Epilepsy can result in a substantial financial drain for owner, as all other diseases have to be ruled out first and foremost. Additionally, the owner could be looking at additional costs by way of MRI, X-Rays, Ultrasound and so forth. Ensure your pet is adequately covered, not just for Epilepsy, but for all other diseases and accidents as well - which as we all know, can happen all too often and unexpectedly. Do visit our website to see our affordable, simple 5 plan options.
Epilepsy in Dogs
By Dr Anthony Zambelli
By Dr Anthony Zambelli
If The Diagnosis Fits … It’s Canine Epilepsy
Bismarck*, the German Shepherd, wasn’t even two years old when his owner, George, noticed he seemed to be having a seizure. George had never seen a dog have a seizure before, but his younger brother used to have them. Thankfully he didn’t panic, and instinctively he DIDN’T put his hand into Bismarck’s mouth to hold down his tongue. When it happened a second time about two months later, it was off to the vet for Bismarck. “Bismarck has epilepsy,” was the verdict after a barrage of tests. Now what?
Epilepsy is a misunderstood and frightening disease of the canine nervous system. But does it deserve such a bad reputation? Probably not! Few dogs die from the disease or its consequences, and it is not considered to be painful. It probably causes some anxiety in the owners and onlookers, as well as anxiety for certain dogs. But what causes it? How is it diagnosed? What other disease can be mistaken for epilepsy? What is grand mal and petit mal ... in the canine sense? Does diet play a role?
So Many Fits … So Many Causes
The key to understanding epilepsy is that seizures are caused by many diseases, not just epilepsy. Seizures, or seizure-like syndromes, can be caused by low glucose, low calcium levels, liver failure, high blood pressure, some types of cancer, and exposure to many, many poisons. Even trauma to the head and neck can cause seizures. Some developmental diseases such as hydrocephalus (‘water in the brain’) can result in seizures.
Seizures or convulsions are the uncontrolled muscle and organ functions (urination, defecation) that occur when any one of these processes interferes with the brain's chemical-electrical balance. The brain fires constantly, and we would all be helpless epileptics, if it were not for the inherent suppressive nature of the brain on its own activity. This is as a result of many things, but when it is overwhelmed (for example, by toxins) or malfunctioning (e.g. in ‘pure’ or ‘primary’ epilepsy) the brain, or part of the brain, can fire and may escape this inhibition. If this wave of electrical activity spreads over the entire brain, like a veld fire, it causes random, uncoordinated and sustained motor activity - convulsions. Since the brain is constantly firing, one could be justified in saying that we are all ‘owed’ a ‘free’ seizure once or twice in our lives ... but when it becomes a pattern, say more than twice a year, it may require investigation and treatment. Epilepsy - primary epilepsy - is a disease of the young (<5 year old dog). When a 10 year old dog is referred to me for recent onset epilepsy, I don't think ‘epilepsy’, I think ‘infection, brain tumour, organ failure’ (liver, kidneys etc.). Sure, the seizures caused by a brain tumour will be controlled by anti-epileptic medications ... for a while. In the meantime, the uncontrolled growth of the tumour means that failure is not far away, and a potentially treatable tumour becomes untreatable.
How Is Epilepsy Diagnosed?
That's not so straightforward. Because CE (canine epilepsy) is an electrical-chemical disease, not a disease where there is a lesion, it is diagnosed by ruling out all other causes first. Then, what you're left with, is epilepsy. To be purist, this can cost a lot of money. But if we are practical about it, just ruling out the obvious and important diseases can give us a high degree of certainty that we are dealing with CE, and a treatment path can be determined.
The breed and age of the dog are very important factors to consider. Labradors, Golden Retrievers, St Bernards and German Shepherds (and a few other breeds) are commonly-afflicted breeds. The first episode usually occurs (in any dog) at under two years of age, but I have seen some patients afflicted at six years of age.
A history, preferably a recording (on a cell phone or digicam) can be helpful for the vet to decide on the true nature - seizure, tremor, fainting, etc. A history of exposure to toxic substances, or even testing for them, is important.
Vaccinations are important, as is contact with unvaccinated animals, as rabies and distemper can cause seizures. For young pups, de-worming and a faecal examination should be mandatory with seizure investigations. Urine and blood tests can rule out the ‘extracranial’ disease - liver, kidney, infection, and so on.
ell your vet if you give your pet any supplement, remedy, or use any washes, shampoos, collars, metal toys, etc. It's all important. A thorough neurological evaluation is important. A good ‘neuro’ can take 20 - 40 minutes, and is a series of tests that completely evaluate the nervous system. The vet will examine eyes and eye reflexes; gait and walking; hopping; swallowing; and muscle tone, to name but a few items. A true epileptic must be normal between episodes.
Each episode of convulsions is called an ‘ICTUS’ or ‘ictal period’ and the period preceding it the ‘AURA’ or ‘prodromal’ period. Some auras can be very brief or even unapparent - a few seconds - while others last a day or so, and are characterised by nervousness, nervous facial or muscle ‘tics’ and pacing. A seizure can be as brief as a few seconds, or last over half any hour –so-called ‘status epilepticus’: This is considered a medical emergency. Epileptics, particularly seriously affected ones, can also be subject to a phenomenon known as ‘kindling’. Kindling, as its name suggests, is an analogy for the burning of a fire. A single episode of seizures can ‘prime’ the brain for more seizures, and set up a status epilepticus in series – a ‘cluster’ of seizures. Cluster seizures can mean your pet seizures on and off over a period of hours or even days. They are also considered a medical emergency and must be halted. It is important to realise that epilepsy rarely causes any direct damage to the brain or other parts of the body. However, uncontrolled seizures, such as a cluster or status epilepticus, can lead to overheating (hyperthermia) and this can damage the brain, liver, kidneys and heart. Lastly, there are some stranger manifestations of CE, such as Focal Epilepsy, wherein only a portion of the brain is affected. You might see this as strange motor activity of just one limb, or peculiar behaviours (so called ‘temporal’ and ‘limbic’ epilepsy, in some forms called ‘petit mal’). Beware! Other conditions, such as nerve and orthopaedic injuries; entrapped nerve roots; disc protrusions; electrolyte abnormalities; and some infections such as rabies and distemper, can also cause similar signs. Furthermore, focal CE can ‘generalise’ and evolve into classic or ‘grand mal’ seizures, such as described previously.
Calmly Does It …
Help your seizing pet by switching off music and lights; and having visitors, children and other dogs leave the room/area; there should be as little extra stimulation as possible. Record the start time and end time and the pattern of recovery. Dogs do NOT ‘swallow their tongues’ and putting your fingers in the mouth is a recipe for a visit to the local emergency room for dog bites! Soothe and stroke your dog – be calm for his sake! If there is a possibility of a poisoning (e.g. a secondary seizure) or if your dog has a history of any new medication or of a chronic disease (liver disease, high blood pressure, heart disease), put the pet in the car as soon as he has settled, and seek veterinary attention. Take any such medicines or potential toxins along to the vet in their original packaging. Also take your dog’s vaccination card along. If your pet has a seizure or seizure-like episode, and your cell phone is handy, make a video recording of the episode, including the recovery period. Seek a medical diagnosis of epilepsy or other relevant conditions once the initial episode has subsided.
Is There Treatment For CE?
The answer is a resounding YES! CE is treated ONLY after a diagnosis has been made and other medical conditions excluded. For this reason, your vet will:
Treatment over 60 – 70% of dogs can be satisfactorily achieved with a starting dose of a barbiturate drug called phenobarbitone. PhB is administered strictly every 12 hours, for 6+ months, or even life long, and requires biannual blood tests to check that drug levels in the blood are within a range that is both safe, and effective. PhB is considered a very safe drug, with liver toxicity occurring very, very rarely, but it does have minor side effects. Most dogs are very sleepy for the first 1 – 2 weeks after starting the drug, as they get used to it. Secondly, many eat a lot and put on weight – discuss a ‘low calorie’ diet with your vet if this is the case. It is vital that you understand the OBJECTIVE of treatment is NOT to completely STOP seizures – this is rarely achievable. Treatment is considered a SUCCESS if the NUMBER and SEVERITY of seizures DECREASES by 50% OR MORE. If a dog has 1 – 2 mild seizures a year, this hardly makes treatment worthwhile. If a dog has 6 bad episodes every other month, a success would be 1 – 3 mild attacks every 4 months. If PhB is not effective enough at the initial dosage, its dosage can be increased, as long as follow-up tests (1 – 2 weeks after each dosage change) are performed. At a certain point, the vet will decide to ADD an additional drug, usually potassium bromide (KBr). KBr and further drugs (and there are third, fourth and fifth choice medications) are much more complex for the vet to manage, and, again, referral or at least the opinion of a specialist may be advisable.
And Lastly …
Many people stay on PhB or other drugs for YEARS – their entire lives – and the treatment ensures a normal quality of life for many individuals around the world. CE is completely manageable and rarely dangerous condition but one which has been the source of much fear, misunderstanding and anxiety for centuries. Your vet can help you diagnose and control this disease, and treatment is rarely expensive, except for the largest dogs or the most severe and complex cases (a rarity). It is a disease to be managed, not feared. Finally, it is worth noting that many forms of epilepsy are heritable, and for this reason breeding of an epileptic animal is absolutely unwise. Ownership of an epileptic is not problematic however – even I have an epileptic pet!
Bismarck*, the German Shepherd, wasn’t even two years old when his owner, George, noticed he seemed to be having a seizure. George had never seen a dog have a seizure before, but his younger brother used to have them. Thankfully he didn’t panic, and instinctively he DIDN’T put his hand into Bismarck’s mouth to hold down his tongue. When it happened a second time about two months later, it was off to the vet for Bismarck. “Bismarck has epilepsy,” was the verdict after a barrage of tests. Now what?
Epilepsy is a misunderstood and frightening disease of the canine nervous system. But does it deserve such a bad reputation? Probably not! Few dogs die from the disease or its consequences, and it is not considered to be painful. It probably causes some anxiety in the owners and onlookers, as well as anxiety for certain dogs. But what causes it? How is it diagnosed? What other disease can be mistaken for epilepsy? What is grand mal and petit mal ... in the canine sense? Does diet play a role?
So Many Fits … So Many Causes
The key to understanding epilepsy is that seizures are caused by many diseases, not just epilepsy. Seizures, or seizure-like syndromes, can be caused by low glucose, low calcium levels, liver failure, high blood pressure, some types of cancer, and exposure to many, many poisons. Even trauma to the head and neck can cause seizures. Some developmental diseases such as hydrocephalus (‘water in the brain’) can result in seizures.
Seizures or convulsions are the uncontrolled muscle and organ functions (urination, defecation) that occur when any one of these processes interferes with the brain's chemical-electrical balance. The brain fires constantly, and we would all be helpless epileptics, if it were not for the inherent suppressive nature of the brain on its own activity. This is as a result of many things, but when it is overwhelmed (for example, by toxins) or malfunctioning (e.g. in ‘pure’ or ‘primary’ epilepsy) the brain, or part of the brain, can fire and may escape this inhibition. If this wave of electrical activity spreads over the entire brain, like a veld fire, it causes random, uncoordinated and sustained motor activity - convulsions. Since the brain is constantly firing, one could be justified in saying that we are all ‘owed’ a ‘free’ seizure once or twice in our lives ... but when it becomes a pattern, say more than twice a year, it may require investigation and treatment. Epilepsy - primary epilepsy - is a disease of the young (<5 year old dog). When a 10 year old dog is referred to me for recent onset epilepsy, I don't think ‘epilepsy’, I think ‘infection, brain tumour, organ failure’ (liver, kidneys etc.). Sure, the seizures caused by a brain tumour will be controlled by anti-epileptic medications ... for a while. In the meantime, the uncontrolled growth of the tumour means that failure is not far away, and a potentially treatable tumour becomes untreatable.
How Is Epilepsy Diagnosed?
That's not so straightforward. Because CE (canine epilepsy) is an electrical-chemical disease, not a disease where there is a lesion, it is diagnosed by ruling out all other causes first. Then, what you're left with, is epilepsy. To be purist, this can cost a lot of money. But if we are practical about it, just ruling out the obvious and important diseases can give us a high degree of certainty that we are dealing with CE, and a treatment path can be determined.
The breed and age of the dog are very important factors to consider. Labradors, Golden Retrievers, St Bernards and German Shepherds (and a few other breeds) are commonly-afflicted breeds. The first episode usually occurs (in any dog) at under two years of age, but I have seen some patients afflicted at six years of age.
A history, preferably a recording (on a cell phone or digicam) can be helpful for the vet to decide on the true nature - seizure, tremor, fainting, etc. A history of exposure to toxic substances, or even testing for them, is important.
Vaccinations are important, as is contact with unvaccinated animals, as rabies and distemper can cause seizures. For young pups, de-worming and a faecal examination should be mandatory with seizure investigations. Urine and blood tests can rule out the ‘extracranial’ disease - liver, kidney, infection, and so on.
ell your vet if you give your pet any supplement, remedy, or use any washes, shampoos, collars, metal toys, etc. It's all important. A thorough neurological evaluation is important. A good ‘neuro’ can take 20 - 40 minutes, and is a series of tests that completely evaluate the nervous system. The vet will examine eyes and eye reflexes; gait and walking; hopping; swallowing; and muscle tone, to name but a few items. A true epileptic must be normal between episodes.
Each episode of convulsions is called an ‘ICTUS’ or ‘ictal period’ and the period preceding it the ‘AURA’ or ‘prodromal’ period. Some auras can be very brief or even unapparent - a few seconds - while others last a day or so, and are characterised by nervousness, nervous facial or muscle ‘tics’ and pacing. A seizure can be as brief as a few seconds, or last over half any hour –so-called ‘status epilepticus’: This is considered a medical emergency. Epileptics, particularly seriously affected ones, can also be subject to a phenomenon known as ‘kindling’. Kindling, as its name suggests, is an analogy for the burning of a fire. A single episode of seizures can ‘prime’ the brain for more seizures, and set up a status epilepticus in series – a ‘cluster’ of seizures. Cluster seizures can mean your pet seizures on and off over a period of hours or even days. They are also considered a medical emergency and must be halted. It is important to realise that epilepsy rarely causes any direct damage to the brain or other parts of the body. However, uncontrolled seizures, such as a cluster or status epilepticus, can lead to overheating (hyperthermia) and this can damage the brain, liver, kidneys and heart. Lastly, there are some stranger manifestations of CE, such as Focal Epilepsy, wherein only a portion of the brain is affected. You might see this as strange motor activity of just one limb, or peculiar behaviours (so called ‘temporal’ and ‘limbic’ epilepsy, in some forms called ‘petit mal’). Beware! Other conditions, such as nerve and orthopaedic injuries; entrapped nerve roots; disc protrusions; electrolyte abnormalities; and some infections such as rabies and distemper, can also cause similar signs. Furthermore, focal CE can ‘generalise’ and evolve into classic or ‘grand mal’ seizures, such as described previously.
Calmly Does It …
Help your seizing pet by switching off music and lights; and having visitors, children and other dogs leave the room/area; there should be as little extra stimulation as possible. Record the start time and end time and the pattern of recovery. Dogs do NOT ‘swallow their tongues’ and putting your fingers in the mouth is a recipe for a visit to the local emergency room for dog bites! Soothe and stroke your dog – be calm for his sake! If there is a possibility of a poisoning (e.g. a secondary seizure) or if your dog has a history of any new medication or of a chronic disease (liver disease, high blood pressure, heart disease), put the pet in the car as soon as he has settled, and seek veterinary attention. Take any such medicines or potential toxins along to the vet in their original packaging. Also take your dog’s vaccination card along. If your pet has a seizure or seizure-like episode, and your cell phone is handy, make a video recording of the episode, including the recovery period. Seek a medical diagnosis of epilepsy or other relevant conditions once the initial episode has subsided.
Is There Treatment For CE?
The answer is a resounding YES! CE is treated ONLY after a diagnosis has been made and other medical conditions excluded. For this reason, your vet will:
- Take a thorough history
- Perform a clinical examination and admit your dog for a neurological examination
- Take a blood smear, blood glucose strip and possibly take more blood for tests of organ function
- Perform urine and faecal tests
- Recommend any other tests such as X-rays or Ultrasound imaging of the chest or abdomen; an MRI scan of the brain; and/or collection of cerebrospinal fluid for analysis. Referral to a specialist vet should be sought for these types of tests.
Treatment over 60 – 70% of dogs can be satisfactorily achieved with a starting dose of a barbiturate drug called phenobarbitone. PhB is administered strictly every 12 hours, for 6+ months, or even life long, and requires biannual blood tests to check that drug levels in the blood are within a range that is both safe, and effective. PhB is considered a very safe drug, with liver toxicity occurring very, very rarely, but it does have minor side effects. Most dogs are very sleepy for the first 1 – 2 weeks after starting the drug, as they get used to it. Secondly, many eat a lot and put on weight – discuss a ‘low calorie’ diet with your vet if this is the case. It is vital that you understand the OBJECTIVE of treatment is NOT to completely STOP seizures – this is rarely achievable. Treatment is considered a SUCCESS if the NUMBER and SEVERITY of seizures DECREASES by 50% OR MORE. If a dog has 1 – 2 mild seizures a year, this hardly makes treatment worthwhile. If a dog has 6 bad episodes every other month, a success would be 1 – 3 mild attacks every 4 months. If PhB is not effective enough at the initial dosage, its dosage can be increased, as long as follow-up tests (1 – 2 weeks after each dosage change) are performed. At a certain point, the vet will decide to ADD an additional drug, usually potassium bromide (KBr). KBr and further drugs (and there are third, fourth and fifth choice medications) are much more complex for the vet to manage, and, again, referral or at least the opinion of a specialist may be advisable.
And Lastly …
Many people stay on PhB or other drugs for YEARS – their entire lives – and the treatment ensures a normal quality of life for many individuals around the world. CE is completely manageable and rarely dangerous condition but one which has been the source of much fear, misunderstanding and anxiety for centuries. Your vet can help you diagnose and control this disease, and treatment is rarely expensive, except for the largest dogs or the most severe and complex cases (a rarity). It is a disease to be managed, not feared. Finally, it is worth noting that many forms of epilepsy are heritable, and for this reason breeding of an epileptic animal is absolutely unwise. Ownership of an epileptic is not problematic however – even I have an epileptic pet!
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