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Seizure - Epilepsy
Epilepsy in Border Collie
Strange behavior in Epileptic Dalmatian
Epilepsy in German Shepherd
Epilepsy and phenobarbital
Inherited epilepsy
Epilepsy and seizure
Refractory epilepsy
very long seizure - with epilepsy
also see Neurological
also see Seizure
also see Phenobarbital
Epilepsy in Border CollieQuestion: Dear Dr Mike
Thank you for your recent answer to my questions on another topic. Unfortunately I have another
question for you.We ve had a bad month. Cut paw = sedation & stitches, anaesthetic, x-rays = hip dysplasia
diagnosis, eating bandages = possibility of another operation (thankfully they came through), and &..Last night our dog what our vet thinks was an epilectic fit. He woke us up jumping on the bed, I
thought he wanted to go out to the toilet, but he jumped off the bed and then fell thankfully onto his
own bed and fitted for about a minute. This is the first one he has had to our knowledge, and it scared
us both badly (me and husband) because neither of us had experienced it before. My husband thought
we were losing him.During the fit he went rigid, eyes open, with his paws flailing about, and frothing a little at the mouth.
He also wet on his bed. This lasted about a minute and then he gradually came round. He firstly didn t
seem to recognise us at all and sort of looked through us almost as though we were invisible and he
could hear something but didn t recognise it. However, that passed and then he recognised us again
and gradually got up and started walking about. He tried to be sick, but just retched. He was
extremely restless for a couple of hours afterwards, but then settled down and went back to sleep.Whilst he was coming to I called our vet. He said that epilepsy was quite common in BCs and that
usually they start between 1- 3 years (he s coming up for 2). He said that this may be the only one he
ever has possibly as a result of all the treatment / sedation earlier in the month, but to keep a log in
case he has another one. According to our vet he said that dogs generally recover well afterwards, to
leave him alone if he has another one so that he can come to on his own (leave him in the sense of
physical intervention but keep an eye on him), and that if he does start regularly fitting, we only really
need be concerned if he goes from one fit to another, or if it lasts more in the region of 3-4 minutes.He has currently had 3 out of 4 weekly cartrophen (not carprofen) injections for his hips and I did
wonder whether this could be a reaction, but the vet didn t seem to think so. He has suggested us
bringing him in over the next couple of days so that he can take a blood sample and check that there
was no underlying cause. We will do this.The only other "new" thing in his life is a red flashing strobe light which we have put on his collar over
the last 10 days so that we, and others, can see him when walking out in the dark. It does tend to
flash under his chin and I wondered whether that may be a contributory factor.Is there any way to recognise whether this may happen again. How do we best deal with him if this
happens, particularly the next day with walking and diet etc. Our vet said that this generally happens
when the dog is relaxed, rarely when out walking. Would it cause brain damage in the long term if
this kept reoccurring.I did have a quick look in your epilepsy section and read a posting where you mentioned
restlessness. Over the past 3 months there have been a couple of nights when he just wouldn't settle
down at all. Because this stopped my husband and myself from sleeping I did, on those two
occasions, put him in another room with access to the outside. I am not aware of him fitting on those
occasions, but it would be hard to say with any certainty because we were asleep in another room. As
far as we know last night's was the first one.Any help welcome.
Thank you. Carolynn
Answer: Carolynn-
I saw a series of news reports on Japanese children suffering seizures due to cartoons with rapid
color changes and have heard of problems with induction of seizures in people due to strobe lights
but I have not seen anything about this happening in dogs, that I can remember. It is sort of intriguing
that the seizure occurred after starting to use the light on his collar, though.Cartophen is not approved for use in the United States, yet, so I don't have much information on it.
I am under the impression that it is a polysulfated glycosaminoglycan product, similar to Adequan
(Rx). If this is the case, there is no evidence that I know of to suggest that this class of medications
causes seizure activity.Border collies are one of the breeds in which inherited seizure disorders are thought to occur. I
approach seizures much like your vet -- tracking them for a while to be sure they will recur and then
to get an idea of how frequently they recur before attempting treatment. I still tend to be slow about
starting phenobarbital even though there is some evidence to suggest that early use might be helpful
in stopping seizure progression in some patients. I just think phenobarbital causes too many
problems to be used lightly.I know this wasn't much help but if you keep track of the seizures as your vet has suggested it will
help a lot in determining what the best course of therapy is as time goes on.Mike Richards, DVM
2/4/2001
Michal response: I'm an Epileptic. Flickering lights, rapid changes of light in movies, anything like that can cause me to have a seizure. Light changes are is very troublesome for most of the other people I know with epilepsy. Light around you looks different just before a seizure and sometimes just after. Use of light changes is one of the ways used to try to induce seizures in testing situations for brain wave monitoring in Epilepsy diagnoses. I don't know why light wouldn't cause similar problems for a dog predisposed to epilepsy. I'd get rid of the collar and buy a reflective one.
Also, seizures are a whole lot scarier for the people watching then they are to have. You are confused and unsteady and tired when you wake up. There is a great need to rest and be quiet. It's bad when the people around you are freaking out. Your dog will have an easier time if you leave him alone and try not to be scared. He'll be his old self after he sleeps it off.
Sometimes I know a seizure is coming - sometimes not. That seems to be true of all the Epileptic's I know. I avoid obvious triggers. Trial and error. I know about light, stress. For your dog we can be careful with flashing or flickering light, stressful situations - things that are probably common to all epileptics though I can't prove it and it's just my belief. You and your Vet will work out any medical treatment and Dr Mike will help you. I'm giving you an Epileptics point of view. I can empathize with your dog - we share a common bond.
Michal
Strange behavior in Epileptic Dalmatian
Question: Dear Doctor,
I am a subscriber and read your newsletter every month. I wrote to you a
while ago about my Dalmatian, Domino. I know you wouldn't remember as I'm
sure you get tons of mail so here's a quick refresher plus an update...
Domino is my 2 and a half year old epileptic Dalmatian. He started having
Grand Mal seizures as early as 11 months old. He is currently on
Phenobarbital and probably suffers from seizures about 2 or 3 times a month.
However at 1:30am this morning, Domino started running into the walls in our
home. I woke up to hear several "thumps" and saw what was happening. It
seemed as though every time he would take a step forward, he'd shake his
head as if he was experiencing some kind of electric shock in his brain, and
then he would jump back and run into the wall, or the fireplace, or whatever was around
him. This went on for about 3 hours, until he was able to wind down and fall
asleep. It was terrible to see him so tired, wanting to fall asleep but his
body wouldn't let him. Then he was fine for 2 hours and it started up again
for another 2 or 3 hours. I took him to the vet/hospital by my house, but
of course by the time they opened up for appointments, Domino wasn't
behaving that way anymore so they weren't able to see what he was going
through first hand. This has happened once before a few months ago. I feel
helpless when this happens, in fact I almost wish he would have a seizure
and get it over with, but these electric shocks - or so it seems, seem worse
because they go on for hours with no relief. Have you ever heard of this or
seen this before in epileptic dogs? Is there something more I could do?
Perhaps ask my vet for a sedative so that he can relax and fall asleep when
this torture happens? I'm hearing so many mixed opinions from vets about
the use of potassium bromide in addition to Phenobarbital. I don't know
what to do. I had them test his pheno level and am awaiting to hear the
results. Anyway, if you've heard of this type of behavior before, would you
be able to tell me what exactly it is he is going through? Any help you can
give me would be greatly appreciated. Thanks so much!Sincerely, Christine
Answer: Christine-
I can't actually recall a patient having the symptoms that your dalmatian
is experiencing, except for patients with a condition referred to as
hepatic encephalopathy, which is brain irritation due to liver failure.
Testing for liver disease might be worthwhile but it probably is not the
cause of this problem even though it can cause symptoms like repeatedly
running into walls.There are a couple of things that I would consider with this sort of
behavior. First, I think it is reasonable to assume that this is likely to
be related to seizure problems, so adding potassium bromide seems like a
good thing to consider, to me. Secondly, it can help a great deal to give
diazepam (Valium Rx) to dogs with cluster seizures or seizures that last
longer than a few minutes, either one of which is possible as a cause of
this problem. The best way for owners to do this at home is to give the
diazepam rectally. This is done by mixing an appropriate dosage with a
small amount of lubricating jelly, such as K-Y Jelly (tm) and using a
syringe (no needle) to administer it rectally. Most dog owners can do this
and it can give a patient a lot of relief prior to the time it is possible
to get to a veterinarian. Finally, since these episodes last a long time,
if you have a camcorder, or can borrow one, it would be a really good idea
to videotape this problem so your vet can see exactly what happens.I think that there is information on using diazepam rectally in Kirk's
Current Therapy XIII, if your vet has this reference.Mike Richards, DVM
10/31/2000
Question: I wrote to you a few weeks ago about my old female German shepherd KC _
she had to be put to sleep not long thereafter.
My young male shepherd is a little over 1 and 1/2 years and has been a
wonderful dog. Friday evening, a few hours ago, he suddenly had a seizure
(no previous happenings) and we didn't know what to do ( I learned on a
German Shepherd website that epilepsy sometimes strikes shepherds.) We
are in a shambles - we will try to get to our vet Saturday AM. We thought
he was going to die - he didn't seem to know us. I tried to comfort him
and bring him out of it.He was very restless for sometime but now is
fairly normal.
I am contacting you at this late hour hoping you can come back sometime
tormorrow wioth your comments. Can this be treated with medicine? We are
both in our seventies and this dog is very precious to us - but we are
wondering if we can handle it if it is a serious problem. THANKS Ray
Answer: Ray-
I am sorry for the delay in getting to your question. Epilepsy is a
problem in shepherds. It is usually better to wait and see if repeat
episodes of seizure will occur before initiating medication, though. If
seizures last more than five minutes (the actual seizure -- where
consciousness is not present, muscle movements are occurring, etc.) it is a
good idea to contact your vet, or an emergency veterinary hospital, and
proceed there, just as a precaution. There can be a lot of confusion after
a seizure and some dogs seem to realize the seizure is about to occur and
become restless. The time taken up by these behaviors isn't counted in the
duration of the seizure activity.If the seizures recur or are severe and do require treatment, there are a
number of medications available for seizure control now. This is important
to keep in mind, because it can be hard to control epilepsy in a German
shepherd so it may take a combination of medications or several attempts at
medication to obtain good seizure control.Keep an account of when the seizures occur, how long they last, anything
you think might precipitate them to discuss with your vet. Knowing these
things can be very useful in decision making.Mike Richards, DVM
5/31/2000Q: Dr. Mike--My questions are about epilepsy. My 28 month old Lhasa, Zak, has been having
seizures for the last 9 months. They were grand mal seizures and he had them one at a time
every two to three weeks. Our vet put Zak on Primidone. Zak continued to have grand mal
seizures but then started to cluster also. Our vet was reluctent to try anything else, he just
changed the dosage. So we went for a second opinion on June 1st and the new vet wanted to
try Phenobarb, which we started with 1/2 grain, twice a day. Then on June 13th Zak had one
seizure and then about midnight June 15th Zak started to having seizures one right after
another and continued non-stop, totaling 20-30 seizures, for about two hours until we got him
60 miles away to the closest animal emergency hospital. He was given valium that night and I
took him to the vet the next day and the vet increased the Phenobarb to 1 grain, three times a
day and a valium protocol when he had seizures. Zak continued to have seizurers on and off
for three more days. This all really took a toll on Zak but he has eventually made a total
comeback. Since this episode we had Zak tested for low thryoid function and he does have
low thyroid and now he also takes 0.3mg of Thyrozine two times a day. Zak went the entire
month on July without a seizure and then had two seizurers, (no cluster) two weeks apart in
August. We gave him liquid and then oral valium and he came right out of it. And then in
September he had a seizure on the 10th and another on the 13th. These seizurers were so mild
that he really fought us when we tried to give him the liquid valium (rectally). Now I have all
these questions--It has been brought to my attention that this is alot of Phenobarb to be giving
to a dog Zak's size, he weighs about 28lbs. I have had his Phenobarb levels tested and the was
41.1, which I was told was a very good level but what about liver damage with this much
Phenobarb? I've heard about adding Potassium Bromide? If he takes Potassium Bromide can
he take less Phenobarb? And how about the herbal milkthistle? Does it help protect the liver
from damage? And should it be taken before there is any damage or wait until there is a
problem? And what about the problems we are having giving Zak the liquid valium, it really
does help keep him from clustering but if the seizurers are so mild and he stays so allert he just
won't let us give it to him, is there anything else we can do? Sorry there are so many questions
but this is all totally new to us and we want to the best we can for Zak. Any input you might
have would be greatly appreciated--Thank you C. C. and Zak
A: Cathy-
I'll try not to miss a question, but if I do, feel free to write again.
The phenobarbital dosage is producing a serum phenobarbital level in the high end of the therapeutic dosage range, which is good considering the experience with seizures in the past. It is OK to give higher than normal dosages of phenobarbital if that is what it takes to get the blood values in the range necessary to control seizures. It is best to keep it below 45 micrograms/ml. In some dogs, it is necessary to give phenobarbital at dosages as high as 8mg/lb of body weight per day to control seizures.
There are several medications that can be used in conjunction with phenobarbital to control seizures but diazepam (Valium Rx) and potassium bromide are two of the more common ones. It is often the goal to reduce the need for high phenobarbital dosages when combining potassium bromide and phenobarbital and this can work. In some dogs it is even possible to switch to potassium bromide alone but I don't think you could count on that in Zak's case due to the severity of the seizure history.
We will dispense injectable diazepam, in some circumstances, for seizure control (same liquid, you just give it in the muscle by injection instead of rectally). If the seizure activity is mild enough that you can give diazepam orally by pill that would be OK, too.
Phenobarbital causes liver damage in some dogs. It is not predictable when this will happen and I don't think that preventative medications are useful in that circumstance so I guess I wouldn't recommend using milk thistle or any other liver medication unless problems occurred.
Phenobarbital is generally considered to be less likely to cause liver problems than primidone, so it was good to switch medications, especially considering the dosage necessary to control Zak's seizures.
It may be worth asking for referral to a veterinary neurologist for help with this problem. They have the most experience with dogs resistant to seizure control. Your vet seems to be doing a good job and so I don't think this is absolutely necessary but it can sometimes be helpful.
It is a good idea to check the phenobarbital serum levels periodically, especially when you are having to use high dosages.
Mike Richards, DVM
9/24/99
Q: Sunday morning I witnessed my dog (Taylor) have 5 seizures in a matter of 20 minutes. He tipped over on his side and his limbs convulsed and I'm sure he lost conscious. He is 2 years and 3 months old. I immediately took him to doggie emergency and they sedated him and observed him overnight. He didn't have another seizure until the next morning at 9:30 am. The vet put him on phenobarbital at this time and I brought him home last night. To the best of my knowledge he has not had another seizure. I just have a couple of questions.
1. Is it common for a dog to have so many violent seizures in such a short period of time and them to stop?
2. I'm walking on "pins and needles" waiting for another. It was truly upsetting and I hope to never witness it again. Will he definately have more?
3. He's left home with our other dog during the day. Should I be concerned about leaving him alone?
4. The doctor did a full blood panel and said that epilepsy was the fist thing to treat because of his age. His blood work came out normal. Should I get a second opinnion? I've read your column and any more information you can provide would be greatly appreciated. Sincerely, Laurie
A: Laurie-When dogs have multiple seizures (or multiple seizure episodes) it is usually best to put them on anticonvulsants, as your vet has done. Sometimes, when luck is with you, there will be no further seizures. A general rule of thumb is to try discontinuing seizure medications SLOWLY if no seizures occur in a year. In most cases, the medications will only suppress the number of seizures and some will occur, despite therapy.
Inherited epilepsy does usually show up between 1 and 3 years of age but it can occur earlier or later and there are many many causes of seizure activity so it is hard to be sure if it is the problem. We generally assume it is present when labwork checks out "normal" and we can't find an apparent cause in the history or clinical exam. That is the closest we can come to a diagnosis of congenital epilepsy, right now.
Try to arrange your house so it is hard for Taylor to injure himself by doing something like falling down the stairs or into a swimming pool while you are away. There isn't much more you can do and worrying won't help much. It is hard not to worry, though.
Good luck with this.
Mike Richards, DVM
Q: My dog, Baxter, is a ten year-old, male, neutered springer spaniel. Two nights ago he had four seizures. The first occurred at eleven in the evening, the next at around one in the morning, the next at four, and the last in the vet's office at seven. The seizures were all severe; he was unconscious, lost control of his bowels and bladder, and experienced tonic-clonic motion (or whatever you call it). Inbetween seizures he was very restless. The vet tells me that tests for tick fever and valley fever (we live in Phoenix) both came back negative. Tests indicate that his kidney and liver are functioning normally. He did seem to be very slightly anemic. The vet feels that my dog is either epileptic, or has some organic brain disease. Can you give me more information? Do his age and the fact that he had four seizures (instead of just one) point to organic brain disease over epilepsy? What else might be causing these seizures? Can other forms of cancer be ruled out from the tests? Thankyou for your wonderful web site.
A: K- I am not sure that this definition is exactly correct, but epilepsy is a term used to describe seizures that can not be explained by identifying a source of the seizure activity. So it is a pretty broad term really. It covers any unidentifiable brain disorder that leads to seizure activity. Congenital epilepsy normally shows up in by the time a dog is two or three years of age, so that doesn't seem very likely in Baxter's case.
It is very likely that Baxter does have some problem that is leading to the seizure activity. Brain tumors are possible in almost any case of seizuring but brain tumors often have some other identifiable clinical symptoms since they often damage nerves exiting the brain or the centers that control these nerves. So gait abnormalities, facial paralysis, vestibular disorders, blindness, or other signs of nervous system damage may occur with a brain tumor, helping to identify it. Viral illness, fungal diseases, trauma, vascular disease or other problems can also lead to seizures by direct effects on the brain. Liver disease, kidney disease, and hormonal disorders cause seizures by more indirect effects. Checking for these problems, as your vet has done, is the correct thing to do. When nothing is found we fall back on the term acquired epilepsy to define the problem, even though it really just means we can't identify the problem.
Seizure control is usually possible. When to start is a issue of some debate among veterinarians. The standard rule of thumb has been to use seizure control medications (usually phenobarbital) when seizures occur more than once a month. Some veterinarians feel that it is wiser to start sooner than this because it appears that "mirroring" and "kindling" of seizures can occur in dogs. Mirroring is when a seizure focus occurs in one side of the brain and then an identical site occurs in the other side of the brain after several seizures. Kindling is when the seizure focus in the brain develops strong enough pathways that it makes it easier for the seizure to occur -- almost as if the brain "learns" to seizure. It is possible that by controlling seizures quickly through the use of medications that these effects could be stopped and that may lessen the amount or duration of need for seizure control medications.
We try to decide on an individual basis what the potential for all of these risks are, whether the pet owner can administer seizure control medications on a set schedule and the risks of the medications themselves. Then we decide when to start attempting to control seizure activity. If a dog has a really violent seizure we may start immediately. If there is a mild seizure and then subsequent seizures occur at long time intervals we may never attempt to control them. This decision just has to be made on a patient by patient basis.
Good luck with this. I hope that Baxter is not continuing to seizure so frequently.
Mike Richards, DVM
Refractory (not responsive to medication) epilepsy
Q: Dear Dr. Mike: In first, sorry for my English. I'm writting you from Ecuador, South America. We have a very urgent case. We have a big dog (San Bernardo). The day before yesterday he was doing well until the end of the day. However at 2 am in the morning, he started behaving like he was feeling sea illness or something like that. After some few minutes, he fell down and started having something like a shock, trembling and with a very forced breathing. These shocks repeated frequently, every five minutes aproximately. His veterinarian thought at first that it was something related to a poison or some bad food, a toxicity problem. He was treated for toxicity during yesterday, but his health is not improving. The shocks are still repeating frequently. Some many veterinarians don't find an answer to this sickness. P L E A S E H E L P U S U R G E N T L Y. Thanks, B.
A: Saint Bernards are known to have refractory (not responsive to medication) epilepsy. The difficulty in treating these seizures makes repeated seizures possible. It is a good idea to make sure that kidney function, liver function and blood sugar levels are all within normal ranges. Addison's disease (hypoadrenocorticism) can cause sudden collapse and the electrolyte levels in the bloodstream are normally indicative of this problem when it is occurring. Antifreeze poisoning could cause the signs you are seeing, too.
I hope that your dog is better by now. I wish I could help but I think that you and your vets need to continue to work to find a diagnosis. Do think about toxins carefully and make sure you look for any possible toxins that your dog could have gotten into.
Mike Richards, DVM
Very long seizures with Epilepsy
Q: I adopted Bean from a rescue. I was aware that she had Epilepsy and Seizured. She averages a Seizure about once a week and it could last from 30 an hour upto 3 hours. She loses balance stiffens her muscles (sometimes the whole front or back of her body seems to contort with the siezure) her body shakes, she gets a blank bulging eyed look but is aware of me and looks for comfort. sometimes after a siezure she may vomit but that is not always the case. She goes from a hard siezure into what seems to be the end of it and then slides into another siezure, this happens frequently during her episodes. She does not lose her bowel support during her siezures and after the siezure is done she is up and running as if she had never had a siezure. She is about 4-5 years old. She has been with me for 9 mo. I have been contemplating putting her on meds. but have heard that they are lifelong, have side affects and that dogs become tolerant to the medication. Can you assist me with the best path to take.
A: I think that you should check into this condition further. Seizures of this duration are very unusual. Sometimes, the actual seizure is short but the recovery period long and that may be what you are describing. Still, seizures lasting more than five minutes are often considered sufficiently serious to warrant treatment with anticonvulsants. It is important to confirm that the problem is actually seizure activity prior to using these medications and your vet may be able to do this or may need to refer you to a veterinary neurologist. One of the hallmarks of true seizure activity is a loss of consciousness to the point that recognition of people or surroundings shouldn't occur. I just have to be suspicious that something else is happening due to this and the duration of the problem you describe. Please work with your vet to be certain that this is seizure activity. That will make the choice of whether or not to use anti-convulsants easier to make.
Mike Richards, DVM
Last edited 01/25/03