Seizures in Dogs - page 2

Seizures in American Eskimo Puppy - Possible causes

Question: My Am Eskimo puppy who is 4 ½ months old started having seizures last weekend. She had her first at 4:30 Sat morning. I was awoken by a puppy who was biting at the crate, foaming at the mouth and was barely able to stand up. I grabbed her up and took her out side after about 5 minutes she was able to stand but she did not know who I was and she did not seem to know who she was. She backed up in a corner and started growling and trying to bite me when I tried to touch her. She lost her urine and seemed unable to even see. Finally she came back and realized who I was. Afterwards she was extreme thirsty, hungry and sleepy. I contacted my vet and was advised it could be several things but probably a spider bite or a seizure and if it was a seizure it could reoccur in clusters. Sure enough 12 hours later she had another seizure. My vet prescribed a very mild dose of Phenobarbital. She had another seizure at 9:00 pm. She had her first dose of medicine at around 10:30 pm. The fourth seizure occurred at 1:00 am and was very mild. The last one occurred at 5:00 am. She was given her second dose of medicine and has not had another seizure since Sunday morning at 5:00 am. My pup's sire is out of a line that has seen this in puppies before. A couple of the breeders claim the J-bar line has developed a sensitivity to the 3 in 1 shot. They advise that the puppies experience seizures because of the shot and will not experience seizures again. My vet disagrees as he said reaction would have occurred within hours not days or weeks (it had been 18 days since her last shot). My vet has been treating my Am Eskimo dogs for over 30 years and has always been right. I have total confidence in his judgment. This is the first Eskimo that I have had out of the j-bar line so I am trying to learn about all possibilities. We have not run any test yet. We are keeping her on the medication for 10 days. When she comes off the medication we will see if the seizures return and begin to run test at that time. Do you have any information for a cause other than Genetic? Any information would be greatly appreciated. At your service, Bonnie

Answer: Bonnie- I can not tell you whether or not a familial tendency to develop seizure activity after vaccination has occurred in a particular line of dogs. If this has happened it has not been reported in the textbooks that I have, nor in the journals I have in my personal database. It is possible that this has been reported in other sources. I think that the odds that this is the explanation for the seizure activity are low based on the lack of reporting of similar problems but that a familial tendency to seizure post-vaccination can't be totally ruled out based on what I know at this time. I do not share your vet's opinion that the timing definitely rules this out as there are other possible vaccine reactions known to occur days to weeks after vaccination such as a possible slight increase in the incidence of immune mediated hemolytic anemia. This is the way that seizure activity is generally viewed based on age of onset of the seizures and also frequency of the seizure activity when it first occurs: Most puppies who have seizures prior to one year of age and almost all puppies who have seizures prior to six months of age have a cause other than primary (idiopathic) epilepsy as the underlying cause of the seizure activity. It is important to look for an underlying cause when seizures occur in young puppies and when the first instances of seizure activity are close together. The most common underlying causes are: Infectious disease (primarily distemper virus) portosystemic shunts affecting circulation in the liver hydrocephalus Less common causes are: Prior trauma (may be an unknown event) parasitism -- roundworms sometimes cause seizures, Neospora caninum infection is possible and other parasites can do this, too toxins - especially lead exposure kidney failure liver disease other than portosystemic shunts hypoglycemia (low blood sugar) There are probably hundreds of even less common causes. Most of the causes of seizure activity in puppies less than 6 months of age are not inherited defects but hydrocephalus can be and portosystemic shunts seem to occur more frequently in some breeds than others, suggesting a genetic component to their occurrence. In general phenobarbital is not very effective at controlling seizures short term, with the exception of using it to obtain anesthesia to stop continuous seizure activity. It takes about 3 to 6 weeks for phenobarbital to obtain good steady state serum levels. If seizure activity occurs similar to what transpired the first time it might be worth considering the use of diazepam to control the seizures short term and staying on the phenobarbital much longer since severe early seizures are one reason to start seizure control medications immediately rather than waiting to see if a pattern develops. Some dogs do only have one seizure episode in their entire lives so you can make a good case for waiting until at least one more seizure episode occurs, though. This is something you and your vet have to work out based on the severity of the seizure activity and the overall health status of the puppy. I think that most neurologist would advocate attempting to identify an underlying cause for seizure activity as quickly as possible in a puppy in this age range. Unfortunately it can be hard to rule in or rule out hydrocephalus without the use of CT or MRI scans which does make that particular problem an expensive rule out. Portosystemic shunts almost always cause changes in bile acid levels which are easy to measure and which also can indicate whether other liver disease might be present. A general chemistry panel helps to rule out a lot of the other metabolic problems. It is possible to rule in or rule out a lot of possible underlying causes without too much expense or time but some of the possible problems do have to be tested for individually (hydrocephalus, lead poisoning, Neospora caninum, etc) and once you get to that point in the diagnostic effort you do sometimes have to work hard with your vet to figure out the best way to work your way through these other possibilities in order to put the least stress on your puppy and to minimize expenses where possible. I hope that this is helpful. Mike Richards, DVM 4/19/2005

Seizures in older malamute on thyroid medication

Question : Dear Dr. Richards, My 9 year old 110 lb. male Alaskan Malamute Kodi had a seizure at 5:15am this past Saturday morning, his first. I called my vet and was told to keep an eye on him for a few days to see if the symptoms returned. He had another seizure at 3:00 pm the same day. I drove him to my vet (several Doctors) where blood was drawn. The clinic checked his blood for everything except thyroid level which they have to send out. He is on thyroid medicine and has been for a number of years. I was told to discontinue the thyroid medicine until they received the test results back. I was told to give him valium (20 mg three times a day for three days) which I was told should keep the seizures from re-occurring, which I guess it has since he has had no more. While I wait the thyroid results, I wonder what else could cause the onset of seizures. He was at the clinic all day Friday for grooming (7:00 AM until 5:00 PM). It takes them most of the day to groom him. He had a slight limp in one front leg when I got him home, but it went away the next day. Could the stress of hours of grooming bring on a seizure? It just seems odd that the first seizure happened only 12 hours after I picked him up. I questioned the vet on duty if the groomer used any shampoos containing any chemicals which might cause the symptoms, or if possibly the groomer used a sedative. He is a big dog and she (the groomer) had told me when rescheduling his appointment she was recently bitten by a dog during grooming. I was told the groomer was not allowed to use sedatives unless requested and a form was signed by the owner, and that the clinic no longer uses shampoos containing harmful chemicals. I have been using the same neighborhood clinic for 20 years and know all of the doctors. They are being very careful in ruling out all other treatable conditions before recommending anti-seizure medicine (Phenobarbital I understand). Regards, Jerry

Answer: Jerry- I think that some dogs do have seizures as the result of stressful situations, when they are prone to a seizure disorder in the first place. This seems to be pretty common in dogs with epilepsy (seizures that occur for no discernible reason). The age at which seizures first occur can be a strong indicator of the type of problem that is likely to be causing the seizure. In an older dog the most common causes of new seizure activity are cancer (usually affecting the brain), liver disease, hormonal disorders (hyperadrenocorticism, hypothyroidism, diabetes), hypoglycemia (although this actually occurs due to insulinoma, a cancer of the pancreas) and toxins. Some older dogs do have late onset epilepsy or seizures from distemper which occurred years before but is just now causing neurologic signs or from trauma at a younger age that is now causing seizures for some reason. Normal blood chemistry panels help to rule out many of these conditions but the hormonal diseases do require specific testing (except diabetes). If there signs such as increased drinking and urinating, hair loss, thinning of the skin, persistent skin or urinary tract infections, panting frequently or muscular weakness it might be a good idea to consider testing for hyperadrenocorticism (Cushing's disease) in addition to the tests for thyroid function. Hypoglycemia does not always show up in blood samples since it can be transient. It will usually show up in repeat blood tests but it may take several tries to find it. Cancer of the brain is often hard to detect because of the limited availability of MRI and CT scanning in veterinary medicine. If you wish to pursue all diagnostic options, it is possible to arrange for these tests if you are willing to travel to the places that can do this sort of testing. Your vet should be able to refer you to someone in your general area (although that might still involve a long drive or even an interstate drive). Hopefully, you have seen no more episodes and this was just related to stress or will turn out to be a one time event. If there are future seizures it may become necessary to consider seizure control medications but it is good that your vets are cautious about using these agents and are waiting for futher evidence that they are needed. Mike Richards, DVM 6/17/2001

Seizure in Rottie

Question: Hi Dr. Richards, A couple of days ago, my almost-2-year-old female rottie had a seizure that lasted about a minute. She foamed at the mouth, urinated, and defacated. This was her first seizure that we know of. She has been eating the same food her whole life (Pro Plan - Turkey), with one switch from puppy food to dog food. She is healthy except for having hip dysplasia and Lyme disease, from which she has been symptom-free for several months. In looking at your answers to questions posed by other subscribers, I would guess that a good preliminary diagnosis would be epilepsy. My question is, how likely is it that the seizures could be related to the Lyme disease? When I wrote to you before about her symptoms from Lyme disease, you mentioned the possibility of leukoencephalomyelopathy and canine neuroaxonal dystrophy. Do either of these disorders have seizures as a symptom? Any info would be much appreciated. Tania

Answer: Tania- When seizures start in the young adult age range, the most likely cause is a primary seizure disorder (epilepsy). There is still a chance of seizures from an earlier trauma, from diseases (distemper in particular) and from congenital problems like a liver shunt, but most of these things do show up a little earlier. Canine neuroaxonal dystrophy is a disease that occurs in rottweilers and leads to difficulty walking, loss of balance and weakness in the legs. Some rottweilers develop head tremors but I haven't seen any mention of seizures in association with this condition. This problem usually occurs by the time a rottweiler is a year of age. Leukoencphalomyelopathy is another disease that is found in rottweilers and also causes weakness affecting all the legs. It shows up later in life, usually between 1 and 4 years of age. Like neuroaxonal dystrophy, this disease tends to get worse with time and no effective treatment is known. I don't think that seizures occur with this condition, either. It is a good idea to have a general chemistry panel and complete blood cell count run early in a seizure disorder to make sure that there isn't a treatable cause or a condition that resembles a seizure such as hypoglycemia. Most of the time the blood work won't be helpful in making a diagnosis but it is still worth checking, just to be sure. It there are any other signs of neurologic disease it is worth considering having an neurologic examination done by a specialist. If there are not, it is reasonable to wait and see how frequently the seizures are going to occur and what happens when they do and then to make treatment decisions based on what you and your vet observe. Keep a diary or mark the seizure dates on a calendar you can keep, so that you will have a record of when they occur that you can discuss with your vet. Good luck with this. Mike Richards, DVM 4/12/2001

Seizures in Golden

Question: Dr. Richards: We just returned from two days of neurological testing on our 10 month female Golden Retriever, (Daisy Mae) at the Veterinary Hospital UC Davis. The tests included: an ultra sound scan; neurology exam; blood tests; thyroid panel (T4 = .4); spinal tap; MRI brain; X-ray of thorax. The symptoms and treatments that led us to this extreme action were a series of seizures. The first incident occurred was on 11/20/00, we notices a swinging of the head to the left with rapid jerking motion of the body -- lasting only a few moments. The second incident was on 12/12/00 and this time there were strong muscular spasms that violently threw her body to the left, frequency of spasms about 3 per minute. I took Daisy to the Vet's office at 9:00pm, her temperature was 105.5 and the spasms had diminished in frequency by that time. She was given an injection of Phenobarbital and dexamethasone. I picked her up the next day and her behavior, since that time, has been that of a nine year old dog instead of a nine month old dog. She was put on 4 mg tablets of dexamethasone twice a day. Due to the extreme change in her behavior, the Vet reduced the dosage in half a few days later. On 12/25/00 at 6:00 am Daisy had a gran-mal seizure -- lying on her side, paddling her feet and foaming at the mouth, lasting about one minute. After this episode she was placed on Phenobarbital 64.8 mg twice daily and continued with the dexamethasone 2 mg, twice daily. As stated in the opening paragraph, due to the noticeable change in her behavior and lethargy, it was recommended that we have a neurological exam. The results were inclusive; however, it was suggested that we slowly reduce the dexamethasone over a two week period and perhaps repeat the spinal tap at that time. We are also waiting further information on the additional thyroid tests. If you have any further suggestions to help Daisy regain her pep and energy, we would very much appreciate your comments. She is a companion dog to my wife who is in a wheelchair. Thank you for your attention regarding our Daisy.

Answer: Lee- Primary seizures are seizures that occur for no discernible reason. Secondary seizures are seizures that occur due to an identifiable cause, such as canine distemper infection, lead poisoning or hydrocephalus. I think of primary seizures as being epilepsy and secondary seizures are being as seizure disorder but at the present time I think the term epilepsy is usually used to designate either primary or secondary seizures that occur on an intermittent but chronic basis. When seizures occur in dogs that are less than one year of age, there is a stronger chance that the seizures are secondary to another cause than when seizures occur in dogs between one year of age and five to seven years of age. There are a number of causes of secondary seizures in young dogs. In a rough order of probability, they include brain abnormalities such as hydrocephalus, canine distemper infection, parasitism (roundworms, toxoplasmosis), portosystemic shunts (blood shunted past the liver), low blood sugar (usually small dogs),trauma (hit by car, electric shock), primary epileptic seizure disorders, lead poisoning, drug reactions, organ system disease (liver storage disorders, kidney failure), allergies (somewhat controversial as a cause of seizures but there are a couple of fairly well documented anecdotal reports for this). In dogs that are between one and five years of age when seizures first occur, primary epilepsy moves to the top of the list and congenital disorders move to the end of the list and the rest of it stays about the same. Daisy is in a sort of gray area when it comes to age, since she is pretty close to a year of age. You have taken the right diagnostic steps, especially since the seizures started at a young age and the possibility of a brain disorder was very high. It was good not to find anything, though. It would be best to have the cerebrospinal fluid (CSF) analysis when it is possible to stop the dexamethasone or at least get the dosage as low as possible. This would help to eliminate the possibility of an infectious or inflammatory cause. I hope that Daisy's seizure activity has remained under control and she is feeling a little better (more like her old self). Mike Richards, DVM 1/22/2001

Seizures in Soft Coated Wheaten Terrier

Question: Hi Dr.Mike, thank you for your reply to my letter. Checking the phenobarbital levels could prove difficult at this stage for 2 reasons, firstly because its not a readily available test (neither is a CT scan or MRI) and secondly because my vet took her off it yesterday ( 17th) and put her on Dilantin instead, 50mg 3 times daily. She's only had 4 capsules so far at regular 8 hourly intervals but there is a definite change...and not for the better. At 2pm today she was slow and stumbling around but not all that different from when she was on the phenobarbital but by 5.30pm when I came home from work she was very unresponsive...she didnt make any attempt to get up and greet me, was shivering and her breathing didnt seem normal to me, 20 minutes or so later she did get up but the incordination was worse than ever, she seemed to have "blank" periods when she was completely oblivious to her surroundings...just stood still hindquarters in particular swaying (although she never fell over completely...always seemed to be able to correct herself before that happened), trying to walk with paws crossed etc, for the 1st time in 12 years the mention of "dinner" didnt get any response either, that really worried me ! I called the vet and he came to the house about 90 minutes later, she'd been stumbling around constantly for the intervening 90 minutes and was getting pretty "good" at it by now, "good" in that she was stumbling less and her lucid periods seemed to last longer but still nothing like her normal self. The vet checked her over and said the symptoms appeared to be drug related....the Dilantin and possibly residual phenobarbital ( I'd convinced myself at this stage that she definitely had a brain tumour) and recommended I didnt give her the next dose of Dilantin until morning. She ate her usual dinner a little later, drank LOTS of water, and slept soundly for a couple of hours. She's awake now and lying quietly, she appears more relaxed and responsive...watching and listening to everything , not pacing etc. but still unsteady when she walks. She's due at the vets in the morning for further blood tests. My question now is, without benefit of blood tests to determine drug levels or MRI to rule out a brain tumour how to safely proceed? I know it takes time for things to stabilize so maybe the change to Dilantin was too sudden ? I'm wondering if it would have been better to reduce the phenobarbital to somewhere between 15 and 30mg twice daily rather than change to another drug? The vet mentioned Potassium bromide several weeks ago but then told me its only available in very large quantities ( 1 kilo ), this would seem to imply that its in powder form so measuring the correct dosage in that case would be very difficult to say the least. I havent given up on it totally though and intend to make my own enquiries tomorrow. Thank you for you help :) Barbara

Answer: Barbara- We have had several patients go into pretty severe seizures due to sudden withdrawal of phenobarbital, although this usually happens only if they have been on it long enough to experience drug withdrawal problems due to dependency. Usually this happens within the first week after the medication is withdrawn and most commonly within the first three or four days. Phenytoin (Dilantin Rx) is not used very often for seizure control in dogs because it needs to be dosed three times a day and because it generally takes fairly high dosages of 15 to 40mg/kg (every 8 hours) to achieve adequate serum levels for seizure control, which makes the medication expensive in comparison to phenobarbital. In addition, some dogs appear to be able to process phenytoin much faster than others, as reported half lives in dogs have varied from 1.5 hours to 8 hours. In general, medications dosing intervals are established based on the half-life of the medication for seizure control medications, so this means that some dogs could require more frequent dosing for good seizure control. Phenytoin causes most of the symptoms seen with phenobarbital, such as sedation and incoordination on first use and if overdosages occur. It also causes liver damage in some patients, so monitoring liver enzyme levels is recommended. Phenytoin is absorbed more consistently from the digestive tract if it is given with food. Potassium bromide can be ordered through compounding pharmacies in the United States but I'm sure that pharmaceutical laws and availability varies widely from country to country and that this may not be the case where you are. Phenobarbital serum levels are usually measured when human patients are on the medication, so it may be possible to work out something with the local hospital laboratory, if there is a need to switch back to phenobarbital. There is limited availability for MRI and CT scans for pets almost everywhere. It will be nice, someday, when the technology is inexpensive enough for it to become more widely available. I'm glad you are keeping in contact with your vet as it is important to do this in difficult seizure control situations. Mike Richards, DVM 10/20/2000

Seizures in Soft Coated Wheaten Terrier

Question: I'm a recent subscriber to your excellent site. I'll try to be brief :) my SCWT had her first seizure round about 8th of May of this year, I dont know how long this 1st seizure lasted, there was loss of bowel and bladder control and bloody saliva, disorientation for quite a while after the seizure. I had her checked out by the vet within an hour of the seizure and he took some blood for routine examination. Those results showed elevated CPK which is explainable but also elevated (not greatly) liver enzymes which were the more worrying, this led to a further visit later that same day, a 2nd seizure also occured before the 2nd visit, not as long this time with no loss of bladder or bowel control and recovery time seemed shorter...although that could have been my recovery time...the 1st seizure was such a shock to me I didnt know what to do, yelling and leaping about dosent help either party :( an ultrasound showed nothing unusual in the liver and phenobarbitol treatment was started (along with Vit B complex to aid liver function). 5 days later, on re-test, her liver enzymes were back at normal levels so phenobarbitol was gradually phased out. No problems until 30th August, her kicking sounds woke me up and I was dismayed to see her stretched on the floor having another seizure. The seizure itself didnt last too long...90 seconds maybe...but her behaviour afterwards worried me. She was very uneasy for at least 90 minutes, pacing, lying down for literally a few seconds at a time, her breathing was at times shallow and very rapid then deep and so slow I wondered if she was still alive, I had some of the phenobarbitol tablets left over from last time and decided to give her a 30mg dose. I informed the vet next day about the seizure and to cut a long story short the dose was cut back to 15mg twice a day ( she weights approx 50 lbs ). This worked, in so far as there wasent another seizure, until Wednesday of this week. She was sleeping in her chair and I thought she was yawning, nope ! It lasted about a minute with no loss of control etc, however, her behaviour afterwards is causing me some concern. She's had 3 seizures since then although none for 30 hours, she's on 30mg pheno twice daily now. She is very uneasy after these latest seizures, whining, pacing etc, it usually last for 1- 2 hours then she sleeps soundly. The increased dosage is causing her to stumble and trip etc, but its the whining that worries me now....is she in pain ?? I'v also been adding a few drops of Bachs Rescue Remedy (herbal remedy) to her drinking water in the hope that it might ease her anxiety.. if thats what it is? Is this normal post-seizure behaviour or a symptomatic of some other disease? I'd be greatful for your comments. Thank you again for a very informative site :) Barbara

Answer: Barbara- There are three phases to a seizure. The "preictal" period, also referred to as the aura, or the time prior to the seizure that the there are identifiable signs of a seizure onset is the first stage. This can be as long as several hours to as short a few seconds. Most dogs seem to have some ability to recognize the onset of a seizure and may try to find someone to comfort them, a secluded spot, or may just be visibly nervous or upset. The icthus is the seizure itself, which usually does last less than 2 minutes. Longer ictal periods, especially greater than 5 minutes, are cause for worry. The postictal phase is the time period after the seizure but before the dog or cat fully recovers. There may be confusion, apparent blindness, incoordination, compulsive behaviors (circling, pacing), lethargy or other signs. The postictal phase of seizures usually lasts a few minutes but there are some patients who have signs for several days after a seizure. This phase of the seizure is often the most upsetting to the owner and it usually will be shorter if control of the seizures is effective. It would be a good idea to consider having serum levels of phenobarbital checked, to assess the necessary dosage for the medication, since you have some signs of phenobarbital toxicity at 30mg twice a day but ineffective control of the seizures at 15 mg twice a day. This is done by checking serum levels at the anticipated low point (trough value) for serum levels during the day, to see if effective levels are being maintained and at the anticipated peak serum levels to see if toxicity is occurring due to elevated serum levels of phenobarbital. In a case like yours, it is probably best to check both the trough and peak levels. The peak level is usually 4 to 6 hours after administration of the medication and the trough level occurs just prior to administration of the next pill (so at least 8 hours and up to 12 hours after the morning pill). It is sometimes possible to use lower levels of phenobarbital if potassium bromide is added as a second anti-seizure medication. It causes drowsiness and incoordination for several weeks when it is added in but then over time it is possible to lower the phenobarbital dosage and most patients have fewer long term side effects if they were having trouble with phenobarbital when it is within the serum levels necessary for it to work. If it is difficult or impossible to get reasonable control of the seizures (reduction in the incidence of seizures and in the pre and postictal periods) that can be a sign of a serious underlying cause, such as brain tumors or liver disease. Sometimes other symptoms of underlying disease occur over time, so periodic evaluations are a good idea when seizures start later in life, since these are more likely to be due to an underlying disease process. Good luck with this. I hope that it is possible to make the postictal periods shorter and less troublesome for your terrier. Mike Richards, DVM 10/18/2000

Seizures in Pugs - possible inheritable causes

Question: I have 4 pugs, Prissy (mom), Nike (dad), Adidas (8-3-97)out of 1st litter, Sadie (2-3-98) out of 2nd litter. Adidas and now Sadie are having seizures. I had always feed them Pro Plan but a year or so I have bought Authority . What steps should I take 1st to see if its a birth defect or something else. Please Help their my babies.

Answer: Melinda- Pugs have a congenital disorder, chronic encephalitis of pug dogs, which often starts as a seizure disorder and then progresses to a more generalized neurologic disorder. This condition is usually fatal within 6 months after the onset of seizures. If you are seeing seizures in Adidas and Sadie that have lasted longer than this, already, then this particular problem is unlikely. There is no sure way of diagnosing this condition, except by examination of brain tissue, so it is hard to rule it in or out, early in a seizure disorder in a pug. Pugs are prone to hydrocephalus (increased fluid pressure on the brain), which can lead to seizures. It is sometimes possible to diagnose this problem by physical exam or with plain X-ray films but an MRI or CT scan is much more accurate. If you wish to continue to breed Prissy and Nike, it may be worth spending the money to rule this condition in or out, if your vet feels that it is a possible problem based on clinical signs. Seizures can occur as the result of other systemic problems, especially liver disease. It would be worth checking a general chemistry panel for signs of liver or kidney disease and also to rule out diabetes (even though that is unlikely). Seizures can occur for no discernible reason (epilepsy) and sometimes this seems to follow family lines. When seizures start at less than a year of age it is a good idea to check a general chemistry panel to try to rule out a systemic cause, to rule out hydrocephalus, if possible, and in pugs, to consider checking cerebrospinal fluid for signs of chronic encephalitis of pug dogs, such as increased numbers of white blood cells. If there is any chance that the puppies may have had canine distemper, that would be another common cause of seizure activity in young dogs. This sounds unlikely, though. I hope this helps some. Mike Richards, DVM 10/17/2000

Seizures in young Choc lab

Question: Hello Dr. Mike, I am writing to you about a puppy I sold to a very loving family. Below you will find a detailed description written by his owner about what has been happening to Bosco. I am hoping you can shed some light on his dilemma. I have a 23 month old chocolate lab that had his first seizure back in November when he was nearly 14 months old. Seizure history: November 11, '99 (1 month and 1 week after last dose of Sentinel) June 8, '00 (1st Sentinel for the year on May 2, his 2nd dose June 2, 1 week exactly before 2nd seizure) July 10, '00 (Another Sentinel dose given July 3, exactly 1 week before 3rd seizure) July 31, '00 (3 weeks since last seizure) First seizure showed rigidness of neck, curling of front leg(s), no loss of consciousness, bowel or bladder control, scared look in eyes, kept trying to get up but couldn't. Lasted approx. 3 minutes. When over, instantly better with no after effects.The last 3 seizures were milder. Mostly a strange look in the face and eyes, uncoordinated walking that sometimes appears to be a lameness in one or both front legs along with back leg staggering, mild head tremors, a confused help me look in the eyes while trying to lick me in the face (I stay away from his mouth when comforting him.) No loss of consciousness, bowel or bladder control, nor snapping of jaws. Duration is approx. 2 - 3 minutes, then perfectly fine. We began phenobarbital July 31. 1 tab 2X a day (64.8 mg). No seizures since then. However, July 14 noticed a weakness in his legs and hind quarters with a dragging of the hind toes on some steps. Did fall down when turning a curve when chasing the ball. That part has vanished and the weakness had improved after a few days.However, it returned after the July 31st seizure and he has been dragging his toes (knuckling) nearly every step. His hips seem to sway in an exaggerated manner when walking. When he trots or runs all of this is hard to detect. It seems most evident when walking at a slow, relaxed pace. Our vet is trying to help us and after going over his symptoms has given his best opinion without further tests, of a possible brain tumor. Needless to say we were devastated. He is quick to admit he is a G.P. and not a specialist and encourages us to get a second opinion or explore other options. The normal neurological testing that can be done in an office by physical manipulation was all good. Testing for hypoglycemia was negative. Have sent blood, stool and urine to Cornell University for examination...testing for toxoplasmosis and neosporosis (he had a severe bout with coccidiosis July '99 and responded well to Albon). I am also checking into a canine chiropractor to see if there is any pinching of the spine due to an injury. Today there is improvement in the knuckling. Instead of every step it is about 1/2 that or less and he is walking a little better. Our vet is seeing an improvement since he last saw him August 10th. Do you have any suggestions or options? Can we be dealing with 2 separate problems here? Reaction to Sentinel or perhaps genuine epilepsy plus some sort of spinal problem? Perhaps an injury in all his 23 month old exuberance? Or could it be toxoplasmosis and neosporosis. Appreciate an insights you can give us. Any help you can give us would be much appreciated by all of us, especially Bosco. Beth

Answer: Beth- You didn't mention whether or not serum phenobarbital levels have been measured. It is usually best to check these levels at 14 and 45 days after starting phenobarbital therapy, in order to try to assess whether the dose of the phenobarbital is appropriate for a particular patient. It is probably best to try to get a blood sample from the expected high point in serum levels (peak) and the expected low point (trough) on these first two examinations but if a choice has to be made it is probably better to check the trough levels. I would really want to have these values in this case, if I was managing it, because of the persistence of neurologic signs after starting phenobarbital. It isn't unusual for there to be weakness or swaying in the rear end during the first few weeks on phenobarbital, but this almost always goes away, unless a patient has higher than expected phenobarbital levels (or if potassium bromide is also being given). An underlying brain problem, such as a tumor, is definitely possible, but given the timing of all of this, it seems reasonable to rule out problems with the phenobarbital, first. Another thing to think about is that any incoordination effect from the phenobarbital will make a problem like hip dysplasia much worse, so there could be a secondary problem that does not involve a brain problem. It is very unlikely that the lufenuron and milbemycin combination (Sentinel Rx) has anything to do with these seizures with the timing you have seen so far, but there are occasional reports of dogs with pre-existing seizure disorders who seem to seizure more easily after administration of milbemycin. This effect has not been confirmed, as far as I know, though. I would be pretty surprised if the seizures were due to toxoplasmosis or neosporosis, even though it is possible and even though I think testing for these problems is reasonable. The hind limb weakness or neurologic deficit is also unlikely to be from these disorders, at this age. But again, it isn't unreasonable to rule it out, anyway. It is a good idea to consider going to a neurologist if the weakness in the rear limbs does not continue to improve, especially if the phenobarbital levels are within the therapeutic range and toxoplasmosis and neosporosis do not seem likely after the lab results are in. This is likely to be primary epilepsy (seizures for no explainable reason) but it is a good idea to be as sure of that as possible and neurology specialists see more pets with seizure disorders than general practitioners and that experience can sometimes help in the identification of unusual seizure disorders. I hope that Bosco continues to show improvement and continues to have good seizure control on the phenobarbital, as well. Mike Richards, DVM 9/20/2000

Seizure cause and control

Question: hello, First I would like to thank you for offering this service. About 4 months ago I brought home a school yard stray, a beagle/hound dog mix estimated to be between 1.5 and 2 years old, which I named Sampson. Sampson initially had several problems associated with being a stray; an ear infection, a bladder infection, worms, and an aural hematoma approaching the size of a football. He recovered well from these problems for the most part. About three weeks later, the same day we had him neutered, he had his first siezure. Incidently, I also have a 7 year old lab whose has had siezures for years but is well controlled with phenobard. Over the next 3 months Sampson had single siezures ranging from 1 day apart at times to up to 3 or 4 week apart. He was not medicated at this time. Two weeks ago he had a cluster of 4 siezures within 30 minutes and we decided to medicate him. His vet perscribed 15mg of phenobarb twice a day. He had no more siezures for two weeks, but yesterday had a cluster of 5 in a half an hour, a cluster of 2 later that evening, and a cluster of two today. His phenobarb dose has now been raised to 30mg twice daily. Following his first siezure he had a full blood workup done, which turned up nothing unusual. Sampson's siesures never look the same way twice, sometimes he twithches, sometimes he paddles, sometimes he yelps while he has them, other times he seems barly conscious, usually he is ridgid, and he often looses bladder and/or bowel control. The strangest thing that we have observed is that he will often vomit voiolently during a siezure which seems to stop the siezure immediately. As a footnote Sampson seems to have some digestive problems, and often has malabsorption type diarreah, as a result of which we feed him food that claims high digestability and have seen a modest degree of improvement. I am sorry this is so long, but I wanted to give you a through history. I am very concerned that they appear to have gotten worse, and would appreciate an ideas or information you can give me. Thank You Again, Debbie

Answer: Debbie- There are many causes of seizure activity that do not show up in routine blood work or through other means of laboratory testing. Not knowing Sampson's early medical history also compounds the problem of trying to identify the cause of seizure activity. If he had distemper when he was young or if he was hit by a car, those things could lead to seizure activity later, for instance. It is possible to treat seizure activity without being able to identify an underlying cause, though. It can take up to 30 days for phenobarbital levels to reach a stabilized point, where blood concentrations can be kept above the minimum levels needed for seizure control on a continuous basis. This means that seizures that occur in the first three to four weeks after initiating phenobarbital may not be occurring due to inadequate dosing. It is possible to get a good idea of the phenobarbital levels after two weeks of dosing by testing serum levels. Initially it is probably best to test the phenobarbital level at times that should show its highest (peak) and lowest (trough) serum levels. To get these samples, it is best to draw blood just prior to giving the morning pill and about 6 hours after the pill. If there are no signs of an overdosage, such as excessive lethargy or incoordination, it is probably OK to wait a few days and check on the new dosage. If Sampson's seizures can not be controlled with phenobarbital it would be a good idea to consider having him examined by a veterinary neurologist. If this is not possible, using combinations of seizure control medications, such as phenobarbital and potassium bromide, will often allow control of more difficult seizure cases. Vomiting occurs in some seizure patients and it does seem to come right at the time of recovery from the seizure in most patients that have this sign, based on the ones we have seen. There is a very small chance, with the emphasis on very small, that a relationship exists between the digestive problems and the seizures. A few cases of seizure activity have been linked to food hypersensitivities or allergies. These can also cause some cases of chronic diarrhea. To see if food allergy is present, it is necessary to use a special diet that contains a protein source that Sampson has never had before (salmon, duck, etc) or a hydrolyzed protein diet such as Purina's HA (tm) or Hill's z/d (tm) for six to eight weeks. If the diarrhea or vomiting is controlled by dietary changes it is acceptable to use a hypoallergenic diet long term. In a few patients, seizures will also improve when dietary changes are made but this is hard to evaluate when using seizure control medications. If there are no seizures at all for six months it might be worth attempting to discontinue to medications to see what happens but this should be discussed carefully with your vet, who is more familiar with Sampson. It is important to remember that absolute control of seizures may not be possible. If the seizures can be controlled well enough that they do not occur in clusters and are infrequent (less than once a month) the seizure control is usually considered to be successful. Hope this helps some. Mike Richards, DVM 8/8/2000

Seizure in Dalmatian

Question: Dear Dr. Richards, I'm a new subscriber. I have a 2 year old Dalmatian named Domino. Domino was diagnosed as having epilepsy at 11 months old. (His mother also suffers from epilepsy). Since he was rather young, we decided to hold off on putting him on any medication for this. Two months later in January, he had a series of really bad seizures, causing him to foam at the mouth, urinate, deficate, and even spit up blood. I rushed him to the animal hospital and they said that the seizures caused 2 of his lungs to fill up with blood. He was hospitalized for 2 very hairy days. One doctor even told he he might not make it. Since then he has been put on phenobarbitol. He usually has a seizure once or twice every 2 or 3 months. However, lately he's been having them every other day or so. I had his pheno level checked out and they said it's in the normal range. I believe his dosage is 1 grain. I'm told Domino has a small liver for his size and this could be causing the seizures as well. Also, in the past 2 months, Domino has lost some of his hair revealing 2 pink patches on his skin. At first the vet thought it was an infection with his folicles. Then when the medicated shampoo we were given didn't clear it up, Domino was given a cortizone shot. It seemed as though the hair started to grow back slightly, but then it stopped. At last, the vet said we should test him for Thyroid. He had blood drawn from him. A week later I was told that the outside lab testing for thyroid, messed up the blood sample and the results came out to be "hyper-thyroid" which my vet told me was impossible to have in dogs. They then drew more blood. A few days later Domino wasn't his active self. He didn't eat in a span of 36 hours and he didn't look good. I rushed him to the vet and they found out he had a 105.1 temperature. They kept him over night, gave him an IV, took more blood to see what was wrong. The closest thing they came too was that they think he has hepatitis. They told me there was no real sure way to tell except to do a liver biopsy. This poor dog has been through so much that they thought it was best to put him on amoxicillan (spelling?) and to watch him the next few days. He seems okay now - still not his active self, but at least he's eating and running around more. So, now after this long story, here are the questions I have... How dangerous is hepatitis? Since I'm told it attacks the liver, and so does the Phenobarbital, is that why Domino is seizuring more now? Domino is acting very weird since he's been home from the hospital. He drinks a ton of water and he urinates and deficates in the house at will - something he never used to do. Is this a reaction from hepatitis? Do you think the rash he has on his skin might have anything to do with this? I noticed yesterday in the backyard, Domino started to eat his feces, I quickly pulled him away, but I was a little too late, as he already swallowed some, could this have caused the hepatitis? And finally, the most dreaded question... with all of these problems, what do you think the life expectancy will be for Domino? I am at a loss. I try so hard to do the best I can for Domino but he seems to get sicker and sicker. If he's not suffering from one thing, it's another. Is there anything more I could be doing? Please help!!!! Sincerely, Christine

Answer: Christine- It is pretty important to figure out what the underlying disease is in order to successfully control seizures long term. There is ample evidence to suspect liver disease in this case. Identifying the liver disorder present could make it possible to devise a treatment plan that will work better than the current one. In addition, phenobarbital can cause additional harm in a dog with pre-existing liver disease so if it is possible to choose a different seizure control medication or to avoid seizure control medications by treating a problem in the liver, it would be much better for Domino long term. Bleeding into the lungs is a really unusual symptom for a dog with seizures and it seems very likely that it is due to another problem. Liver disease can make it difficult for the blood to clot, since the liver makes some of the clotting factors. Liver disease will cause seizures in some dogs. A small liver may indicate that the liver never developed properly in the first place. So it seems likely that liver disease may have been present a long time and may be the initiating cause of the seizures. On the other hand, phenobarbital causes hepatitis in some dogs and it is not an uncommon side effect. Phenobarbital also causes a lot of dogs to drink more and urinate more, so that may also be an effect of the medication. I would want to make sure that a portosystemic shunt was not the problem with the liver. The initial testing for this disorder would be bile acid response testing. If this is indicative of liver disease and the results high enough to be suspicious of a portosystemic shunt, then an ultrasound exam and/or scintigraphy would be the next steps to take in making a diagnosis. If the liver disease does not appear to be due to a portosystemic shunt, then it will probably be necessary to have a liver biopsy done in order to try to identify the liver disease and develop a plan to treat it. At Domino's age it could make a huge difference in the long term quality of his life to have a diagnosis on which to make treatment decisions. Itchiness and secondary skin infections will sometimes occur due to reactions to phenobarbital. But primary skin infections are very common in dalmatians, too. Common enough that it is probably more likely that this is a second problem rather than a complication from the medications or first problem. Skin problems are frustrating but are usually not life-threatening and can usually be controlled with effort. Portosystemic shunts can be surgically repaired. Medical treatment is possible in some cases when surgery does not seem advisable or is not successful. It would really be worth ruling this possibility in or out. Other liver disorders are treatable, too. If liver disease is present, changing from phenobarbital to potassium bromide therapy may help to lessen the liver damage and there are other seizure control medications that might help, if potassium bromide alone is not sufficient. In a case like Domino's it may be best to ask your vet to refer Domino to a veterinary college or large veterinary referral center where it will be possible to figure out if liver damage is present and if it is, what type of liver disease is present. At one of the larger veterinary referral centers there will also be specialists in other fields, in case this turns out to be a problem that is not related to liver disease. I wish that I could answer your question more accurately but despite the efforts so far, you are still early in the diagnostic process. Even though things look pretty bad, there really is a chance that a treatable condition is underlying the seizures. Mike Richards, DVM 6/14/2000

Seizures

Question: Dr Mike, Thank you for answering so quickly. I just have a few more questions. in your experience would cluster seizures most likely constitute a brain tumor? When he takes the cluster seizures he starts out looking like he has something caught in his throat and he's trying to vomit it, then he falls over and goes into the typical seizure activity. Is it normal for him to look like this at the start? What is leptopirosis? He is due for his shots, rabies etc... in May is it OK to get them done? |My vet told me not to upset him that this could bring on seizure activity, is this true? My last two questions are the one's that concern me most. I've read on your site that the seizures do not hurt him. Is this true? And last what is the life span of this condition? He is still just a pup and very playful, when he is not sick. The last thing I want to do is put him down. But I know if he is suffering it's the right thing to do. I really appreciate all your help. I think I've covered everything, if you could just answer these last few questions my mind would be at ease. Thanks Again!!!!!!!!!!!!!!!!!!!!!!!!1 Janice

Answer: Janice- Seizures often start with a behavioral or physical symptom that can be recognized after several seizure episodes. It would still be worth making sure your vet knows this happens and getting an exam of your samoyed's oral cavity, just to be sure there isn't some sort of problem that might be inducing this behavior. Leptospirosis is a bacterial infection. It is fairly uncommon but there have been several recent outbreaks so it comes to mind. The bacteria may cause kidney or liver damage, leading to other problems, such as seizures. I think that there is a pretty complete description of leptospirosis in one of the VetInfo Digests in the subscriber area. Vaccinations are a tricky issue in dogs with a recent history of developing seizures. Usually, there is no problem with going ahead with vaccinations but they do put some stress on the dog's immune system and in a few cases that may be enough to induce seizures or allow an underlying problem with the immune system or an organ system to surface. The rabies vaccination is required by law in most states, though. So you may need to go ahead with that particular vaccination, at least. Especially since a seizuring dog may bite someone without any conscious intention to do so. When my terrier becomes anxious, excited or stressed she seems to have seizure episodes. She is particularly prone to having them the day or so after we return from a trip in which she stayed behind and was cared for by the pet sitter. Even though we have a very good pet sitter and she is in her own home, the anxiety of the situation and her excitement when we return seems to induce seizures. OK, on the seizure and pain issue. Seizures look like they are painful but I have asked several people I know who have seizures if they are. The people I have spoken with don't remember the seizure episode, usually. They do mention having muscle aches or pains sometimes and one person I know has headaches afterward. So, I think that seizures in dogs are probably not painful, or that if there is pain, the patient forgets it on recovery. There may be some pain associated with the strenuous effort of seizuring and there may be subsequent head aches or confusion. However, without being able to ask our patients, I don't think we can be absolutely certain. The life span of dogs with seizure activity depends on what is causing the seizures. For dogs with seizures that have no identifiable cause, there is probably little to no change in life span. For dogs with seizures due to liver disease or kidney disease, the severity of that problem is more important in determining life span than the presence of seizures. For pets with brain tumors the tumor type and growth rate determine the life span most frequently but seizures may become extremely difficult to control or very frequent, in which case many pet owners do opt for euthanasia, making the seizures have a direct impact on life span. I can only remember two patients in our practice who died as the direct result of seizure activity that we could not control, so this can happen but it seems to be very rare, based on our experiences. I would keep working with your vet to try to determine if there is an underlying cause for these seizures, at least to the point where both you and your vet feel that an underlying cause is not likely to be found. If no cause for the seizures can be identified that isn't a totally bad thing, since it at least eliminates a lot of potentially bad problems, such as liver disease, low blood sugar, kidney disease, infectious diseases, etc. Good luck with this. One thing I missed in the earlier note was the phenobarbital level. While 28.8 is in the normal therapeutic range for phenobarbital, it is considered to be more effective if the trough (low value) for the day is in the 30 to 40 range and for seizures that aren't being controlled, trying for a higher serum concentration might be useful, too. You can ask your vet about this. There was a pretty good review of phenobarbital and potassium bromide therapy by Dr. Hoskins in the April 2000 issue of "DVM" magazine. Your vet might get this magazine. Mike Richards, DVM 4/25/2000

Seizures in Samoyed

Question: Hi Dr. Mike, I have a 5 yr./Samoyed (Bongo) He started taking seizures in October of 99. The first time he did this he had about 5 seizures (cluster) in one day. They lasted anywhere from 30 seconds to 2 minutes. My vet put him on phenobarb. He was taking 3 @ 64.8mg a day. Before he started to take these seizures, he brought me home a dead chipmunk or squirrel.(Couldn't really tell what it was) Then a few days later he started his first seizures and meds. His blood was tested and they found nothing. His levels were checked in December they were 28.2, "good" the vet said. After the holidays we started him on 2 3/4 a day. He developed ringworm and we put him on Gefulvacin & some blue liquid to rub on his belly. On Feb 6th we started him on 2 1/2 a day. Feb 8th he had his next seizure, we put him back up to 3 a day. Feb 28th another, we put him up to 3 1/2 a day. March 16th another, he vomited earlier in the day. And after this seizure I could see a small trace of blood in his tear duct. On April 5th he caught a rabbit and ate it. The next day he took 7 long seizures in one day. We upped his pheno to 4 a day. Now my vet may want to start him on potassium bromide. He took a lot of valium the last set of cluster seizures also. My questions are: Could any of this be related to him eating the rabbit or touching the dead squirrel? Because he was sick the day after he ate the rabbit, could his sickness have brought on the cluster seizures? Does the bromide have side effects? My vet suggested an MRI, should I have one done and do you know of anyone in NE PA that does it? Could there be something else wrong with him instead of Idiopathic Epilepsy? I've also taken any red die or smoke flavor out of his diet. He's very disoriented after the seizures. Do they hurt him? He's my child and I want to do everything to make him better. It kills me to see him this way. I hope I've explained everything and I know I might be asking alot of questions, but I've been reading your site alot and you seem to be very knowledgeable. Any advice you could give me would be GREATLY appreciated. Thank you so much. Janice

Answer: Janice- I am pretty sure I will miss something in this reply, so please feel free to write back, if you need to. I really would be surprised if eating squirrels or rabbits had anything to do with the seizure activity, as far as immediate responses (like seizuring the day after this). There is a very small chance that it might have something to do with it from the standpoint of contracting an illness that may have lead to seizures, although the only one I can think of offhand is leptospirosis and that doesn't seem too likely. Potassium bromide may cause a lot of side effects the first few weeks that Bongo has to take it. It causes the same sort of "drunken" behavior that phenobarbital often causes when it is first used. This will go away with time but you have to be prepared for it. Less commonly, there may be vomiting, loss of appetite, diarrhea or pancreatitis. Since incoordination and sedation are expected effects, these last few things would probably count as the side effects. It is likely that there is something else wrong other than epilepsy due to the timing of the start of the seizures later in life. A general blood chemistry exam is a good idea ( and I'm willing to bet your vet already did that), an exam by a neurologist is a good option, although most vets are pretty good at recognizing a lack of neurologic signs and I do think an MRI would be a good idea if it is an affordable option (if you aren't bothered by the cost), as it can help in making a prognosis and understanding the problem, if it shows a brain lesion. There are several relatively new seizure control medications. At the present time I think that phenobarbital and potassium bromide in combination is still the preferred option for a first try at controlling difficult seizures but if this doesn't work, it isn't the only possible combination. Keep working with your vet to get this under control. It can be frustrating but usually, over time, it is possible to help or to discover why the medications aren't working. Mike Richards, DVM 4/22/2000