possible for the seizures to be
controlled while waiting for the phenobarbital or bromide to begin
to work.
There is some possibility of kidney damage with the increased BUN and
high phosphorous levels. It
may be best to use sodium bromide instead of potassium bromide in patients
with kidney disease but
this is probably not absolutely necessary with the levels in the lab
work.
Bile acid testing is usually done by fasting the patient for at least
twelve hours, then drawing a
baseline blood sample. A small meal (at least a couple of tablespons
of food) is fed and then a
second blood sample drawn two hours later. In patients with liver disease
the baseline bile acid level
may be high and/or there may be a significant rise (above the normal
rise) in the bile acid level in the
second blood sample, indicating that the liver is having problems functioning
properly.
Hopefully you have seen improvement with the combination of phenobarbital
and bromide. If this
works well but there are still intermittent clusters of seizures, adding
diazepam at the time that
seizures occur can be helpful. If your vet needs information
on this therapy, it is described in the new
Kirk's Current Veterinary Therapy (XIII).
Mike Richards, DVM
3/23/2001
Last edited 08/30/02
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