Promoting a Lifetime of Good Health.
What the Veterinary
Staff and Owners Should Know About Seizures...
A seizure is a terrifying thing to watch.
Most people think a seizure patient is dying.
The patient becomes unreachable, as if in another world, and the overwhelming
fear is that he won't return.
For a veterinary professional, it is during these moments
of profound fear and helplessness that you can have the most positive impact on
your clients. By learning a few principles
about seizures, you can help the patient and address your fears and questions.
Principle 1 - Most seizures
are short, so stay calm.
It is rarely necessary to panic and rush the pet into the
hospital. Ask the owner what time the seizure
began(if you ask how long the seizure has been going
on, he will always overestimate, but he often will remember the actual time).
Wait until the seizure is over before picking up the pet, unless the seizure
has been going on for more than 10 minutes.
Principle 2 - Overheating
is the biggest danger to the seizure patient.
This is especially true in overweight pets, and unfortunately
these are the hardest ones to move. If
a pet is seizing outdoors on a hot day, even a short seizure can become dangerous.
Every effort must be made to cool the pet.
Usually, moving him into an airconditioned
house is sufficient. If the seizure is
prolonged, a cool bath may help prior to transporting to your hospital.
Principle 3 - Seizures beget
seizures.
Seizures are caused by aberrant electrical activity in the
brain and the electrical activity often has not completely calmed when the outward
signs of seizures subside. The brain makes
every effort to calm this activity, but it is often unsuccessful.
It is therefore most common to have a second seizure within a few minutes
or hours of the first. You should be prepared,
and you should prepare the owner for a second seizure.
Usually if the pet has gone 24 hours since the last seizure, the brain
has likely been successful in calming the electrical activity.
Principle 4 - Seizures occur
more commonly in times of stress.
Any change in the pet's routine may precipitate seizures.
A nervous pet may have a seizure during or after his yearly visit and be
fine for the rest of the year. A pet that
has a "great day" at the park or playing with houseguests may seize that evening
or the next day. This is particularly frustrating
to owners, especially when it happens during a dinner party.
Often this can be avoided by altering medication schedules before the change
in the pet's routine occurs.
Principle 5 - Oral anti-epileptic
drugs take time to work.
Owners hope that the nightmares of seizures
is over after they have started epilepsy medications.
On the contrary, Phenobarbital may take two weeks to have a full
theraputic effect, and
potassium bromide as long as four months.
It is crucial that owners not become discouraged during this time.
You may need to remind them that the medications take time to work every
time a seizure occurs. Additionally, there
is no benefit to an owner giving an extra dose of medication at the time of a
seizure.
Principle 6 - Most seizing
dogs are epileptics, most seizing cats are not.
Calling a seizing pet epileptic implies that there is not
an insidious underlying cause for the seizures, such as encephalitis or a brain
tumor. Diagnostics steps must be taken
to prove this. However, studies have been
done that suggest that somewhere in the range of 90% of dogs who have a seizure
do not have a life threatening underlying disease process.
Studies in cats are not so positive, less than 10% of cats with seizures
have a non-progressive etiology. Cats
who have seizures are more worrisome than dogs.
Principle 7 - Epilepsy is
manageable, but not curable.
Even with anti-epileptic drugs, breakthrough seizures will
inevitably occur in epileptic patients. The goal of therapy should be to reduce
seizures to a mangeable level, while maintaining a
good quality of life. It is rare that seizure control cannot be achieved, sometimes
with the help of a specialist. With care and monitoring, epileptic dogs generally
live long, full lives.
Principle 8 - Epilepsy medication
is different in pets than in people.
Potassium Bromide, which has been very successful for use
in pets, is rarely used in people. The bromide side effects of slurred speech
and acne like breakouts that plague human epileptics are not a worry for pets.
Likewise, dilantin, which
has been widely used for people, can cause an irreversible, fatal liver disease
in dogs.
Principle 9 - Epilepsy requires
monitoring.
An owner should be taught that medications have side effects
and epileptic patients require lifetime monitoring. A pet on
phenobarbitol should be checked 10 days after initiating
therapy until a therapeutic level has been achieved, then every 3 months for the
first year. After that, twice a year CBC's and Chemistry
profiles as well as phenobarbitol levels should be
done.
Because
of potassium bromide's long half-life, it takes as long as three weeks to get
halfway to the therapeutic level, so blood should be drawn three weeks into therapy.
The blood level at this point should be one half of your goal therapeutic dose,
and if it is not, the doctor should adjust it accordingly. After achieving therapeutic
levels, the monitoring is basically the same as with phenobarbitol.
Always make sure you know when your next appointment is and DON'T wait for a cluster
of seizures to bring your pet in again.
Principle 10 - Epilepsy drugs
can be quirky in some patients.
Owners expect pets to be quieter than usual on
phenobarbitol. Paradoxically, many are hyperactive.
Fortunately, this only lasts a couple of weeks. Some owners mistake this hyperactivity
and behavior change as a sign of a brain tumor, and need reassurance. Most dogs
on phenobarbitol will eat, drink, and urinate more.
Some may gain large amounts of weight because of the excessive appetite.
Phenobarbitol can also, rarely, cause an allergic
skin reaction.
Potassium
bromide will almost always make a pet vomit if given on an empty stomach. Owners
should always give it with food. If vomiting continues to be a problem, give the
medication with a tablespoon of yogurt or cottage cheese.
As always, if you should have
any questions at any time, please contact us at:
262-886-3337
Promoting
a Lifetime of Good Health.