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Friday, March 13, 2009

Preparing For Epilepsy

Christina sends in this question. It's a long one, and so is my answer, but this is a great topic for discussion.

My husband and I are looking to adopt our first dog soon, and one online listing in particular has caught our eye. This dog is being rehomed because he has idiopathic epilepsy, which I understand means that he has seizures without any known cause. He is currently on phenobarbitol and potassium bromide but still seizes about once a month, usually at night while sleeping. We don't object to taking in a dog with special needs, in fact we would be happy to, but we want to be absolutely certain that we can handle this particular condition before we commit. I have done a lot of research already, but as much as I want to help him I'm still not sure if this would be getting in over our heads. What advice do you have about living with and caring for an epileptic dog? Give me the lowdown dirty facts, please - I've seen a lot of "you and your dog can still live a normal life" but I know that there would be bad days as well as good, and I feel it would be unfair to the dog if we didn't know that we were prepared for both. I'd also like to know the hard facts about what seems to be called a "continuous seizure" - most sources I've found just say "if your dog has a seizure longer than 5-10 minutes or more than 3 seizures in one day, take him to an emergency vet immediately." Of course I would do that, but I'd like a little more information about how common a continuous seizure is among epileptics, and what to expect at that ER visit and after it.

Sounds like you've certainly done your homework, Christina! I wish that I could give you some easy answers, but this can be a complicated subject. First, you are right that epilepsy usually doesn't have a known cause. There are definitely some disorders that can cause neurological signs (including seizures), such as hypoglycemia, meningitis, brain tumors, certain kinds of liver disease, and so on. When we talk about idiopathic (a fancy medical term for "we really don't know what the heck is causing it") epilepsy, it's a "diagnosis by exclusion". This means that we rule out other causes with various tests, and when we come up empty we say it's this kind of epilepsy.

In simple terms, a seizure is caused by misfiring of neurons in the brain. This causes signals to be sent in unpredictable and uncontrollable ways. If the seizures only last a few minutes, they really aren't directly harmful. The concern is if they go on for a longer period of time, such as what you found. Five to ten minutes is a good rule of thumb to consider, though there isn't a hard rule about this. If the seizure starts to go on longer, we worry about possible brain damage, muscle fatigue or damage (from the contractions), arrythmias of the heart, and simply a worsening of the underlying causes. When a dog goes into a prolonged seizure (status epilepticus), or when seizures happen back-to-back with little rest inbetween, you should definitely go to the emergency clinic. There are ways to stop most seizures, but it requires IV medications, and then continual monitoring. If you end up with this, expect to leave your dog at least overnight. They will probably do IV fluids and anti-seizure medications, ECG, blood testing, and general supportive therapy. Obviously, this won't be cheap, and you should have at least $1000 in a savings account set aside in case this happens. You also won't be able to qualify for pet insurance as this is a pre-existing condition, so you'll have to do the costs on your own.

Every case of epilepsy is different. Some cases have seizures only a few times per year, and in these cases probably don't need medication (my own dad's dog has seizures like this). When seizures start happening every month or more often, I recommend medication. The main medication used is phenobarbital, and needs to be used twice daily every day to be effective. Unfortunately, this medication does have the potential to be toxic, so at a minimum you will need to have phenobarbital levels and liver values checked at least twice per year. Potassium bromide is usually used in conjunction with phenobarbital when the latter doesn't control the seizures and you have reached the maximum safe dosage. Monthly seizures when on both of these can indicate a very severe case that may end up worsening, or a case where one or both medications may need to have the dosage increased. There are a few other antiepileptic medications out there, but these two are the most commonly used.

I wish I could tell you exactly what to expect, but that's hard to do, even if you were one of my clients. These can be unpredictable, and can worsen with time. It does sound like this will be a more difficult case to manage, but as long as you are expecting that it is likely manageable. Besides considering the health situations and emergencies, you definitely need to be financially prepared for regular monitoring, medications, frequent vet visits, and emergency visits. This is definitely more than simply an emotional commitment! Also be prepared to watch your beloved pet seizure for several minutes uncontrollably, with you not being able to help. This can be heart-wrenching, even if you know it will stop and it's not harmful.

Here's my best recommendation for you. Find a vet that you really trust (if you don't have one already), and pay for an office visit to sit down and consult with him or her. With a special needs case like this, you will be working very closely with your vet and seeing him/her a lot more than with an average dog. You want your vet to know all of the details, and find out directly what his/her comfort level and expertese is with a case like this. If you decide to take this dog, try to get all medical records possible and give a copy to your vet. Then allow your vet do to a thorough workup, including complete blood chemistries and phenobarbital level. Heck, you may find that the dosages can be tweaked a bit to improve the seizure control! But your vet will be the best person to help you make the decision as to whether or not you want to take this on.

I admire you for even considering this! Good luck!

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