Seizures: at what point do you start to medicate

[koalathebear]

Hi, one of my dogs Hoover is an 8 year old Kelpie.  Generally healthy - not on any medication and does not have any other health issues.  Over the last three years,  he has suffered a number of seizures as follows:

 

15 May 2016: confirmed seizure
 

5 January 2017: suspected seizure
1 April 2017: confirmed seizure: 
7 Sept 2017: confirmed seizure
10 October 2017: suspected seizure
 

8 February 2018: confirmed seizure
10 April 2018: confirmed seizure
13 December 2018: confirmed seizure

 

*

Until yesterday, each seizure was of relatively short duration.  The pattern is usually as follows:

• hunger spew/stress spew followed by seizure
• empties bowels, bladder, very heavy thick saliva comes pouring out of his mouth.

 

Yesterday's seizure lasted about a minute so was one of the longer ones.  When he comes out of it, he's confused, disoriented and afraid of us.  Then he returns to normal within an hour or so.  What it means is that we generally do not leave him alone, we minimise stressful situations for him and give him snacks to avoid hunger spews.  If we see him licking his lips a lot, we apply an ice pack to his back.  We've also removed rosemary from his diet as we know that has triggered seizures in some dogs.  Yesterday was a relatively late dinner and I can't help thinking that if we'd given him a snack, we might have been able to avert the seizure.

 

Based on the symptoms, the vets are pretty sure he has epilepsy although there is not a definitive test.  They've conducted blood tests and a variety of other tests on him and he seems otherwise healthy.

 

So we have two choices.

- we start medicating him now, but he will be on the meds permanently   

- we wait until the seizures become more frequent.  Hopefully they won't but it would be a gamble and we know each seizure causes damage and could kill him ...

 

The vets have said typically they would not recommend medication until the seizures were more frequent but understand how worried we are.  They've suggested, if we do want to medicate, pexion, as apparently there are less side effects with this medication than others - but it still means meds twice a day for the rest of his life.

 

So my question for others who have dogs with seizures - at what point did you decide to medicate?  Thanks very much in advance.

 

 

 

[Maddy]

A couple of times a year is pretty infrequent so I wouldn't medicate at that point. 

In our case, we did start medication after only a couple of seizures but that was on account of his age (first seizure at only 6 months old) and the fact that he had known neurological issues already.

Another option is phenobarb. Our vet is of the opinion that it's a lot safer than some people believe, and from my experience with Idiot Dog, side effects weren't too bad. You can start on tiny doses and if it needs to come up to keep threshold up, that's easy enough to do. (Should add that it's worth getting peaks/troughs done once everything is settled, to make sure levels are within therapeutic range) 

If you'd rather not go down the road of medication, I'd stick with keeping his threshold up. For Idiot Dog, being a very shy boy, the big stress was visitors, so we managed that more closely. We did end up losing him a couple of years ago, but that was to an insulinoma, which unfortunately had many of the same symptoms as his existing condition, so we didn't catch it until it was too late. His epilepsy got worse as he aged, even with significant medication (PB and KBr) and I think that if it's going to decline like that (he'd have at least one seizure a day), nothing much is really going to stop it.

[persephone]

ohhhh, poor Hoover - and poor you . 
it would be such a worry . 

Knowing a bit of how you are - I am VERY sure he is in the BEST of hands ..and that you have noted every possible trigger , ie: food/activity/environmental pollutant/chemical exposure  etc  

Just based on friends' dogs who have been epileptic ..they waited for some time before medicating ..as adjustment to, and dosages of, different meds did alter  their dogs  for some time ...the drugs are pretty powerful , as you can imagine. 

 

[sandgrubber]

I'd wait and watch.  I may be wrong, but I think that relatively mild (not grand Mal) seizures do very little or no lasting damage. A few per year can be weathered.  The meds aren't nice.

[persephone]

You've probably discussed this with a vet ..
perhaps, as he ages , his blood sugar levels are not keeping stable , and seizure activity is result of hypoglycaemia?
Maddy's mention of her dog's isulinoma   made me think of this ..as a friend's dog had a similar problem .

[Maddy]

3 minutes ago, persephone said:

You've probably discussed this with a vet ..
perhaps, as he ages , his blood sugar levels are not keeping stable , and seizure activity is result of hypoglycaemia?
Maddy's mention of her dog's isulinoma   made me think of this ..as a friend's dog had a similar problem .

It's certainly an interesting issue.

In our case, was there already some underlying pancreatic issue, at only 6 months old? Seems unlikely, but I suppose not impossible. Or was it the outcome of his combined medication (PB + KBr), as it is known to predispose some dogs to pancreatitis, which may perhaps lead to malignant cell changes? Seem unlikely but again, not impossible. Was he just unlucky enough to have epilepsy, and on top of that, develop an uncommon cancer that also caused seizures from BGL drops? Seems unlikely but.. you get the idea.

So far as our vets could tell, his blood tests had always come back good. His liver function was good, CBC and WBC were always as expected, glucose had never raised an eyebrow. But the trouble with insulinomas is that levels will be erratic, and so you have to get lucky to catch a major trough. For us, maybe it had been going on for a long time but we never caught a break with the blood tests. It's impossible to say where the epilepsy would have gone, if the cancer hadn't got him first, or even if it was definitely the cancer that caused the increase. The increase started at a very young age (well and truly by 18 months) and that just seems unlikely young for a dog to develop that sort of cancer but.. I don't know.
Epilepsy can be a tricky thing to deal with. I have a human family member with epilepsy (from a brain injury) and hers were terribly controlled for a long time (getting so frequent and increasingly severe) and then a simple change of meds and.. not a single seizure in 10 years. Brains..

[koalathebear]

Thanks all, I feel much better now.  Vet, husband and part of me thinks: "Seizures are not frequent enough to warrant medication."

 

The other part of me thinks: "What if the medication could prevent him going through this at all?  What if the next seizure kills him?"

 

For a couple of the seizures, it's been hard to tell if it's been two seizures in a row or if it's one seizure but he has a momentary pause in the middle of the one seizure - and so I have a fellow dog owner who is making me feel quite guilty (in a very well meaning way of course) about not medicating him yet. 

 

Comments include:

 

"If he’s had one after the other, that counts as a cluster and you should probably consider meds"

 

When I told her: "Our vets aren't keen at all to medicate unless it's very necessary eg. seizures on a weekly basis b/c once he's on the meds, it's for good. We let them know every time he has had a seizure and they have been monitoring him." she said:

 

"That’s too conservative on the meds and not what the latest vet advice is. Every seizure primes the brain for another. "

 

and

 

 "More recent opinion is that any seizures are too many and you should medicate earlier rather than later. "

 

As mentioned, our vet is willing to medicate if that's what we want - but they've made it clear that the frequency does not yet warrant them actively recommending meds.  But yeah .. it's so awful to watch ... his eyes when he has the seizures ... and how confused and frightened he is when he comes out of it. It's just so sad - and he's normally just the sweetest, most affectionate and lovely dog ever.

 

Re the questions above - he's had a lot of blood work and tests done.  Absolutely nothing out of the ordinary.

Edited December 12, 2018 by koalathebear

[Maddy]

Don't let anyone guilt you into making decisions for your boy. You know him best, he's under the care of a vet who has offered you good advice, and you seem very aware of his triggers and how to manage him.

I know of a few epileptic dogs who have/had infrequent seizures and for those dogs, they remained infrequent. Other cases might be different but you're keeping good track of things and if the situation changes, you can always reassess.

I absolutely understand about the guilt though. It's hard enough watching your dog going through a seizure (more so because they can't understand what's happening), it's even worse when other people decide to lay on the guilt about your management decisions. I had people tell me that epileptic animals should simply be put to sleep. And as someone with a human family member with epilepsy, that sort of thing is incredibly hurtful. Those sort of people probably mean well but.. it really doesn't help.

[persephone]

9 minutes ago, Maddy said:

Don't let anyone guilt you into making decisions for your boy. You know him best, he's under the care of a vet who has offered you good advice, and you seem very aware of his triggers and how to manage him.

I agree .

 

[sandgrubber]

BTW, it's not true that once on seizure meds, it's for life.  My old girl (a Lab) had focal seizures at 6 yrs.  She got put on phenobarbital after a cluster (apparently triggered by flea meds, but very frightening).  I gradually reduced her dosage over two years (against veterinary advice) and then stopped altogether.  She's now 14.  She has very mild seizures a few times a year... muscles tense up, walks funny then lies down for a minute or two but stays conscious and wags tail...but they are infrequent and not a big deal.  For me the bottom line is that seizures are complicated and not predictable.  But the label "epilepsy" is not particularly useful... it encompasses a wide range of conditions.  You have to play it by ear... and you may have a better sense of where your dog is at than the vet does. 

[BarbedWire]

Deleted because as usual I have totally failed to answer your question.

 

Happy Christmas everyone.

Edited December 13, 2018 by FootprintsinSand

[Tassie]

A couple of thoughts, which you may already have followed up.  (Based on a friend's experience with mild seizures in her do.)   It can be helpful if yo can video the seizures if you haven't already done so.   Even if it's only part of them.  My friend was also able to get an MRI done to rule out brain lesions.   There is no vet neurologist down here, and it's not safe for the dog to fly, but her vet is able to liaise with a vet neurologist in another state.    And one thing that struck me reading your post .. you seemed to be feeling it might be related to food intake, or have some connection, so I was wondering if feeding several smaller meals a day might be useful.    In your situation, given the infrequency of the seizures, I would probably hold off on the meds too till I'd tried other things.  You know your dog well, and will certainly be weighing up what is going to make him more comfortable short and long term.

[BarbedWire]

I don't really know where to put this and I hope KTB won't mind but my girl has just had another seizure which lasted for at least five minutes. Is it true that seizures lasting that long cause brain damage? Also my vet gave me some valium and I am supposed to put it up her bottom if she has a seizure. How would I do this? Just with my finger inside a latex glove. My vet has  closed down for Christmas and I am feeling quite alone with this. I had my dog there on Thursday for something else and I never thought she might just be brewing another seizure. 

[Gallomph]

Have you got a small syringe? That's what my vet told me to use for my old boy. Use some lube, of course! Use the valium as soon as possible - when you see the initial behavioural warning signs. Don't wait until the seizure full on.

Hope this helps.

[persephone]

1 hour ago, FootprintsinSand said:

Also my vet gave me some valium and I am supposed to put it up her bottom if she has a seizure. How would I do this?

 what a worry

Is the valium a suppository, a liquid, or what ? 

if it is a suppository ..yes, you just use some lube and push it in thru the sphincter muscles and up as far as you can . 
If it is in lquid form..then it would need the syringe ....( NO needle!) 

[Gallomph]

@koalathebear -  when my old boy initially started having seizures, I did a lot of research. There was a fair bit of anecdotal stuff out there in google land that mentioned a link to high protein food, and I had noticed that the seizures seemed to happen when the gaps between meals were too long (but in our case, the seizures happened about 2 hours after a 'delayed' meal). The vet didn't want to medicate at that point. So I changed to Hills Kidney diet, and fed small amounts more often (3-4 times a day). He stopped having seizures for almost 5 years. They only began again when he was 16, shortly before he passed away.

[BarbedWire]

31 minutes ago, Gallomph said:

Have you got a small syringe? That's what my vet told me to use for my old boy. Use some lube, of course! Use the valium as soon as possible - when you see the initial behavioural warning signs. Don't wait until the seizure full on.

Hope this helps.

Thank you so much Gallomph. That is exactly what I wanted to know. I don't have a syringe but I will go to the chemist tomorrow. She is sleeping at the moment.

[koalathebear]

4 hours ago, FootprintsinSand said:

I don't really know where to put this and I hope KTB won't mind but my girl has just had another seizure which lasted for at least five minutes. Is it true that seizures lasting that long cause brain damage? Also my vet gave me some valium and I am supposed to put it up her bottom if she has a seizure. How would I do this? Just with my finger inside a latex glove. My vet has  closed down for Christmas and I am feeling quite alone with this. I had my dog there on Thursday for something else and I never thought she might just be brewing another seizure. 

Of course I don't mind. I hope your dog is ok - it's always very, very upsetting.

I'm surprised the vet didn't give you a syringe along with the valium.  we also have some but were told that the valium is only needed for a longer seizure eg 15 min.  5 min (feels like forever) but isn't considered long - just try to keep them from hurting themselves.  Hoover's last one was a total mess though - he basically urinated, vomited, defecated and drooled heavily so the floor was a complete and utter mess all around him ... and we were a mess as we were trying to keep him from hurting himself.

Hope she's ok <3 <3

[Maddy]

11 hours ago, koalathebear said:

Of course I don't mind. I hope your dog is ok - it's always very, very upsetting.

I'm surprised the vet didn't give you a syringe along with the valium.  we also have some but were told that the valium is only needed for a longer seizure eg 15 min.  5 min (feels like forever) but isn't considered long - just try to keep them from hurting themselves.  Hoover's last one was a total mess though - he basically urinated, vomited, defecated and drooled heavily so the floor was a complete and utter mess all around him ... and we were a mess as we were trying to keep him from hurting himself.

Hope she's ok <3 <3

Pretty much this, but I would add that if they're having grand mal seizures, in my experience, their temperature can skyrocket from the exertion, and obviously, the longer the seizure, the hotter they get. For us, this wasn't a huge concern- he was a smooth-coated dog, living in a part of Australia that doesn't get all that hot, and he was always kept inside- but if your situation was different, like a seizure that happened outside on a hot day, the dog could get hot enough for it to be a problem.