It's been years since I've had to deal with seizures,
& phenobarb was all they had at the time.

I think now there are much better meds, but I haven't had any experience with them.

It seems like the phenobarb was prescribed according to weight, & I do remember that I was to give it at certain intervals.

However, it made my cat into a zombie, so I just gave him some when I saw him getting twitchy.

I also turned off the lights & the tv or stereo, as light & sound stimulates the nerves.

I'd investigate via google, & I really do think I'd find another vet.

My toy poodle also has seizures and I know they can be very scary to witness. My vet also thought she was too young for epilepsy, but that is her diagnosis. I'm not sure what tests they ran to determine that.

She was about 18 months old when I got her as a foster dog and about a month later she had a seizure. Her former owner/breeder claimed she had never had one before, but I don't really believe him.

The day after her seizure I had her at the vet. She was immediately placed on phenabarb - based on her weight. I had to tell them her symptoms and how long the seizure lasted, but she didn't have to have a second one before being placed on the meds.

She had to have her meds adjusted as she had several more seizures later.

If your friend's dog does go on phenabarb - tell her she must give the meds at the same time each day. We do allow a half hour interval so she gets the pill between 7:30-8 a.m. and then 7:30-8 p.m. We slacked off some during the summer as my kids were sleeping in while I went to work and she had a pretty bad seizure - bad enough that I scooped her up and rushed her to the vet.

The vet told me this was not a "drug of convenience" - it must be given consistently every day (wish they had told me that the first time!)

Even with the consistent meds she will have a break thru seizure every 2 or 3 months it seems. Those we just keep track of the date and how long they last.

We have had her just over 1 year now and she's probably had 5 seizures total. She loves to lay on our open stairs and twice she's had seizures there and slowly tumbled down the steps. It is very upsetting to see. I just pet her and tell her its ok and try to keep her calm but I doubt she can even hear me.

We haven't noticed any changes in her behavior on the phenabarb, thank goodness. She's a real sweetheart. I hope some day to also find a natural alternative for her, but for now the drugs will have to do.

Good luck to your friend. I'd also call around and find a vet who will treat the dog now and not wait.

Sher

I'm a somewhat surprised the vet didn't insist on an appointment for a check up.

I had a sweet dog who was diagnosed with epilepsy at 4 months old. He was on phenbarb and did well on it for 15-1/2 years. No residual side effects and they MUST stay on the med's as prescribed to keep a consistent level in the bloodstream.

BTW, the med's are cheaper at Costco.

I have a 12 yr old lab who has been on phenobarb since she was about 2 yrs old. She had seizures and the vet put her on the phenobarb right away. She has stayed on the same dosage, 120 mg. at breakfast and 120 mg. at dinner for her entire life. She has had some seizures during the ten years following her diagnosis, but they weren't bad and I usually just give her another pill or two once the seizure starts and it brings her around.

I am surprised as well that the vet didn't give your friend the phenobarb rather than make her wait. I would not want to do that since my gal had seizures that would last 30 minutes and then occur again in an hour for another 30 minutes. Dogs can loose their bowels or urine during a seizure.

The vet told me when old gal started having seizures that they were caused by one of two things, brain tumor of epilepsy. The prognosis for a brain tumor is a diminished life span of about two years. When she was around after the two years we knew she had epilepsy. Didn't spend the money on all the diagnostics that are available since I wouldn't have done chemo on her anyway.

I think your friend's vet is full of it. He should give her the lowest dose of phenobarb and let her give it a.m. and p.m. If it works, good, if the dog needs more the med can be adjusted. I think it is totally unnecessary for your friend to sit through and document the seizure activity before getting any meds. JMHO but I would find another vet. You have no idea what it is like to watch your pet have seizures, it is horrendous for the pet owner as well as the pet.

We had a Lab who had her first seizure at about 9 months. Rather than put her on meds right away, we switched her from Science Diet to Eucanuba and the seizures went almost entirely away. Maybe two or three a year and relatively minor. No meds ever. Perhaps you should try diet changes first, you can alway escalate to medicine if none of the foods work. There are so many available now which are all natural, Eucanuba was the best at the time, but now there are many better.

You don't want to start a dog on a lifetime of a medication that is known to cause irreversible liver disease if it can be avoided. That's just dumb. There are many reasons that a young dog could be having seizures. The diagnosis of epilepsy is reached by eliminating all other causes of seizures.

There are other medications. Potassium bromide is a good one- not nearly the amount of side effects with liver. But you do have several weeks of dosing before it gets to a therapeutic level. Gabapentin is also used, but it is VERY expensive.

There are other causes of seizures that may be treatable by means other than anti-seizure medication. Depending on how young the dog is, it could have a liver shunt. By documenting the time of seizures in relation to eating, it would become obvious that the dog seizes a certain amount of time after eating. Some dogs have leaky blood-brain barriers because of a defective MDR gene. It's not only certain breeds that have this problem. Perhaps the dog seizes a certain amount of time after being given ivermectin-based heartworm medication or other medications. My Ana had a seizure after being given a sulfa-based antibiotic; we never gave that class of drug again and she never had another seizure. Even though the dog is young, it could have a brain tumor. I know a soft-coated wheaten terrier that died of a brain tumor at age 2. The dog could be diabetic and having a hypoglycemic episode. The dog could have eaten snail bait or some other toxin. It could have an inflammatory or infectious cause- fungal, protozoal, rickettsial, bacterial. Some breeds are predisposed to certain types of neurological disorders that can cause seizures. Trauma can cause seizures. Some dogs have 1-2 siezures for unknown reasons when they are young and never again. A seizure for any reason looks exactly the same as an epilectic seizure.

Anti-seizure medication is totally inappropriate in those cases, and the primary cause of seizure is possibly curable, but not if you don't look for the primary cause.

I totally agree that seizures are horrible to watch. I was horrified to see Ana turn blue when having a seizure, and for attacking my husband who is her favorite person in the whole world. We rushed to the emergency vet, and after little discussion determined that her seizure may have been caused by her medication she had 6 hours before. It was a very odd reaction to that type of drug, and the vet wasn't entirely convinced that the drug caused the seizure. In any case, she never had another seizure, and it's been 4 years. Her liver may have been totally trashed by now if we had started on phenobarb at that time. Instead, we have a perfectly healthy seizure-free dog.

All we know is that a young dog had a seizure and that the vet tentatively diagnosed epilepsy without even looking at the dog or looking for another cause. The vet may be full of it, but not because he wouldn't prescribe phenobarb.

I had a dog who had seizures and it is very common not to prescribe meds upon the first seizure. As Meghane says, they can be caused by lots of things. Also, some dogs will not have more than the occasional, relatively mild seizure and in those cases it is better not to medicate at all.

After doing lots of research I tried switching my dog to hyperallergenic food. We used Dick Van Patten's food (Natural Balance or something?). It was duck and potato formula. She didn't have seizures for a long time after that.

I just want to say THANK YOU for all the info - My friend posted this on here because she said you all would be VERY helpful and so far you all have been! I needed info on what the best treatment would be as this scared me so badly and I now know I should take several accounts into factor. All info is helpful and very comforting and I welcome your input. Thank you all again!

Thank you Meghane for explaining there are many different reasons for seizures!!! Here's just a few other reasons:
Glucose tolerance test, to check for hypoglycemia.
Thyroid panel, 6 tests, to check for low thyroid function/hypothyroidism.
Metabolic imbalances
EEG, to see if there are findings suggestive of a lesion (an abnormal EEG is standard with epilepsy, but a vet or a physician will also be able to tell if there is a lesion.
Cerebrospinal fluid analysis, to look for encephalitis, distemper and other infection.
Blood test to check for lead poisoning;
CT scan or MRI, again to look for a brain lesion
Certain parasites, etc. Epilepsy should only be ruled in after other things are ruled out.

And to that list - complete tick panel. TBDs can cause siezures.

I hope your friend has a big pocketbook if she is going to have all tose tests peformed as described above.

When my gal starting having seizures, our then vet told me there was no definitive test for epilepsy. Also, I was told that the phenobarb should stop the seizures no matter the cause. After an exam and the requisite bloodwork, the vet put her on the phenobarb which stopped the seizures. All bloodwork was fine and vet thought unnecessary to do CT Scan. Old gal (12) has lived a long life on the phenobarb,(longer than any lab I've had). She has yearly blood work to evaluate her phenobarb levels to ensure they are within a safe limit, and her liver tests always come back within range? If I had it to do over again, I would do it exactly the same way I did 10 years ago.

I have seen Potassium Bromide used when the phenobarb is given at the highest does and seizures are still occurring. After a dog reaches the highest safe dose, there is nothing more the vet can do. They give the Potassium Bromide as a "push" for the phenobarb, at least this is the way a friend with a German Sheppard who seizes explained their use of Potassium Bromide.

My SIL recently had this happen with a Petfinder dog she adopted this past summer. Dog was heartworm positive and being treated for same. It was difficult for the vet to pinpoint why this dog was seizing. Ended up that the dog was suffering from some sort of encephalitis. His seizures were constant, although they were not always severe. The drooling and staring is a sign of a petit seizure. The shaking is more of the grand mal seizure sign. The phenobarb did not stop this dog's seizures and the dog was back and forth to the vet 20 or more times, 1/2 of which he spent a couple of days for observation. It was hearwrenching to watch.

I hope your friend and her pet don't have to go through too many seizures before getting an exam and treatment.

& don't forget thyroid deficiency.

You can use just potassium bromide without phenobarbital. I know many dogs that are doing that because the owner wanted to avoid the adverse side effects of phenobarb.

Another thing I forgot to mention is that there is no such thing as a "low dose" of phenobarb. The lowest dose that reachest therapeutic blood levels can also cause the liver disease. Each epileptic dog has a different seizure threshold and a different response to phenobarb, but the checking is still done the same- a blood level test. If the dog doesn't have a therapeutic level of phenobarb on a certain dose, it has to be raised. There is no use in giving a sub-therapeutic dose, as it won't control seizures.

There is no single test for epilepsy, as I mentioned before. It is a diagnosis of elimination. You don't have to run every test in the book though. For example, a dog with Rocky Mountain Spotted Fever may have seizures, but it will also have (you may have already guessed) a fever. No fever, no need to run that test. If a dog had thyroid deficiency serious enough to cause seizures, you'd expect other signs of hypothyroidism, such as lethargy, a dull brittle haircoat, possibly bilaterally symmetrical alopecia, weight gain. Hypothryoidism is rare in young dogs too, so the vet would be perfectly justified in not running that test in a young dog without other symptoms.

Sure, phenobarb may control seizures no matter what. But for arguments sake let's say the dog is seizing because of bacterial menigitis. Phenobarb will help control the seizures, right up until the dog dies. Doesn't really help anything, and the death would have been prevented if the underlying cause of seizure was detected. All it would have taken is some aggressive antibiotic therapy and the dog would have lived and stopped seizuring.

I don't think that is this dog's problem, I was just using it as an example. The point being that controlling seizures that are caused by other things with phenobarb can be at best useless, at worse dangerous.

meghane, would a dog with the menengitis have other syptoms that a pet owner could look for, that would stand out. Lethargy, or anything rather than running CT scans and all of the other expensive tests?

Thanks.

I hope your friend has a big pocketbook if she is going to have all tose tests peformed as described above.

Labmamma, a seizure dog should be seen by a neurologist that is trained to look for certain seizure triggers based on all symptoms, therefore the patient wouldn't need all those tests.
The point in listing all those things are to help owners be aware of all the different reasons for seizure disorders.

Thanks cindyx. What is the most common cause associated with seizure disorder?

What do you think a consult with neurologist would cost a pet owner?

We had to see a cardiologist at one point for a now deceased lab. This is going back at least 10 yrs. Sonny had an x-ray taken because he kept being diagnosed with kennel cough and I was tired of his being misdiagnosed. He never was kenneled as I have a petsitter. He had not been around any other dogs.

Any event, the then vet took a chest film of my dog. I get a call - you need to get him to Penn for a cardiology appointment, his heart is enlarged. Of course, I make the appointment post haste. We go to Penn - 1st step -get an exam by two veterinary students and then the sum up for the actual doc. Sonny stays for the day, has a cardiogram, sonogram of his heart, stress test, etc.

At the end of the long day, the cardiologist asks my husband and I to step into a room so he can discuss the findings. We are thinking this is really bad, he's taking us into a private area to give us bad news... He puts the film up and says, there seems to be a problem in the WAY THE ORIGINAL FILM WAS TAKEN. Apparently, our vet at the time did not position my dog properly for the film. The sternum and back bone were not aligned properly, putting him in a somewhat sideways position, making the heart look larger....

Bill total $3,800 for one day. Knowing my dog was healthy - priceless.

That is only one of many battle stories I could tell you that we've had over the years with our dogs.

BTW, I was right about the kennel cough, when my poor guy was finally properly diagnosed it was much too late. Although he did have the surgery to correct the laryngeal paralysis, he passed 6 mos. post surgery. Pre-surgery prep (insisted upon by vascular surgeon) and surgery and post surgical care approx. $6,500.

Thanks cindyx. What is the most common cause associated with seizure disorder?

well I would say Endocrine and Nutritional metabolic disorders far out weigh true epilpesy.
As far as what it costs for a neurologist, well it's not cheap, no specialists are, but many times a one time cost outweighs many different needless meds, ER visits and wasted time not getting the correct diagnosis.

I can help with the costs, based on the prices at NC State vet school.

Physical exam, neurological exam, and minimum data base (CBC, chem panel, UA, thyroid panel) is about $250. Since the dog in question hasn't had anything yet, if there is a specialist available I'd just do that because the PE and neuro exam is probably only about $40 more than the regular vet's physical exam, and you get it done by the boarded neurologist. Bloodwork costs usually about the same if the regular vet is using a send-out reference lab as the vet school. With those tests, you can rule out many metabolic and endocrine causes of seizures. One that wouldn't be ruled out is if the dog has a portosystemic shunt or other serious liver disease, then you'd diagnose that with a pre- and post- bile acids test, which runs about $100. It wouldn't be wrong to skip that test if liver disease was not high on the differential list.

Next level of diagnosis is the tick born disease panel. At school, we have the super-duper tick panel that includes Ehlrichia canis, Babesia canis, Bartonella henselae, Bartonella vinsonii, Rickettsia rickettsii, and Borrelia burgdorferi for $100. Since both Ehlrichia and Bartonella can cause seizures and the dog can look relatively normal otherwise, that would be a good panel to run. Also both diseases are very treatable.

Fungal diseases can also cause seizures, so you could test for those too. Apparently, NC State doesn't often run a fungal panel, because that isn't an option in the clin path lab. It may be something they send out, so I don't know the cost.

Next step or somewhere in there would be a CSF tap. That requires general anesthesia. All together it would probably cost about $300, including CSF culture and sensitivity, cytology, and fluid analysis.

If up to this point nothing is found, you could elect to stop diagnosis if 1) the dog is of an age where epilepsy would be common to occur (1-3 years) and is otherwise completely healthy and the labwork is completely normal or 2) if you weren't going to do anything about a brain tumor anyway (surgery or radiation).

If you wanted to go all out, an MRI is $2000 and a CT is $1200. Like I said though, if you weren't interested in doing brain surgery, and I have no idea how much that would cost, and were just going to treat with anti-seizure medications in either case, then you could easily forego the brain scans.

I found an article that said about 30% of seizures can be traced to an underlying cause. Which means that if the dog has recurring seizures, it is most likely to be due to epilepsy. Certain breeds are predisposed, and epilepsy usually starts between ages of 1-3 years. The emergency vet who saw Ana thought she had epilepsy, because she was the right age and right breed. He's still not entirely convinced that the sulfa drugs caused the seizure. But since she only had the one, I don't particularly care what the problem was because it's long gone.

Labmomma- usually a dog with menigitis is very sick, so that was a really poor choice for an example. A better illustration would have been if I said the dog had Ehlrichia or Babesia, both of which can cause seizures in otherwise healthy dogs. So can fungal infections, many toxins, protozoal infections, and some metabolic disorders such as hypocalcemia.

Meghan, What are Ehlrichia and Babesia? I am very interested since many of my lab mom friends' dogs have seizure disorders that have been diagnosed epilepsy. All of the dogs have been within the 1-3 year range at the onset. All have had the bloodwork, no one's done the CTs or MRI's. I thought it was something in the water where we live Mid-Atlantic, but it seems that I know alot of lab owners with epilepsy (or we think) seizures.

Also, UofPA is much more expensive on alot of the diagnostics than you posted. The exam of my long gone lab, going back 10 years cost $180 just for two vet. students to evaluate my dog. I know they did a good job. I was in the room with them, but they really didn't do much more than my regular vet would do on an annual exam. Take a history, look in the ears, take the temp, etc. To me, back then, it seemed like a lot of $$ for an exam by two veterinary students? I mean no offense, but you have to at least admit when you get into University veterinary care, it really adds up from the moment you step over the threshold.

That said, their care has been invaluable to me over the years on certain issues and I am fortunate to have Penn close enough that I can do it in less than a 1/2 hour drive. Also, it is much more cost effective if you have a serious problem to start out at the University level rather than the regular vet's office, at least for me.

Thanks for sharing your knowledge. It is a big help to talk to somebody who is actually treating and studying the most recent cases and up-to-date on the science. I hope you are enjoying yourself now that your holiday break will soon be starting:)).

I have one other question, do licensed vets do continuing education, and is it mandatory,and if so, does is it regulated by State mandates? I am in a different field (non-medical), but I do even non-required continuing education. I have seen some friends with vets who are older and not so up to speed on the latest developments...

Thanks for being so gracious!

What are Ehlrichia and Babesia?
I'm not meghane..LOL but they are tic born diseases.

Now statistically many dogs are diagnosed with epilpesy
But that doesn't mean they actually have it. Sometimes the meds used will work on other seizure disorders, many times they don't and the dogs get put down from not being able to come out of a seizure. With that said you don't see people dying from uncontrollable seizures at the rate you have from dogs.
On top of which if epilepsy does get ruled in, than you have to figure between the 30 plus different types of seizures the dog is having. No matter how you look at it it isn't something that should have a quick diagnosis made for that's for sure.
In fact on a K-9 kidney group A few years back almost every single dog in that group had never been tested for hypothyroidism.

In fact on a K-9 kidney group A few years back almost every single dog in that group had never been tested for hypothyroidism

whoa.. that was strange the rest of that paragraph vanished!
anyway until the last few years most hypothyroid seizure dogs were either not being checked or being misdiagnosed by incomplete thyroid testing, so many slipped under the radar so to speak. With the newer full thyroid panels alot of dogs have been able to be diagnosed and treated correctly for thyroid conditions and remain seizure free.

From the information I could dig up, hypothyroidism is an aggrevating factor in epilepsy, but very rarely the primary cause. However treating hypothyroidism seems to help reduce the frequency and severity of seizures. Also hypothyroidism is relatively easy to diagnose and treat, unlike other causes of seizures, so you'd might as well rule out the easy diseases in the early workup rather than spend $2000 for an MRI only to find out that later that all the dog needed was a thyroid panel. The thyroid panel with anti-T4 and anti-thyroid receptor antibodies is a bit more expensive than the basic panel with just T4, free T4, and TSH, but may be worth it in difficult cases.

Labmomma- most, but not all, states require continuing education for vets. The requirements of those that do require it vary. Believe it or not, some states do not require anything more than passing the national boards- no state licensing exam. But most do have a separate test, mostly so that vets know what diseases are common in that area.

There are MANY opportunities for CE. I've been to numerous conferences as a tech, but attend mostly vet lectures and wet labs. I just volunteered my K'Ehleyr for an abdominal ultrasound CE course for vets at school. There are also online courses and journal readings and tests that count as CE. Good vets would do the CE anyway, even without the requirement. I don't think it's a good practice builder for your clients to know more about their animal's condition than the vet. Of course, the client will always know more about their pet, and are the greatest resource for information in diagnosing and treating any pet. But the vet should be interested enough in their chosen field to want to learn the newest advancements.

UPenn is expensive as a school too! I looked at them for about 2.2 seconds, and decided I can't afford it. One of my favorite conference speakers is there- Dr. Rosenthall- she's an exotic animal vet and does a lot of work on metabolic disorders in reptiles. NC State is much more reasonable tuition-wise and apparently also from a client standpoint. The vet school used to be even cheaper from a client standpoint, but several years ago NC state legislature ruled that the vet school had to be self-sufficient; no more state funding, and the prices went up dramatically. But the service also improved, and State went up into the top 4 vet schools in the US once they dropped state funding, so I guess it all worked out.