Seizures In Cats

Seizures in Cats

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Blind cats with seizures, sleep apnea, phenobarbitol

Question: Dear Dr. Richards some weeks ago I wrote you about two young blind cats with seizures. Now the cats, Renato and Marcelino are 10 months old. In your answer, you suggested the possibility of portosystemac liver shunts and recommended a blood test for bile acids. My vet has done the test and the results are the following -Bile acids T1=11.2 mmoles/l (before eating) -Bile acids T2=15,3 mmoles/l (after eating). So it seems that there is a liver problem. The cats have copper colored iries, but they are pretty big, even a little fat. They eat well, drink a lot, and suffer the seizures when they are sleeping. My vet wants to do a complete blood test, but he do not understand how the cats are big with some kind of liver problem. On the other hand, I wonder if the problem could be some kind of apnea. In these case, does a treatment exit? Is phentobarbital dangerous in this case? We (my vet and me) appreciate your oppinions and advices. Thank you in advance Maria-Jesus Answer: Maria-Jesus I am used to bile acids being reported in micromoles (umol/L). I am wondering if the values you have are in millimoles per liter (mmol/L). This would make a difference in the meaning of the values. The reason that this seems important is that we usually consider values of 15 umol/L or less to be normal on the sample prior to eating and 25 umol/L or less to be normal on the sample taken after eating. Which would make the values reported normal. However, if this sample is in measured in a different way than micromoles/L there could very well be a problem. The lab that measures the sample usually provides normal values so it would be easy to check on this. Portosystemic shunts are supposed to be one of the most common cause of seizuring in young cats. I have been reading some about the relationship between copper colored irises and portosystemic shunts and have found that there is serious disagreement about whether there is a real correlation between this and cats with portosystemic shunts among feline specialty practitioners. In cats, seizures that can not be related to an underlying cause are much less common than in dogs. So continuing to look for an underlying cause, including parasites (roundworms, toxoplasmosis), viral illnesses such as feline immunodeficiency virus, feline infectious peritonitis, feline leukemia virus, environmental toxins (primarily lead) and other possible underlying causes of seizure would be a good idea. If it would be possible to videotape one of these instances it would be a good idea to do that, too. I know that seizures are unpredictable and this is very hard to accomplish, even when there is no problem obtaining a video camera. Because you mentioned sleep apnea, I searched for sleep problems in cats. There is a disorder in cats, in which violent motions occur during sleep, which is described in an article by JC Hendricks, et. al. in the AVMA Journal (March 1, 1989). It was suggested in the article that clonazepam might be helpful in controlling this behavior. Dr. Hendricks has authored or co-authored a number of scientific articles on sleep and you can find most of them by searching on "Hendricks JC" at the PubMed web site: http://www.ncbi.nlm.nih.gov/PubMed/ Since the cats seem to be doing well other than this problem and since it is occurring during sleep, it might be worth considering the possibility of a sleep disorder, as you suggest. It doesn't seem like it would hurt to try treatment for this prior to considering phenobarbital for seizure activity. The dosage for clonazepam listed in the article was 0.016mg/kg (so about 0.02mg/kg seems reasonable for calculations), which is a lot lower than the usual dosage recommendation for dogs, which is 0.5mg/kg. I am not sure why there is such a discrepancy but it would make sense to use the dosages that seemed to work based on the article. I can't think of a sure way to differentiate a sleep disorder from sleeping seizure activity but if the cats are instantly alert when awakened, rather than a little confused or lethargic as is common with seizures, it may help differentiate the conditions. I guess that just being able to awaken the cats would help differentiate between these problems since seizuring animals don't respond to external stimulus and sleeping ones should in most cases. Phenobarbital is not completely safe to use in any circumstance, so it should be used only when it is necessary. I hope this helps some. Mike Richards, DVM 2/2/2001

Seizures, Low potassium levels

Question: Really unfortunate that I had to write you twice in a week....but when it rains it pours. Spot, another of our cats (4 in the house), F/S, 10 years old started having seizures night before last about 7 pm. Started with sudden onset of shallow, rapid respirations, nose and pads bright red, neck extension with head rolling back, paws and legs fully extended, tensing of body, then returning to neutral position, extension of front limbs, leading into a batting motion, dilation of pupils, low moan, twitching of facial muscles, and then relaxing back to neutral position. The whole seizure lasted about 30 seconds, with a rest period of approx 30 seconds to 1 minute then a return of the above signs about 10 times. 20 minutes passed then, while she presented herself "glazed and dazed". Whole scenario repeated itself at least three times. We rushed her to the emergency vet. He ran blood work, took chest films. She seized while we were there (the only good part was he got to see it). Blood work disclosed potassium level of 2.76 under the normal 3.7 - 5.7 range. Body tempurature was 94 degrees!! Started her on lac/ringers with added potassium chloride injection into the solution. 500 mls infused over 10 hours. That night we did not witness any additional seizure activity although there was marked incontinence during the night hours. Returned to vet at 8 am following morning. Body tempurature normal at 101. Potassium levels back into the range at 3.7. No other obvious imbalance. Continued infusion as above with d/c at 5 pm that day. Cat had returned to normal appearing self with no other obious incontinence or other issues. At 6:45 pm that evening (approx 24 hours after the first episodes), cat began to exhibit milder versions of previous night's symptoms with exception of upon completion of active seizure, she appeared to be alert and oriented. This continued with approximately 5 episodes over 30 minute period each ending within 15 - 30 seconds from start. Then for 30 minutes everything was fine and then started again. Regular vet contacted. Spot transported to clinic. Local clinic could not do potassium in-house. Checked hemocrit and general physical with no abnormal findings. Cat did not exhibit any seizure activity while at the clinic. Cat placed back on straight Lactated Ringers IV with no added potassium and no apparent seizure activity subsequent. Using box in cage. Help. What could this be, any ideas? Could it really be a potassium deficiency - have you ever heard of that causing seizures? And what could have possible caused a potassium deficiency....she seemed just fine prior to the seizures. What other tests should we have done.....living in a rural area we are somewhat limited with regard to sophisticated testing/diagnostics. Would it be worth going to the university (4 hours away) for a neuological work up. Or should we see if the seizures recur. Your thoughts. I really respect your opinions. You have helped me immensely in the past. Ellen Answer: Ellen- Low potassium levels are most commonly caused by chronic renal failure in cats but other causes include insulin overdosages, excessive fluid therapy, diuretic use (not too common in pets), vomiting, diarrhea and hypothermia (low body temperatures). Low potassium levels usually cause muscle weakness, such as inability to hold the head above horizontal or inability to stand up. I can't recall seizure activity that we related to low potassium levels as an inducing cause but I am not certain that it could not cause seizures. I think that hypothermia would have to be a consideration in Spot's case. In this case, the potassium is absorbed by cells outside the circulatory system and this will self-correct as the patient is warmed. We have seen both high and low potassium levels in blood samples taken shortly after seizure episodes, so movement of potassium between the muscles and blood stream might also be a factor but I haven't actually seen this listed as a cause of hypokalemia in the literature and because we often draw blood after administering anti-seizure medications it is possible they influence potassium levels, even though I haven't seen this in the literature, either. Most of the time when severe seizures suddenly occur in older patients there is an underlying cause such as liver failure, cancer, feline leukemia virus, feline immunodeficiency virus, feline infectious peritonitis, toxoplasmosis, kidney failure or other systemic illnesses. It is best to do a good work up looking for a primary cause. If one can not be found it is reasonable, if desired, to do more advanced diagnostic testing, such as CT or MRI scans. I am glad that Spot was doing much better in the morning and hope that there has been improvement in his condition since that time, as well. Mike Richards, DVM 2/1/2001

Seizures in Kittens

Question: Dear Dr. Richards I have two seven-month old male cats. They are blind and suffer seizures when they are sleeping or just begin to sleep. They began to have seizures when they were one month old. The seizures were very hard, painful and the cats “pitched”. Their blood was analysed then (last May) and seemed to be corrected. The vet prescribed clamoxil and vitamin B, I gave these them during two weeks (I continued with vitamin B two weeks more), but the seizures didn’t disappear. After, when the cats were three months old, in July, the vet suggested a taurine deficiency (in part, because they walk with some rigidity in their extremities). But Turin tablets did not work. Finally, the vet suggested two possibilities: congenital cerebellar hypoplasia (without treatment?) or toxoplasmosis. During these last two months I have given them clindamycin, pyrimethamine and folic acid. The results are not clear. One of them, Marcelino, has several mild seizures during the day, he is very quiet and spent the day resting or sleeping. But the other, Rennet, has two or more very strong seizures per day. Rennet is more active and nervous. As I say, the cats are blind and the seizures occur when they are slept or almost slept. Seizures last only some seconds, and after the convulsions (with signs of pain in head), usually they have a contraction of their legs and move around theirself. In the case of Renato, a seizure lasts more seconds, is very strong with saliva bubbles, maybe with breath difficulty, and just after he runs and jumps very nervous, without control. What can I do? Please, help me. Marcelino seems to be better, but Renato is worse. I am afraid that he can develop a heart problem. Must I continue with toxoplasmoxis treatment? How I can know if they suffer encephalitis or other brain illness? (in my city it is not possible to do tomographies or these kind of proofs). What is the treatment in this case? Other details that can help you in your diagnosis: - Renato needs to eat after the seizures. - They have mild “mioclonias” (leg restless?) when they are sleeping. - They eat and grow well. - Maybe they drink more than normal (but I can not confirm this). Their sister is fine. My vet has suggested Phenobarbital (is it a barbituric?), but I think that maybe it would be better to try with softer medicine (benzodiacephynes?). What is your opinion? Thank you in advance. Maria- Answer: Maria- The most common causes of seizures in young kittens are feline leukemia virus (FeLV), feline infectious peritonitis (FIP), congenital portosystemic shunts (blood vessels that bypass the liver, causing it to function poorly), toxoplasmosis, parasites leading to toxin release or poor nutritional condition (cuterebra larvae, roundworms, hookworms), hydrocephalus, feline immunodeficiency virus (FIV), lymphosarcoma (cancer) and cryptococcus infection of the nasal passages invading the brain. Of these, congenital portosystemic liver shunts are most likely to cause blindness but it can occur with FeLV, FIP and toxoplasmosis, as well. It is a little unusual for cats with congenital liver shunts to grow normally (they are often smaller than littermates or other cats of the same age) but with the clinical signs you are seeing, it would be a good idea to eliminate this possibility. Bile acid testing would be helpful in eliminating the possibility of this problem (or finding it). Bile acids are stable in serum for some time so it would be possible to mail these samples to a lab that does them, if the test is not possible in your area. Cats with copper colored irises (the part of the eye that determines the color) are supposed to be more likely to have this condition but it definitely can occur in cats with any color iris. I have not heard of congenital cerebellar hypoplasia causing blindness but it does usually inhibit the menace response (the act of blinking or turning away from a threat to the eyes, one of the tests used to evaluate for the presence of blindness). If you need help with options for therapy, should one of the possibilities mentioned above turn out to be the problem, I will check into that for you. Mike Richards, DVM 11/23/2000

Seizures in Persian

Question: Hi Dr. Richards: I am a new subscriber and was referred to you by another satisfied subscriber to your email site. I look forward to your comments about my red purebred Persian male cat, Karma. Karma is 3 1/2 years old. He has a very radical smooshed-in nose and is a frisky, kind, exuberant Persian (does not like sitting around on pillows). The cat has had mysterious seizures starting at a young age, probably around 4 to 5 months of age. The breeder never encountered him having a seizure. I have brought him to four or five vets, none of which seem to draw any conclusions about what the condition could be. Two separate times, I rushed the cat to the vet during the seizure and in both cases, the vets couldn't determine what it was. They won't say epilepsy and they're not sure about a congenital heart problem. Another suspicious element to this is that before age 1, his heart sounded normal. But by 1 year of age until he turned 3, he was diagnosed with a very distinct heart murmur and in fact, the ultrasound revealed an enlarged heart. Then, by age 3, the heart murmur went away, so by all accounts now, his heart appears normal now, even though he continues with these seizures. I notice he breathes differently than another Persian I've had--he breathes very much from the stomach, a very pronounced jagged breath. Two vets commented that his breathing didn't seem normal, although they both said that this could be normal for him given his radical nose structure. During two separate seizures, the vets took x-rays thinking there may be fluid in the lungs; however, this was never the case. The x-rays always appear normal. His weight is normal. He was tested for the usual cat diseases and is normal. The seizure almost looks like heat stroke--although weather has nothing to do with it. Here are a list of the symptoms: 1.During the onset of the seizure the cat may let out a 'distress call' and struggles to get into the kitchen where he collapses on the floor 2.As the seizure goes into effect, his breathing turns into extremely heavy, heavy panting and he must open his mouth to breathe 3.During the seizure, he is alert and recognizes his name by wagging his tail (he has never been unconscious) 4.Along with the heavy panting, there is severe drooling where I have to occasionally wipe his fur so he doesn't drown 5.While it's hard for me to tell, it appears that his heart is racing uncontrollably--almost like he is on drugs or has ingested a poison 6.There is no jerking, just the heavy panting and drooling 7.The cat is able to move his body and may even roll over to get comfortable during the seizure 8.During the last few seizures, he has lost bladder control and urine goes all over him and the floor (this is a new condition and did not happen previously) 9.The seizure will last 45 minutes to 1 hour 15 minutes (they seem to be lasting longer) 10.While he may have these while I'm at work, I estimate that he's had at least a dozen or so attacks since he was 5 months old to present (now 3 1/2 yrs.old) 11.Many of these seizures occur right when we get up in the morning 12.There also seems to be a correlation between him going outside on the patio where there is soil, plants, and insects (I pulled out all sorts of plants in the patio thinking he may be nibbling on plants looking for grass substitutes); The most recent seizure was last Thursday, February 24, where he went outside for only 4 minutes and was seen eating something off the ground (could have been an insect, but not sure) then 3 hours later, a bad seizure occurred which lasted over an hour and he lost bladder control 13.After the seizure is completed, he may drink water and eat; he tends to not overexert himself; he'll usually take a long nap or sleeps heavily through the night I'm now petrified to let him out on the patio, thinking he may be eating a spider or a piece of plant. It is very disturbing to see this and I feel helpless when this condition occurs, other than to reassure him and stand by. Do you think this is caused by some sort of poisonous plant or insect he could be ingesting? Or, do you think it is some sort of congenital heart or brain ailment? I informed the cat breeder about this so she is aware there may be a problem with the line. The cat has come from a very well-known and respected cat breeder, who will replace the cat if he passes. The breeder was a vet technician and has raised Persians for 18 years. The breeder has seen everything and was suspicious it could be a heart ailment but never saw a seizure related to a heart condition. Therefore, the breeder felt it may be a brain related situation. Please let me know what you think or can suggest for this one. Thanks for your help, Dr. Richards. Regards, Gloria Answer: Gloria- Based on the history that you give, I think that there are several possible problems. Persians are predisposed to portosystemic shunts, a condition in which blood returning to the heart from the abdominal cavity bypasses the liver, which results in a decrease in liver function and signs of central nervous system disease due to increased levels of ammonia in the blood stream. This could appear as an episodic problem and can produce changes in behavior as well as seizures. It seems to me that it would be worth ruling this condition out, since it is something that would have an early onset and could conceivably cause long term problems. There is some chance that your vet already considered this and has ruled it out based on lab work and ultrasound exam but it would be worth asking about. Persians also seem to be predisposed to hypertrophic cardiomyopathy, a heart condition that can produce murmurs and could produce many of the other signs that you are seeing, as well. If the ultrasound exam that was done was performed by a cardiologist, or reviewed by a cardiologist or radiologist or if your vet is very good at ultrasound examination, this seems less likely. However, it isn't a bad idea to recheck an ultrasound exam at a later date if clinical signs suggestive of problems continue to occur, as has been the case with Karma. We have had disagreements between specialists over cardiac ultrasound examination results in a couple of our patients, so I think that it isn't too unusual for it to take more than one ultrasound exam to find or definitively identify a problem in some cats. There are rare cases of dilated cardiomyopathy, still, in cats. This is a problem most commonly caused by taurine deficiency. Cat diets are supplemented with this amino acid but there are still a few isolated cases, even with supplementation. This should also show up on an ultrasound exam but again, there are times when it takes more than one exam to find this condition. Hypoglycemia might produce symptoms similar to what you are seeing but low blood sugar disorders are more common in dogs than in cats so this is probably unlikely. I am discounting the possibility that this is a true seizure disorder because of the duration of these events. This has to be thought through carefully, though. Often, the actual seizure only lasts a minute or two but there are clinical signs of an approaching seizure and then clinical signs that occur after a seizure and sometimes when all that is considered it does take an hour or more for the whole sequence of events to occur. Cats do get unexplained seizures and they get seizures for many of the same reasons as dogs, including brain injuries, cancer, parasites (especially toxoplasmosis in cats) and all the other reasons they occur. Another less likely possible problem is polycystic kidney disease. This is a problem in Persians, too. Usually the signs associated with it are more typical of renal failure, like weight loss, not eating, increased urination and drinking, etc. There is a chance that this could cause pain or discomfort sufficient to cause the yowl and perhaps some of the other signs could be pain related, as well. Again, this isn't too likely but if you have an ultrasound exam done again, which I would recommend, you might as well check Karma's kidneys anyway. Screening for polycystic renal disease by ultrasound exam in a Persian is a good idea, even when they seem normal. It would be hard to rule out an allergic response to something leading to respiratory signs and even CNS signs. It would be unusual for allergies to be quite this severe and quite this episodic, though. I would put this very low on the list of differentials but wouldn't want to forget it was a possibility. Respiratory disease due to upper airway obstruction leading to lower airway compensatory disorders is also a possible problem. This is a common problem in short nosed dog breeds but doesn't seem to be a common problem in short nosed cats. Those are the things that I can think of that might produce the clinical signs that you are seeing. Your vet can help you determine if any of these conditions or problems do seem likely. A portosystemic shunt usually causes elevations in bile acid response testing. Repeating the ultrasound exam and rechecking the heart and lungs seems like a good idea. Checking the liver and kidneys would be reasonable to do at the same time. I'm sure that a general blood panel has been evaluated but if not, that would be a good idea, too. If all of these things fail to turn up a problem, it would be a good idea to consider asking for referral to the veterinary school at UCD, just because they have specialists in several fields and would have a neurologist, who could help determine if seizures are present and advise you on the best course of action to take if they are. Hope this helps some in thinking over Karma's problems. Mike Richards, DVM 2/29/2000

Seizures in cats

Question: Dr Richards- May I first say your website has been extremely helpful for gaining information about my cats. I have two cats who I adopted about two years ago. They had been dumped somewhere and found by the woman who I adopted them from. This being said, I have no idea who/what their parents are or anything about their medical histories. About two months after I adopted them, the male, Scamper had a seizure. It was in the middle of the night and it seems he was coming out of a deep sleep. Like other letters I have read on your site, he urinated, and proceeded to convulse for about 2 min. After this he was incredibly affectionate and had an insatiable appetite- I was worried about letting him eat because I didn't want him to choke as he appeared to be incredibly stimulated after this event. That night I took him to the emergency vet clinic and they proceeded to do all the blood work and test for diseases that could cause seizures in cats. Everything came back clear. Scamp did not have another seizure for about 30 days and, like the first one, all of the actions were the same, this time I picked him up and held him through it, I found it was much less stressful for the both of us. Thus began a cycle of about 30 days between seizures except once when two happened within two weeks. He has only had two during the day that I know of, and none of the events have lasted over 4 min. Last October 1998 I moved to CA. Scamper had one seizure late in the month and did not have another until two nights ago. So that makes it almost a year exactly. I am totally perplexed as to what has happened. Is it strange that cats experience seizures at such great time intervals? It just seems so odd to me that he would not have one for a year and then suddenly seize again. The only thing I can think of that is different is his food- they get wet food on Sunday's always a different flavor- which was IAM's chicken (they had never had this flavor before). The thing is, there is chicken in every food they have. Do you have any experience with this kind of seizure occurrence, and would you recommend an EKG, MRI, or CAT scan (no pun intended)? My greatest fear is that he will have a prolonged seizure- more than 5 min- and that I won't have time to get him to a vet's. Is there anything over the counter, or homeopathic, that has been shown to either reduce the seizing or stop it completely. I have heard of some things, but can't remember what they are. Your response would be greatly appreciated on this matter. One other thing pertaining to both kitties. Ever since I have had them they have been incredibly itchy. They do not have fleas, are indoor cats, their coats are clean, and they do not appear to have incredibly dry skin. The itchiest areas are pretty much central to their top line and tails, although they love having their entires bodies scratched. One vet said it was fleas, another said it was food allergy, and another said it could be a form of Lupis. They used to get one sore every three months or so, but that has stopped and now they are just itchy. In your opinion do you have any idea what it could be and any suggestions how to help. They are not itchy enough to be candidates for any kind of steroid treatment or antihistamine, this is more just a curiosity question. Thank you very much for your time, and having such a great website! IL Answer: IL- There are a lot of things that cause seizures in cats and it isn't too unusual for the seizures to occur frequently for some time and then to have longer intervals between them. If your vet subscribes to "Veterinary Medicine", it had an article last summer by Dr. Shell that listed known causes of seizures and how to differentiate between them. In young cats parasite infections (roundworm and toxoplasmosis, especially) will sometimes cause seizure activity and may respond to treatment or stop occurring on their own over time. Food allergies have been implicated in seizure activity and hypoallergenic diets may be helpful in eliminating them as a cause. Trauma is also a very common cause of seizures and since you don't know the cat's early medical history it has to be considered in the potential causes. There are a number of claims of benefits for high dosage vitamin therapy using Vitamin C and homeopathy for seizure control but no substantial documentation for these claims. There isn't much harm in trying these approaches, though. One of the biggest problems in documenting effectiveness is the variability in seizure intervals when medications aren't used. In general, it is a good idea to try to diagnose the cause of seizure activity. In all honesty, I do not know if the ability to do magnetic resonance imaging (MRI) and computed tomography (CT) scans has substantially increased the ability to pinpoint the cause of seizures. They would help with problems like hydrocephalus (increased fluid pressure in the brain) and tumors, but being able to diagnose these conditions may make only a minor difference. On the other hand, this is the best way to examine a patient for brain abnormalities and if the cost is not a major obstacle (if it wouldn't upset you to spend the money if no diagnosis was possible from the test), then it seems reasonable to try. With the interval between seizures getting so much longer it seems reasonable to me to wait and see what happens, too. It might be even longer before the next one occurs. With two cats being itchy it seems like a good idea to rule out two additional causes of itchiness --- mite infestation such as demodecosis, notoedric mites and cheyletiella. Sometimes it is possible to see cheyletiella mites without magnification (not if you're my age but maybe if you're younger). They are supposed to look like "walking dandruff". Skin scrapings are necessary to diagnose the other mites. Another thing to consider is ringworm. Sometimes it is itchy in cats and some cats seem to have it for extended periods of time. A "toothbrush" culture to rule it out might be helpful. Your vet will know how to do that. Hope this helps some. Mike Richards, DVM 11/6/99

Seizure control in cats

Q: We have a five year old "Raggdoll" named Rocky. About two years ago Rocky began having Seizures. Each Seizure lasts 2-3 minutes, his body, and limbs shake uncontrollably. While he does not urinate, he does foam some around the mouth. These Seizures occur once every thirty days (give or take a day). Immediately after the seizure Rocky is somewhat disoriented for a few minutes. After he regains his "Composure" he eats as if he had not been fed in weeks, and then all seems normal again. Rocky has had all his required shots, and blood test show no disorder. The Vet suggests that he most likely has Epilepsy, and since he only has one seizure a month that we not introduce Seizure medication because this type of medication can shorten Rocky's life. Since we do know within a day or two when a Seizure will occur,is there anything at all(Other than life shorting medication) that can be done to help lessen the severity or perhaps even eliminate this Seizure entirely? Thank You, A: Wally- I do not know of a medication other than phenobarbital with a good track record for seizure control in cats. Diazepam has been used and does seem to help in some cats but our clinical experience with it has not been very satisfying. The recommended dosages for seizure control vary pretty widely --- from as little as 1mg per day in divided dosages to as high as 15mg three times a day. I have to admit that I have not exceeded 5mg three times a day as far as I can remember. I think Valium is more likely to work as a short term inhibitor of seizures than phenobarbital. Since that seems to be what you are looking for you might want to talk to your vet about this use. Mike Richards, DVM

Seizures and phenobarbitol

Q: Dr. Mike - Last week, our sixteen year old tom cat started having seizures. I came home from work to find him in the middle of the living room with his head twisted around and unable to walk or 'loosen up'. I took him to our vet who prescribed phenobarbitol for the seizures, a few days later it was followed by 1mg of valium as the phenobarbitol alone wasn't totally stopping them. During the day, they have been mild with very bad attacks at night. A few days later, a return visit to the vet for more in-depth blood work and a series of Xrays revealed that he's totally fine....no tumors, no stroke, normal white cell count. I felt a bit relieved! It's been a week now, and the seizures have stopped during the day and generally happening only once at night which I promptly treat with 1mg of valium, on top of his twice daily phenobarbitol. Mentally, he's very alert - I'd say he's back to normal in that respect. It's just that he still can't use his legs and has very poor balance when he tries to get up and walk. His legs all function, as he demonstrates by scratching my arm to shreds when I tickle his belly (our form of playing) with all four paws. He can prop himself upright and uses his front paws to pull his food dish to him and to clean himself. The only test left according to our vet is a spinal tap. Is there a chance that it's just taking him longer than usual to recover because of his age? He's only had one previous seizure in his life, which debilitated him for only a few minutes last December. Should the phenobarbitol have taken immediate affect and stopped the seizures by now? As I said, he's very alert and not groggy at all anymore, still has all his other bodily functions under control as well. I understand that he is getting up there in age, but he's a very big part of our family. I just want to make sure I give him every possibility for recovery and wanted to ask you if there's anything else that I can do. Thanks! Jon A: Jon- It can take as long as three weeks to reach a stable blood level and consistent suppression of seizures when using phenobarbital. It is important to check blood levels of phenobarbital to ensure they are adequate if seizures continue. I am not sure what to tell you about the weakness in the rear legs. If the labwork did not include a check for electrolyte levels, especially potassium, it would be good to check this. Muscular weakness can occur with low potassium levels but usually this affects all muscles and there is evidence of neck weakness (flexed neck), too. Circulatory and spinal problems can be difficult to discern without studies such as myelograms and spinal taps. Hopefully this problem has resolved itself by now and this will be unnecessary. Mike Richards, DVM Last edited 03/13/04