Subject: rec.pets.dogs: Canine Epilepsy FAQ
From: [email-masked] (Alicia Wiersma-Aylward)
Date: 17 Apr 2004 11:26:55 GMT
Newsgroups: rec.pets.dogs.info,rec.answers,news.answers

Archive-name: dogs-faq/medical-info/epilepsy
URL: http://www.k9web.com/dog-faqs/medical/epilepsy.html
Last-modified: 10 Nov 1997

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                                Canine Epilepsy
                                       
Author

   Alicia Wiersma-Aylward ([email-masked])
   Copyright 1995.
   
Table of Contents

     * Introduction
     * Types of Epilepsy
     * Types of Seizures
     * What is a "seizure threshold"?
     * Stages of a Seizure
     * Diagnosing Epilepsy
     * Treatment
     * Monitoring Drug Treatment
     * Why Treatment Fails
     * Alternative Therapies
     * Parting Considerations
     * References
     * Acknowledgements
       
     _________________________________________________________________
                                      
Introduction

   It happened without warning. One moment my young male Belgian
   Tervueren was snuggling against me as I sat on the couch; the next
   moment he lost control of his hindquarters and fell onto his side,
   unconscious. His lips writhed back over his teeth; his legs stretched
   out, then became rigid; and his head twisted up and back as if an
   unseen hand was trying to raise his chin to an impossible height. It
   seemed like an eternity, but actually only two minutes passed before
   his body relaxed and consciousness slowly ebbed back. For an hour
   afterward he seemed exhausted and disoriented. I was shaken too, never
   having witnessed such a seizure before. Yet later that day the dog was
   romping about as if nothing out of the ordinary had occurred.
   
   My dog is lucky. His seizures have been few and far between. We now
   believe they are caused by hypothyroidism. Other dogs are not so
   lucky. Seizures can be severe and frequent. They may occur in
   "clusters" (several in one day), or progress to the life-threatening
   state of status epilepticus. In extreme cases where seizures cannot be
   controlled, a veterinarian may advise euthanasia.
   
   Epilepsy is found in all breeds and mixed breeds of dogs. Belgian
   Tervueren are listed among the breeds for which a genetic factor is
   either proved or highly suspected. Other breeds so listed include the
   Beagle, Dachshund, German Shepherd Dog, (Alsatian), and Keeshond. A
   high incidence of seizure disorders is also found in Boxers, Cocker
   Spaniels, Collies, Golden Retrievers, Irish Setters, Labrador
   Retrievers, Miniature Schnauzers, Poodles, Saint Bernards, Siberian
   Huskies, and Wire-Haired Terriers. (Oliver, Seizures). The prevalence
   of epilepsy in the general dog population has been estimated at .5 to
   5.7%. (Koestner, Cunningham).
   
   A progress report on the epilepsy survey conducted by the American
   Belgian Tervuren Club in cooperation with John Oliver, Jr., DVM in
   1983 found that 57 (21%) of the 268 Tervueren studied had suffered
   more than one seizure. The authors of that report concluded, "At this
   time, we believe there is sufficient evidence for the probable genetic
   basis of seizures in Tervuren to warrant concern on the part of
   breeders". (Mahaffey). Unfortunately, this survey was discontinued.
   
   The term "epilepsy" can be confusing because some authors use it to
   describe recurrent seizures of any etiology (cause), while others use
   it to specify recurrent seizures unrelated to brain disorders or
   underlying disease processes. (Shell, Understanding). The definitions
   below are helpful in distinguishing types of epilepsy.
   
Types of Epilepsy

   Primary epilepsy: also known as idiopathic, genetic, inherited, or
   true epilepsy. There are no positive diagnostic findings that will
   substantiate the diagnosis. It is a case of ruling out every other
   possibility. The first seizure in a dog with primary epilepsy usually
   occurs between the ages of 6 months and 5 years. (Oliver, Seizures).
   However, a diagnosis of primary epilepsy is not proof of a genetic
   defect; only careful breeding studies could prove that. The breed, the
   age, and the history may suggest a genetic basis for primary epilepsy
   if there is a familial history of seizures.
   
   Secondary epilepsy refers to seizures for which a cause can be
   determined, and there are many. In dogs less than one year of age, the
   most commonly-found causes of seizures can be broken down into the
   following classes: degenerative (storage diseases); developmental
   (hydrocephalus); toxic (lead, arsenic, organophosphates, chlorinated
   hydrocarbons, strychnine, tetanus); infectious (distemper,
   encephalitis, and others); metabolic (such as transient hypoglycemia,
   enzyme deficiency, liver or kidney failure); nutritional (thiamine,
   parasitism); and traumatic (acute injury). In dogs 1-3 years of age, a
   genetic factor is most highly suspected. In dogs 4 years of age and
   older, seizures are commonly found in the metabolic (hypoglycemia,
   cardiovascular arrhythmia, hypocalcemia, cirrhosis) and neoplastic
   (brain tumor) classes. (Oliver, Seizure). Dr. Jean Dodds has mentioned
   that seizures are also associated with hypothyroidism, which is a
   familial (inherited) autoimmune disease of purebred dogs.
   
Types of Seizures

   The types of seizures most commonly reported are listed below. If you
   believe your dog is having a seizure, it is important to note all the
   details so that you may accurately describe it to your veterinarian.
   Types of seizures include:
   
   Generalized Seizure: Tonic-clonic (may be Grand Mal or Mild): In the
   grand mal seizure, the tonic phase occurs as the animal falls, loses
   consciousness, and extends its limbs rigidly. Respiration also stops
   (apnea). This phase usually lasts 10-30 seconds before the clonic
   phase begins. Clonic movements include paddling of the limbs and/or
   chewing. Other signs that appear during the tonic or clonic phase are
   dilation of the pupils, salivation, urination, and defecation. The
   mild seizure involves little or no paddling or extension of limbs, and
   usually no loss of consciousness. Generalized seizures are usually
   associated with primary epilepsy.
   
   Petit Mal Seizure (aka Absence Seizure): Depending on the authority
   quoted, petit mals are described as either very rare or usually
   unrecognized in animals. Signs are brief (seconds) duration of
   unconsciousness, loss of muscle tone, blank stare, and possibly upward
   rotation of eyes. According to one authority (Kay), the term petit mal
   is misused by veterinarians and should only be accorded to cases
   manifesting very specific clinical signs and EEG abnormalities.
   
   Partial Seizures: Movements are restricted to one area of the body,
   such as muscle jerking, movement of one limb, turning the head or
   bending the trunk to one side, or facial twitches. A partial seizure
   can progress to (and be mistaken for) a generalized tonic-clonic
   seizure, but the difference can be established by noting whether or
   not a seizure starts with one specific area of the body. Partial
   seizures are usually associated with secondary epilepsy.
   
   Complex Partial Seizures (aka Psychomotor or Behavioral) Seizures: are
   associated with bizarre or complex behaviors that are repeated during
   each seizure. People with complex partial seizures experience
   distortions of thought, perception or emotion (usually fear),
   sometimes with unusual visual, olfactory, auditory and gustatory
   sensations. If dogs experience the same things, it may explain the
   lip-smacking, chewing, fly biting, aggression, vocalization,
   hysterical running, cowering or hiding in otherwise normal animals.
   Vomiting, diarrhea, abdominal distress, salivation, blindness, unusual
   thirst or appetite, and flank biting are other signs. There is an
   obvious lack of awareness though usually not lack of consciousness.
   Abnormal behaviors may last minutes or hours and can be followed by a
   generalized seizure. Complex partial seizures are usually associated
   with secondary epilepsy.
   
   Cluster Seizures: Multiple seizures within a short period of time with
   only brief periods of consciousness in between. May be confused with
   status epilepticus.
   
   Status Epilepticus: Status can occur as one continuous seizure lasting
   30 minutes or more, or a series of multiple seizures in a short time
   with no periods of normal consciousness. It can be difficult to tell
   status epilepticus from frequent cluster seizures; but both are
   considered life-threatening emergencies. Most status patients usually
   suffer from generalized tonic-clonic seizures. Though status
   epilepticus can occur with either primary or secondary epilepsy, it
   may also suddenly arise in dogs with no previous history of seizures
   (traumatic brain injury, toxins, or disease). (Dyer & Shell,
   Managing).
   
What is a "seizure threshold"?

   Dr. Alexander de Lahunta of Cornell University and others suggest that
   each animal inherits a "genetically determined predisposition to
   seizures", and that seizures occur when this threshold is exceeded.
   (Cunningham, Inherited). In other words, a physical condition (see
   examples under section on secondary epilepsy above) which may cause
   seizures in a low-threshold animal may not cause seizures in a
   "normal" animal.
   
   The seizure threshold is apparently exceptionally low in animals that
   suffer from idiopathic (primary) epilepsy. (de Lahunta). An animal's
   threshold can also be altered by other means. Certain types of
   tranquilizers (e.g. acepromazine) may induce seizures in animal with a
   low threshold. The medical condition of alkalosis is reported to
   decrease the threshold. (Shell, Differential)
   
   Karen R. Dyer, DVM, PH.D, and Linda G. Shell, DVM, Dilp. ACVIM, note
   that there is "convincing experimental evidence" that repetitive
   seizures can "irreversibly lower the seizure threshold" in a process
   called kindling. William Fenner, DVM and Julie Haas, DVM, describe
   kindling as a mechanism in which epileptic neurons in the brain
   "recruit" normal neurons into the original seizure focus, enlarging
   the area of the brain that can produce seizures. Linda Shell, DVM
   describes kindling as the "increased excitability of neurons", and
   notes that normal neurons, sufficiently stimulated, become
   increasingly able to cause seizures independent of outside
   stimulation.
   
   The mirror focus phenomenon also deserves mention. Each hemisphere of
   the brain is a "mirror image" of the other. A seizure focus on one
   side of the brain will show itself as abnormal wave forms on EEG
   recordings. Within a period of weeks, the "normal" side of the brain
   will start to show similar EEG abnormalities. In time, the mirror
   focus becomes capable of causing seizure activity on its own. Thus,
   repetitive, uncontrolled seizures also lower the seizure threshold in
   any given animal. That is why early intervention is so important in
   the control of seizures.
   
Stages of a Seizure

   There are 4 basic stages to a seizure: 1) the prodome, 2) the aura or
   preictus, 3) the ictus or seizure stage, and 4) the postictus.
   
   1) The prodome may precede the actual seizure by hours or days. It is
   characterized by a change in mood or behavior. Human epileptics
   experience mood changes, headaches, insomnia or feelings about the
   impending seizure. It is not known whether animals experience a
   prodome except for any behavioral changes observed by their owners.
   
   2) The aura signals the start of the seizure. Signs include
   restlessness, nervousness, whining, trembling, salivation, affection,
   wandering, hiding, hysterical running, and apprehension.
   
   3) The ictus is the actual seizure, characterized by sudden increase
   in tone of all muscle groups. The ictus is either tonic or
   tonic-clonic, generally lasting from 1-3 minutes.
   
   4) The postictus may be the only sign of epilepsy the owner sees,
   particularly since many seizures occur at night or early in the
   morning. For minutes to days after the seizure, the dog may be
   confused, disoriented, restless, or unresponsive, or may wander or
   suffer from transient blindness. At this stage the animal is conscious
   but not functional. (Shell, Understanding; Kay; Oliver, Seizures).
   
   What can you do when your dog seizures? Note the time to determine how
   long the seizure lasts. Keep the dog as quiet as possible. Loud or
   sharp noises may prolong the seizure or make it worse. Other dogs
   should be removed from the area, as they may disturb or attack the
   seizuring dog. Should you attempt to comfort the animal? Opinions on
   this vary. My own dog is comforted by my presence and looks for me as
   he returns to consciousness. I make a point of calmly maintaining
   physical and voice contact with him throughout the seizure and during
   recovery.
   
Diagnosing Epilepsy

   What do you do if you think your dog has had a seizure? Veterinarians
   have a number of diagnostic tools at their disposal.
   
   For dogs who have had only one isolated seizure, a complete physical
   and neurological examination is in order. Owners will be advised to
   watch for further seizures if no abnormalities are found. Medical
   treatment will not be instituted until future activity can be noted.
   
   For every patient having more than one seizure, a minimum data base
   should be developed. The data base contains the patient's profile,
   history, results of complete physical and neurological examinations,
   and basic tests. The profile consists of the dog's breed, age, and
   sex. Pertinent history includes vaccinations, potential exposure to
   toxins, diet, any illnesses or injuries, behavioral changes, and
   whether seizures occurred in any animal related to the dog.
   
   Owners are also asked to give a complete description of the seizures:
   frequency, duration, and severity, as well as any behavioral
   abnormalities associated with them. An accurate description is
   important because there are other conditions with symptoms that mimic
   seizures, such as cardiac and/or pulmonary disease, narcolepsy,
   cataplexy, myasthenia gravis, and metabolic disturbances.
   
   Among the recommended tests are: CBC, urinalysis, BUN, ALT, ALP,
   calcium, fasting blood glucose level, serum glucose level, serum lead
   level, fecal parasite or ova examination, and others if indicated.
   When the results of the examinations and tests have been analyzed, one
   of three conclusions will be drawn: a definitive diagnosis, a
   potential cause of seizures requiring further tests to confirm, or no
   suggestion of a cause.
   
   When further tests are required a complete date base should be done.
   This may include computed tomography or magnetic resonance imaging;
   CSF analysis (cell count, protein levels, pressure), skull
   radiographs, and an EEG.
   
Treatment

   Medical treatment is generally advised for animals who have one or
   more seizures per month. Animals who have cluster seizures or go into
   status epilepticus may be treated even though the rate of incidence is
   greater than once per month. Successful drug therapy depends upon the
   owner's dedication to delivering the drug exactly as prescribed, with
   absolutely NO changes in the dose or type of medication without
   veterinary consultation. Haphazard drug administration or abrupt
   changes in medication is worse than no treatment at all, and may cause
   status epilepticus.
   
   William Thomas, DVM, MS feels it important to remember that the goal
   of treatment is to decrease the frequency and severity of seizures and
   avoid unacceptable side effects. It may not be possible to stop the
   seizures altogether. A number of drugs and some alternative therapies
   may be used to control epilepsy. Phenobarbitol and primidone are the
   most widely used anticonvulsant drugs, but others have their place in
   treatment as well.
   
   Phenobarbitol is one of the most commonly prescribed drugs. Frey
   reports that while dogs rapidly develop tolerance to the sedative and
   hypnotic effects of phenobarbitol, at high concentrations tolerance
   may be lost and persistent depressive side effects may appear. Dogs
   may eat or drink more than their usual amounts. Liver function can be
   impaired. When use of the drug is terminated, signs of physical
   dependence (tremors, incoordination, restlessness, seizures) may
   develop. There is danger of triggering status epilepticus during
   withdrawal. To avoid this, dosages should be gradually reduced in
   small steps over a prolonged period.
   
   Primidone's side effects include sedation when treatment is initiated,
   and eating or drinking more than usual. High concentrations of liver
   enzymes have been reported with prolonged treatment at high dosages.
   
   Diazepam (Valium) is used for treatment of status epilepticus.
   Phenytoin (Dilantin), carbamazine, and valproic acid are not currently
   recommended for use.
   
   Potassium bromide (KBr) is gaining new recognition for use in
   refractory (difficult to control) canine epilepsy, though used to
   treat human epileptics as early as 1857. It is the anticonvulsant of
   choice for dogs with liver disease. Sodium bromide is preferred for
   dogs with kidney problems. Combining potassium bromide or sodium
   bromide and phenobarbitol may be useful for patients who do not
   respond well to phenobarbital or primidone alone.
   
   One recent study (Pearce) reported that 10 dogs who had uncontrolled
   seizures with phenobarbitol alone had improved control with the
   addition of potassium bromide to their drug regimen. The severity of
   the seizures and the tendency to cluster were significantly decreased.
   An earlier study by Professor Dorothea Schwartz-Porsche
   (Sisson/LeCouteur) reported that 5 of 9 epileptics uncontrolled by
   phenobarbitol responded to the addition of potassium bromide to either
   phenobarbitol or primidone. Podell and Fenner reported that bromide
   therapy improved seizure control in 83% of dogs previously unimproved
   by phenobarbitol; 26% of the 83% dogs became totally seizure free.
   
   Bromide is not approved for use in dogs, nor is it commercially
   available at this time. Veterinarians can obtain it from chemical
   supply houses as an American Chemical Society reagent, which dissolves
   in water and is added to the dog's food. Dog owners are asked to sign
   release forms and are advised to handle the drug with gloves. Thomas
   notes that some custom pharmacies will now formulate bromide in
   capsules or suspension so the veterinarian doesn't have to.
   
   Side effects of bromide toxicity (bromism) can include incoordination,
   depression, muscle pain, and stupor. There are no dermatologic or
   gastrointestinal signs as seen in humans taking KBr.
   
Monitoring Drug Treatment

   In order for any drug therapy to be effective, the amount of drug
   found in the body (serum concentration) must be consistently
   monitored. No two animals may react to the same dose in the same way.
   Farnbach reports a sixfold variation in the ratio between daily dosage
   and serum concentration was demonstrated in a large population of
   epileptic dogs. In 3 dogs given roughly the same dose of
   phenobarbitol, one dog's condition did not change, the second dog
   achieved seizure control, and the third dog experienced toxicosis. The
   amount of drug found in the body correlates much better with seizure
   control than daily dosage.
   
   If your dog is on medication, work with your veterinarian in observing
   your dog and testing his/her serum levels to ensure he/she is
   receiving the appropriate amount of drug to achieve control and avoid
   side effects.
   
Why Treatment Fails

   There are many reasons why medical treatments can fail. The biggest
   reason is the owner's lack of proper administration of the prescribed
   drug. The progression of an underlying disease (such as brain tumor)
   may resist treatment. Also, gastrointestinal disorders can affect drug
   absorption, and tranquilizers may stimulate seizures. Drug
   interactions can occur and adversely affect the level of
   anticonvulsant drug in the dog's system. And it just might be that a
   particular drug may not work for that animal. (LeCouteur).
   
Alternative Therapies

   These range from acupuncture to vitamin therapy. Traditional
   acupuncture therapy for epileptic dogs involves the placement of
   needles in up to 10 areas of the body. Needles can be left in place
   from 20 minutes to over a month.
   
   Acupuncture is not usually considered a substitute for drug therapy,
   but is used in conjunction with them. Of 5 dogs with intractable
   epilepsy, followed after gold bead implants in acupuncture points, 2
   dogs relapsed after five months. Two reports of epileptic dogs given
   acupuncture in the ear (Shen-men point) are more positive. One dog
   enjoyed a six-fold increase in time between seizures; the other was
   seizure-free for 200 days after a previous history of monthly
   seizures. (Joseph, van Niekerk).
   
   Holistic veterinarian Roger DeHaan, DVM states that some forms of
   epilepsy respond to supplementation of vitamin B6, magnesium, and
   manganese. Drs. Wendell Belfield and Martin Zucker stated that "It has
   long been known that a deficiency of vitamin B6 or any interference
   with its function can cause seizures in any mammalian species,
   including man and dog".
   
Parting Considerations

   If your dog is experiencing either mild or severe seizures, there is
   help for both of you. Work with a veterinary professional with whom
   you feel a good rapport, and educate yourself on seizures and their
   treatment. Follow the vet's instructions, never change medication or
   dosages without a consultation, be observant, monitor serum levels as
   recommended, have patience and be willing to try another form of
   treatment if that seems indicated. Above all, if your breed club
   sponsors a health registry or research project on seizures or epilepsy
   in your breed, participate fully in it. New research on epilepsy is
   being done each year in an effort to determine how it's inherited and
   ultimately, to design a test that will allow breeders to select
   against this health defect.
   
References

     Bell, DVM, Jerold: Telephone conversation, December 1993.
   
     Bielfelt, S.W. MS, H.C. Redman DVM, and R.O. McClellan DVM: Sire-and
   Sex-Related Differences in Rates of Epileptiform Seizures in a
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     Cunningham, James G. DVM Ph.D. and George C. Farnbach VMD Ph.D.:
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     DeHaan, Roger L. DVM MTS: Natural Care of Pets. Articles published
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     de Lahunta, Alexander DVM Ph.D: Special Report - Seizures: How They
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     Dodds, W. Jean DVM: Letter to the Editor, Pointer Points, Spring
   1992.
   
     Dyer, Karen R. DVM Ph.D and Linda G. Shell DVM Dipl. ACVIM:
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     Farnbach, George C. VMD Ph.D.: Seizures in the Dog. Part I. Basis,
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     Fenner, William R. DVM and Julie A. Haas DVM: Mechanisms of Seizure
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     Oliver John E. Jr., Michael D. Lorenz: Chapter 14, Seizures and
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     Parent, Joanne M., BSc, DVM, MVSc: Clinical Management of Canine
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   study of epilepsy in Belgians at the University of Guelph, Canada).
   
     Pearce, Laurie, DVM: Potassium Bromide as an Adjunct to
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     Podell, M., and Fenner, W.R. Bromide Therapy in Refractory Canine
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     Shell, Linda, G., DVM Dipl. ACVIM: The Differential Diagnosis of
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     Shell, Linda G., DVM Dipl. ACVIM: Understanding the Fundamentals of
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     Sisson, Allen, DVM MS and Richard A. LeCouteur BVSc Ph.D. Letter to
   the Editor re: Potassium Bromide as an Adjunct to Phenobarbitol for
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     Thomas, William B, DVM, MS. Email correspondence of 1/10/95.
   
     Valrie, Gerard Ph.D. and Cliff Conarck DVM: Identifying the Cause of
   an Early onset of Seizures in Puppies with Epileptic Parents.
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     Van der Velden, N.A: Fits in Tervueren Shepherd Dogs: a Presumed
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     van Niekerk, J. and GN Eckersley: The Use of Acupuncture in Canine
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   Readings. J. Small Animal Practice, 16:1-10, 1975.
   
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   In Tervueren News Tales, newsletter of the American Belgian Tervueren
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     Yohn, Susan E. DVM MS, Wallace B. Morrison DVM MS, and Patrick E.
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Acknowledgements

   Without the encouragement, support, and wisdom of the following people
   and organizations, this article would not have been possible.
     * Debbie Eldredge, DVM, Vernon, New York
     * JoAnne LaFear, University of Maine-Augusta
     * Barbara Licht, Ph.D., Florida State University
     * Libbye Miller, DVM, Elizabethtown, Kentucky
     * Alan Pothoff, DVM, Portland, Maine
     * Jerold Bell, DVM, Enfield, Connecticut
     * Alexander de Lahunta, DVM, Ph.D., Cornell University
     * Paul R. Lennard, Ph.D., Emory University
     * Kansas State University Information & Documentation Services
     * United Belgian Shepherd Dog Association (UBSDA)/UKC
     * University of Southern Maine
       
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    Canine Epilepsy FAQ
    Alicia Wiersma-Aylward ([email-masked])
    
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