Seizures in Pets
1) Seizures are a signs of disease of the forebrain and there are many different causes including epilepsy, toxins, metabolic disease, stroke, encephalitis and cancer. The basic work up for all animals includes blood work to evaluate for metabolic disease and a blood pressure. However, an MRI (with possible CSF tap) is needed to rule out most causes. Epilepsy is common in younger dogs and is a diagnosis of rule out. If you would like to pursue MRI, I would refer you to Dr. Galano (veterinary neurologist) at VCA Shoreline. The cost of this test ranges from $2000 – 2500. Prior to doing this, we would want to take a chest x-ray to make sure there are no signs of cancer in the chest and a bile acids test to confirm the liver functions correctly (standard testing before running a big gun test like an MRI).
2) Siezures are scary and can be very violent. Despite the urge to pick up and sooth your pet, it is actually best to leave the pet and to remove anything surrounding them that could cause them harm. Seizures are typically short lived (under 1-2 minutes) and the patient is often very disoriented afterwards. Be careful not to get bitten as your pet is not aware of its surrounding following a seizure and may be startled easily. Finally, remember to record the time the seizure occurred, how long it lasted, a description of the seizure and how long they were disoriented afterwards.
3) Anticonvulsant medications can greatly diminish the frequency and severity of seizures. They are started in patients that have frequent seizures (more than 1 -2 every 3 months), violent seizures, or when we suspect cancer or other structural abnormalities. The decision to start these medications should be made in consultation with your veterinarian with a thorough understanding of the risks as these medications often require a life-long commitment. The role of the medication is to reduce the frequency and the severity of her seizures. They will not likely eliminate seizures from occurring all together.
4) Most seizures do not require immediate veterinary care; however, your pet must be taken to a veterinarian immediately if they have a seizure that lasts greater than 5 minutes (status epilepticus) or if there are greater than 2-3 seizures in less than 12 hours (cluster seizures)
- This historically was the most commonly used anti-convulsant medication and is still the most effective (works in 80 % of dogs). It is given as a tablet by mouth twice per day. Phenobarbital takes 2 – 3 weeks to be maximally effective and it is okay to miss a dose from time to time.
- The biggest disadvantage to phenobarb is the potential for side effects. Common side effects include sedation, lethargy, and drunken gait, which typically resolve after the first 2 weeks of therapy. Additional side effects include increased thirst, increased urination, and increased appetite (weight gain), which are dose dependent. The more serious side effect that can occur throughout therapy is liver dysfunction and possible failure (typically occurs when on too high of a dose). Finally, rarely dogs will have suppression of certain blood cell lines that vary in severity, but are typically reversible.
- The other big disadvantage of phenobarb is the need for close monitoring of blood work and blood levels. This includes full blood work 2 -3 weeks after starting therapy and then every 6 months. In addition, serum drug levels need to be checked 2 -3 weeks after starting the medication or adjusting the dose and every 6 months long term.
2) Potassium Bromide
- This is a dietary salt that is effective in 60 % of dogs and has been used for a long time. This medication is compounded into a liquid or capsule and given once or twice per day. Potassium Bromide is inexpensive.
- This medication takes 2 -3 months to be maximally effective and it is okay to miss a dose from time to time.
- The most common side effect of this medication is vomiting or loss of appetite and pancreatitis, which typically resolve when reducing the dose and giving with food. Less common side effects include weakness, increased thirst and increased appetite. Rare side effects include neurologic signs, which is reversible.
- While on potassium bromide it is important to maintain a very stable diet and especially important not to offer high salt treats.
- Monitoring while on this medication includes blood work every 6 months and blood levels after 3 months of therapy.
3) Keppra (leviteracetam)
- This is a newer medication, but has been used for the past 10 – 20 years and has been found to be both effective and very safe. Some dogs build a tolerance to this medication after 8 months or so and it losses efficacy.
- This medication is more costly and must be given three times per day (roughly every 8 hours), although some dogs (larger dogs) can get the extended release tablet which allows for twice daily administration. This medication is effective on day 1 of therapy and is started at a low dose that can be increased if needed.
- Rarely this medication causes sedation.
- Recommended monitoring includes bloodwork every 6 – 12 months.
Diets high in fat that help boost the presence of ketones as an energy source and increase the levels of omega fatty acids can help to lessen seizure frequency. If your pet is suspected or confirmed to be an epileptic, consider seeking the advice of a nutritionist or using the prescription diet Neurocare from Purina. Information on the study done regarding Purina’s diet can be found at the following link: http://marketplace.dvm360.com/product/purina-pro-plan-veterinary-diets-nc-neurocare
There are medications available that are not included in here. They are reserved for patients that needed secondary medications to help control the seizures and can be discussed with your veterinarian.