The Patient
Bruno, a 2 year old male neutered Alaskan Malamute, came to see me after his owner witnessed him have a seizure at home. When he arrived at the hospital, he was acting pretty normal but was a little bit "off" per his owner. I asked his owner to describe what she had witnessed at home. She told me that Bruno had started acting funny, pacing around and seeming on edge followed by collapsing onto his side, with his whole body convulsing, paddling his legs, opening his mouth and foaming a little bit as well as urinating on himself. The whole episode lasted about 1 minute followed by a short period where Bruno seemed confused, dazed, and weak. He was then able to stand and then just seemed a little unsteady. She rushed him right in to see me.
The Case
On examination, Bruno was quiet but alert and friendly. His entire physical exam was normal aside from him seeming a little bit disoriented. I recommended we take his blood pressure followed by drawing his blood to run some laboratory tests. His blood pressure was normal and when I received his labwork results the following day, everything was normal including his liver numbers, kidney levels, and blood sugar. I confirmed with Bruno's owner that he did have a seizure at home and may continue to have them moving forward so to be sure to let me know if another one occurred. Based on Bruno's young age of onset and his normal labwork results, Bruno was diagnosed with canine epilepsy. Epilepsy is actually a diagnosis of exclusion, meaning you have ruled out all other causes of the seizure such as low blood sugar, high blood pressure, liver or kidney disease, toxin exposure, or a brain tumor. The only way to rule out a brain tumor is with an MRI which requires general anesthesia with the veterinary neurologist. Bruno's owner declined the referral for that procedure since the chances of a brain tumor in a 2 year old dog are very small. Canine epilepsy is a genetic disease where there are periods of excessive electrical activity in the cerebral cortex (largest part of the brain) that lead to loss of consciousness, muscle tremors/spasms, jaw/tongue tremors which lead to foaming at the mouth, and loss of control of urination or defecation. These types of seizures are called "grand mal" seizures and are the most severe form of a seizure. But, seizures can come in a wide variety of symptoms such as uncontrolled use/movements of one leg or even just one part of the face. These are called "petite mal" or focal seizures. Watching a dog have a seizure is, in my opinion, one of the scariest things for an owner to witness. A feeling of overall helplessness and fear is inevitable. Thankfully, the seizure itself is not super dangerous for the dog unless they hurt themselves while having one or the seizure does not stop within a few minutes. Seconds feel like minutes when a dog is seizing so it is helpful to time the length of the seizure if possible. Keep the dog away from stairs, swimming pools, or sharp edges to prevent harm. Never try to touch a dog's mouth when it is seizing as it can easily bite and hurt you unconsciously.
Linked below is a video of a dog experiencing a grand mal seizure:
Be aware, this video is for educational purposes only and may be difficult to watch for most viewers.
The Treatment Plan
The treatment for epilepsy is oral anticonvulsant medications for life. Our goal for seizure management in canine epilepsy is less than one seizure a month, not an absolute seizure-free life. Owners of dogs with seizure disorders should know what to look for that indicates the dog needs to go to the ER: seizures lasting more than 5 minutes (which can lead to hyperthermia and brain injury), seizures that cluster together (which is defined as more than 3 in a 24 hour period), or if the dog becomes injured during the seizure.
It is also important to know that we don't typically start anticonvulsant therapy after the very first seizure. We want to make sure there is an ongoing need for treatment first. Each case is different but for Bruno, he did go on to have another grand mal seizure about 5 days later so I started him on a medication called phenobarbital which will be continued longterm. Bruno did improve on this medication but he had another seizure after taking the medication for about 1 month. Since his seizures were so severe and he is such a large dog, I decided to start a second medication for him called levetiracetam.
The Outcome
Bruno is doing better now and we seem to have found the right combination of medications for him. We check Bruno's labwork every few months to make sure he is processing all of his medications properly. As long as the patient has good seizure control, dogs with epilepsy can lead a normal life.
The Drake Center for Veterinary Care is an AAHA-accredited animal hospital located in Encinitas, CA. The Drake Center loves being a source of information for all pet owners across the country; however, if you have any questions regarding pet care and do not live in Encinitas, CA or surrounding cities, we encourage you to contact your local veterinarian.