Health Focus – Epilepsy

EPILEPSY

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What is Epilepsy?
Is my pet having a seizure or fit? What does it look like?
Types of fits – Grand and Petit Mal
If my pet has a seizure, is it epilepsy?
The most common other diseases that cause seizures
First aid for a seizing/fitting pet
Diagnosis of Epilepsy
TREATMENT FOR EPILEPSY
Drugs to avoid with Epilepsy

What is Epilepsy?

Epilepsy is a disturbance of the electrical circuit in the brain. Nerves in the body and the brain act like electrical wires do – they conduct electricity up and down the nerves. This electricity is produced by chemical reactions in the nerves and movement of this electricity is what allows your dog or cat to move their muscles, breathe, digest food, and in fact do everything that is vital to life.  Nerves are also similar to wires, in that they have an insulating layer or myelin sheath round them, like the plastic coating round wires. When nerves lie close together, for example, in the brain, this myelin sheath stops electricity jumping from one nerve to the next, when the brain is healthy.

Nerves work like electrical wiring

Nerves work like electrical wire and also have an insulating plastic or “myelin” sheath round them

With epilepsy there is a problem with this system and the electricity starts jumping from nerve to nerve in the brain, the brain becomes overloaded and your animal has a fit or seizure. Epilepsy can be as a result of damage to the brain or genetic. With damage to the brain, something has often happened to your pet, for example, they were hit on the head in a car accident, or they got an infection or inflammation of the brain (encephalitis) or the membranes round the brain (meningitis.) When an injury or infection occurs in the brain, there can be bleeding in the brain. The blood clots to stop the bleeding and save the animal’s life, but the blood clot and the damage round it can leave a scar on the brain where the nerves are damaged or the myelin sheath is missing and this can cause epileptic fits. With genetic epilepsy, which occurs in pure breed dogs, the pup is born with a genetic fault in the nerves in the brain which leads to epilepsy. Most of the dogs I have seen with genetic epilepsy are German Shepherds or Labrador or Golden Retrievers, but it can happen in any pure breed dog. Kittens that seizure may be born with a problem in their brains from the mother having contracted a virus, or having been vaccinated while she was pregnant.

Labradors are prone to epilepsy

Labradors may be prone to genetic epilepsy

Is my pet having a seizure or fit? What does it look like?

Is my pet having a seizure?  A seizure is different from a “heart spell”. A heart spell or a faint from a weak heart causes an animal to collapse suddenly, often with a cry and then lie very still.The heart may pound and the tongue go blue. They may stop breathing for a few seconds. There may be loss of bladder control. A seizure or fit usually involves some sort of twitching/activity of the muscles. The eyelids may flick, and the legs and body twitch. Animals will also collapse into a seizure, but usually not with a cry.They may lose bladder control and sometimes bite their tongues so the mouth has blood in it. The breathing can be rough and intermittent and the tongue may also go blue.

There are two basic types of fits you see

“Grand Mal” – which is a full seizure in which the animal loses consciousness, and often bladder and bowel control, the legs, body and eyes twitch, and there may be interruption or difficulty with breathing, so the tongue may often go blue. This is the dangerous type of seizure, because if it goes on too long, the brain may become deprived of oxygen and the animal can die. In most cases, however, seizures last between thirty seconds and two minutes and the animal comes out of the seizure on their own. Before the seizure happens, animals can be in a pre-ictal or prodromal state which you may see as confused, disorientated or abnormal behavior until the seizure starts. With people that have epilepsy and own a seizure dog, this stage is often picked up by the dogs, who push the owners to the ground because they can sense the person is about to have a seizure.  When a seizure is over, animals are often exhausted and very disorientated. As a teenager, I owned an epileptic dog, who would try and climb behind, or even into the dishwasher after a seizure.

dog having a seizure

A dog having a “grand mal” seizure or fit

Partial or “Petit Mal” seizures are mini seizures which may or may not progress into full seizures. Animals are fully aware of what is happening, but their legs, faces and bodies may twitch and they may lose the ability to walk properly. They will usually try to crawl to their owners for comfort during the seizure, which again, usually lasts for a short time only.

If my pet has a seizure, is it epilepsy?

It can be, but it can also be a totally different problem.  A purely epileptic animal will be totally normal between seizures and will show no signs of being sick at all and not have any changes in their behavior. If your dog shows changes in his behavior such as lethargy, poor appetite, vomiting, aggression when he was timid before, howling, circling or central blindness, it’s most likely not epilepsy.

If your dog has a fit or seizure, your vet will look at his age and history: A seventeen year old dog that suddenly starts to have fits is highly unlikely to have epilepsy, and is more likely to have a seizure from failing liver or kidneys or a brain tumor. A nine month old, otherwise healthy male Labrador is far more likely to have epilepsy.

The most common other diseases that cause seizures are

Low blood sugar (hypoglycemia)


Liver problems


Kidney problems

Problems with kidney function can cause seizures

If the kidneys don’t work well, toxins build up causing seizures or fits


Cancer in the brain or body


Deformities of the brain such as water on the brain (hydrocephalus) in small dogs with dome shaped heads or kittens born when their mother has been vaccinated while she was pregnant.


Poisons – Carbamate, Organophosphate, strychnine, toxic plants, dog’s eating owner’s medication.

Very low thyroid levels in the blood

Picture of a brain and epilepsy fits seizures

Inflammation or infection in the brain can cause seizures eg encephalitis


Inflammation in the brain eg. GME (granulomatous meningioephalitis) or a stroke

Infectious diseases – Distemper in Dogs, Feline infectious Peritonitis (FIP) in cats, Canine Babesiosis (biliary or tick bite fever) in Africa, parasites such as worms and single celled organisms (protozoa) that infect the brain.


Heavy worm burdens in tiny puppies

Heavy worm burdens in puppies can cause fits

If puppies have lots of intestinal worms they can cause fits or seizures

Low calcium levels in small breed bitches feeding huge litters

Diagnosis of Epilepsy

If your pet has had a seizure, your vet should suggest running a blood test to rule out other causes of seizures such as liver failure.
The only way to definitively diagnose epilepsy is a MRI scan of the brain. Spinal taps will rule out inflammation and infectious causes in the brain itself, as well as certain brain tumors. Unfortunately, these may be out of many people’s budgets. If your pet’s blood tests are clear and he or she shows no other clinical signs at all, then your vet may make a provisional diagnosis of epilepsy.

MRI scan for epilepsy dog

The only way to definitively diagnose true epilepsy is with a MRI brain scan

First aid for a seizing/fitting pet

If your pet has a fit at home, make sure that his head is on something soft so he doesn’t bang it. Monitor the color of his tongue. If the seizure lasts more than two minutes, and his tongue is blue, you need to contact an emergency vet. If he doesn’t come out of a seizure this is called “Status Epilepticus” and it is an emergency. He needs to have an anti epileptic drug, such as Valium (Diazepam) or even a  general anesthetic to stop the seizuring as soon as possible. Some people with epileptic pets are allowed to keep vials of injectable Valium or Valium tablets at home. If you have the injectable Valium, you can either inject it into the muscle, if your vet has shown you how, or squirt it up the nose or into the rectum, where it will be absorbed. There’s point in shoving tablets down a seizuring dog’s mouth – you will only get bitten, the tablets may be inhaled rather than swallowed and even if they do get to the stomach, they take a while to be digested and absorbed.

Injectable valium/diazepam

Valium injectable can be squirted up the nose or into the rectum

If your pet has a seizure that lasts less than two minutes, you can give him some sugar water to drink when he comes out of it, as his energy reserves will be low. If he is on anti epileptic medication, or has Valium tablets, you can ring the emergency vet and get instructions on increasing the dose temporarily to reduce the chance of his having another one.  Sometimes pets only ever have 1 seizure in their life, but there is a chance that they may have a second seizure close to the first one. If your pet has a series of short fits, these are called “cluster seizures” and again, usually have to be suppressed by injections of rapidly acting anti seizure drugs such as Valium or barbiturates.

I would always advise taking your pet to see the vet if he has had an undiagnosed seizure.  If you do not have 24 hour access to a vet, at least phone an emergency center and speak to the vet on duty during the night and if that vet advises it is safe to wait, then take your pet up first thing in the morning.

TREATMENT FOR EPILEPSY

The medication that is used for animals and humans can be very different. In fact some human anti epileptics can make dogs seizure. There are some very reliable medications for pet epilepsy on the market. An animal is considered to have their epilepsy under control if they seizure 1 time a month or less. If they are on medication but are fitting more often, then their treatment needs to be re evaluated. The most common medications used in animals are:

Phenobarbitone (Phenobarbital)

Phenobarbitone is an anti epileptic drug for dogs

Phenobarbitone is the most common anti epilpetic drug used in animals

This is a barbiturate drug, which means it is related to anesthetics. It can have a sedative action when given in high doses. This drug has been around for many years and used to be the mainstay of therapy for epilepsy in dogs and cats but in the last ten years it has been used in combination with other anti epileptics such as potassium bromide which seems to work a lot better. It is given every day to your pet. It can cause the liver enzymes to increase on blood tests. Animals should have their bile acids checked every 6 months by a blood test. If an animal is still fitting on this drug, the blood levels should also be checked to see if they are high enough. Animals can also become “used” to this drug over time,as their liver produces higher levels of enzymes to break it down, and the dose may need to be adjusted after a blood test. Side effects: Sedation, drinking/urinating a lot in higher doses and ataxia which is like dizziness and stumbling. It comes in tablet form and in a pediatric syrup.

Potassium Bromide

This is used as a chronic medication for epilepsy, often combined with Phenobarbitone. The syrup form can be very bitter tasting. It takes more than a week after therapy has started before it reaches therapeutic levels in the blood stream, and some vets thus put the dogs on very high doses initially to control seizures. It is given every day to your pet. Side effects: nausea in high doses.

Diazepam/Valium

Valium diazepam tablets

Valium is used to control of seizures + to reduce the chance of seizures again

This drug is used to control a seizure when it is happening and is often give as an injection following a fit to prevent another fit from occurring. It wears off very quickly, has sedative qualities and thus is not for long term use, only for emergency use.

Primidone

Older drug sometimes used in dogs. Broken down to Phenobarbitone in the body. It is given on a daily basis. Some blood and liver abnormalities may be seen and dogs should have a blood test every 6 months.

Valproic Acid

In dogs it is considered a second line drug, used mostly in dogs whose seizures are not well controlled with phenobarbitone or Potassium bromide. Side effects include nausea, drowsiness and hair loss(6)

Gabapentin

A painkiller for nerve pain that has anti epileptic properties. Used in cats. (1) Should not be used in animals with poor kidney or liver function. May cause sedation and ataxia. (4)

Levetiracetam

A human anti epileptic drug used when animals don’t respond well to other medications. (1)It should be used in conjunction with other drugs. Also known as Keppra, side effects include changes in behavior, a stiff and wobbly gait, vomiting, and salivation(3)(5).

Dilantin (phenytoin)

Not recommended as it is broken down in the body too quickly. There are better drugs on the market. (2)(6)

General anesthetics

Propofol is a general anesthetic

General anesthetics like Propofol will stop a seizure or fit

Used if an animal is not coming out of a seizure. Either barbiturates or Propofol can be used as both lower the seizure threshold. The barbiturate type anaesthetic lasts longer.

Clorazepate

It is converted in the body to a chemical related to Valium.  Side effects include drowsiness and wobbly gait(3)(6)

Felbamate

Side effects include liver toxicity and bone marrow suppression(3)

Homeopathic preparations

Homeopathic preparation for epilepsy

Pet Alive Ease Sure is a homeopathic preparation for fits

“Eco Epilep” and “Pet Alive Ease sure” do have some effect in very mild cases of epilepsy for example animals that seizure less than 4 times a year or have partial seizures only. Given up to four times daily. Possibly used together with anti epileptic drugs to reduce the dose and toxic side effects of them.

Drugs to avoid with Epilepsy

Do not use acepromazine (ACP)  (commonly used to calm pets for travel, or fear of fireworks) under any circumstances if your pet is prone to seizures or fits. It will cause a fit.

REFERENCES

1. http://www.vetspecialists.co.uk/06_Animal_Welfare/Neurology_Facts/Treatment_Epilepsy.html

2.http://www.essortment.com/all/epilepsydogs_rhac.htm

3.http://hubpages.com/hub/dog-seizures (pictures)

4.http://www.wedgewoodpetrx.com/learning-center/professional-monographs/gabapentin-for-veterinary-use.html

5.http://www.wedgewoodpetrx.com/learning-center/professional-monographs/levetiracetam-for-veterinary-use.html

6.http://www.canine-epilepsy-guardian-angels.com/OtherMeds.htm


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