The Best Time to Start Treatment of Epilepsy in Dogs
If your dog has had one or more seizures and has been diagnosed with epilepsy, one of the first decisions you will have to make is when should you start treatment for epilepsy in dogs.
It’s not simply the case of starting medication as soon as a dog has one seizure. This is what you need to know.
The decision to start epilepsy treatment
A dog is not generally started on anti-seizure medication just because they have had a single seizure. The decision to start treatment is based on a number of things including:
The diagnosis of why a dog is having seizures (this post discussed the possible seizure causes in dogs)
How bad the seizures are
How long recovery takes
How frequently the fits are occurring
The perceived risk of a dog developing severe or repeated seizures
The owner's ability to live with a dog who is having seizures.
Why not treat seizures immediately?
But why don’t we just start a dog on treatment as soon as they have one seizure?
Well, the reality is that it is not all that unusual for a dog to only have one or two seizures which never then develop into a lifelong problem. Alternatively, a dog may only have one or two very short seizures a year, from which they recover very quickly.
Another key consideration is the fact that drugs and monitoring cost money, which no one wants to waste, and all treatments come with the small risk of side-effects. Starting treatment for epilepsy in dogs is very much based on a risk-benefit analysis. How likely is a dog to develop either severe or frequent seizures, weighed up against the cost, time and potential for side-effects of that treatment.
Aims of epilepsy treatment
It is also worth mentioning at this stage that the goals of treatment are not necessary to completely eliminate all seizures ever. While this will be the case for a reasonable proportion of epileptic dogs, the dose or number of drugs needed to obtain this will be very high in some individuals, making the risk of serious side-effects very high.
Instead, we aim to reduce seizures to a more manageable frequency, reduce the severity of the seizures and reduce the risk of a dog dying as a result of having a seizure.
Early treatment improves success
With these aims in mind, and knowing that a single seizure should not automatically mean your dog is started on anti-seizure medication, we also know that the earlier treatment is started the better the outcome. Early treatment improves how well treatment works, reduces drug resistance developing - a situation where an anti-seizure drug has no significant effect on a dog's seizures - and reduces the likelihood of hospitalization or death due to frequent of severe seizures. Early treatment likely significantly improves the quality of life as well as the life expectancy of an epileptic dog.
Epilepsy treatment guidelines in dogs
So here are the general guidelines:
The treatment of epilepsy in dogs should be started if a dog has multiple seizures within a very short period of time, typically 3 in a 24 hour period.
Treatment should be started if a dog develops status epilepticus, a state when a seizure lasts longer than 5 minutes. It’s important to try and measure exactly how long your dog’s seizures are. They are really scary to watch and can feel like they are easily lasting for longer than 5 minutes. The reality for the majority of epileptic dogs though is that their seizures will only typically last somewhere between 30 seconds to 2 minutes. 5 minutes is a very long time and a true emergency.
Even if the seizures are short and not rapidly recurring, if a dog has 2 or more seizures in a 6 month period treatment should be strongly considered. This will depend a bit more on the severity of seizure and speed of recovery. 1 seizure a month should certainly trigger treatment to begin, but knowing that early treatment improves a dogs long-term prognosis 2 or more seizures in a 6 month period is probably a better trigger to start anti-seizure medication in the majority of epileptic dogs.
And then the final trigger to starting treatment is if a dog takes a very long time to recover from a seizure, no matter how severe, or if there are any other concerns regarding their recovery. In most instances, a dog will be disorientated and tired to start with but then steadily return to normal. If this is not the case then treatment is likely to be highly beneficial.
It is all a bit of a balancing act, and the exact time to start treatment should be made after discussion with your vet, taking into account the unique history, circumstances and wishes that you and your dog have.
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