One of the most common dilemmas in veterinary neurology is the question of how to address the concept of medicating epileptics. Do we ply them with meds to soothe the seizures or treat them with the benign neglect of a drug-free existence?
Seizure disorders are common in pets, perhaps more common than we know given that not all are of the obvious falling, paddling, convulsive variety (a grand mal seizure). “Chewing gum” seizures (where the jaw convulses independently of the rest of the body) fly under the radar regularly, while sensory seizures (where a certain odor might nag at their brains for a length of time) will never be detected.
Any stimulus that triggers neurons (brain cells) to fire randomly throughout the whole brain will produce a grand mal seizure whereas localized reactivity will generate the petit mal variety (like the so-called “chewing gum” seizures). These brain storms may be initiated by poisons, drugs, liver diseases, infections, tumors, blood clots and, often, for no clear reason. We tend to lump these latter cases into the disease category designated “epilepsy.”
I’m sure you know this but it’s important to consider any pet’s seizure a medical emergency until a diagnosis has been established. This is one of those times when it’s imperative you see a veterinarian immediately — in the middle of the night if need be — to assuage the seizure activity with drugs if necessary and to begin to determine what went wrong in the animal’s brain.
A vet must first undertake an initial series of tests to rule out the more obvious causes of an abnormal nervous system. Diagnostics range from the simplest blood work to the complex (and expensive) CT scan now available at many veterinary specialist centers. Only once other abnormalities are ruled out is a diagnosis of epilepsy rendered.
Epilepsy can be frightening for owners and dangerous for pets. But not all concerned suffer to the same degree. Some epileptic dogs will experience very frequent, intensely stressful episodes which can leave their bodies ravaged by fever and use up their crucial blood glucose, while others convulse infrequently and seem completely unfazed by the disease. Similarly, some owners are less unnerved by seizures than others.
Hence, the decision to medicate a dog with anti-epileptic drugs is based on seizure duration, frequency and intensity of episodes, and the overall level of stress the seizures induce — in both humans and their pets. Because all drugs can have side-effects (especially with long-term use) to medicate or not is an important decision best undertaken with the help of a trusted vet who understands both the pet’s condition and his household’s limitations.
And here’s where vets differ. How we handle the dilemma is based not always on research and clear science but on the individual pet and family circumstances. If seizures are occasional (or rare) and the severity of the episodes mild, she may well live a full, comfortable life without medication. But not every vet offers this choice (many believe that failing to medicate a potentially medicatable disease is the height of cruelty).
However, if a family is stressed out beyond belief by any sign of a seizure (months apart though they may be) every effort is often made to ensure a minimal disease experience for all involved through the use of seizure-blunting meds like phenobarbital and potassium bromide (by far the most prevalent daily-use seizure drugs used in vet medicine).
I like the option of choice, believing that seizure drugs are riddled with liver-toxifying side effects some might choose to eschew—not to mention the cost of the drugs (though they’re relatively inexpensive) and the frequent testing to ensure drug levels are controlled and evidence of liver toxicity monitored. In any case, my take is that informed consent is impossible without offering options.
Nonetheless, I caution animal parents not to skimp on their pets’ safety and comfort. If thorough consultation with any patient’s regular vet should leave any lingering doubts as to course of action, you should always inquire about a referral to a veterinary neurologist. Newer (read: more expensive) drugs are available here and thorough diagnostics are typically offered only at this now-common resource.
Dr Patty Khuly