Diving Deeper into Epilepsy

The ultimate goal for any dog with epilepsy is seizure control with good quality of life. Seizure control is considered one or fewer seizures per month.  We were not achieving control on the first two anti-seizure medications, Zonisamide and Keppra.

During April, Elton’s seizures became more frequent and culminated in a series of cluster seizures and a trip to the emergency vet. Three or more seizures within 24 hours or any seizure lasting more than 5 minutes is considered an emergency situation that could lead to a life threatening seizure condition called “status.” 

Elton’s neurologist recommended further diagnostic testing to determine if there was some underlying condition other than epilepsy that was causing the seizures. The most common tests performed are Computerized Tomography (CT) scans, Magnetic Resonance Imaging (MRI), and analysis of cerebral spinal fluid. On April 25th, Elton had an MRI and spinal tap and results were completely normal. 

Our next step was to introduce a third anti-seizure medication, phenobarbital, to achieve seizure control. Phenobarbital is a barbiturate and central nervous system depressant. Common side effects of phenobarbital are increased appetite and thirst, and hind end weakness. A long term side effect of phenobarbital can be liver toxicity, so blood levels of phenobarbital and liver function must be monitored every few months.

At this point, we were willing to take the risks and deal with the side effects to help reduce Elton’s seizures but we were not prepared to deal with Elton being unable to walk. The first day on phenobarbital was terrible for Elton as he had complete hind end collapse, and we were struggling to help him walk. Our vet ended up reducing the pheno dosage and the hind end weakness improved greatly within 24 hours. So now we waited and hoped that seizure control was within reach.

Learn More about Epilepsy and Follow-up Care-Ohio State University Veterinary Medical Center

Phenobarbital by Rania Gollakner, BS, DVM

7am, 3pm, 7pm, 11pm

Elton has epilepsy, so what do we do now?

We had already started Elton on a twice daily course of CBD oil. For some dogs and people, CBD has become an alternative treatment for epilepsy. And it would have been wonderful if CBD had been enough, but CBD did not reduce or control Elton’s seizures. We had to venture into the world of anti-seizure medications.

There are four main anti-seizure drugs of choice for dogs with epilepsy:

• Phenobarbital 
• Potassium Bromide 
• Levetiracetam (Keppra) 
• Zonisamide

There are other choices as well, each medication has its own side effects and risks. Some can cause damage to internal organs with long term use and some side effects can greatly impact quality of life. Elton’s neurologist recommended starting Elton on Zonisamide.

The good thing about Zonisamide was there were no side effects for Elton and only had to be given twice a day, 7am and 7pm. Elton was happy and playful but the bad thing was that after three weeks without a seizure, Elton seizured in a cluster of three. Our vet added Keppra and unlike on just Zonisamide, we saw a range of side effects that we called “the drunken sailor” that included lack of coordination, sedation as times and agitation at other times, lots of impulsive behaviors and lots of vocalizing.

The other challenge was having to give Keppra three times a day, 7am, 3pm and 11pm. Our lives now revolved around the times that Elton needed his medications, 7am, 3pm, 7pm, 11pm.

I work full time on a revolving schedule and Paul is retired. So we have more flexibility that most people. Being on this schedule means that we can’t ever sleep in, one of us has to be home at the dose times or we have to take Elton with us, and we can’t ever, ever miss a dose or even be late with a dose. Missing a dose or being late can be the catalyst to a life treatening seizure.

After two weeks on Zonisamide + Keppra, the seizures started again. And the seizures we were seeing were more intense and convulsive. Our vet increased the Keppra, but the seizures continued until we ended up at the emergency vet after Elton had three seizures in one day. It was time to bring out the the big guns in our fight with Elton’s epilepsy.

Canine Idiopathic Epilepsy-University of Missouri College of Veterinary Medicine

Cluster Seizures in Dogs-Canna-Pet

Understanding Your Pet’s Epilepsy-Dennis O'Brien, DVM, PhD

Epilepsy 101

On February 22, 2019, our 13 month old Elton was diagnosed with Ideopathic Epilepsy. Paul and I knew very little about Epilepsy, what this meant for Elton, and what this meant for us too. We had to fast-track our Epilepsy education.

What is Ideopathic Epilepsy? 

• Epilepsy is recurrent seizures caused by abnormal activity in the brain
• Ideopathic means there is no known cause

Which dogs get Ideopathic Epilepsy? 

• Epilepsy is the most common neurological issue in dogs 
• Most dogs have their first seizure between the ages of 1 and 5 years of age
• Male dogs more more likely to have epilepsy
• There are many at-risk breeds including Australian Shepherds and Border Collies

How is Epilepsy treated? 

• The goals of therapy are to reduce the frequency, intensity, and duration of seizures. They may never be eliminated. 
• Veterinarians will prescribe anti-seizure medications
• One third of dogs do not respond to anti-seizure medications 
• Each anti-seizure medication has its own side effects that can impact organ function and quality of life
• Dogs on anti-seizure medications must be closely monitored, given blood tests to check organ function
• Medications must be given at timed intervals every day to achieve the desired level of the drug in the blood. 
• Taking dogs off of anti-seizure medications cold turkey can bring on a life threatening seizure. 
• Most dogs require lifetime treatment. 

What is Status?

• For anyone that has a loved one with Epilepsy, status is what is dreaded. Status, or status epilepticus is a series of seizures with no recovery time inbetween. 
• Status can cause brain damage and can be deadly. 

This all seems daunting and a lot to process, no doubt. Paul and I looked at each other in the neurologist’s office and agreed that this was going to be challenging for us emotionally, financially, and logistically. But if ever two people were up to the task, it was us. 

Resources

Epilepsy Fact Sheet-Australian Shepherd Health and Genetics Institute

Coughs of the Brain: Seizure Control for Dogs with Ideopathic Epilepsy

Disease Progression and Treatment Response of Ideopathic Epilepsy in Australian Shepherd Dogs

What is Epilepsy-The Epilepsy Foundation

Diagnosis Epilepsy

On February 11, 2019, the morning we saw Elton have a seizure, we took him immediately to our vet, Dr. Matt at Oakpark Pet Hospital in Oakville, Ontario. Elton had a physical exam, a complete blood panel, urinalysis, and a 4AD Snap test to rule out tick related infections.

We discussed everything that Elton has eaten, where he had been in the previous days, anything he may have been exposed to. Every test came back normal and there were no obvious causes. Elton was seemingly healthy as a horse. 

Dr. Matt strongly suggested that we schedule a neurological consultation at MOVEH, Mississauga Oakville Veterinary Emergency Hospital, also a referral clinic. They would be able to provide additional testing to rule out possible underlying issues like a brain tumor. 

It was a two week wait until an appointment could be scheduled. In the meantime, we had to watch and wait for other seizures. I started Elton on CBD oil (more on CBD in a later post.) Elton had two more seizures within that time, three days apart, the same time of day 7am, and the same duration and intensity. In between the seizures, Elton was his usual enthusiastic, mischievous self.

On February 22nd, we saw neurologist Dr. Carolina Duque at MOVEH. She diagnosed Elton with  idiopathic epilepsy. Meaning epilepsy with no known cause. 

Dr. Duque detailed why Elton’s seizures were so concerning. He was having cluster seizures, which are seizures that occur hours or days apart. Cluster seizures can be life threatening as each seizure is training the brain for the next. The most important thing was to reduce the seizures in frequency. Dr. Duque recommended starting anti-seizure medications immediately. And down the rabbit hole we went...

Seizures 101

I never had a dog that had seizures before Elton. And seeing him have his seizures is heart wrenching. There is a feeling of helplessness and anguish watching your loved one experiencing a seizure. But what is a seizure anyway?

According to The Epilepsy Foundation, the simplest definition of a seizure is a sudden surge in the electrical activity of the brain. There are different types of seizures that are different intensities and durations with different physical characteristics. Seizures are a symptom of an underlying issue which could be injury, exposure to toxins, disease or an inherited issue.

Elton’s seizures are tonic-clonic, generalized seizures often called grand mal seizures. He has the textbook physical characteristics of a grand mal seizure with loss of consciousness, involuntary muscle movements, convulsions, excessive drooling, chomping of his mouth, dilated pupils, and loss of bladder control. All of his seizures so far have occurred between 5am-7am, between sleeping and waking, which is a very common timeframe for seizures.

Generalized seizures have three phases:

1. Aura-the period of time before the seizure where the dog may seem out of sorts, nervous, or seeking affection. We’ve never seen this phase with Elton, because all of his seizures have occurred in the morning when we are all asleep. 
2. Ictal-the period where there are convulsions and loss of consciousness. This phase of Elton’s seizures last about two minutes. 
3. Post-ictal-a period of continued disorientation. The convulsions end and he’s left confused, unable to stand, and obviously unsure of what’s happened for about 5 minutes. This can last in dogs for many hours. 

If your dog is having a seizure:

• Keep Calm and Stay Back-My first reaction was to get right next to Elton and try to comfort him. This was not the appropriate thing to do because animals or people that are seizuring can bite. Stay calm, talk to them, wait for them to regain consciousness. 
• Keep Your Other Pets Away-It is best to quickly and calmly move other pets to another area to keep everyone safe. Our other dog George sleeps near Elton’s crate and has not reacted to any of Elton’s seizures. But, the safest place for Elton is the crate he sleeps in at night where George cannot get too close to him. 
• The Longer the Seizure, the More Dangerous-Seizures that last longer than 5 minutes can be life threatening. If your dog is not coming out of the seizure, they need immediate veterinary attention. 

RESOURCES

The Epilepsy Foundation-What is a Seizure?

Canna-Pet-Types of Seizures in Dogs

Elton’s Seizures

On February 8, 2018, Elton had his first grand mal seizure at exactly 7am. We just didn’t realize it.

Paul and I were both fast asleep, but we heard Elton “dreaming”. Elton sleeps in a crate at the end of our bed so I can hear him, but can’t see him very well. I heard his feet moving, as if he were running in his sleep. I didn’t think anything about it, then I found the puddle of drool in Elton’s crate. Elton seemed unusually sedate the rest of the morning, but nothing that would have prompted concern.

Three days later, at the exact same time in the morning, we heard and witnessed the second seizure. If you’ve never seen a person or animal seizure, it is unsettling to say the least. Elton was on his side, front legs extended, body contorted, feet paddling, and eyes dilated and wide open. The convulsing seemed to last a lot longer than the two minutes we calculated. Elton had a puddle of drool around his mouth and a puddle a urine this time too. After several minutes, he was able to stand up and wanted to go out in the yard to pee and poo. He came in, had a huge drink of water and again was subdued.

I called our vet, Dr. Matthew Croskery at Oakpark Pet Hospital, and we scheduled to take Elton in that morning. Everything came back within normal ranges, bloodwork, vitals, urinalysis, and a basic neurological exam. Due to Elton’s age and breed type, Dr. Matt felt that Elton needed more testing and a full neurological consultation at MOVEH specialty hospital. The first available appointment was February 22nd.

On February 14th, at 7am, Elton had another seizure. And three days after that, another at 7am. They were all similar in length and intensity. And we started keeping videos of each seizure as a reference for the neurologist.

This is a video of Elton’s seizures #2, #3, and #4. This is a warning that this video could be disturbing for some people. We missed most of seizure #2 just getting our cell phone out to record it. And #4 is unusual in that Elton had his muzzle pressed up against the crate so hard that it was disrupting his breathing. I got in the crate to reposition him. We really had no idea what we were dealing with.

Elton is Special

We adopted Elton when he was five months old. He was described to us as a dog that would crawl up into your heart if he could. That’s a great description of Elton and our hearts needed some mending. Paul and I had lost both two beloved dogs in eight months, Bernie to cancer, and Royal to a stroke.

I knew Australian Shepherds well as a breed and loved their intelligence and train-ability. Elton would be my seventh herding dog and fourth puppy that I had raised.

It was obvious that Elton had all the wonderful traits of an Aussie, but there were other things about Elton that we noticed early on. Specifically, Elton would startle at sudden environmental changes. If someone left the room, changed clothes and came back into the room, Elton would bark at as if the person was a stranger.

Elton had major impulse control issues. No, seriously, major. He wouldn’t just jump up on furniture or people. He would launch himself like a missile at anyone and anything and try to physically climb up the walls or jump entire flights of stairs. We really had to manage Elton to keep him from jumping on the dining room table or into the oven.

He especially could not control himself around our older dog George. He would grab onto George like a lampray. It made managing both dogs in the same space a larger and larger challenge.

And the chewing! Like nothing I had experienced in all my years as a dog owner and trainer. It was more like the chewing phase that beaver would go through.

Because of my experience as a professional dog trainer, I knew that these things were not all that unusual in a puppy, especially a puppy of Elton’s age. Every puppy goes through “fear periods” and behavioral difficulties during adolescence. So we amped up our training and socialization, enrolling in ongoing puppy classes and committing ourselves to helping Elton work through each issue.

Months went by and despite our best efforts, we couldn’t seem to work through these issues, no matter how hard we tried. I reached out to many friends and colleagues for advice and hired a professional IAABC behavioral consultant for more help. Elton seemed stuck in patterns of behavior of a very young puppy as he grew to nearly 70 pounds.

What we didn’t realize, but our trainer did, was there were some neurological aspects that we had yet to discover.

This is Elton

This is Elton. Elton is our 14 month old Australian Shepherd. Elton is affectionate, intelligent, high energy, and Elton was recently diagnosed with epilepsy. This blog is all about Elton, his diagnosis, his challenges, and how how we, as Elton’s people, navigate life with an epileptic dog.

I’m Jenn. I’ve had dogs all my life and I had a 15 year career as a professional dog trainer and Tellington TTouch Practioner. I know dogs. I blogged for 10 years about my beloved Aussie at The Life of Royal. You would think that someone with my experience would have been prepared for Elton’s challenges. But I have never had a puppy quite like Elton and I had never had a dog with epilepsy.

This is my husband Paul. Paul knows dogs too. He’s a Tellington TTouch practitioner and has had dogs his whole life. Paul has also spent 30 years working with special needs children in a therapeutic riding program. But Paul didn’t quite expect to be spending his retirement raising a puppy with epilepsy.  

This is George. George is our older Australian Shepherd that we adopted in 2017. George is a settled gentleman that did not approve the arrival of a puppy into our lives. 

 

We have a lot to learn about how best to help Elton lead a happy life with epilepsy. So begins a new journey!