Epilepsy in Dog
by Shawn Messonnier, DVM
Epilepsy is the name given to seizure disorders in dogs and cats for which there is no identifiable cause. Primary epilepsy is the result of functional cerebral disturbances without obvious causes other than a possible hereditary predisposition. For a diagnosis of epilepsy to be made, other causes of seizures including poisoning, infection, tumors, and cranial trauma must be ruled out through diagnostic testing. While true epilepsy can occur in pets of any age, most commonly pets with epilepsy begin demonstrating seizures between 6 months to 5 years of age. Seizures occur in epileptic pets as hyperexcitable neurons within the brain show activity. As the development of progressive and refractory seizures correlates with the number of seizures, early diagnosis and treatment are important in preventing a worsening of future seizures. In people, seizure triggers have been defined for some epileptics. Triggers probably do occur in pets but have not been well defined and most owners can't identify what causes seizures in their pets. Generalized (grand mal) seizures are the most common form in pets; petit mal seizures are extremely rareand possibly not even noticed by most owners if and when they occur.
Generally, conventional antiepileptic medicine is not prescribed unless the pet has at least 1 seizure per month, as the goal of treatment is to reduce, rather than eliminate, seizure frequency, severity, and length. This is because we can't ever guarantee that a pet won't have further seizures, and it's important for owners to have realistic expectations of treatment.
Conventional Therapy
Conventional therapy involves various anticonvulsant medications including phenobarbital, potassium bromide, or diazepam (Valium.)
Phenobarbital is commonly used to control seizures in dogs with epilepsy. Side effects include increased thirst, urination, and appetite; occasionally, excess sedation and a wobbly gait are seen, especially as the dosage increases. Increased liver enzymes, that may or may not be associated with liver damage, can be seen, as can anemia. Dogs taking phenobarbital should be reevaluated periodically and have regular blood profiles to monitor side effects and therapeutic blood levels (generally every 3-6 months.)
Potassium bromide is not officially approved by the FDA for use in dogs. It has become a popular medication for the control of seizures in dogs and has been used successfully for several years. It appears to be a safer medication than phenobarbital (fewer side effects,) although phenobarbital rarely produces any significant side effects in dogs. Potassium bromide can be used in dogs as the sole therapeutic agent, in combination with phenobarbital (if needed,) or in place of phenobarbital for those dogs whose seizures are not adequately controlled with phenobarbital or who suffer from secondary liver disease as a result of phenobarbital therapy. Many doctors are now using potassium bromide as the initial (and often only) medical therapy for dogs with epilepsy. Side effects of potassium bromide may include tremors, stupor, wobbly gait, lack of appetite, vomiting, and constipation. Potassium bromide may rarely cause pancreatitis when it is used in combination with phenobarbital or primidone (another anticonvulsant that is rarely used in dogs.) Dogs placed on low salt diets may have increased bromide toxicity as a result of decreased chloride ion levels. Extra salt in the diet, as well as use of diuretics, may decrease the blood levels of bromide and increase the frequency of seizures. Dogs taking potassium bromide should be reevaluated periodically and have regular blood profiles to monitor side effects and therapeutic blood levels (generally every 3-6 months.)
Valium is most commonly used as an injection for pets in status epilepticus, which is a state of active, ongoing seizures, but is not usually used as a sole medication for treating dogs with epilepsy.
Natural Treatments
There are several natural therapies to assist pets with epilepsy. Every doctor has his own favorite regimen; I've included some of the different therapies that I commonly employ in treating epileptic dogs.
Natural diet
A number of pets with epilepsy have been reported to show improvement upon dietary manipulation. Suggested dietary changes (which may decrease a food hypersensitivity that causes the pet to seizure) include: diets free of red meat, homemade diets free of common dietary allergens (beef/chicken/corn,) diets free of preservatives, and diets using minimally processed foods. Some pets may also be sensitive to the flavoring in monthly or daily heartworm preventative medications; using a non-flavored product may also be helpful when dietary manipulation alone is not successful. Since seizures are a medical problem, owners should not try dietary manipulation without a proper diagnosis and veterinary supervision.
Choline/Lecithin
Lecithin contains a substance called phosphatidylcholine (PC) that is presumed to be responsible for its medicinal effects. Phosphatidylcholine is a major part of the membranes surrounding our cells. However, when phosphatidylcholine is consumed it is broken down into choline rather than being carried directly to cell membranes. Choline acts like folic acid, TMG ( trimethylglycine), and SAMe (S-adenosylmethionine) to promote methylation. It is also used to make acetylcholine, a nerve chemical essential for proper brain function.
Choline and phosphatidylcholine are effective for treating human neurological disorders with presumed choline deficiencies including tardive dyskinesia, Huntington's chorea, and Friedreich's ataxia.
For use as a supplement or a food additive, lecithin is often manufactured from soy.
One choline containing product that has been used successfully in pets is CholodinR. Cholodin contains choline, phosphatidylcholine, DL-methionine, and vitamins and minerals. Choline provides methyl groups used by the body in a number of biological reactions and acts as a precursor of acetylcholine. Phosphatidylcholine (lecithin) in part of the plasma membrane of mammalian cells and also provides additional choline for acetylcholine synthesis. Methinonine and inositol also are involved in neurotransmitter metabolism.
Due to its ability to interact with cells of the nervous system, Cholodin is also recommended for pets with epilepsy. Studies have shown decreased seizure frequency in pets supplemented with products containing increased levels of choline and phosphatidylcholine. Cholodin, given at 1-2 pills daily for a small dog or cat, and 2-4 pills given daily for a large dog, and other choline-containing products can be tried to determine effectiveness under your veterinarian's supervision. Do not stop anti-epileptic drugs without your veterinarian's permission.
Lecithin is believed to be generally safe. However, some people taking high dosages (several grams daily) experience minor but annoying side effects, such as abdominal discomfort, diarrhea, and nausea. Maximum safe dosages for young children, pregnant or nursing women, or those with severe liver or kidney disease have not been determined; the same precautions are probably warranted in pets.
Flower Essences
Rescue Remedy is a commonly used flower extract that helps many pets with various anxiety disorders. For pets with epilepsy, I recommend using it in 2 ways. If you see a seizure coming on, give the pet a dose and this will often prevent the seizure. If the pet has a seizure, give another dose after the seizure and the pet will often return to a normal mental state more quickly than if the remedy had not been given.
Miscellaneous Considerations
In general, I always try to reduce the presence of environmental toxins in all of my patients. In pets with various disorders such as epilepsy, I believe this is very important. I recommend minimal use of vaccinations (through the use of vaccine antibody titers,) as seizures have been shown to occur in some pets following immunization. Natural holistic diets (discussed earlier,) and minimal use of various medications and chemicals (including chemical flea control products) are also important in a well-rounded approach to seizure control.
Conclusion
Epilepsy is usually a lifelong problem. In most pets, a combination of the proper diet, addition of nutritional supplements, and a reduction in environmental toxins will reduce the need for prescription medications. |
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