Seizures – Why? Is it time to start medicine?

I received an email with a question about seizures today

I have had my little chihuahua (female, about 4 or 5 years old, weighs approx. 7 lbs)—she is having seizures. Today she had 2 back to back, first time for that. I live in NM & the seizures have started about 18 months ago & seem to have been limited to the cooler temp. time. My vet said that not to worry about it, but I am. She urinates while seizing, her back legs totally go out, today all 4 went out & during the second seizure she fell over. I am worried. Do you have any information you can give me to help her?

I can only give you the general guidelines that I follow, as per what the neurologists have recommended to me. I am certainly not a neurologist, nor an internal medicine specialist.  Without actually seeing your pet, I cannot really give you definite advice.

Seizures are caused by something having a bad effect on the brain tissue, anything from head trauma to brain infection to a tumor to "idiopathic".  Idopathic means "self-caused", and what it really means is that we have no idea what's going on.  EEG, MRI, C-T scan all look okay, but the patient has seizures.  Epilepsy (which usuallly starts at a young age) comes under this category.

The brain is the body's "electrical switchboard". The form of the seizure can vary, depending on which area of the brain is affected.  One can see anything from altered behavior (staring at the wall), to loss of consciousness, to twitching of a single body part.  The most common types are tonic-clonic (very rigid, legs extended, head drawn back, muscles rigid and quivering), and convulsive (down, paddling and jerking with all legs).  These are often accompanied by emptying of the bladder and bowels.

Seizures typically go through three phases.  The actual seizure is referred to as the "ictus", so you have the pre-ictal, ictal, and post-ictal phases. 

In the pre phase, one can see that the patient is "not right".  They used to call this the aura in human medicine.  "Something's happening to me…"  This may last for a few seconds or longer.

Then the actual seizure occurs, with outward signs as noted above.  This can last seconds, minutes, even hours.  In very severe cases, the seizure will not stop without medical help, and the patient could die.  Seizures that do not stop within just a few minutes require emergency medical care.  When the seizure goes on for long periods of time, permanent damage may result.

The post-ictal recovery period is variable in length.  The patient is no longer doing the seizure activity, but they may be unconscious, or just very "out of it".  Gradually they return to normal function, going from  "Where am I? Who turned out the lights?" to completely normal in outward appearance.  With a first seizure this can all take place in such a short time that the dog is normal by the time people finish describing it to me on the telephone. 

It is not uncommon for the owner to rush the dog to the clinic, certain that he is dying, and find him bopping around the room having a great time by the time they arrive.  They have rushed in wearing their pajamas and the dog acts perfectly fine.  They feel like idiots, but it is just how the condition proceeds.  It's good that the dog (or cat) is okay, and we spend some time talking about how to monitor the condition.

Each seizure can cause additional damage.  Thus, while some dogs have one seizure and never have another one, the typical course is for the seizures to gradually become more severe, longer lasting, and more frequent.

Because of this, some neurologists have recommended starting anti-convulsant medicines if a dog has had three seizures, no matter how far apart they are.  While this may prevent further damage, it seems a bit much to start twice-a-day, every day, medicine if a dog is having a mild seizure lasting 10 seconds, once every year or two.

We always start by checking a blood chemistry panel to be sure that there are no obvious problems with liver, kidney, blood sugar, or electrolytes.  If this is normal, I ask the owner to keep a log, noting every seizure's date, form, length, time to full recovery, and the circumstances that preceded the seizure.  The log allows us to make a more objective determination about whether the condition is getting worse.

If seizures are coming frequently (every couple of months), if they are severe, if they are long-lasting (minutes), if they won't stop without medical treatment, or if we have cluster seizures, we start anti-convulsant medicines.

A cluster seizure means that you are having multiple seizures in a day, or seizures daily for a few days.   This is always an indication to start medication, in my opinion.

Does two seizures in a day constitute a cluster?  I can't answer that without looking  at the whole case.

Once you start medication, you will continue giving it daily (maybe twice daily) from now on.  After you've been on it for a couple of weeks, you'll bring the pet in to check the blood levels of medication.  This will have to be monitored periodically.  The pet will need to be examined twice yearly (at least) in order to legally continue prescribing controlled substances (drugs like phenobarbital, the most commonly used anti-convulsant drug).  Aside from being good medicine, it is a legal requirement.

Most seizure patients can achieve good control of their problem with minimal side effects.

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