Seizures complicated by other disorders or problems in dogs


Seizures or obsessive compulsive behavior with liver damage

Question: When my 10 year old Lhasa Apso mix, Buddy, was about 2 or 3 years old her started turning his head to the side, darting out his tongue, and jerking his head several times a day. Also, excessive licking of his feet, the bed, or the floor. My veterinarian asked that I take a video of this which he sent to the Oklahoma State University School of Veterinary Medicine. This was diagnosed as limbic epilepsy and he was put on phenobarbital with the dosage adjusted to control what were termed "seizures". He took 30 mg. twice daily for several years. Blood tests were done for a few years, but not since 1996 until his current troubles. The same vet has taken care of him throughout this time. In early June, Buddy became lethargic, reluctant to jump up on the bed or into the car, etc. and began eating dirt.

Buddy' regular vet was on vacation so one of the other doctors examined Buddy and recommended x-rays and liver profile tests. The test results revealed alkaline phospatase of 3192 and SGPT 372. Dr. S immediately cut his phenobarbital to 15 mg. twice daily, put him on Science Diet L/D and lactulose, and scheduled additional blood tests in two weeks. After Buddy's regular vet returned, the two of them consulted on Buddy's case.

The second liver profit came back normal, in fact extremely low. Alk. phos. of 13 and they did another a few days later which came back high again. The second test was obviously in error for some unknown reason. Following are the test results that I have. (Can get complete results if needed.)

Alk. Phos. SGPT Cholesterol

1/94 829

8/94 1140

1996 1802 114 276

6/8/00 3192 372

7/3/00 2303 369 up

At this time the two vets recommended an open exam. and biopsy of the liver, skipping bile acid and ultra sound tests which they felt would be inconclusive. The surgery was done 7/7 and they found that the liver was damaged and hard to the tough, with nodules throughout, and different, larger nodules int he spleen. Biopsies of both were sent to OSU pathology. No cancer was found. The spleen nodules were found to be hyperplasia and the liver damage to be extensive but reversible. The Tulsa surgeon had a long telephone conversation with the OSU small animal specialist and pathologist, and they went over Buddy's entire medical history. (He had a severe case of pancreatitis when he was about 1 1/2 but none since, He has been on thyroid for several years.) They are now of the opinion that his problem (head jerking, licking, etc.) is obsessive compulsive disorder and are trying to determine how best to control it and also allow his liver to recover. His phenobarbital has been cut to 7 1/2 mg. twice daily then raised to 7 1/2 mg. a. m. and 15 mg. p.m. but he has been having unacceptable levels of licking, etc. and is having what appear to be panic attacks - frantic leaps onto my lap, trembling and restless pawing.

Since early June when his diet and medicine levels were changed Buddy has improved greatly but is still slow to get started in the morning and fatigues easily. Sleeps a good deal, but still loves to go on his short walks. Through it all he has eaten well and has not lost weight from his usual 17 lbs. He looks good and is alert.

I have read through your files and other sites on the Internet re dogs, phenobarbital, and liver damage. His seizures or obsessive behavior must be controlled to some degree or his life would be miserable, but I worry about the phenobarbital. What are your thoughts on this situation? Do you have an opinion as to whether his actions are limbic epilepsy or obsessive compulsive behavior, and/or a suggestion as to control thereof. Any help you can offer will be greatly appreciated.

Thank yoj

Answer: Yoj- It does not surprise me that there is some disagreement over the diagnosis in this case. It is really hard to distinguish partial seizures and partial complex seizures from obsessive compulsive disorders. As far as I know, response to treatment with seizure control medications is still the method used to distinguish seizure activity from obsessive-compulsive behavioral disorders. This isn't a perfect test, because the depressant effects of the seizure control medications might mask some cases of obsessive-compulsive disorders.

Partial seizures usually involve motion of a limited area of the body. Eyelid twitching, running motions in one leg and rhythmic movement of the head in one direction are typical motions that might be associated with a partial seizure. In simple partial seizure activity the patient retains full consciousness despite the inability to control the movement.

In complex partial seizures there are similar movements but the patient is either unconscious or only partially conscious during the seizure activity. Repetitive floor licking has been associated with complex partial seizures, as has tail chasing and other repetitive activities. Since this type of thing is exactly what is seen with obsessive compulsive disorders, it can be very hard to distinguish them.

In theory, if it could be established whether the patient was experiencing some loss of consciousness, such as an inability to respond to the owner or to make an appropriate response to some stimulus, it would make seizure activity the more likely diagnosis. The only problem with this is that really obsessive/compulsive activity often involves such strong concentration on the activity that the dog appears to be unable to respond to the owner.

Since Buddy's behavior got better with the use of phenobarbital, I would vote for the seizure activity as the likely problem. But I'm not a neurologist and am just basing my guess on response to treatment, which as I pointed out earlier, can be misleading.

At the present time, when phenobarbital can not be used due to toxic effects on the liver, the most commonly recommended alternative seizure control medication is potassium bromide. It works well in many dogs and can be used to help lower the necessary dosage of phenobarbital, or as the sole seizure control agent in some dog. If this doesn't work there are a number of other seizure control medications, such as felbamate, clorazepate and gabapentin, that are less well studied for use in dogs, but which might prove to be beneficial in some cases.

If this is obsessive-compulsive behavior then the use of selective seritonin-reuptake inhibitors (SSRIs) is the medical course usually recommended. Clomipramine (Clomicalm Rx) and fluoxetine (Prozac Rx) are two of the commonly recommended SSRI medications (although I think that clomipramine has two effects - some SSRI effect and some tricyclic antidepressant effect).

The other thing I would wonder about would be subtle damage from hydrocephalus. This is sometimes only possible to detect using CT or MRI scans and might cause the head movement and licking behaviors, or at least it seems to do this sometimes in the patients we have seen in our practice. This is probably really unlikely, though.

While phenobarbital is the most reliable anti-seizure medication available to vets right now, it is often possible to find an alternative medication to control seizures. Potassium bromide is a good second choice since it is pretty effective and not too expensive. Other medications are available but are effective in smaller numbers of dogs and are more expensive than phenobarbital or potassium bromide.

It will probably take some teamwork between you, your usual vet and the vet school to find an alternative solution to Buddy's problems that works well. It can be frustrating while you are searching for the right alternative, but usually one can be found.

Good luck with this.

Mike Richards, DVM 8/7/2000

Seizures and allergy

Question: Dear Dr. Richards, I wrote to you on July 3,2000 about my Shepherd mix dog, Bubba and his seizures, since I wrote we got back the blood level tests, Bubba is now taking five 64.8 Phenobarbitol twice a day (8:00am & 8:00pm) and we increased the Potassium Bromide to 9.0ML once a day at 6:00pm. Since I wrote you Bubba has not had a seizure that I'm aware of. I did forget to mention in my first letter that he had developed an allergy problem, we ran tests to see what he was allergic to, there was quite a few things, some common ones were ants, mulberry trees, bermuda grass. I received a mixture to begin hyposensitization treatments. We began the injections on 5/23/00 at 0.1cc every other day, we are now at 1.0cc and just finished the every 10 day series, now it's every 14 days, the next one is due July 30th. Even though the allergy seemed to develop after the seizures I was wondering if there is some sort of connection. Bubba has lost alot of hair due to scratching. I give him a bath once a week with a shampoo called Relief, (it gives some) If I found someone who does dog acupuncture, I'm assuming I would still leave Bubba on all his regular medications, correct? Since he has had no seizures that I am aware of since the increase of the medication, I'm hoping this is a good sign, am I right? What, in your opinion is the long term prognosis for Bubba? I really appreciate your taking the time to answer my questions, I'm VERY concerned. Thank you again, Bubbas Mom P.S. The allergies started in the winter months, probably around January.

Answer: Bubbas Mom-

There are scattered reports of seizures due to allergies and some of these have been documented very well. If this were the case, it would improve the prognosis significantly. In some of these dogs, seizures were the only clinical sign, so it is possible that an allergic condition was present prior to the time other clinical signs, such as itchiness, appeared.

Just to thrown in a note of caution, if you became suspicious of allergies due to itchiness and the itchiness occurred after administration of phenobarbital, you have to think about the possibility that phenobarbital is causing some of the problems. There are a few dogs that get very itchy when they are on this medication. On the other hand, if this is what it took to discover allergies that were part of the problem, that isn't necessarily a bad outcome.

It takes a long time for potassium bromide to exert a reliable anti-seizure effect (sometimes two or three months after starting the medication), so there is also some chance that the dose changes are responsible for the seizure control. That would also be an acceptable situation, since gaining control of the seizure activity is a good sign.

Shepherds are known for having difficult to control seizures, so cautious optimism is probably called for here. Knowing allergies are present and controlling them with hyposensitization is good, having a break from the seizures is good but it will take some time to be certain that you have control of the situation. After several months without seizure activity it may be possible to cut down on the dose of phenobarbital, gradually, to see if control can be maintained a lower dosages.

I hope that you have found the solution to Bubba's seizures but even if you haven't, controlling the allergies will make him feel better and may very well decrease the number of seizures even if it doesn't eliminate them.

Mike Richards, DVM 7/24/2000

Seizures and Mange in Lab

Question: I have a chocolate Lab. who is 10 months old. He was a healthy, happy, energetic dog. Very intelligent and eager to learn new things and meet people. Back in late September, after coming back from vacation, on which we had taken him and one of my Lhasa with us, my Lab started scratching heavily and continously. But not my Lhasa. We had to kennel them twice for a few hours during our vacation, so we thought that perhaps he had picked up some fleas, although we were treating the with Advantage. But after a couple of weeks of returning home, we noticed that the Lab was losing hair, on his abdomen and around his eyes. I went to my Vet and he diagnosed him with the Mange. My Lhasa had no effect of it at all and still does not. My vet. gave him 3 injections over a 6 weeks period, but he was still scratching quite a bit. Especially, around his mouth, and face. The hair did not seem to re-grow, and we were worried that he may still have some residual effect of the mange. So with my worries, my vet recommended dips. Therefore, my vet gave me "Lindane" which I mixed to the ratio of 1/2 oz to the gallon. I had sprayed him twice, fairly heavy; and that day my wife took in a "Fushia" plant back inside the house and the dog ate it. On October 29, @ 02:00hrs. he woke my wife and I up, with a full fledge seizure, which lasted perhaps 3-5 minutes. He drolled very heavily for 1 hour and seemed unconcious for part of that hour. And then the rest of the night he was calm but seemed somewhat dis-orientated. The next morning, he recognized us and was happy to see us, but seemed tired, as if he had not sleep for the past week. Nonetheless, we never gave another thought, because we were treating him at the time for the mange, and I thought that perhaps the spraying of the insectides had been too heavy plus him eating that plant all it was that he had suffered was a severe reaction. I since discontinued the spraying. His hair has started to regrow and all seemed fine and dandy. But a couple of days ago, Monday Dec.6 he started convulsing around 11:00hrs., by noon time he was still seizing and I went to visit my Vet who took him in right away, and took blood sample, and checked him out. I asked him if he thought it was epilepsy. He said it was possible, but with the blood sample he hoped to confirm a diagnose soon. He gave him an injection of "Atrovet", and gave me "Phenobarbitol" pills to be given 1 pill twice a day. After returning home the convulsion, kept up and I called the Vet back who then suggested that I give him 1 pill. This was perhaps 12:45hrs., I then went to work, but my vet said that he would call us back in the early part of the evening to see how the dog was doing and to give us the result of the blood sample. He was good and some what resting until 18:30 when he started seizing every 15 mins. So my wife contacted the Vet who asked my wife to give him another pill which she did. It did not help, the dog any. The vet told her that the blood did not show any poison substance, or viral infection or parisites. He felt that given a bit more time for the drugs to take effect, all should get under control. I returned from work @ 23:30hrs. and the dog was seizing every 15-20 secs. since 19:30hrs. at this point I gave the dog 2 pills and after 2.5 hours the dog was still seizing but the seizures did not seem as severe but just as frequent. Throughout this day he drolled very heavily, he never ate, he drank perhaps 1-2 oz of water, he was not recognizing us or at least did not wag his tail, he never laid down and seemed to be scared of us, confused sweaty and totally wore out. We went to bed @ 01:55hrs and although not seizing as severely and often he was still standing and did not layed down. The next morning @ 05:15hrs he was laying down, seemed to know me but was very scared and confused, he did not attempt to get up as he usually would. But he seemed happy to see me, I gave him fresh water which he licked a couple of time only, I gave him some food of which he only ate a few bites. He never had a bowel movement or bladder void for almost 22 hours. He attempted to roll over so that I could rub his belly but seemed sore to attempt to roll over. So I left him, and he laid back down and rested. He seemed to be finally over his seizures, and he was now walking around a bit, still scared like, still seemed sore and he constantly had a facial (MOUTH) twitch and still drooling, although not as heavily as for the past day but still drooling a bit. At around noon time he started convulsing again, I immediatly gave him another pill and my wife took him back to the Vet office. Where he is still there at this time today and at least until tomorrow. My vet and his team discussed different diagnosis. From Rabie, which he was vacinated against back in June, to epilepsy. One of his colleague, mentioned " Familio Labrador disease". But my vet feels that it does not fit his thoughts, but wants to further investigate. He is now treating the dog with "Diazupan" and this morning the dog his alert, and responding. Still seems to be scared and sore but he his happy, according to my vet. He feels that he should keep him for another 24 hrs. and try to find out if the Phenobarbital or the Diazupan is responsible for arresting the seizures. He wants to treat him with only Diazupan, but he said that possibly a combination of both drugs might be required. Anyhow, I tried to find out on your site the disease but could not find anything out. Have ever heard of such a Genetic disease for Labs. and if so where can I get info on it and what is the expected live and quality of life for my dog. I had purchased him for breeding purposes, but I am sure that this will be out of the question but I sure don't want to put him down, he his a member of my family along with my other 2 Lhasas, which he gets along very well with, well my female Lhasa is not to interested in him and does not hesitated to put him in is place went she had enough of his curiousity. If you can help or advise me I would certainly appreciate your comments and advise. Sincerely, J. B.

Answer: J.B.-

There are several issues raised by your note that need to be addressed. I'll try to make sure I address all of them, but if you have further questions, please feel free to write again.

Mange issues:

There are two types of mange mites that commonly affect dogs, Demodex mites and Sarcoptes mites.

Demodex mites cause demodecosis. This is a non-contagious disease that occurs because of a defect in the dog's immune system. The reason the condition is considered to be non-contagious is that almost all dogs have Demodex mites on their body. Most dog's immune systems suppress the reproduction of the mites and the mites are present in very small numbers. They live on the dog in relative harmony with the dog in this case. Some dog's immune systems can not suppress the mite. This leads to large numbers of mites being present. Since they live in the hair follicles the presence of large numbers of mites causes the hair to fall out and makes secondary bacterial infections common. The immune system problem may be temporary due to a problem with the immune system due to stress, growth or other conditions that will not permanently affect the immune system. In this case, the dog will eventually control the demodecosis on its own. The immune system problem can be permanent, in which case it is necessary to treat the demodecosis because the dog has no way of making it go away on its own. It is difficult to treat dogs that have a permanent immune deficiency and only three medications have been shown to have a good effect against demodecosis in this situation. They are amitraz (topical), ivermectin (oral or injection) and milbemycin (oral). Demodecosis alone does not itch much but since itchy bacterial infections are often present, there can be a lot of itchiness associated with this type of mange.

Sarcoptes mites cause sarcoptic mange. This is a contagious illness and affected dogs are very itchy. Sometimes so itchy that they sit down every few feet and scratch persistently. This type of mange responds well to a number of treatments. Lindane will kill sarcoptes mange mites but it isn't a very good choice for treatment because it causes seizures in some dogs treated with it and other, equally effective medications are available that do not have this effect. There are a number of medications that will kill sarcoptic mange mites, including ivermectin (orally or by injection), selamectin (topical), fipronil (topical), lime-sulfer dip (topical) and organophosphates (topical, several available that are less likely to cause seizures or other toxic effects than lindane).

Seizure issues:

Why are seizures occurring? The first seizure was probably due to lindane lowering the seizure threshold enough for your dog, who appears to be prone to seizures, to have one. Since there was such a long time between seizures it seems unlikely that the second one is directly attributable to lindane. So it is likely that there is another explanation. Checking a complete blood panel for systemic illness and doing a good neurologic exam would be good first steps in trying to find an underlying cause. If nothing is found that can be treated it may be necessary to control the seizures lifelong.

Phenobarbital is the medication most commonly used to control seizures in dogs. It is a good medication for long term seizure control. But it takes about three weeks of oral dosing to reach sufficient steady-state blood levels to control seizure activity. This makes it a good seizure prevention medication but a poor treatment for seizures that are already occurring. So it isn't surprising that it didn't work to control the seizures seen so far. But it is still the best choice for prevention of future seizures. It is a better choice than diazepam (Valium Rx) for this use. Phenobarbital should not be considered ineffective until it has been proven that serum phenobarbital levels are stable and are adequate to control seizures. It may not entirely control seizures even after that time but if they are significantly diminished in frequency or duration it is still worth continuing phenobarbital.

Diazepam is capable of stopping a seizure that is already in progress. That is why it appears to be working better than phenobarbital right now. It isn't as good for long term use in seizure control, though. It may be necessary to use diazepam to control seizures that occur over the next few weeks while waiting for phenobarbital to reach effective blood levels, though. It is possible to decrease the time it takes to get adequate phenobarbital levels by giving phenobarbital intravenously initially. If control of seizures can't be achieved with diazepam and phenobarbital then general anesthetic agents may be necessary in order to stop seizure activity.

To sum this all up, it would help a lot if you could find out which type of mite is present. Knowing this would make it possible to get a better idea of prognosis and to figure out how to treat both the mange and the seizure activity without the medications interacting or complicating the other condition. It is likely that seizure activity this severe will require treatment and phenobarbital is a much better long term choice than diazepam for seizure prevention, even though diazepam probably did stop the seizures that were already occurring.

I will look into the "familio Labrador disease" but do not recognize this term offhand. Labradors have several hereditary neurologic or neuromuscular conditions but none that I can think of lead to seizures of the duration your dog experienced.

Mike Richards, DVM 12/10/99

Last edited 08/30/02


Michael Richards, D.V.M. co-owns a small animal general veterinary practice in rural tidewater Virginia. Dr. Richards graduated from Iowa State University's College of Veterinary Medicine in 1979, and has been in private practice ever since. Dr. Richards has been the director of the PetCare Forum...