My Dog's Seizures Won't Stop (what to do when epilepsy drugs don't work)
Epilepsy is distressing enough without the treatment not working.
But what are the aims of treatment and what are your options if your dogs treatment is not stopping their seizures?
Hi, my rescue dog is now 3, about 23.5 kg and has developed daily seizures for 3 days, 2 weeks ago. He is now on phenobarbitone 30 mg BID but he just had a seizure again today and it happened twice. I feel so bad for him and I want to do something to help him however he is unable to be examined without sedation, even for collecting blood. Should I still send him to the vet for another blood test or what should I do? He had just been sedated 2 weeks ago. - Gigi
Is it Epilepsy?
So there's a couple of different problems here and I'm going to start by saying that there's a number of different causes of seizures and I've said this many times in several other questions. you can read here all about the causes of seizures in dogs.
Really for a young dog with repeated seizures, with no problems on bloods, with no access to any toxins and who's fine between seizures, the cause of seizures is most likely to be epilepsy.
Aim of epilepsy treatment
And really it's important to say that the aims of epilepsy treatment is to reduce seizure frequency and reduce seizure severity. So we're not necessarily trying to eliminate all seizures. Although that would be nice, it's not something that we're going to realistically be able to achieve in every epileptic dog.
Now if we take phenobarbital as kind of the example here, then 80% of epileptic dogs on phenobarbital are going to have their number of seizures reduced by at least ½, and about 1 in 3 dogs on phenobarbital are actually going to become seizure free. So phenobarbital is a pretty effective drug.
If your dog is on phenobarbital then you can download my free guide here.
Monitoring a new epileptic dog
When a newly diagnosed epileptic dog is started on phenobarbital in particular, after 2 weeks the blood levels are going to have stabilized. At this point we can then check them. And the reason we do this is for a number of factors. The first is that in some dogs they will need to have a higher dose just to reach the desired range within their blood. The second is that we actually don't want the level to be too high because that can lead to an increased likelihood of side effects.
What if the treatment fails?
If we take a blood test and the level is within the therapeutic range and a dog is still having seizures, then there are a number of different things we can do. We may be able to increase that dose a little bit, just to bring those levels up a bit without them reaching the toxic dose. Alternatively, we may need to start thinking about adding additional anti-epilepsy drugs.
This could be something like potassium bromide.
The other thing we can do is consider switching to a different anti-epilepsy, anti-seizure drug. The primary example here would be Pexion or imepitoin as another front line epilepsy treatment. If we're still having problems and we're still not getting any seizure reduction, then there are other things that we could be doing but that’s a much deeper topic that's going to really vary depending on that individual dog.
Now, if we're then talking about Gigi’s dog who needs sedation, we may need to do frequent blood testing at least in the initial stages. Sedation is generally very, very safe, depending on the drugs and techniques we use. The vast majority of drugs don't have any cumulative effect, so we can sedate her dog very safely, day after day after day if we need to. This is something that can occasionally be needed. For example, we've got a really nasty, painful wound and we're having to change a bandage every day.
Clearly, some dogs will have an increased risk than others. You could also talk to your vet as well to see if there's anything else that your dog can take at home to make them easier to handle in the clinic. This might help avoid the need for a full sedation. There's a number of different things that may be able to be given so that he feels a lot more comfortable and calmer.
Socialization visits are another great idea. Just go to your vet clinic, give treats that you know your dog likes, sit in the waiting room for a couple of minutes and then leave again. The aim is that your dog learns that when they go to the vet it’s not going to be the end of the world and something nasty isn’t going to happen every time. As you progress through those socialization visits, they can get longer, you can go on the scales, you can visit the consult rooms. You could then have the staff give treats. All these positive experiences will help to desensitize your dog to the stress of the vet clinic and can make a huge difference.
So those are my thoughts here. We definitely want to be considering monitoring bloods and then a change in dose or additional treatment in this dog. Having a couple of seizures in quick succession is not something that's ideal.
But equally, if your dog is epileptic and they are on medication and they're having the odd breakthrough seizure, obviously be in touch with your vet, but that is not necessarily in itself a need to trigger additional treatment or additional measures.
The above is a transcript taken from “The Dr Alex Answers Show”.
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