Four week long seizure cycles?

This is the place for general questions about drugs, long-term treatment concerns, possible influences of other drugs (such as antibiotics, heartworm preventatives, or anesthetics) for epileptic dogs, and other concerns. Please note that we cannot make specific recommendations for individual dogs - for this, please consult your veterinarian.

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Anastasia
Posts: 43
Joined: Wed Jul 09, 2008 6:30 pm
Location: Carbondale, Illinois

Four week long seizure cycles?

Post by Anastasia » Thu Aug 06, 2009 6:23 am

I have to know if anyone else here has experienced a similar situation, because I feel like Dawson and I are the only ones. I posted for the first time last year, but it's been a while so here's an update.

We think he's a chihuahua/terrier/King Charles mix, 21 lbs, 3.5 yrs old, started having seizures when he was 10 mos after he was dropped by a family member. He started on pb, we added KBr. His MRI last year showed a dilated right lateral ventricle and some type of damage elsewhere in his brain from which the seizure activity appeared to be originating. No infection. We added zonisamide last fall, and then Levetiracetam, i.e. Keppra, in April of this year. At the end of April he was hospitalized with hepatic encephalopathy, was in ICU for a couple of days, and was tube fed for ~ 5 weeks. The pb was discontinued and he has fully recovered, all lab work is normal. After stopping the pb his seizures started again. We increased the Keppra 0.5 ml, which seemed to INCREASE the focals. After cutting it back 0.5 ml the seizures stopped.

However, after 5 weeks of no seizures, he has had seizures for the last four weeks. A couple of grand mals a week & numerous focal seizures until we increased the Keppra 1 week ago. Since the Keppra increase he has had numerous focals (too many to log) throughout the day, although they are not severe. Mostly jaw spasms, which spread to his head and sometimes upper body/entire body. If I gently push his head forward while it is involuntarily tilting backward the seizure usually stops. Maybe I should cut back on the Keppra again?

What I really want to know is: do any of your pups exhibit this month on/month off type of seizure cycle? And can you "interrupt" your dog's seizure? The above cycling started a year ago. I know this is not "normal" epileptic behavior, but is this something that can go on for years? I see no obvious pattern in the timing of these focals. His diet is allergen free, no obvious environmental contaminants like lawn treatments, harsh chemicals indoors/outdoors. He gets his meds at the appropriate times without fail.

Are we the only ones who go through this? This doesn't sound like the typical seizure activity described in this forum.

While I wouldn't wish this on anyone, I just want to know we're not alone.
Dawson (aka "Peanut") - Cavalier King Charles/chihuahua/terrier mix?
Adopted at 5 mos old, now 3.5 y/o
1st seizure at 10 mos old, 12/30/07
KBr: (1ml) 300 mg, SID
Zonisamide: 150 mg, BID
Keppra: 3 ml, TID
Thyroxine: 0.15 mg BID

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

Post by MK's mom » Thu Aug 06, 2009 7:09 am

I used to use Keppra and noticed the partial seizures were worse and the drug didn't seem to do much anyway, so I stopped giving it.

I've never been able to see a pattern in my boy's seizure activity. He can go long stretches seizure free, then start having them close together. Your dog's situation is different because you know the seizures are from a head injury and not true epilepsy, so I cannot comment on that one as I have zero experience with head traumas. You're not alone though, dealing with hard to control pooches is very difficult and the seizures don't remain the same, they're ever changing in their severity, frequency, etc.

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

skrpio
Posts: 1143
Joined: Sun Sep 25, 2005 5:34 pm
Location: Auckland , New Zealand

Post by skrpio » Thu Aug 06, 2009 2:17 pm

It seems that these seizures are caused by the head injury and are not idiopathic. If you can stop the seizure by moving the head slightly I think this suggests some sort of pinched nerve or damaged nerve. Is there any way this can be checked out as releiving this may stop the seizures. You have to be careful with stopping and starting the medication particularly the PB.
Jane
In loving memory of my special KiKi Bean
Seizure free forever now
Nov 25th 2002 - Nov 1st 2006
Dogue De Bordeaux

Anastasia
Posts: 43
Joined: Wed Jul 09, 2008 6:30 pm
Location: Carbondale, Illinois

Post by Anastasia » Thu Aug 06, 2009 3:42 pm

Thanks for both of your replies! Actually, I don't know for sure if the seizures are a result of a head injury. I do think it's too coincidental, the abuse followed by his first seizure in a matter of days, but our neurologist hasn't confirmed the cause.

It's just too weird that I can interrupt the seizures, I know that this cannot be done with idiopathic epilepsy. I will ask the neuro about the pinched/damaged nerve, as this has occurred to me as well. I'm also going to monitor the Keppra's possible effect on his behavior. I'm not sure if it helps or not.

The neuro discontinued the phenobarb when Dawson was hospitalized with the encephalopathy, since they believed the phenobarb caused his liver function to decline. I have to admit, since stopping the pb he is better physically than he has EVER been. No ataxia, no stumbling, no mental fogginess; he completely stable on his feet and extremely alert. Except when he has the seizures.

Thank you both for your feedback! I am relieved I'm not the only one who has noticed the absence of a pattern, a change in the type/severity of the seizures. I just wish none of us, canine or human, had to go through this.
Dawson (aka "Peanut") - Cavalier King Charles/chihuahua/terrier mix?
Adopted at 5 mos old, now 3.5 y/o
1st seizure at 10 mos old, 12/30/07
KBr: (1ml) 300 mg, SID
Zonisamide: 150 mg, BID
Keppra: 3 ml, TID
Thyroxine: 0.15 mg BID

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

Post by MK's mom » Thu Aug 06, 2009 7:04 pm

Have you seen the videos and explanations of the different seizures on the CEN homepage? Maybe you'll find somehting that looks similar to what your pup is going thru. You're correct, if this was epilepsy you wouldn't be able to interrupt a seizure, although I have heard of a pressure point that one can press around the stifle/hock area. I tried finding it to stop a seizure and couldn't, but some claim that if you apply pressure to the right area it will stop the seizure.

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

claires friend
Posts: 194
Joined: Fri Sep 21, 2007 2:49 pm
Location: California

Post by claires friend » Thu Aug 06, 2009 11:41 pm

Occular compression will stop Grand Mals in Morgan. I know it works for a lot of people. I just wish it would stop her partials as well. You might try it if you haven't already.
Susan Marie
Morgan -Foster Golden, now ours FOREVER !!
First seizure Aug 16, 2006 @9 months old ,very low thyroid
She has been with me since the end of July 07
150mg PB BID
.5 soloxine BID
400 Kbr BID

Anastasia
Posts: 43
Joined: Wed Jul 09, 2008 6:30 pm
Location: Carbondale, Illinois

Post by Anastasia » Sat Aug 08, 2009 12:16 pm

Thanks for your suggestions. I will try the occular compression (I read about this a while back) and check out the videos. It's been a difficult two days...

Ithought he was improving on Thursday and most of yesterday, since I decreased his Keppra to 2.5 from the 3 mL to see if that would result in an improvement. In early June he was going through a similar seizure cycle and the neuro told me to increase it from 2.5 to 3 mL - we had been steadily increasing it by 0.5 ml each week for 4 weeks because stopping the phenobarb cold turkey after his hospitalization for hepatic encephalopathy sent him into seizures - but the increase in Keppra seemed to increase his seizure frequency. Once we took him back down to 2.5 mL the seizures stopped. We increased it back to 3 mL a little over a week ago since perhaps his system was equilibrated to the 2.5 ml and it no longer was a sufficient dose to control the sieuzres. The 3 mL seemed like it was helping, but then not really. The decrease to 2.5 seemed like it was helping but not really. We had to take him with us to a friend's house last night (they have 6 dogs but they let only 2 small ones out and Dawson was fine) but he had 2 grand mals. Overstimulation and the stress of a new place, I guess. He has had another "grand mal" just now. (But I don't know if I can even call them that because he appears totally conscious during them.) The focals seem to have no pattern at all, but then they also seem to occur within 30-60 minutes of the Keppra doses. My poor sweet boy has no peace, as the seizures start when he's asleep or on the verge of sleep. I 've already started on my first glass of wine today...while I usually have strong faith, today it just seems hopeless.

He also has started losing his hair. An all over symmetrical loss that started about a month ago. At first I didn't notice, I thought his skin pigmentation was darkening or he was chewing/licking more at his paws and legs because of the seasonal allergies he appears to have. But his coat has thinned out markedly and the hair is a bit coarse. Maybe this is a severe allergy? But I also read where Keppra can cause alopecia in humans, and I wonder if anyone who has tried Keppra with their dog has encountered this side effect?

Vivian, how did you know exactly that the Keppra was causing an increase in the seizures? It helped tremendously the first month he was on it, but afterward it seems to have lost its effectiveness, and then there was that apparentl relationship between the 0.5 ml increase anad the increase in seizures. I guess maybe I will just increase the Keppra back up to 3 ml until I hear something from the neurologist. Most of the communication is via email or phone since I live 4 hours away from the hospital (UMC).

I've noticed that over the last month he has also started to cry out during some of his grand mals, like he's in pain. Can he be in pain? Do the seizures hurt? He just had one right now and was crying...and now I'm crying too.

Thanks for listening. Thank God for this forum and its wonderful contributors. You guys are a godsend. Thank you so much.
Dawson (aka "Peanut") - Cavalier King Charles/chihuahua/terrier mix?
Adopted at 5 mos old, now 3.5 y/o
1st seizure at 10 mos old, 12/30/07
KBr: (1ml) 300 mg, SID
Zonisamide: 150 mg, BID
Keppra: 3 ml, TID
Thyroxine: 0.15 mg BID

claires friend
Posts: 194
Joined: Fri Sep 21, 2007 2:49 pm
Location: California

Post by claires friend » Sat Aug 08, 2009 1:53 pm

My Morgan is like you boy in that her seizures come from a brain injury (At least that's what the "experts" say). We used Keppra from one week and had no seizures at all. I thought it was the miracle we had been looking for, even though it was costing over $300.00 a month, I didn't care, I was so desperate. Then bam, the partials got so bad, almost worse than the Grand Mals because they were so physical and lasted 30-40 minutes. We kept her on another week and then had to stop. We put her back on Zonisamide and it has been a year of tweaking but I feel we are making some progress. We are coming up on a year that we went for the Neuro work up. At that time they said to put her back on Keppra or put her to sleep! Thankfully I had educated myself enough and knew my dog well enough not to listen to that advice. The support here has helped me get through this last year.
Susan Marie
Morgan -Foster Golden, now ours FOREVER !!
First seizure Aug 16, 2006 @9 months old ,very low thyroid
She has been with me since the end of July 07
150mg PB BID
.5 soloxine BID
400 Kbr BID

Anastasia
Posts: 43
Joined: Wed Jul 09, 2008 6:30 pm
Location: Carbondale, Illinois

Post by Anastasia » Sat Aug 08, 2009 3:37 pm

Susan, thanks for sharing your experience with Morgan and the Keppra, bless her heart. I also thought Keppra (Levetiracetam, actually) was the answer, as it stopped the seizures for 4 weeks when we added it to his regimen in April. It went generic at the same time the neuro suggested it, so it was much cheaper ($75-90 for a 500 ml bottle from Costco - this lasted us slightly over 2 months). However, simultaneously his overall condition worsened dramatically and this is when he ended up in ICU (but no seizures) from apparent phenobarb induced liver toxicity.

So Morgan's partial seizures increased basically overnight - not gradually - after she had been on it for a week? This must have been horrible for all of you, especially since you thought it was the answer to her problems. Have you achieved decent seizure control on her current meds? Does she still have partials? If so, are they really short or longer or both? How often? Thank goodness we don't always listen to the doctors...we know our pups better than anyone else!

It's been three hours now since Dawson's most recent keppra dose (I increased it back up to 3 ml), and he hasn't had anything. Maybe he DOES need the higher dose. But maybe I could be grasping at straws too. I guess I'll give it more time, and if his condition doesn't change I'll suggest we tweak his Zonisamide/KBr doses. Of course I just shelled out $90 for a new bottle of Keppra. It's only money.
Dawson (aka "Peanut") - Cavalier King Charles/chihuahua/terrier mix?
Adopted at 5 mos old, now 3.5 y/o
1st seizure at 10 mos old, 12/30/07
KBr: (1ml) 300 mg, SID
Zonisamide: 150 mg, BID
Keppra: 3 ml, TID
Thyroxine: 0.15 mg BID

claires friend
Posts: 194
Joined: Fri Sep 21, 2007 2:49 pm
Location: California

Post by claires friend » Sat Aug 08, 2009 9:44 pm

Morgan is also 3.5 years old, her first seizure was at 6 months old. When I first got her she only had a few Grand Mals, about 1 every 4 weeks. But we switched her over from KBr to Pheno because the KBr doped her up so much. What I didn't know was how slowly the KBr was leaving her system and as it did she started having very small partials( Sniffing and eye blinking). I had no idea they were even seizures, all I knew about then ,were Grand Mals. So we started upping her Pheno, but the partials kept getting worse. Once the vets finally recognized them a seizures we put her back on KBr, but we had to go very slowly because the side effects are so bad until she gets used to it. We had good control for about 3 or 4 months after that and then I gave her Heart Worm preventative (on the advice of all her doctors including Jean Dodds). She had a Grand Mal that very night and we have not gotten close to control since. That was over a year ago. We started with the Keppra and Zonisamide after that.
Susan Marie
Morgan -Foster Golden, now ours FOREVER !!
First seizure Aug 16, 2006 @9 months old ,very low thyroid
She has been with me since the end of July 07
150mg PB BID
.5 soloxine BID
400 Kbr BID

Anastasia
Posts: 43
Joined: Wed Jul 09, 2008 6:30 pm
Location: Carbondale, Illinois

Post by Anastasia » Sun Aug 09, 2009 2:13 pm

When Morgan's increase in seizures began after putting her on the Keppra, did you notice an overall increase without any pattern? Or did you notice that after giving her the Keppra dose she would have the partials? Like I mentioned in an earlier post, sometimes Dawson's seizures seem to occur without any obvious pattern, yet on some days the seizures begin 15-20 minutes after I've given him the Keppra.From your post it also sounds like you saw a different type of partial seizure while she was on the Keppra (longer, more violent partials). Did you continue to see these after she was taken off of the Keppra?

Did you taper Morgan off of the Keppra while upping the dose(s) of her other meds? Or eliminate the Keppra immediately? I'd like to know how you approached this situation with your neuro before I discuss it with mine, especially since they told you she'd have to be put back on it or else.
Dawson (aka "Peanut") - Cavalier King Charles/chihuahua/terrier mix?
Adopted at 5 mos old, now 3.5 y/o
1st seizure at 10 mos old, 12/30/07
KBr: (1ml) 300 mg, SID
Zonisamide: 150 mg, BID
Keppra: 3 ml, TID
Thyroxine: 0.15 mg BID

skrpio
Posts: 1143
Joined: Sun Sep 25, 2005 5:34 pm
Location: Auckland , New Zealand

Post by skrpio » Sun Aug 09, 2009 2:34 pm

I am jumping in here. Have you thought about the food you are giving Dawson. I find the quality of food I give my non-epi boy really shows in the quality of his coat. I found a product in the US that I had shipped to me called Showstopper really helped.
Also have you asked your vet about using Sodium Bromide. This seems to have less side effects that KBr or PB.
If you don't have to dose for flea, tick or heartworm then leave it alone as this just adds to all the chemicals you are asking your dog to deal with.
Jane
In loving memory of my special KiKi Bean
Seizure free forever now
Nov 25th 2002 - Nov 1st 2006
Dogue De Bordeaux

claires friend
Posts: 194
Joined: Fri Sep 21, 2007 2:49 pm
Location: California

Post by claires friend » Sun Aug 09, 2009 2:43 pm

I don't like her Neuro, felt like she totally ripped me off. They had done a complete work up on Morgan with her old owners to the tune of $5,000. I went back thinking since they had history they would not have to run ALL the same tests again, even told me they wouldn't. The did run them all over and then a lot more, everything came out EXACTLY the same as it had the year before and then charged me $7,000 !! Original quote was$2,000 - $3,000.The only new info was that she was missing part of her brain from an infection. Now I have two other experts who say otherwise. But all three are in agreement that drugs are the only answer. Sorry for the rant.
I did stop the Keppra cold turkey and put her back on Zonisamide. The awful partials stopped right away too. But she had only been on the Keppra for less than three weeks. Now I am finding the Zonisamide is driving up the Pheno and KBr to toxic levels, so we are backing off with some of that. I didn't know for over a year to have her Zonisamide levels checked along with Pheno and KBr, which I do monthly.
Susan Marie
Morgan -Foster Golden, now ours FOREVER !!
First seizure Aug 16, 2006 @9 months old ,very low thyroid
She has been with me since the end of July 07
150mg PB BID
.5 soloxine BID
400 Kbr BID

Anastasia
Posts: 43
Joined: Wed Jul 09, 2008 6:30 pm
Location: Carbondale, Illinois

Post by Anastasia » Sun Aug 09, 2009 4:26 pm

Before Dawson was hospitalized in April I was giving him the Dick Van Patten Natural Balance allergen-free formula (potato and duck, sweet potato and fish, etc.). In the hospital he was tube fed with k/d canned, which I continued for 5 weeks after he came home. Since early June he's been on a mixture of the k/d canned and dry as he refused to go back to the Natural Balance. I thought maybe the k/d was deficient in some nutrient, and this was affecting his coat, so last week I started incorporating Deli Fresh into the k/d mixture. The idea is to wean him off of the k/d altogether or at least include more nutrient dense food in the form of the Deli Fresh (this is gently cooked chicken, brown rice, carrots, peas with added vitamins; no preservatives).

I'll check into the Showstopper. Is it a supplement you add to the food?

As far as the heartworm, I pretty much have to give it to him (we live in tick-infested southern Illinois), although I try to space it out to 45 days instead of 30. I don't give him any flea/tick preventative. I'll ask about the sodium bromide.

Susan, no apologies for the rant. I understand how you feel. We might as well open our bank accounts so the money can be siphoned out and then we still don't get the answers we need, or even consistent answers. What do they think is the problem with Morgan's brain now, if not the missing portion?

It's good you are having the drug levels checked on a monthly basis. We didn't have Dawson's Pheno and KBr levels checked regularly until he started seeing the neuro. Our regular vet just isn't equipped for anything other than very basic textbook epilepsy. It was when we added the zonisamide that the pheno started to really tax his liver function. You should be able to stave off any extreme liver toxicity since you monitor the levels on a monthly basis. We were told in March that both his resting and post-meal bile acids were abnormally elevated and it was 1 month later - after adding the Keppra - that he was in ICU.

I'm going to ask that the neuro give me a definitive answer regarding the Keppra and other med adjustments. I'm so tired of seeing my boy like this. One more question, did you notice that Morgan's vision was affected by the Keppra? I've noticed that in addition to the increase in frequency and severity of the focals, while Dawson is still having the focal he can walk right past me as if I'm not there. Or if I call him he'll look in my direction but to my left, as if I'm standing slightly to the side.
Dawson (aka "Peanut") - Cavalier King Charles/chihuahua/terrier mix?
Adopted at 5 mos old, now 3.5 y/o
1st seizure at 10 mos old, 12/30/07
KBr: (1ml) 300 mg, SID
Zonisamide: 150 mg, BID
Keppra: 3 ml, TID
Thyroxine: 0.15 mg BID

claires friend
Posts: 194
Joined: Fri Sep 21, 2007 2:49 pm
Location: California

Post by claires friend » Sun Aug 09, 2009 5:47 pm

I don't think you should give giving Heartworm meds with Ivermectin. With brain damage ,his brain barrier might be damaged (most likely is) and the Ivermectin will go straight to his brain. There are other options. Dr. Jean Dodds at Hemopet can tell you more about this. I am wondering if this isn't what is causing his seizures in the first place. Morgan does have trouble seeing and is completely blind in one eye sometimes.The vets say it's because of the seizures, but like you I am more inclined to think it is the meds. The part of Morgan's brain that is supposedly missing is the EXACT part they cut out to control seizures. So I really don't know what to think. At this point she has gone from being a rescue dog I had planned on adopting out to something akin to my child. I tell her all the time I couldn't love her any more if I had given birth to her myself.
Susan Marie
Morgan -Foster Golden, now ours FOREVER !!
First seizure Aug 16, 2006 @9 months old ,very low thyroid
She has been with me since the end of July 07
150mg PB BID
.5 soloxine BID
400 Kbr BID

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