Seizures are scary as an owner, an even as a veterinarian. Understanding the terminology, differentials, and treatment options will help you inform your clients and work toward a solution for their pet.
Epilepsy is classified into three categories: genetic (idiopathic), structural-metabolic, and epilepsy of unknown cause.
Genetic epilepsy: “The epilepsy is genetic when the result of a known or presumed genetic defect; seizures are the core symptom of the disorder” - ILAE Commission Report, Epilepsia 2010. Breeds include beagles, golden retrievers, german shepherds, vizlas, and many more.
Structural-Metabolic: The result of a structural (glioma, malformation, etc.) or metabolic (mitochondrial disease, storage disease, etc.) abnormality in the brain. Please note that metabolic refers to primary metabolic cerebral disease; seizures resulting from hypoglycemia or hypocalcemia are not epileptic as once the abnormality is corrected, the seizures should cease. Hepatic encephalopathy seizures are considered structural epilepsy.
Epilepsy of unknown cause: Seizures that are likely caused by a structural or metabolic abnormality but no cause has been identified.
What makes up a seizure?
Seizures can be broken up into three main components; prodrome, ictus, and the post-ictal phase.
The prodrome is defined as abnormalities preceding the seizure itself. Examples of abnormalities include vomiting, being withdrawn, or other abnormal behaviours. The prodrome may occur hours or days before the seizure occurs.
Ictus is the seizure itself.
The post-ictal phase occurs after the seizure. It may involve sleep, wandering, blindness, and other abnormal behaviours.
Seizures can be broken down into two broad categories; generalized and focal.
Generalized seizures are what most people typically think of when they think of seizures; full body, trembling/shaking, +/- unconsciousness.
Focal seizures are limited to a more localized area; for example a persistent facial twitch.
We have diagnosed seizures; now what?
It is not necessary to treat all epilepsy; seizures that are detrimental to the patient are to be treated.
- generalized tonic-clonic seizures.
- frequent seizures, cluster seizures, or status epilepticus (when epileptic seizures follow one another without recovery of consciousness between them - this is an emergency).
- any seizures that impair the patients quality of life.
What drugs can we use?
Phenobarbital:
This is the most used anti-epileptic drug in veterinary medicine; can be used for focal and generalized seizures.
Therapeutic levels (effective levels) can be reached quickly when needed.
Serum levels should be monitored every two weeks after a change is made (after the start of treatment and each dose adjustment). A liver profile should be performed every 6-8 months if serum levels are within therapeutic range.
Possible side effects: sedation, increased appetite, weight gain, polydipsia/poluria (drinking more and urinating more), hepatotoxicity (increased ALP and ALT do not necessarily mean the animal has liver disease; do bile acids).
Zonisamide:
Approved in humans for generalized and focal seizures.
Experimental data exists on rate, rabbits, mice, and dogs.
Possible side effects: sedation at onset of use, decreased appetite, and renal calculi have been reported in humans.
Levetiracetam (Keppra)
Used for focal and generalized seizures.
MUST be given three times per day (every 8 hours).
Possible side effects: this drug has a wide margin of safety!
Potassium Bromide:
Used for generalized seizures and refractory epilepsy (not responding to other treatments).
This drug is significantly impacted by changes in salt consumption; it is very important for diet to be regulated.
Possible side effects: increased appetite and dietary indiscretion (which may lead to pancreatitis), sedation, ataxia, aggression.
If your first choice isn’t working, don’t give up!
Sometimes it takes different does, different medications, or combinations of medications to control a patients seizures.
It is important for the seizures to be recorded; get your clients to keep a seizure journal that includes date, time of day, severity, length, post-ictal phase.
As always, feel free to join the discussion!
Is there somthing I left out? Is there something you want to know more about? Questions?
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im pretty sure a medication im on has given me a side effect of arfid and its fucking horrible. like how to i explain to people that im afraid of food? i always had some particulars, but now i will just sit at dinner with my plate full and be super anxious and stressing out because of the food served. ive lost twenty pounds, im not anorexic, im in agony and i dont know what to do. how do i explain to someone that im not eating the food they made because im fucking insane not because its bad maybe? its just everything seems scary and gross and icky and anxiety causing and makes me want to cry and no one in my family gets it. im cold all the time and im tired, this is all so stupid. and its the best epilepsy drug ive been on
Read this Medication Guide before you start taking ZONEGRAN and each time you get a refill. There may be new information. This information does not take the place of talking to your healthcare provider about your medical condition or treatment.
for anyone who has taken zonisamide/zonegran; did you experience extreme mood and/or behavior changes while on it? I am trying to determine if the extreme mood swings, paranoia, and depression that I have been experiencing in the past two months are due to me taking this medication. I started at the end of November, and I am currently at a dosage of 100 mg. perhaps it's just me perhaps it's this medication Did you experience something similar?
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dizzy almost all day with weird vision (not necessarily fuzzy, but I was having problems focusing on things).
then a headache while I was dizzy.
I took my usual meds.
eventually the headache went away, but I was still dizzy and later my entire face was tingly/numb which is the entire reason I stopped taking topamax.Â
the dizziness has finally gone away, and the numbness/tingling comes and goes.
I'm starting Zonisamide again, I started it once last year and it made me really sick (throwing up, dizziness, double vision, tiredness) so I stopped taking it. After talking to my doctor we concluded the reason it made me sick was because I was taking a lot of other medications at the time and figured it was a drug interaction because it is soooo unlikely that this medication would do that to me *insert eye roll*. Now after almost 8 months of seizures and constant increase/decrease of other meds we decided to start Zonisamide again. But I'm starting to think maybe that wasn't the best idea. I feel like shit, my stomach hurts and I feel like throwing up, just. like. last. time.
And once again, everyone keeps telling me how unlikely it is to get so sick and asking are you sure it's from the prescription? Do you really think that's what is making you sick? So what, you think I am making it up? Or I don't want it to work? Because its not like I enjoy taking pills and then still unconsciously convulsing on the floor. So it would be greatly appreciated if people would stop telling me how I should and shouldn't feel.
