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Saturday, October 23, 2010

Inaction On Seizures?

Jessica sent this in yesterday....

A night or two ago, my mom called me at school hysterical, saying that something was wrong with the dog.
She described to me that the dog, a Boxer/Beagle mix named Cooper, had fallen to the ground, couldn't stand up, and was foaming at the mouth. He peed himself and I guess it looked pretty bad. Then in less than three minutes apparently he was up and wagging his tail.
I'd never seen him do that, but before I went to university my sister woke me up one morning, freaked out, saying that something was wrong with the dog and he was growling at her. I got up and checked on him and he was laying on the couch. He seemed fine and wasn't acting out of the ordinary but when felt him his chest was soaked and I noticed there was some remnants of foamy saliva on his mouth. At least one other time before leaving I found him with spit all over his chest. I thought that he must have eaten something strange that made him salivate heavily like that, like when our last dog somehow stole a whole pork roast off the counter and ate the whole thing... in one gulp.
But when my mom told me about this I thought something must be wrong with him neurologically. I work at a doggy daycare and I know of a few dogs that are on seizure meds and what happened to him sounded like a seizure.
I told my mom to call the vet and they said to bring him in, but he would be fine, but when they ran the bloodwork everything came back positive. I thought it was strange that they would run bloodwork for something that seemed neurological but they said they wouldn't do anything for now and that he might have to go on meds if it kept happening.
I thought that their inaction was REALLY strange. What do you think? Can you tell me more about identifying seizure problems and its treatment? I'm puzzled by this. Especially since evidently he's had more than one in a short span of time. Maybe two or three months tops, he's had at least three, the last one being fairly serious. 
Good questions, Jessica, and I'll try to answer them.  There is a lot that goes into seizures that people may not think about, and it's not always a simple situation. A seizure is basically a mis-firing of the neurons in the brain.  Imagine a city with lots of one-way streets and traffic flowing fairly well along the roads.  Then all of a sudden cars start going in directions that they shouldn't, ignoring stop lights, and pretty much moving around erratically and with no regard for the normal rules of the road.  Chaos would ensue and the city would be tied up in gridlock.  In a very simplistic nutshell, that's what happens during a seizure.

Seizures can be caused for numerous reasons.  Certain toxins can cause seizures, including many over-the-counter flea preventions.  Low blood sugar (hypoglycemia) can also lead to seizures, as well as liver dysfunction or failure.  Brain tumors and even infections can affect the nervous system and lead to various neurolgical disorders.  And then there is epliepsy, which in dogs is a seizure disorder with no discernible cause.  Once other causes have been ruled-out, a good rule-of-thumb is that if the seizures start at or before five years old, it's probably epilepsy; if they start after five years old there is a high likelihood of a brain tumor.

When we're examining a pet for seizures, the first set of testing that we do after the exam is basic blood testing.  As I mentioned above, there are many reasons why various metabolic and organ disorders can impact the nervous system, and we want to screen for infection, toxicity, and other disorders. Any of these problems are treated very differently from each other, so we need to try and figure out what it may or may not be.  

If all of the tests are normal, this is a good thing.  It means that the vet has eliminated many disorders and in this case indicates that we likely have epilepsy.  This disorder is not life-threatening and doesn't normally cause long-term damage to the brain or nervous system.  It can become worse with time, but there is no way to predict ahead of time whether this will happen.

Treatment is normally reserved for very severe or frequent seizures.  The medications must be given twice daily every day on an ongoing basis in order to effectively prevent seizures.  These medicines also can have some significant side-effects and can damage the liver, so we don't normally use them in mild cases.  My own rule of thumb is that I start to consider anti-seizure medication when the patient is having a seizure every month or more frequently.  Short seizures that happen every few months aren't normally treated, as in these cases the risks of the side-effects of medication don't outweigh the benefit of controlling the seizures.  In cases like this it's common to NOT treat and observe for worsening, at which time we can consider treatment.

So basically it sounds like your vet did what I would normally do and made similar recommendations.  Hopefully you understand a little better the reasoning behind those decisions. If you have any further follow-up questions, feel free to ask.