Gazette Vet: A Tremble in the Night

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By John Andersen, DVM

In the middle of the night, about a year ago, Michelle and I were completely passed out sleeping in bed only to be woken by the sound that gets me out of bed quicker than any alarm clock ever could—the sound of one of our animals puking!

“Gurk, gurk, gurk,” said the stomach of our yellow Labrador Boone as he stood up in his crate ready to puke up something likely interesting. Our dogs, like many, are very indiscriminate creatures. The most popular non-food indulgence is vegetation—mulch, leaves, sticks—and heavy sessions of these “veggie snacks” typically will cause our dogs to puke, interestingly always at 4 a.m. when we are deepest asleep.  But of course we are likely to see regurgitated Lego men, plastic animals, etc., as we are also raising a nine-year-old boy.

So I sprang out of bed and quickly released Boone from his crate so I could start the cleanup.

But this time something was wrong. Boone started frantically racing around our bedroom as if his rear was on fire, eyes wide. As my 4 a.m. brain was trying to comprehend what was happening, Boone suddenly tightened up in a ball, fell on his side, and started a violent seizure.

“Michelle! Boone is seizuring! Grab a towel!”  Now Michelle’s 4 a.m. brain had to deal with war-quality commands being thrown her sleeping way. The towel was because Boone was uncontrollably urinating as he convulsed on the ground. I quickly made sure Boone’s body was clear of any furniture and just tried my best to hold him as he convulsed on the ground for what seemed like an eternity (probably about 45 seconds in reality).  He was wide-eyed, but clearly not conscious, and was making a terrible whimpering noise as his jaw chomped repeatedly.

Finally, like a crashing wave finally dispersing back into the ocean, the seizure ended. Boone started coming to and was looking around like, “what the heck just happened!” But then just as quickly as it started, his tail started wagging and he was asking to go outside and for a treat!

Boone was just four years old at the time, and had been perfectly normal earlier that day, and was totally normal the following morning after we all managed to get back to sleep.  Boone had just had an epileptic seizure. Shoot. My previously perfect dog has epilepsy.

Epilepsy is just a word for a seizure disorder with no obvious underlying cause (such as a brain tumor or head trauma). I describe it as a temporary “short circuit” of the brain, because that’s kind of what it is—seizures are transient bouts of uncontrolled electrical activity in the brain. It’s pretty hard for us to understand it past that, anymore than we can understand how our brain cells produce consciousness, memory, and emotions. We are all pretty miraculous beings!

Primary epilepsy is surprisingly common in dogs. I diagnose it and help people manage it very regularly. Epilepsy typically starts in young dogs from two to five years of age.  Though there are some breeds that are clearly over-represented (Labrador and Golden Retrievers, Pit Bulls), epilepsy can affect just about any breed, and we do sometimes see it start in older dogs as well.

The diagnosis is pretty straightforward: young adult dog who was totally normal yesterday, had a seizure last night, and was totally normal afterwards. We always do blood work to make sure they don’t have low blood sugar, liver disease, or electrolyte abnormalities, but if the blood work is normal and the dog is otherwise perfectly normal on exam, we are happy diagnosing primary epilepsy. Boone’s blood work was perfectly normal when I brought him into work with me the next day.

So your dog just had a seizure, and is now happily looking at you waiting to get a treat. What now?

I typically educate our clients about epilepsy, and perhaps the hardest part of the talk is that we’re not going to do anything on that day. Almost all dogs are going to continue to have seizures throughout their life, but how frequently and how progressive is quite variable. Some dogs will only have two or three seizures a year, while some will have their second seizure one week after their first. Some dogs may present to us after having five seizures in just one day.

The only thing we can do for epilepsy is treat with anti-seizure medications, aka anticonvulsants. When we start dogs on these meds, we are typically committing for life, because if we start and then stop these meds, we can actually make the seizure condition worse.

So do we start your dog on lifelong seizure medication after it had its first seizure? Absolutely not! A seizure in itself is not harmful, and some anticonvulsants can have some side effects, so we really don’t want to start lifelong medication until we are convinced we need to.

So when do we need to start anticonvulsants? Though the scenario is different for each dog, my general guidelines are: 1) The dog is having seizures more frequently than every two months, 2) The dog is having “cluster seizures,” i.e., three in one night, and/or 3) The dog has very concerning seizure activity, such as aggression right after the seizure or severe lethargy the day after the seizure.

Boone didn’t have another seizure for about three months.  Then about three months after that we came home to find urine on our kitchen floor and a chair knocked over, so we presumed that was another one (note, not every dog urinates when they seizure.) Then he went five months until the next, however he had one more just three weeks after that.

As I knew it was coming, we recently started Boone on phenobarbital, one of the most commonly prescribed anticonvulsants. Most epileptic dogs will eventually need to go on an anticonvulsant. The problem with waiting too long is the dogs will develop a “seizure memory,” where it becomes easier and easier for seizures to occur, and ultimately you’ll need more medication to control them.

There are many different anticonvulsant medications available now, all with different sets of potential side effects and differing costs. However I can confidently say that I have never had a dog die or be put to sleep because of epilepsy. That is to say, these dogs truly do live completely normal lives, and even dogs with severe cases that require a lot of medications to control their seizures. These dogs, too, seem to adjust and live long, spoiled lives.

I’m completely bummed to have had to put my dog on a lifelong medication, but such is life.  I know it is the right move, and I have the experience to know that Boone will still be with our family when he is an old man.

Life is never perfect and is certainly not always fair, but we are certainly fortunate to be able to share it with our pets.

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