Seizures

Why is my pet seizuring?

 

We usually suspect idiopathic epilepsy when a patient begins seizures between the ages of 1-5 years old. They are also normal between seizures. This is a seizure disorder in which we do not have a cause or reason. However, we cannot rule out other possible causes of seizures without more advanced diagnostics. Possible other causes include metabolic, infections, inflammatory process, vascular events, toxins, trauma, neoplasia (cancer), among other possibilities. When a pet begins seizures before the age of 1 year old, or beyond the age of 5 years old, idiopathic epilepsy is less likely as a cause.  Your vet will discuss these and your options for diagnostics, depending on each individual patient.

How can I find out what is wrong?

Non- invasive diagnostics are commonly a blood pressure measurement and blood work including a CBC (complete blood count), electrolytes and chemistry panel (organ function testing). If we are concerned with liver function, a bile acid blood test may be advised. Some blood work is also important to evaluate prior to starting certain anti-convulsant medications, as well.

Advanced procedures are available to assist in diagnosing other causes of seizures. These include MRI or CT imaging, CSF tap, blood and/or spinal fluid analysis for infectious causes, among others. Please ask your veterinarian about these advanced tests.

Idiopathic epilepsy is a diagnosis by exclusion. This means we rule out other causes. If we do all these diagnostics and do not find an answer, then we diagnose idiopathic epilepsy.

What should I expect?

It is important to note, that seizures can be very frustrating to control/manage. Each individual is unique. This may be a long road of struggling to find appropriate control, and even need to seek a veterinary neurologist for management, or advanced diagnostics.

Compliance, or strict regimenting of yourself in dosing the medications as directed, as well as following up with your vet for needed blood testing, is critical for successful management!

What are the common medications for seizure control (anti-convulsants)?

1) Phenobarbitol              

  • This medication is relatively inexpensive. It does require blood level checks intermittently and liver panels along with CBC’s (blood work) due to possible side effects. It is common for the medication to require increased dosage over time.
  • After starting the medication or changing a dose, it takes about 2 weeks to reach appropriate blood levels.
  • This drug MUST be given every 12 hours to be effective.
  • A baseline blood work should be evaluated prior to starting this medication.  
  • Contraindications - liver disease, bone marrow reaction and skin reactions.
  • Adverse effects possible– anxiety/agitation, sedation, wobbly or weak gait, increased thirst, increased urinations, increased appetite and elevation of liver values (but toxicity uncommon). RARELY - anemia, low platelets and low WBCs.   Ask your veterinarian for exact detail.
  • This medication should never be suddenly stopped. If it is to be discontinued, a taper should be advised by your veterinarian.

2) Potassium Bromide

  • This is a relatively inexpensive drug. It is usually given once daily, after the initial loading dose over the first 5 days.
  • Blood level checks are required to maintain therapeutic range and monitor for toxicity. Recommendations are at 3 weeks, 3 months and then every 6 months.  Monitoring the diet is important while taking this medication. Salt consumption should be kept to a minimum. Your vet will give more detail if this is the drug of choice.
  • Adverse effects – sedation, possible wobbly gait.

3) Zonisamide

  • This is now available as a generic and more affordable, but more expensive than phenobarbital and potassium bromide. It is given twice daily. There is no required blood level testing or blood work monitoring parameters required.
  • Side effects are less common than the other medications above.

4) Levetiracetam  (Keppra)

  • Not metabolized in liver.  More expensive than phenobarbital and potassium bromide; can be more expensive than Zonisamide.
  • Requires THREE times a day dosing, as it clears the system within about 6-8 hours.
  • There is no required blood level testing or blood work monitoring parameters required.
  • Side effects are less common than the other medications above.  Considered a very safe drug for dogs and cats.

5) Other medications

These are usually selected if the above listed medications are ineffective or not tolerated. They are often cost prohibitive and require 3 times daily dosing. Seek a veterinarian opinion as needed.

How do I know my pet is controlled? Or how often should I expect seizures?

We consider a patient “controlled” in seizure management if they have less than 1 seizure every 8-12 weeks (less than 1 seizure every 2-3 months). If your pet is experiencing seizures more frequently than this, we advise consultation with a veterinarian. Your pet may need a dose change, or even multidrug therapy (more than one medication). Consult a veterinarian before altering any medications!

What can I do at home if my pet seizures?

  • Pets will often urinate or defecate when seizuring.   You can clean this area and your pet after the seizure is over.
  • DO NOT put your fingers or hand in or near the mouth! Sometimes, pets will bite their tongue or cheek, causing bleeding. They may accidentally bite you if you attempt to “help” them.
  • You may talk to them, comfort them with your voice, or pet them.   You can place a blanket or towel near the head, in attempt to prevent injury to themselves. If they are on a bed, where they can fall off, place them on the floor (if possible) or attempt to confine them with pillows so they cannot fall. Be sure they are away from stairs, where they could injure themselves, as well.
  • Do not attempt to give your pet any medication in the mouth while seizuring. Please call a vet if you have any question.

What is an Emergency?

We advise to seek veterinary care if your pet has more than 3 seizures in a 24 hour period, any seizure lasting longer than 5 minutes in one period, or is “clustering” (seizure activity lasting longer than 5 minutes in one period). Also, when they have multiple seizures back to back, or cannot come out of a seizure. If they have a seizure lasting longer than 10 minutes, this is an emergency!