Diagnosing and Treating Seizures In Dogs.
–by Elizabeth F. Baird, DVM, CVPP, CCRT, CVMA
SEIZURES ARE A RELATIVELY COM- MON OCCURRENCE in dogs (and humans). An accepted definition for seizure is sudden and uncontrolled movement of the body caused by abnormal brain activity. The com- monplace comparison to an electrical short circuit is not inappropriate as brain activity is electrical in nature. Many seizures are generalized (Grand Mal) with whole body stiffness accompanied by unconsciousness and paddling or rhythmic movement of the limbs. This may be associated with vocalizations, urination or defecation and is typically followed by a postictal phase of abnormal behavior and grog- giness. Partial or focal seizures may vary more in appearance; it may look like facial twitching or the classic “chewing gum” seizure seen with Distemper Virus. Another form of partial seizure is a subtle, brief change in behavior where the pet just has episodes of disorientation or may appear to be hallucinating. There are a myriad of medical conditions that can cause a
seizure. A seizure is more a symptom of the medical condition than a disease in and of itself. For example, many toxins and metabolic imbalances can cause seizures, although the brain is healthy and normal otherwise. Infections, parasites, trauma, inflammatory diseases and tumors can impact the brain structure directly leading to seizures. Idiopathic epilepsy is an inherited predisposition to seizure activity that is not caused by any of these other medical conditions. Diagnosing idiopathic epilepsy involves testing for all the long list of causes and ruling those out, which leaves idiopathic epilepsy as the diagnosis. There is no actual test for inherited epilepsy itself. Various lab tests are used to look for metabolic disease, evidence of toxins or other potential causes of the seizure. If no cause is found, the tests to diagnose many infections, inflammatory or immune-mediated diseases of the brain and tumors are the next step, but these are much more involved. Advanced imaging may include a CT scan or MRI to look at brain structure and CSF taps (collection of cerebral spinal fluid for testing) are often useful to examine the cells in the fluid surrounding the brain and central nervous system. Certain causes of seizure are more common in certain popula-
tions of dogs. Youngsters under six months, especially toy breeds, can be susceptible to seizures from low blood sugar. Infections, parasites and congenital defects are also more common in this age group. Dogs between six months and six years are often suffering from inherited epilepsy, and this is more common in certain breeds including Schnauzers, Cocker Spaniels, Golden Retrievers, Poodles and Beagles to name just a few. After five to six years of age, tumors and
76 THE NEW BARKER
cancers become much more com- mon and often require advanced imaging to diagnose.
WHAT TO DO IF YOUR DOG JUST HAD HIS FIRST SEIZURE?
lKeep the pet safe as they have no awareness of their environment or immediate control over their body. Do not put your hands near their mouth as you may be bitten acciden- tally (they will not swallow their tongue). If they are up on a bed or sofa, move them to the floor. lRemove other pets from the area as some pets can be aggressive when rousing from a seizure. lTry to be calm and measure how long the generalized seizure lasts. If it is unabated at five minutes, seek
immediate veterinary attention. Irreversible brain damage can occur in longer lasting seizures. If it is under five minutes and the dog comes back to normal within the next few hours, it is probably not immediately life threatening but do contact your veterinarian so a neurological exam and diagnostic tests can be performed to help determine the cause. This may be just the first of many seizures. lIf the seizure was under five minutes but they have two or three in a 24 hour period, promptly seek veterinary care.
WHEN TO BEGIN TREATMENT FOR IDIOPATHIC EPILEPSY AND RECURRENT SEIZURES?
lIf the seizures appear in clusters of three or more in a 24 hour period.
lIf the seizures last more than five minutes. lIf isolated seizures occur more often than two every six months. The previous recommendation was to begin treatment if the seizures occurred more than once a month, but the American College of Veterinary Internal Medicine has changed that to two or more in a six month period in their 2006 consensus statement. lIf the dog has a visible structural lesion on a CT or MRI. lIf the dog has a history of brain injury or trauma prior to the seizures.
MEDICATION OPTIONS: This is a bit complicated as there are many anticonvulsant med- ications for your veterinarian to choose from and the selection will be based on the specific patient and history. The initial lab results will help guide the selection also particularly if there were any indications of organ dysfunction that might impair metabolism of certain drugs.
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