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Idiopathic Epilepsy in Dogs

By: Dr. John McDonnell

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Treatment In-depth

  • The most overlooked aspect of treatment is keeping a seizure log in which you write down exactly when (time and day) your dog has a seizure, including the total length of the seizure and any predisposing activities that you remember. Note what your dog does during the seizure. If you suspect your dog had a seizure but you did not witness it, list it as a question mark in your seizure log.

  • Treatment is indicated for idiopathic epileptics depending on the severity and time between seizures. Generally, medical treatment is generally advised for animals who have one or more seizures every six weeks. Dogs who have cluster seizures or go into status epilepticus (more than one seizure in a 24-hour period) may be treated even though the time between seizures is greater than six weeks.

  • If you and your veterinarian decide to treat your dog with an anticonvulsant, you must make a commitment to giving the medications exactly as prescribed with absolutely no changes in the dose or drug without veterinary consultation. Haphazard drug administration or abrupt changes in medication may be worse than no treatment at all and may cause status epilepticus.

  • The goal of treatment is to reduce the severity and the frequency of the seizures while avoiding unacceptable side-effects. It is rare to eliminate completely all seizures in dogs with idiopathic epilepsy.

  • Phenobarbital is usually the drug of first choice for idiopathic epilepsy. It is usually effective in more than 80 percent of the cases when administered at the correct dose and frequency. It is given two to three times a day. During the initial treatment period of 10 to 14 days, side effects are usually seen with this drug consisting of excessive drinking, urinating and eating. Some dogs may act very lethargic as well. These side-effects are temporary and diminish two weeks after initiating treatment.

  • Phenobarbital comes in 15, 30, 60 and 100 mg tablets. Phenobarbital tablets are often referred to according to grains (gr.). For reference 1 grain equals 60 mg. There is also a syrup or elixir available.

  • Blood phenobarbital concentrations should be measured two weeks after any change in dose or if there is a change in seizures frequency or severity. Concentrations are determined by drawing blood. The level of drug needed to control seizures varies between individual dogs but generally should be above 25 ug/dl before treatment is considered failed.

  • Dogs can have liver problems with chronic, high-dose phenobarbital treatment. Regular annual or semi-annual blood tests may be recommended to evaluate your dog's liver function.

  • The other common anti-convulsant used in dogs is oral diazepam or valium given three times a day.

  • Bromide is the active ingredient in potassium bromide and sodium bromide and is another anticonvulsant that can be used in addition to phenobarbital or as an initial drug. Many dogs that do not initially respond to phenobarbital alone will have a dramatic decrease in seizure frequency and severity with the addition of bromide.

    Bromide is the drug of choice for animals with liver disease. Bromide is always given on a full stomach. Giving bromide on an empty stomach can cause vomiting. Bromide is not approved for use in dogs, nor is it commercially available at this time. Bromide can be given as a capsule or dissolved in water or as syrup.

    Bromide has an extremely long half-life which means it can be given once a day. It also takes 6 to 8 weeks to reach therapeutic levels in the blood unless your veterinarian recommends giving a loading dose. Side-effects from the bromide include increased eating, drinking, urinating and incoordination. These side-effects are usually temporary but if they are problematic, a dose reduction in either one of the drugs may be recommended.

  • Diazepam (Valium) is used for the treatment of choice for status epilepticus. Your veterinarian usually gives it in emergency situations by the intravenous (IV) route. Your veterinarian may recommend diazepam by rectal or nasal administration if your dog has severe seizures. This is not a common situation and requires special training. Other therapies taht may be used if diazepam is ineffective in your pet include the use of other drugs that include propofol, zonisamide or levitiracetam.

  • Alternative therapies range from acupuncture to herbs and vitamin therapies as well as dietary recommendations. Work with your veterinarian in selecting the right treatment for your dog's seizures.

  • Other drugs such as primadone, felbamate, zonisamide, levitiracetam, phenytoin, gabapentin, carbamzaine and valproic acid are used in certain specific situation as tertiary drugs.

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