Sunday, May 12, 2013

Seizures. What I Tell Parents

My friend wrote an informative article on seizures it highlighted recommendations from another veterinarian, and some alternative therapies to stop a seizure. It was a wonderful article and it served as a springboard for this one. I asked her if I could use it as the backbone for this one and thankfully she agreed. The links to those are listed below.

Here is my article, my thoughts, experiences and advice on seizures.

Seizures, I see them all too often. They strike at any age, any breed, and in any range of severity.

SEIZURES IN CATS
As a veterinarian I see seizures in dogs. I have seen it in cats but all of the cats were ill, dying, or had some other very severe disease that precluded them to having seizures, OR, the cats were exposed to a toxin. Beyond a doubt the most common toxin that I see in cats with seizures is using an inappropriate flea and tick medication  Specifically, using a dog flea and tick product (that clearly says "DO NOT USE ON CATS") on a cat.

PUREBRED DOGS
Here is my observation. I don't think I have ever seen a seizure in a mutt. (I just looked that up, and yes, they occur most often in purebred dogs). In dogs seizures are most often a result of epilepsy. The statistics say that epilepsy is the most common neurologic disorder in dogs and affects 0.5 to 5.7% of dogs.

SEIZURE OVERVIEW
I just looked up the definition of seizure to provide it to you. Unfortunately it is cumbersome, confusing, and not at all user-friendly. OK, disclosure time, I AM NOT a neurologist. I am a veterinarian., but, in an effort to make this sensible I am going to describe seizures how I describe them to clients. If you have a pet with seizures it is always advisable to seek a veterinary neurologist before deciding on a definitive diagnosis and a long term treatment plan. A veterinary neurologist will have the most experience and widest range of treatment options for your pet, they are an invaluable resource for what might be a life long affliction.

A seizure is a hyperactive nervous system response in the brain. Think of the brain as an intricate network of electrical activity. When the wires all fire at once the brain goes into overload. This manifests as a seizure. Most pets have a seizure with three parts to it.

Prodrome Phase;
The first part is called the pre-ictal (prodomal) period. For some pets they will look dazed, confused, start pacing, start licking their lips, or act oddly. I inform my clients about this phase because I want them to start observing for this. My hope is that they can be preparing for a seizure before it occurs. Also, there are some triggers that can cause seizures. These can include light, noise, chemicals, etc. Knowing this we hope that these can be removed to help avoid a seizure. I also instruct my clients to close off the area that the seizing pet is in. I have seen family pets attack and injure the seizing pet because they do not recognize it, or they fear it. In the pre-ictal phase I instruct my client to get their emergency kit out.

The Emergency Seizure Kit should include;
  • A blanket, to use as a transport tool, soak up urine, or protect the head from banging on floor.
  • A baggie with gloves, lubricant and anti-seizure medications. I advise and give this to all pets on seizure medications or with re-current seizures.
  • The phone number to your veterinarian, and the closest emergency hospital.
  • Your pets medical summary, just in case you need to head to the ER
Ictus;
The second phase of a seizure is called the ictus period. This is the seizure itself. A seizure can look like rigid extension of the limbs and possibly the head, shaking of the body and limbs, the pet may urinate and/or defecate, and they may lose consciousness, vocalize, or salivate. The seizure should only last a few minutes. IF it lasts longer I advise getting into the car with your pet (be very careful to not get bitten or injured) and start heading toward the vet. A seizure is an electrical disturbance in the brain, it can be a life threatening occurrence. Wrap your pet safely up, ask for an assistant to help restrain them for the ride and start for help.

If you have been given an emergency seizure medication apply it as directed by your vet.

The subject of having an anti-seizure medication for use at home is somewhat controversial. It is my opinion that allowing the owners to have some ability to treat and stop the seizures is not only essential to the possible life saving of their pet it also benefits the owners to feel as if they can assist their pets in a time of an emergency. After all the goal is to simply stop the seizures and lessen the chance of them clustering (or recurring quickly).

If your pets seizure lasts longer than ten minutes you need to bring them to the closest emergency hospital for assistance from them to stop the seizure.

Postictal Phase;
The postictal phase is the phase after the seizure has stopped. After a seizure the pet is usually tired, disoriented, unable to stand or walk, confused, blind, hyperactive, or depressed. The postictal period can vary greatly in length from minutes to hours.

The First Seizure
If you believe that your pet is having their first seizure they should be immediately brought to your veterinarian. After a thorough examination a complete blood and urine should be done. I always tell my clients that I am looking for the "easy" answers to a seizure like imbalances in glucose, calcium, and electrolytes. All underlying causes for the seizure should be discussed and the rule out list for etiologies to seizures started.

After the first seizure I advise my clients to begin keeping a journal. Any clue that they can document helps in understanding and diagnosing the seizures. I look for any kinds of clues to try to find a cause. Remember to list all topical products all medications, including heartworm preventatives, any holistic or homeopathics, literally anything that goes on or in your pet. I also review all dog foods and snacks. I urge them to think and analyze every item that their pet is exposed to. In most cases the cause is not identified and the seizures are by default attributed to epilepsy, but in a few cases we have been able to avoid life long medication and lessen the seizures to infrequent enough to not need medication.

The first seizure appointment is a long exchange of what owners observed, how the pet appeared before, during, and after the seizure. A whole bunch of questions about diet, lifestyle, and environment, and the journaling I am asking them to start. We also talk about an emergency plan, the emergency kit, and our long term plan.


Long Term Plan
The long term plan should be discussed at the first seizure so that owners have some idea of the plan should medication be required. Epilepsy is the most common cause of seizures. If epilepsy is diagnosed the treatment is a long term anti-epileptic. In veterinary medicine we use phenobarbital or potassium bromide, or sometimes both.

There are varying guidelines for when to decide to add an anti-epileptic. Here is the advice I give my clients, and here is the advice I took when caring for my own pet. When the seizures become weekly, or when the severity increases to the point of being concerned about not being able to get them under control, or if they start to cluster (a cluster seizure is when they occur in close proximity to each other), then for me it is time to add an anti-epileptic. It is important to remember that these anti-epileptics are usually given for the rest of the pets life. They also should be checked routinely by blood monitoring. Drug monitoring can be expensive and the pets response to these drugs can be alarming and troublesome to some.

I tell my clients that the phenobarbital or potassium bromide is given to help control or minimize the seizures because seizures are life threatening events. If the seizures respond to the medications it is recommended to stay on them for the rest of their pets life. All anti-epileptics have a loading period. This is the period of time it takes for them to reach adequate concentration in the pet to control the seizures. During the loading period many pets act intoxicated. They stumble, are groggy, and seem dull. It is difficult for some people to see their pet this way. It passes over the first few weeks.

With every drug there are possible side effects. The longer you stay on a drug the more likely you are to see its side effect. Long term use of the anti-epileptics are damaging to the liver. Our hope is that the seizures will be long gone by the time the liver fails from the phenobarb or potassium bromide. This is another very important reason to check the blood levels checked and in the reference range.

I will continue this discussion about seizures next with an overview of the types of seizures seen in dogs.

Here are the articles published by DawgBusiness on seizures arresting them via a holistic method and another dog's experience with addressing seizures please see the links below;

http://dawgbusiness.blogspot.com/2013/05/how-we-handled-alexs-seizures.html


http://dawgbusiness.blogspot.ca/2012/08/veterinary-highlights-arresting-canine.html

If you have any questions or ideas for this article, or this blog please contact me.

I can be reached at http://www.pawbly.com/ at anytime for any pet question. Please visit me there.

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