Epilepsy is not uncommon and can strike
with out warning, make sure you are able to afford the care and treatment
your dog needs from the vet. If you are going on frequent trips and
check ups at the vet pet insurance
is a great thing to have. Dog
health insurance can even cover medication. It will cost you
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today and the best
pet insurance can save you thousands of dollars and give your
dog the proper care it needs for a long and fulfilling life.
Copyright 1995 Alicia Marcinczyk
For permission to reprint contact author:
(This article was written primarily about epilepsy in the Belgian
Tervueren; however epilepsy is a much underdiscussed topic among
Border Collies.)
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 a 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.
Phenobarbital and primidone are the most widely used anticonvulsant
drugs, but others have their place in treatment as well.
Phenobarbital is one of the most commonly prescribed drugs.
Frey reports that while dogs rapidly develop tolerance to the
sedative and hypnotic effects of phenobarbital, 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 phenobarbital 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 phenobarbital 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 phenobarbital responded to the addition of
potassium bromide to either phenobarbital or primidone. Podell and
Fenner reported that bromide therapy improved seizure control in
83% of dogs previously unimproved by phenobarbital; 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 phenobarbital, 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.
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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 Purebred Beagle Dog Colony. American Journal
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Cunningham, James G. DVM Ph.D. and George C. Farnbach
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the American Animal Hospital Association, February 1987, pp.
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DeHaan, Roger L. DVM MTS: Natural Care of Pets. Articles
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de Lahunta, Alexander DVM Ph.D: Special Report - Seizures: How
They Happen and What You Can Do. (Handout).
Dodds, W. Jean DVM: Letter to the Editor, Pointer Points,
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Dyer, Karen R. DVM Ph.D and Linda G. Shell DVM Dipl.
ACVIM: Anticonvulsant Therapy: A practical guide to medical
management of epilepsy in pets. In Symposium on Seizure Disorders,
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Dyer, Karen R. DVM Ph.D. and Linda G. Shell DVM Dipl.
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Farnbach, George C. VMD Ph.D.: Seizures in the Dog. Part I. Basis,
Classification, and Predilection. The Compendium of Continuing
Education, Cont. Ed. Article #6, 6:6, 569-574, 1984.
Farnbach, George C. VMD Ph.D.: Seizures in the Dog. Part II.
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Fenner, William R. DVM and Julie A. Haas DVM: Mechanisms of Seizure
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Epilepsy. Problems in Veterinary Medicine, 1:4, 558-577, 1989.
Hendricks, Jan: Epilepsy in the Belgian Tervueren. In Tervueren
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March 1987, pp. 19-21.
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Koestner, Adalbert DVM Ph.D.: Neuropathology of Canine
Epilepsy. Problems in Veterinary Medicine, 1:4, 516-534, 1989.
Kornegay, Joe N. and Stephen B. Lane: Seizures. Chapter 15 in
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LeCouteur, Richard A. BVSc Ph.D., and Georgina Child, BVSc:
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Tales, newsletter of the American Belgian Tervueren Club. Fall
1980, pp. 9-10.
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the Tervueren: Progress Report. In Tervueren News Tales, newsletter
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Seizures. Veterinary Clinics of North America: Small Animal
Practice, 18:4, 947-964, 1988. (Note: Joanne Parent is now
conducting a EEG study of epilepsy in Belgians at the University of
Guelph, Canada).
Pearce, Laurie, DVM: Potassium Bromide as an Adjunct to
Phenobarbital for the Management of Uncontrolled Seizures in the
Dog. Progress in Veterinary Neurology, 1:1, 95-101, 1990.
Podell, M., and Fenner, W.R. Bromide Therapy in Refractory Canine
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Shell, Linda G., DVM Dipl. ACVIM: The Diagnostic Approach to
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July 1993, pp. 641-646.
Shell, Linda, G., DVM Dipl. ACVIM: The Differential Diagnosis of
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July 1993, pp. 629-640.
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Fundamentals of Seizures. In Symposium on Seizure Disorders,
Veterinary Medicine, July 1993, pp. 622-628.
Sisson, Allen, DVM MS and Richard A. LeCouteur BVSc Ph.D. Letter to
the Editor re: Potassium Bromide as an Adjunct to Phenobarbital for
the Management of Uncontrolled Seizures in the Dog. Progress in
Veterinary Neurology, 1:2, 114-116, 1990.
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. Veterinary Medicine, November 1991, pp.1060-1061.
Van der Velden, N.A: Fits in Tervueren Shepherd Dogs: a
Presumed Hereditary Trait. J. Small Animal Practice 9:63-70,
1968.
van Niekerk, J. and GN Eckersley: The Use of Acupuncture in Canine
Epilepsy. Journal of the South African Vet Association, 59:1, 5,
1988.
Wallace, Margaret E.: Keeshonds: A Genetic Study of Epilepsy and
EEG Readings. J. Small Animal Practice, 16:1-10, 1975.
Wilcock, Brian DVM: Genetic Diseases of the Belgian Shepherd Dogs.
In Tervueren News Tales, newsletter of the American Belgian
Tervueren Club. April 1990, pp. 14-16 (reprinted from Belgian
Sheepdog Club of American newsletter, Summer 1989).
Yohn, Susan E. DVM MS, Wallace B. Morrison DVM MS, and Patrick E.
Sharp DVM: Bromide Toxicosis (bromism) in a dog treated with
potassium bromide for refractory seizures. JAVMA, 201:3, 468-470,
1992.
ACKNOWLEDGEMENTS
Without the encouragement, support, and wisdom of the following
people and organizations, this article would not have been
possible.
Jerold Bell, DVM, Enfield, Connecticut
Debbie Eldredge, DVM, Vernon, New York
JoAnne LaFear, University of Maine-Augusta
Alexander de Lahunta, DVM, Ph.D., Cornell University
Paul R. Lennard, Ph.D., Emory University
Barbara Licht, Ph.D., Florida State University
Libbye Miller, DVM, Elizabethtown, Kentucky
Alan Pothoff, DVM, Portland, Maine
Kansas State University Information & Documentation Services
United Belgian Shepherd Dog Association (UBSDA)/UKC
University of Southern Maine
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