Potassium Bromide addition- worsening seizures?

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midousuji
Posts: 5
Joined: Wed Aug 23, 2017 5:36 pm

Potassium Bromide addition- worsening seizures?

Post by midousuji » Sat Dec 02, 2017 11:21 pm

Apologies for making an additional topic while I already have one, I figure this is a totally separate topic so it should be on its own.

My Australian Cattle Dog, Hal, has been having issues with Keppra (500mg, 3 x per day). It simply isn't as effective for him as phenobarbital was, which we stopped during the summer of this year because of elevated liver levels. After having a series of cluster seizures over months, each time barely managed under control by rectal valium, we decided to put him on potassium bromide. Since his dose of keppra is pretty high for a dog his weight (32 lbs/14.5 kg) he is on a fairly low dose of kbr (375 mg only once per day) which gave him almost two weeks seizure free.

I know kbr takes a long time to level out, weeks, if not months, but I had high hopes for those two weeks without incident. Today he had a cluster of three seizures within a 5 hour period, and they were the absolute worst seizures he has ever had. His grand mal seizures are fairly manageable, only lasting about 30 seconds to a minute at the longest and mostly being him 'paddling' as well as loss of bowel control. These were longer and more intense, his body got more rigid and he foamed at the mouth and snapped, he twisted around in very strange ways and had one seizure where he tried to get up and run, full on galloping across the room to slam into the wall before I held onto him.

As of today he is also on zonisamide (100 mg, 2 x per day) in an attempt to control the seizures while the kbr takes full effect. But the terrible cluster he had today, has anyone experienced anything like that after adding in kbr? Is it normal for a medication to completely change the way your dog seizes? Does kbr often make seizures more intense and painful looking? I can't think of anything else that has changed that would cause that drastic of an effect on the seizures, he still eats, drinks, walks, and plays normal, no changes in his diet or anything. It was a really worrying experience, I never want him to have a grand mal seizure like that again.

SpencerBhumi
Posts: 218
Joined: Sat Feb 11, 2012 9:25 am
Location: South Australia

Re: Potassium Bromide addition- worsening seizures?

Post by SpencerBhumi » Sun Dec 03, 2017 6:08 pm

Hi midousuji,

I’m sorry you need to join this forum but I hope you can get the same great help and support that I have received over the years.

I recall going through what you have described here, like it happened this morning.

We journeyed through all of the anti-seizure medications. We experienced so many varieties of seizures – from just strange suspicious behavior, through petit mal absences to extended writhing/wrenching grand mals and clusters. We also suffered many variations of post ictal behavior.

Here I say suffered because most of the seizures were matter of fact and short lived but when Spencer roused into post ictal confusion we really suffered most during this period. In the latter years Spencer would rest a bit then rouse a bit (more) dreamy for about 30 minutes then get back to ‘normal’.
However we went through episodes of severe blind running, senseless howling of ?grief, ?confusion ?brain irritation… (Spencer made noises (and contorted convulsive posturing) that Steven Spielberg would envy to use in his horror movies. One night Spencer was running blindly and howling like he’d been speared – I picked him up and he continued to run – air paddling, and howling for over an hour).
Spencer became ravenously/dangerously hungry, his social being declined to primate, he became aloof to the point of environmentally vulnerable, from a few hours to a few days.
These severe post ictal episodes usually escalated with cluster events or during periods of illness where the epilepsy got out of control. (Here I can recall that a cluster always necessitated a vet review and on occasions an underlying illness was revealed through a thorough vet exam, where there were no earlier evidence was manifest). Also, the worse the cluster (necessitating more breakthrough medication), the post ictal period was more prolonged, variable & unpredictable so being more grievous and difficult to manage. Nothing was predictable.

“Is it normal for a medication to completely change the way your dog seizes?”

I too watched this happen over the years. I can’t answer your question but I wonder and comment: ‘is it the chicken or the egg!?’
1) I wonder what would happen if our dogs went untreated – would this disease quickly escalate to a terminal event where we would see ever worsening seizures and post ictal to the point of death?
2) The various medications do work in various ways so yes; it is likely that different medications will – when a new seizure strikes through cause/allow the body to respond in a different way subject to that medication’s mode of action.
3) It is so often shown on this forum that each epi-dog is an individual. They manifest different seizure & post ictal activity, and they respond (or do not respond) differently to different medications.
4) Given the evidence that this disease is progressive (and yes, we merely chased this disease in Spencer for 7+ years and never controlled it) I suspect that when a drug does not work/stops working effectively, maybe the disease is progressing and will manifest differently anyway. When we add another drug, maybe the body responds differently – subject to the disease progress and the new medication’s mode of action on the body.
Sadly it is not predictable and you (each individual member here/with your individual vets) will need to treat your dog individually for what you have there & then.

We reached the point where we had trialed all of the drugs available to us and had reached a safe max level on those that did work somewhat, knowing that every two to four weeks we’d get a breakthrough grand mal. Our plan became to hit that first grand mal hard to prevent a second, to prevent any kindling and reduce the chance of clustering. Our post ictal became mostly slight and short, followed by about four days of heavier sedation and then we’d resume our new run of ‘normal epi-dog life’ (watching carefully for any signs of irritability, precursor or trigger).

I don’t know if I have answered your question, but hopefully maybe offered a little better understanding of how much we don’t know about this disease.

If Hal’s liver enzymes are still up, try adding some Milk Thistle – discuss this with your vet.

I wish you and Hal ‘all the best’ and I will keep you in my prayers. Stay strong and be patient with Hal.

Regards, Trevor.
In memory of Spencer 7-12-2005 – 22-8-2017
Grateful for the good days, weeks (months).

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