Human error one cause of seizures
What is a seizure anyways?
A seizure, fit or convulsion is defined as an uncontrolled, transient electric discharge from the neurons in the brain. Most seizures are due to epilepsy, which means there is no underlying disease in the brain such as encephalitis, metabolic disorders, toxicities or brain tumors. You may have heard from your veterinarian or doctor that epilepsy is a disease of ‘rule outs,’ which in plain English means: “If we can’t find any reason for the seizures, we call it epilepsy.”
How do you treat them?
Epilepsy is controlled and not cured. The medications – called anticonvulsants– most commonly used in animals are phenobarbital and primidone. Dilantin, a commonly used drug in humans, is less effective in animals and is also expensive. As stated in the title, the most common reason the anticonvulsants fail is human error: “The most common reason….is improper administration of the medication,” writes Cheryl Chrisman, DVM in Small Animal Neurology.
Owners and veterinarians are both to blame for this problem. Dr. Dorothea Schwartz-Porsche writes in Current Veterinary Therapy XI that some of the factors responsible for inadequate control of seizures are, “Improper choice of drugs, insufficient drug dosage, too rapid change of medication/dosage, and noncompliance.” Most of veterinary neurologists would agree.
So what do you do if your dog or cat is having seizures?
Your veterinarian will want to try to rule out other diseases or causes for the seizures. The evaluation will include a complete blood count, serum chemistries, urinalysis and skull X-rays. Additionally, they may recommend an electroencephalogram and cerebrospinal fluid analysis, for which you and your pet may be referred to a neurologist.
If all the tests are normal and epilepsy is diagnosed, you and your veterinarian have some decisions to make. As a rule of thumb, anticonvulsant medication is not started unless the seizures are very severe, occur in clusters or occur more often than once a month.
Some owners get very upset about seizures and this is also considered a valid reason to start therapy. A good relationship with your veterinarian is crucial to successfully manage the seizures as several attempts with various drugs and doses may be required until a proper program is found.
I advise most owners to keep a diary or log – information kept should include time and dose of drugs administered, mood of patient, side effects and any seizure activity.
What drugs are prescribed?
Phenobarbital is usually the first drug selected for dogs and cats;. It is relatively inexpensive and works pretty quickly, usually within 2 to 3 days. Side effects include sedation, hyperactivity and increased thirst and urination.
Primidone, the next most common drug, is metabolized by the body to phenobarbital and PEMA. Primidone is toxic to cats and it is also more expensive than phenobarbital and has more side effects.
Valium or Diazepam are used as a single agent in cats or combined with another agent in dogs. It is not effective as a single agent in dogs.
What if these first line drugs don’t work?
If one of these drugs does not control the seizure, another “first choice” drug should be chosen rather than combining two drugs. One drug should slowly be discontinued while the other one is slowly added.
This method is much more effective than combining drugs and it helps to minimize the side effects of combination therapy.
If this doesn’t work, we go to combination therapy. If combination therapy is not successful, there may be an underlying cause that was not present on initial examination such as a progressive encephalitis or a brain tumor and reevaluation may be necessary.
As a last result, your veterinarian may want to try some human drugs such as Potassium Bromide, Klonopin, Valproic Acid, or Tranxene. Unfortunately, many of the doses for animals is guesswork so there is some risk.
As you can see, controlling seizures can be difficult, but it can also be quite easy and uneventful. The important factor is the human factor: you and your veterinarian.
Since these are powerful drugs that often interact with other drugs and medical conditions, keep open a good line of communication with your veterinarian. Keep in mind that we are not going to cure the seizures, but rather control them. An occasional seizure is bound to happen so be prepared.