Idiopathic Epilepsy in Dogs

Epilepsy is a general term for neurological disorders that are characterized by recurrent seizures. In some cases, the seizures are caused by trauma, a toxin, a brain tumor, an infection, or an issue with your dog’s blood, kidneys, or other organs. At other times, the epilepsy is referred to as “idiopathic,” which simply means that there is no identifiable, underlying cause.

Seizures commonly fall into two categories: generalized (grand mal) or partial (focal). Generalized seizures commonly appear as involuntary jerking or twitching movements of all four limbs with loss of consciousness. Partial seizures may involve one limb, side of the body, or face. Partial seizures may progress to generalized seizures. Seizures may also result in abnormal behavior, vocalization, salivation, chomping/chewing, and involuntary urination and defecation.

Dogs with idiopathic epilepsy typically have their first seizures between the ages of 6 months to 6 years. Though idiopathic epilepsy can occur in any breed, it is considered an inheritable disease in many breeds and in some breeds a genetic basis has been identified. Therefore, dogs diagnosed with idiopathic epilepsy should not be used for breeding. Commonly affected breeds include:

• Labrador retrievers

• Golden retrievers

• Poodles

• Keeshonds

• Beagles

• German shepherds

• Dachshunds

• Irish setters

• Cocker spaniels

Symptoms of Epilepsy in Dogs

Prolonged seizures lasting more than 5 minutes or two or more consecutive seizures without full recovery are referred to as status epilepticus. This is a true emergency and you should seek immediate veterinary care for you pet. Two or more seizures in 24 hours are referred to as cluster seizures and are an indication for beginning anti-seizure medication.

In dogs, seizures often occur in three distinct phases:

1. The first is called the aural phase and the most common signs are behavioral changes. These changes may be subtle and include restlessness, attention seeking or anxious behavior.

2. The second phase, called the ictal phase, is when the seizure itself takes place. A seizure can last from just a few seconds to several minutes.

3. The final phase is called the postictal phase, which occurs after the seizure. During this phase, your dog may seem restless, incoordinated and/or disoriented. Occasionally, temporary blindness, deafness or other neurologic abnormalities may occur.

It may be difficult to watch your pet have a seizure but most are of short duration and cause no permanent harm. Avoid being bitten by keeping your hands away from your pet’s mouth during a seizure. If it can be done safely, provide padding and move your pet away from stairs to prevent injury.

Diagnosis of Epilepsy in Dogs

Your veterinarian will take a complete history and perform a thorough physical and neurological exam to determine if there is an identifiable, underlying cause of your dog’s seizure.

In order to do so, the following tests may be recommended:

• Chemistry tests to evaluate kidney, liver, and pancreatic function, as well as sugar levels and electrolytes

• A complete blood count to screen for infection, inflammation, anemia, and other blood-related conditions

• Urinalysis

• PCR testing and/or serology to evaluate for infectious diseases that may cause seizures

• Referral to a neurologist for advanced testing including MRI and cerebrospinal fluid analysis

• Cultures, PCR testing, and other specialized tests that can identify if specific parasites or diseases could be the cause

Treatment of Epilepsy in Dogs

Epilepsy cannot be cured, but it can usually be controlled with anticonvulsant drugs. If your veterinarian determines that your dog’s epilepsy is idiopathic, one or more of the following medications may be prescribed:

• Phenobarbital helps reduce the frequency of your dog’s seizures and is the most prescribed medication for dogs with idiopathic epilepsy. It is generally a well-tolerated drug.

• Potassium bromide is another seizure medication that may be added to your dog’s treatment, if she does not respond well to phenobarbital alone.

With these medications, as with all drugs, some patients experience side effects. In order to make sure an adequate dose is being given, and to monitor for side effects, it is important that blood levels of each medication as well as complete blood counts and blood chemistry profiles be monitored periodically. Liver function tests may also be indicated. Your veterinarian will advise what monitoring needs to be done and how often. Medication dosages should not be changed without talking to your veterinarian.

Dogs diagnosed with idiopathic epilepsy may require treatment for life, and sometimes more than one drug is needed for adequate seizure control. And while many dogs are well controlled, some are not despite multiple medications. In addition, adequate seizure control does not necessarily guarantee that a dog will be entirely seizure free. The degree of seizure control may need to be balanced against potential side effects of the medications.

Management of Epilepsy in Dogs

Besides medication, there are many ways for you, yourself, to help manage your pet’s epilepsy:

• Maintain a seizure log that lists date, time, length and severity of seizures as well as videotape and share this with your veterinarian

• Do not change or discontinue medications without consulting your veterinarian

• Have blood work and other lab work done when recommended by your veterinarian

• Consult your veterinarian whenever you notice a change in your pet’s condition

• Put a medical alert tag on your pet’s collar so that if he becomes lost, whoever finds him will be aware of their seizure disorder and need for medication.

Several treatments are available for pets with epilepsy. By working closely with your veterinarian, you can maximize the chances of controlling the disorder and giving your pet a long, happy, and comfortable life.

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Head Tilt and Disorientation in Cats

Idiopathic Vestibular Disease in Cats

Head tilt is a medical condition that may be indicative of a serious underlying disorder, usually of the vestibular system. If a cat is tilting its head frequently to either side of the body (away from its orientation with the trunk and limbs), this is an indication that the cat feels imbalanced. The cat may even struggle to retain a balanced posture and fall.

A common cause of head tilting in cats are disorders of the vestibular system, a sensory system located in the inner ear which provides information needed to hold the body in an upright position and move about confidently. In essence, the vestibular system "tells the body where it is in relation to earth— whether it is upright, up-side-down, moving, being still, etc.

Symptoms and Types

• Abnormal head posture

• Head tilt to either side

• Stumbling, lack of coordination (ataxia)

• Constantly falling over

• Eye movements erratic, apparent inability to focus

• Circling (turning in circles)

• Nausea, vomiting

Causes

Although the underlying cause for vestibular disease is unknown, the following factors may contribute to the condition:

• Ear injury

• Brain disease

• Metabolic diseases

• Neoplasia (abnormal tissue growth)

• Nutritional deficiencies (e.g., thiamine deficiency)

• Toxicity (e.g., use of toxic antibiotics in the ear)

• Inflammation of the central and inner ear canal due to bacterial, parasitic, or other type of infection

Diagnosis

Your veterinarian will perform a complete standard physical exam, including a blood chemical profile, a complete blood count, a urinalysis and an electrolyte panel. You will also need to give a thorough background history of your cat's health leading up to the onset of symptoms. The results of the blood tests are usually normal, though changes may be present depending on whether there is an existing disease, such as an infection. Further tests will be required to diagnose underlying systemic diseases like thyroid problems, and infections.

Nutritional status will be evaluated, and you will need to recount your cat's normal diet, along with supplements or additional foods you may have fed to your cat. Thiamine deficiency, for example, can be the result of feeding your cat food that does not have B1, the source for thiamine, in its ingredients. Thiamine deficiency can also result from over consumption of raw meats and fish.

To determine if an ear infection is present, your veterinarian will thoroughly examine your cat's ear canal and will take a sample of the material present within the ear canal for further testing. Visual diagnostic tools, X-rays, computed tomography (CT), and magnetic resonance imaging (MRI) may be required to confirm a middle ear disease. Another important test used to diagnose this disease is a cerebrospinal fluid (CSF) analysis. (CSF is a clear, watery liquid that surrounds and protects the brain and spinal cord.) The results of a CSF analysis is useful in the diagnosis of inflammation and/or infection within brain. A bone biopsy may also be performed is an advanced test to confirm the involvement of the bone due to tumor or infection.

Treatment

In case of severe disease, your cat may need to be hospitalized for treatment and supportive care. Fluid replacement therapy is required in patients with fluid deficits due to frequent vomiting. These patients don’t require a special diet except in those cases where some nutritional deficiency is present. For example, thiamine supplements are often required in patients with head tilt due to thiamine deficiency.

In some cases, surgery is required to treat the underlying disease. If an ear infection is present, your veterinarian will prescribe broad-spectrum antibiotics that can enter and eradicate the infection in the brain and middle ear.

Living and Management

The prognosis is highly variable depending on the underlying disease. If the head tilt is due to involvement of the ear, chances for complete recovery are fairly high. In some cases, head tilt may persist. You will bring your cat to your veterinarian for regular follow-up examinations. Follow treatment guidelines strictly and give medications at proper doses and time. Incorrectly medicating your animal is one of the most preventable accidents with pets. In addition, do not use any drug of your own, or any drug that has not been approved by your veterinarian, especially in the ear, as it may complicate symptoms further.

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Encephalitis: Brain Inflammation in Dogs

Encephalitis in Dogs

The term encephalitis refers to an inflammation of the brain. However, it also may be accompanied by the inflammation of spinal cord (myelitis), and/or the inflammation of the meninges (meningitis), membranes which cover the brain and spinal cord.

German short-haired pointers, Maltese, and Yorkshire terriers are all found to be predisposed to encephalitis.

Symptoms of Encephalitis

Although symptoms may vary depending on the portion of brain affected, they typically appear suddenly and are rapidly progressive. Such symptoms include:

• Fever

• Seizures

• Behavioral changes (e.g., depression)

• Decreased responsiveness

• Head tilt to either side

• Paralysis of face

• Uncoordinated movements or circling

• Unequal size of pupils (anisocoria)

• Smaller sized pinpoint pupils

• Decreased consciousness, which may worsen as disease progresses

Causes of Encephalitis

• Idiopathic (unknown cause)

• Immune-mediated disorders

• Post-vaccination complications

• Viral infections (e.g., canine distemper, rabies, parvovirus)

• Bacterial infections (anaerobic and aerobic)

• Fungal infections (e.g., aspergillosis, histoplasmosis, blastomycosis)

• Parasitic infections (e.g., Rocky Mountain spotted fever, ehrlichiosis)

• Foreign bodies

Diagnosis of Encephalitis

You will need to give your veterinarian a thorough history of your dog’s health, including the onset and nature of the symptoms, and possible incidents that might have precipitated the unusual behaviors or complications. Your veterinarian may then perform a complete physical examination as well as a biochemistry profile, urinalysis, and complete blood count (the results of which will depend on the underlying cause of the encephalitis).

If your dog has an infection, the complete blood count may show an increased number of white blood cells. Viral infections, meanwhile, may decrease the number of lymphocytes, a type of white cells (also known as lymphopenia). And abnormal reduction in platelets (small cells used in blood clotting) is a good indicator of thrombocytopenia.

To confirm lung involvement and related complications, your veterinarian may require chest X-rays, while MRIs and CT-scans are used to evaluate the brain involvement in detail. Your veterinarian may also collect a sample of cerebrospinal fluid (CSF), which is then sent to a laboratory for cultures. This is necessary for definitive diagnosis and to determine the severity of the problem. If culture assays are unsuccessful, a brain tissue sample may be necessary to confirm the diagnosis, but this is an expensive procedure.

Treatment of Encephalitis

Your veterinarian will focus on reducing the severity of the symptoms, such as brain edema and seizures, and halt the progression of the disease. Severe forms of encephalitis require immediate hospitalization and intensive care. For instance, those suspected of having bacterial infections will be given broad spectrum antibiotics, which can reach the brain and spinal cord.

Living and Management

With proper treatment and care, symptoms gradually improve within two to eight weeks; however, the overall prognosis depends on the underlying cause of the condition. For example, in some dogs, symptoms may reappear once treatment is discontinued. In such instances, a second round of treatment (or long-term treatment) may be required to save the dog's life.

Your veterinarian will schedule regular follow-up exams to evaluate the effectiveness of the treatment and the dog's state of health. Your vet may even recommend a new diet for the dog, especially if it is frequently vomiting or severely depressed.

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