Advanced Imaging

General questions about tests and procedures for diagnosing canine epilepsy. Please note that we cannot make a diagnosis or interpret specific test results via this forum - please consult your veterinarian for specific advice for your individual pet.

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ibycus
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Advanced Imaging

Post by ibycus » Fri Apr 03, 2009 10:20 am

Was wondering what people thought about advanced imaging (MRI/CT).

Specifically, when you had it done, did it alter the clinical outcome? (Did you change your treatment regime as a result of the advanced imaging).
Dale Atkin
UCVM 2012

MK's mom
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Post by MK's mom » Fri Apr 03, 2009 12:09 pm

Are you a veterinary student or a professor? You posted UCVM under your signature, that is why I'm asking you.

I'm not sure how an MRI or a CT scan can 'alter' any outcome, perhaps you know something I don't. My boy had an MRI/CT scan to rule out any head injuries, tumors or toxins, etc. It was a lot of money and didn't give me any answers. If I knew then what I know now, I may skip the expensive procedures at the age he was at the onset of seizures(17 months), but if my dog was older than 5 years I may consider scans in the event a tumor might be causing seizures.

Vivian
Nathan
3.5 yo Irish Setter boy
First seizure 7/26/2013
Last seizure 3/24/2014
__________________________________
MK
5 yo Irish Setter boy
First seizure 1/25/06
Last seizure 9/4/2009

Aug 17, 2004- Sept. 22, 2009
May the shamrocks fall softly sweetpea

ibycus
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Post by ibycus » Fri Apr 03, 2009 10:15 pm

I'm a vet student at the university of Calgary (the 2012 indicates the year I'll graduate).

What I'm looking for, is how many people find anything that they can actually do something about.

Ideally what I'd like to hear from someone is "We did an MRI/CT, found x was wrong, and cured the dog", or to a lesser extent "We found out that 'x' was causing the seizures, so now we can better control the seizures with 'y'"

I really don't know what 'x' might be.

If for example you'd done a scan, and found a tumor, would you have gone for brain surgery? Would that have been on the table? (I'm of the perhaps mistaken impression that brain surgery in dogs is (a) pretty uncommon, (b) not particularly successful. )

I guess what I'm getting at, is how often is it simply 'diagnostically interesting' (i.e. now we know what is wrong, but can't do anything different), how often is is clinically important (i.e. now we know that 'x' is wrong, we can do 'y' about it that we couldn't reasonably do before), and how often is it completely unrevealing.

I've read a lot of stories where people have spent a lot of money on advanced imaging, and a lot of stories that say "we found nothing", I've heard stories that went "we found 'x' and knew there was no hope", but I haven't yet read one that says "and because we did it, my dog was able to live a longer, healthier life", and I'd really like to hear that from someone.

Dale
Dale Atkin
UCVM 2012

MK's mom
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Post by MK's mom » Sat Apr 04, 2009 4:04 am

One of the posters discovered thru an MRI that her bitch had hydrocephalus, hopefully she'll see this post and share her experience wtih you.

Vivian
Nathan
3.5 yo Irish Setter boy
First seizure 7/26/2013
Last seizure 3/24/2014
__________________________________
MK
5 yo Irish Setter boy
First seizure 1/25/06
Last seizure 9/4/2009

Aug 17, 2004- Sept. 22, 2009
May the shamrocks fall softly sweetpea

MK's mom
Posts: 1708
Joined: Wed Mar 01, 2006 9:48 am
Location: Michigan

Post by MK's mom » Sat Apr 04, 2009 4:09 am

Do you as a veterinarian student feel that MRI's are basically expensive tests that usually aren't helpful in regards to idiopathic epilepsy? From the dog owner's point of view, hindsite is 20/20, but in the event my pup would have had a tumor or head injury, the MRI would have pointed that out leaving us an answer for the seizures, where the docs could of only guessed what was going on otherwise.

As a vet student, perhaps you could make it your mission to do research into canine epilepsy and find out what is causing it. I work at a university and there's an MD that is researching epilepsy in humans. He said the brain is the most mysterious of organs and they still know so little about it. maybe it will be you that will crack the code (as it were) or at least help us find DNA markers in our breeds? :)

Regards,

Vivian
Nathan
3.5 yo Irish Setter boy
First seizure 7/26/2013
Last seizure 3/24/2014
__________________________________
MK
5 yo Irish Setter boy
First seizure 1/25/06
Last seizure 9/4/2009

Aug 17, 2004- Sept. 22, 2009
May the shamrocks fall softly sweetpea

ibycus
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Post by ibycus » Sat Apr 04, 2009 11:09 pm

MK's mom wrote:One of the posters discovered thru an MRI that her bitch had hydrocephalus, hopefully she'll see this post and share her experience wtih you.

Vivian
I'm curious, do you know, was she able to do anything about it treatment-wise?
Dale Atkin
UCVM 2012

ibycus
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Post by ibycus » Sat Apr 04, 2009 11:19 pm

MK's mom wrote:Do you as a veterinarian student feel that MRI's are basically expensive tests that usually aren't helpful in regards to idiopathic epilepsy? From the dog owner's point of view, hindsite is 20/20, but in the event my pup would have had a tumor or head injury, the MRI would have pointed that out leaving us an answer for the seizures, where the docs could of only guessed what was going on otherwise.
Let me turn that around on you... Would you as an owner have seen value (equivalent to the cost of the MRI) in knowing the cause but not being able to *do* anything about it? (assuming you aren't going to do brain surgery). My gut feeling, and it remains just a gut feeling, with no real evidence behind it (and this may change as I learn more) is that an MRI/CT may be useful in pinpointing the cause of some seizures, which 'solves the mystery', but might not be particularly useful clinically (i.e. change the actual actions that you take). I'm fully aware that this feeling comes mostly out of ignorance of the possibilities, and I'm not happy with it, but I'd really like to know what can be found on an MRI/CT that can cause seizures that is treatable.

I know as an owner of an epileptic dog, I don't feel that I'm likely to get anything useful (equivalent to the value of the test) out of an MRI/CT. Yes, there is some psychological benefit to knowing the cause, but if there is nothing we can *do* about that cause...well... I don't think I'm ready to shell out the dollars. (and I'm not sure I could in could conscience advise a client to do the same)
As a vet student, perhaps you could make it your mission to do research into canine epilepsy and find out what is causing it. I work at a university and there's an MD that is researching epilepsy in humans. He said the brain is the most mysterious of organs and they still know so little about it. maybe it will be you that will crack the code (as it were) or at least help us find DNA markers in our breeds? :)
I find all this stuff facinating, and I think if we're going to make any real progress on reducing the incidence of epilepsy in dogs, its going to come through genetics research. That being said, research isn't what *drives* me. Right now, I love the clinical side of things way too much. I love the interactions with the people, and the animals. I don't think that is really there in research.
Dale Atkin
UCVM 2012

MK's mom
Posts: 1708
Joined: Wed Mar 01, 2006 9:48 am
Location: Michigan

Post by MK's mom » Sun Apr 05, 2009 1:23 pm

Let me turn that around on you... Would you as an owner have seen value (equivalent to the cost of the MRI) in knowing the cause but not being able to *do* anything about it? (assuming you aren't going to do brain surgery).
Nathan
3.5 yo Irish Setter boy
First seizure 7/26/2013
Last seizure 3/24/2014
__________________________________
MK
5 yo Irish Setter boy
First seizure 1/25/06
Last seizure 9/4/2009

Aug 17, 2004- Sept. 22, 2009
May the shamrocks fall softly sweetpea

MK's mom
Posts: 1708
Joined: Wed Mar 01, 2006 9:48 am
Location: Michigan

Post by MK's mom » Sun Apr 05, 2009 1:37 pm

**Let me turn that around on you... Would you as an owner have seen value (equivalent to the cost of the MRI) in knowing the cause but not being able to *do* anything about it? (assuming you aren't going to do brain surgery).***

I can only speak for myself when I say that I knew nothing about epilepsy when my boy started to seize, so when the neurologist told me it would be beneficial to do an MRI along wtih the spinal tap, I wanted to do all that I could to help my boy. Looking back on it now and knowing what I know now, it was a lot of money spent that I wish I had back to pay down all the bills I've acquired due to this monster.

You have a point by wondering if an MRI can show anything that is actually treatable. If a dog's skull is fractured or there's a tumor, can the vets do much? If it's hydrocephalus, that has to be treated differently than idiopathic epilepsy, yes? You're correct when you say the tests are done to rule out any injury or tumor, it's all for the owner's and vet's peace of mind. We also have full thyroid panels done at the onset of seizures, but how many dogs have hypothyroidism and seize? I can only say that the vets have a list and scratch things off as the tests come back negative, then slap an 'idiopathic' sign on our dog's foreheads. We're out a boatload of money and still don't know what's actually causing our pups to seize. Still, if there's the slightest chance that a test or a scan can show something that can help, we go for it. It's the old 'damned if you do, damned if you don't' thing.
Nathan
3.5 yo Irish Setter boy
First seizure 7/26/2013
Last seizure 3/24/2014
__________________________________
MK
5 yo Irish Setter boy
First seizure 1/25/06
Last seizure 9/4/2009

Aug 17, 2004- Sept. 22, 2009
May the shamrocks fall softly sweetpea

frasalone
Posts: 17
Joined: Fri Mar 06, 2009 10:17 am

Post by frasalone » Sun Apr 05, 2009 4:10 pm

Even though the MRI didn't show what was causing the seizures in my dog, it did rule out tumours etc. It also showed that the seizures had not caused any significant brain damage. OVC in Guelph, Ontario told me that a clean MRI is one "sure indicator" that they really are dealing with epilepsy.

Now having said that, I believe the MRI actually caused a seizure in my dog the very next day!!

Carolyn
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Location: Long Island, NY

Post by Carolyn » Mon Apr 13, 2009 7:06 am

When Kiya's seizures began the word "epilepsy" didn't even come to mind. I had no idea what was happening, at the time I was ready to do every test to find out what happened to her. My vet said "lets get the seizures under control first, you can spend thousands on testing and never know why." So thats what I did, its like a waiting game. There's nothing you can do but wait for the next one. After all I have learned I am very greatfull that is the path we went. Unfortunately I will never know why Kiya has seizures but she does, its part of our life and life does go on with epilepsy. I hate hearing when new people say the vet's make them spend thousands on testing right off the bat, unless of course money isn't an issue. These days I don't know of many people that can really afford such an expence. I think thats why so many epi dogs get dumped when they have a seizure, because people fear the expense when "some" can be controlled at a minimal cost. Sorry its a sore subject for me.
Carolyn
Kiya 11yr Shiloh Shepherd
PB 60mg am 90mg pm, 1teas kbr 1200mg, turmeric paste
1000mg milkthistle bid
First seizure 11/27/05
Last seizure 5/21/15

ibycus
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Post by ibycus » Mon Apr 13, 2009 7:02 pm

Its interesting that you should comment re. the word epilepsy not coming to mind. I try and avoid saying 'epilepsy' when I'm talking to other dog owners (I stick to saying 'he has seizures'*). That word comes with way too much bagage for my tastes (Come to think of it, I don't think my vet ever explicitly used it).

I was pretty much the same way when we found out that his seizures were seizures (he has focal seizures that weren't immediately apparent that they were seizures, we were thinking more musculoskeletal problems, which he also has). If the vet had said "I think we need an MRI, go get one", I would have done it without a second thought, and I think many owners are the same way.

Stepping back from the problem though (knowing that one day I'm going to be advising owners on how to best deal with this), I'm forced to wonder if the advanced imaging techniques, aren't more useful from a research perspective than a practical/clinical perspective**. How often does it change the clinical outcome? Is this a good way to spend the client's money? Or would you be better off advising the client to spend their money on treatment, rather than diagnostics.

Now if the seizures were resistant to treatment, I might be tempted to (eventually) advise that a CT might be worthwhile to make sure there wasn't an underlying cause of *why* we hadn't been able to control them (I'm assuming that if there were something to see on a CT, the seizures would be more likely to be refractory), rather than just trying one expensive drug after another.

In a case like that, it does change the clinical outcome***, so might be worthwhile.

Dale

* His seizures are/were correlated with high activity, so I bring it up when I need to explain to people in the park why I don't want him to get too excited, otherwise they think I'm just a big meanie.

** The cynical part of me wonders a little bit if there is something of a pressure to use the fancy toys in order to pay for them. I mean if you just spent a couple million bucks on a CT machine, you'd want to use it at every turn, wouldn't you? You'd want the vets working for you to use it too.

*** By "clinical outcome" I mean what you *do* rather than what you know. If nothing changes in the clinical outcome, then the utility of doing the test is questionable.
Dale Atkin
UCVM 2012

Mandypop
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Post by Mandypop » Tue Apr 14, 2009 5:13 am

My dog had an MRI and a spinal tap done after recurring seizures. The first MRI scan showed that she had narrowed tubes that drain the fluid away from the brain (I can't remember the proper wording!). She did have some build up of fluid.

We planned to do a comparison MRI scan and spinal tap a few months later, before starting any treatment, but her seizure acitivity increased so this was brought forward.

The narrowing of the tubes had not changed, so this narrowing was considered as congenital and not a trigger of her seizure activity.

If the narrowed tubes and fluid had got worse by the second MRI scan, it was discussed that she may need a VP shunt.

Although expensive, I felt it helpful to know that there were no other reasons for seizures (ie. brain tumor). It did not change the treatment for seizures.
Poppy - 9 year old whippet/greyhound (20 kg)

First seizure- 17th Oct 2006
Last seizure - 17th Nov 2009

90mg Pb twice daily
320mg KBr daily

MK's mom
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Post by MK's mom » Tue Apr 14, 2009 6:36 am

Dale,

You're a good thinker, I hope that doesn't change once you're in veterinary medicine trying to earn a living. :)

I understand that vets want to push MRI's because someone has to pay for that Magnet!! I also understand that specialized facilities are paying good money for vets, equipment, supplies, etc., to run those facilities and the money has to come from somewhere. I also agree that having an MRI done on a young dog that just started seizing is a tool to rule out any 'chance' that there may be a brain injury when a dog starts seizing and yes, it's more for the vet's education than it is for the client's peace of mind. BUT, there's always that outside chance that the seizures are actually secondary to something else and the MRI's and spinal taps will tell the vet what he/she needs to know.

From my own experience, had I known then what I know now, I would have skipped the MRI and spinal tap because my boy was 17 months old at the onset of his seizures, a prime age for idiopathic epilepsy. I was devastated, scared and wanted to do anything and everything that would help him (and still do), but the tests came back negative and I'm still battling seizures. Still no answers for me and I'm $3000 poorer! :D
Nathan
3.5 yo Irish Setter boy
First seizure 7/26/2013
Last seizure 3/24/2014
__________________________________
MK
5 yo Irish Setter boy
First seizure 1/25/06
Last seizure 9/4/2009

Aug 17, 2004- Sept. 22, 2009
May the shamrocks fall softly sweetpea

Carolyn
Posts: 440
Joined: Thu Feb 16, 2006 12:08 pm
Location: Long Island, NY

Post by Carolyn » Tue Apr 14, 2009 11:44 am

The word "Epilepsy" is treated like a disease from ancient times like leprocy or the plague. When my vet said the diagnosis is "idiopathic epilepsy" my life changed forever. This was my baby, she was 18 months old, I was absolutely devistated. It became my quest in life to make sure other dog owners heard about it. I was shocked to find that so many people said "oh yeah we have/had a dog that had seizures" even worse to find some people did nothing about it. I had a story done in Newsday to also help spread the word. I don't know how to get the link on here, I could send you a copy if you would like.
As far as extensive testing, if you can afford it great, but a lot of people are under the impression they "have to" spend exorbitant amounts and would rather dump the dog. I am very fortunate that Kiya's siezures are being well controlled with meds and other than routine blood tests I hope thats it.
Carolyn
Kiya 11yr Shiloh Shepherd
PB 60mg am 90mg pm, 1teas kbr 1200mg, turmeric paste
1000mg milkthistle bid
First seizure 11/27/05
Last seizure 5/21/15

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