# Seizures



## Daisy's Mom (Sep 7, 2010)

Hi, I have not posted for some time! I thought I would ask others if your pup has had seizures? Daisy had her first seizure on September 30th. This past weekend she had 3 on Saturday and 2 on Sunday. These are grand mal seizures. This morning she had 2 more. We went to the vet on the 30th, they referred us to a neurologist whom we will see tomorrow. About a year prior she had joint pain, not wanting to walk and just odd behavior. She was diagnosed with anaplasmosis. In August we went in for a lab check and they also did a full chemistry work up as she was experiencing odd behavior. Looking at the wall or back of the couch, pacing, up and down on furniture (unable to just relax). Now these seizures! I am so worried about my pup!


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## kd1212 (Nov 5, 2013)

My Chihuahua had seizures. They started in 2008 when he was 12. He had a cluster of them. At that time, we did an MRI and it showed nothing. He was on phenobarbital for around 6 months after that. We were seizure free until 2012 (4 years) and at 16 years old. They started up again and we began treatment with a neurologist. Because pheno gave him a poor quality of life, very drugged--couldn't climb steps, acting dizzy--even on a lower dose, she put him on Keppra. Do you have any questions in particular?


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## wkomorow (Aug 26, 2011)

Do you know the cause yet. 2 of my dogs had epilepsy, both lived long lives. It was scary at first watching it, but then we started to discover what would trigger them and we would notice subtle changes that can shortly before them. Sandy would drag his front leg a few minutes before the seizure.


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## Daisy's Mom (Sep 7, 2010)

Hi, thank you for your post. How did your dog do on Keppra? My son has seizures and was on Kepra and went crazy! I'm sure it's different in dogs. I just hope they can help her! I don't want to do an MRI or other expensive tests. We've already spent $500 on vet visits within a month! I luv this little pup&#55357;&#56471;


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## Daisy's Mom (Sep 7, 2010)

We do not know what's causing them


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## kd1212 (Nov 5, 2013)

Daisy's Mom said:


> Hi, thank you for your post. How did your dog do on Keppra? My son has seizures and was on Kepra and went crazy! I'm sure it's different in dogs. I just hope they can help her! I don't want to do an MRI or other expensive tests. We've already spent $500 on vet visits within a month! I luv this little pup��


He did much better than the pheno. There were no negative effects--the goal was to give him a good quality of life and the doctor succeeded. I bought the generic brand of it at Costco and saved a lot--at CVS it was super expensive. Do you have insurance? My insurance covered 1/2 of the MRI. That will be the only way to see if there's a tumor or other issues. They also gave Trevor a spinal tap. If you don't want to do the other tests, maybe you can ask to try the Keppra vs. Pheno. When the seizures resurfaced in 2012, the neurologist did not want to do another MRI, but we did go back for monthly visits and she did tests with him like watch him walk and other things. Don't forget, Trevor was already 16 though, but maybe that's what your doctor will do.


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## Daisy's Mom (Sep 7, 2010)

Ok, thank you! I do not have insurance ....thought about it when she was younger, but never did buy it! I do have a Costco membership though. Thanks for your help.


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## CloudClan (Jan 31, 2007)

I don't want to be alarmist, but has your vet looked at the possibility of Maltese Encephalitis? (GME/NME). Sadly, far too many of our beloved animals have had to battle this issue and it should be investigated when a Maltese is presenting with seizures. 

Many things can cause seizures, but if it is Maltese encephalitis, prompt diagnosis is important.


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## wkomorow (Aug 26, 2011)

Daisy's Mom said:


> We do not know what's causing them


As Carina mentioned, it is important to determine the cause - maybe a vet hospital with a neurologist might have an answer or a good specialty practice. It could be as minor as epilepsy - epilepsy is not a life threatening condition, my dogs lived until their mid to late teens with their epilepsy and had no other major health issue (one did have kidney stones late in life) or it could be a more serous condition like GME.


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## Snowbody (Jan 3, 2009)

I recently had an AMAR foster who had long, cluster seizures that were taking place every 3-5 days so learned a lot about seizures. There are degrees of seizures and varieties of causes for it. Some are grand mal, some are clusters, some are focal which is the most minor or combos of some of these. There are some causes that require certain drugs to help How old is Daisy? How long do the seizures last? You should be timing them - very important. Seizures that last over 5 minutes and/or clusters need medical attention. You mentioned that she was diagnosed with a tick borne disease that presented in another way. It could be that. I really think that the neurologist will be the key. An MRI though expensive is often the definitive way to find out what is causing it. They will look for a tumor, an abnormality or particularly in the case of GME/NME, lesions. 

No matter what the cause time is of the essence getting meds and a proper diagnosis. It made a big difference for my foster who is now on two meds and much better controlled seizures. Let us know what the neuro says.


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## Daisy's Mom (Sep 7, 2010)

Hi everyone this is our neurologist report from our appointment yesterday. We started the Keppra last night. Its kinda expensive at $31. She seems a little off today, but pretty good so far. Has anyone ever done this Bile test? Let me know your thoughts, Thank you.. Karen

Presenting Complaint:
seizures, staring at walls

History:
Owner stated that Daisy had Anaplasmosis in June 2014 (had clinical signs of joint pain). Daisy was treated and things seemed to improve. Then owner said that Daisy started acting strange around the beginning of the year 2015. She was restless, and started staring at random things (closet, couch, etc.) and walking into corners and staring. Owner also has noticed that Daisy used to go on very long walks and is now only able to go a few blocks. There was a point that Daisy was trying to jump on things and would miss but that seems to have resolved. Owner took Daisy into her family vet for the strange behavior in Aug, and they ran bloodwork and did not find anything abnormal. Then on Sept 30th, Daisy had a grand Mal seizure. Owner stated that it lasted about 5 minutes. Daisy was lateral and convulsing and foaming at the mouth. The postictal period lasted about 3 hours and Daisy was falling over and appeared blind and drank a ton of water. They did not start any medications. Mom said that things seemed ok since then. Then, this past weekend, Daisy had 3 seizures early Sunday morning. Each seizure lasted about 1 1/2 minutes and the postictal period was shorter (only about an hour). She also had 2 generalized seizures yesterday.

Physical Examination:
Weight: 3.000 kg, 6.60 lb, 0.21 m2
Temperature = 101.5 Pulse = 142 / steady Respiration = 45 Oral MM = pink CRT = < 2 sec 

Appearance: BAR
EENT: No significant ocular or aural lesions observed. No nasal discharge. Mild/moderate dental disease, no other oral lesions observed
Integument: No significant skin or haircoat abnormalities
Lymph Nodes: No peripheral lymph node enlargement
Abdomen: No pain or other abnormalities detected on palpation
Heart/Lungs: No murmur or arrhythmia ausculted. Strong, synchronous femoral pulses. Normal lung sounds
Musculoskeletal: BCS 5/9. No apparent orthopedic pain or lameness
Urogenital: Neutered
Rectal: Not performed 

Neurology: Bright and alert. Normal gait and posture. Normal CP responses. Menace response difficult to assess (patient tends to squint when this response is tested). Patient is visual. Menace appeared present OD but absent OS. Pupillary light reflexes within normal limits. Remainder of cranial nerve reflexes normal.

Diagnostics Performed:
None today

Diagnosis/Assessment:
Seizures
Decreased exercise tolerance
Probable behavioral changes

Summary for Owner:
Causes of seizures are numerous. In Daisy's case, no major abnormalities were identified on her bloodwork from late August that would definitively explain Daisy's seizures. Since Daisy has had some behavior changes (staring at walls) as well as decreased exercise tolerance, idiopathic epilepsy is an unlikely cause of her seizures. Moreover, her neurologic exam was not entirely normal (her menace response/vision appeared absent in her left eye). I recommend testing her liver function, especially since her BUN and albumin levels are at the lower end of normal. Decreased liver function would explain some of the abnormalities that Daisy is exhibiting (staring at walls and decreased exercise tolerance). I recommend a fasted and postprandial bile acids test. This test can be a bit challenging to interpret in the Maltese breed. If the test is normal, then we know that her liver function is normal. If her bile acids are higher than normal, Malteses are known to have a substance in their blood that can interfere with accurate bile acids measurement. For this reason, I also recommend a complete urinalysis (to specifically screen for ammonium biurate crystals). It is less common for liver dysfunction to cause generalized seizures like you've observed recently. If her liver function is normal, then brain MRI and cerebrospinal fluid analysis are recommended to determine if a primary brain disease (encephalitis, malformation, or tumor) is present. Per our conversation, it is unlikely that you will pursue these tests. You elected to follow up with your family veterinarian for the bile acids testing and for the urinalysis. I am happy to review these results with your veterinarian, but they will directly contact you with results and recommendations.

Since Daisy has had such frequent seizure activity over the last couple of days, I have prescribed Keppra (generic-levetiracetam) as a daily antiepileptic/anti-seizure medication. She will need to remain on this medication indefinitely.

Care Required & Medications:
Levetiracetam (Keppra) 100/mgml suspension (written Rx provided for #65, refills pending response): Please give 0.7 mls by mouth every 8 hours. The most common side effects are mild sedation and weakness. Adverse effects are rare, but levetiracetam has only been used in veterinary medicine for the past 5-10 years so complete spectrum of adverse effects may be unknown.

Recheck Instructions for Daisy:
Please schedule fasted and postprandial bile acids test and complete urinalysis. This can be done either here at BluePearl or with your family vet at your regular clinic. Daisy needs to be fasted for 12 hours for the bile acids test.

Reasons to pursue emergency treatment of seizures include cluster seizures (3 or more seizures within 24 hours) or status epilepticus (seizure activity lasting longer than 5 minutes).

Obviously, if she is not doing well at any point in time, please seek veterinary attention as soon as possible.


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## silverhaven (Sep 6, 2009)

Sorry to hear all you are going through with Daisy. As for bile acid test, I would say most of us on here have had our dogs tested, and if possible before purchase. Maltese have known genetic liver shunt issues. 

If you do a search you will find even stickies, I think, on bile acid testing  and if bile acid are off then protein C. 

Essential to find the cause. Hope all goes well.


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## wkomorow (Aug 26, 2011)

Karen, 

I hope she is better soon, but it is important to get to the bottom of this. It is so difficult because there are so many possible causes.


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## maggieh (Dec 16, 2007)

I know the tests are expensive, but liver problems can be easily detected and usually managed long term. Other problems that the MRI can show are far more serious and treated differently.

Good luck!


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## lyndy (Jul 9, 2011)

The bile acid test is pretty common for our Maltese. My Daisy had one done when she had similar neuro problems as well. They will do a blood draw, feed her, and then do a second blood draw. I know they did a urinalysis too. Her results came back normal so we proceeded with the MRI/Spinal Tap and the neurologists diagnosed her with MUE and we started a Prednisone regimen. Daisy has been on Keppra as well and she did great on it. Seizure meds make them a bit sleepy at first, but after a couple of days they should get their energy back to normal. Just make sure you give it every 8 hours. It is not a medicine that can be skipped or given later than needed. 
Good luck!


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## LOVE_BABY (May 5, 2015)

I hope Daisy will be OK, I'll say a prayer for her. I hope you can get to the root cause of the problem. My parents Golden Retrieve also has seizures. They seem to occur most often when she is exited or agitated in some way.


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## sherry (Jan 4, 2013)

I'm so sorry Daisy is going through this. The bile acid test is easy as noted above. I would have them do a blood draw at the same time to send to Cornell for a Protein C test. This can rule out liver shunt. My boy Riley has MVD and it is easily controlled with diet and meds.


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## Daisy's Mom (Sep 7, 2010)

Hi everyone, Daisy had her bile acid test today. I guess they will contact us with the results. I have not checked this forum as I have had many sleepless nights with her. She would pace all night long, unable to settle down. Running into things and going under the furniture as well as pressing her head into corners 
Sherry, I didn't the the info about the C-reactive protein test until right now. I wonder if this was done with her full blood Workup in August when she started acting strange.
I guess I'll just have to wait and see how the test comes back. Thank you all!


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## glo77 (Feb 10, 2015)

Bless yur heart. I do hope the tests will give the vet the info needed to treat Daisy successfully. Try to come back and let us know how she is doing. I can tell you really love her.


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## wkomorow (Aug 26, 2011)

Karen,

I am sorry. The systems that you describe in your recent post is classic symptoms of a liver issue. With liver disease, ammonia builds up in the system. Treatment is an antibiotic and lactulose. I do not want to scare you but this can get serious. If this is a liver issue, withholding meat protein, especially dark meat can help. The protein in meat can increase the ammonia in the body, which the liver is unable to process.

A protein C test is only done after a high bile acid test.

Good luck.


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## lyndy (Jul 9, 2011)

the head pressing is a serious neurological sign and if you haven't already you need to call her neurologist back asap and let them know. That would not be a sign of liver issues.


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## Amazing Grace (Sep 22, 2015)

Gme can cause ALL of the symptoms you mention. especially head pressing, apparent blindness, overreaction to sedation and anesthesia, seizures, pacing, all of them.

These can all be brain reactions ( encephalopathy) to a liver dysfuntion generally worsened after eating protein. Have you observed that the seizures occur after eating protein? This would be a key sign.

A lower total protein ( but high quality protein) diet can improve these Symptoms if the cause is liver disease. There are prescription liver diets you could try if you think this might be the case.

If the cause is primarily neurological the diet wont make any difference. 

Trying a lower protein diet might help narrow dwn the possibilities.


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## wkomorow (Aug 26, 2011)

I think you need answers. Is there a vet teaching hospital that might be able to help? It could be a number of things. Having gone through something similar, I know how scary it can be and how difficult it is to find the answer. We had a number of misdiagnoses before Lucky's liver shunt was found. He did have a bout of hepatic encepholapathy. That was three years ago and today he is doing great. He is on medical and dietary therapy. We ended up at Cornell and we lucky to see Dr. Center.


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## maggieh (Dec 16, 2007)

The neurological symptoms of hepatic encephalopathy can mimic GME /NME and the tests you are having done right now should help you know if it is the liver. The build up of ammonia is frightening and serious, but can be medically treated. Years ago I transported a liver shunt dog with serious neurological symptoms and, while he had a rough go of it at first and has had a few setbacks, he is doing very well five years later. 

I hope you have test results quickly.


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## Daisy's Mom (Sep 7, 2010)

Hi Everyone, Thank you all for your replies! I hadn't heard back from her vet yet, so called this afternoon. They said, didn't you get our phone call on Wed.? I said NO!
Anyway, a vet called back and said her liver bile acids tests were not normal..Pre Value was 138.5 and post value after high protein was 136.5. Suggested we go back to our neurologist as it may be a Liver disfunction or Liver shunt problem. I have contacted the neurologist, but have not heard back yet. I will check into a lower protein food for her. Thank you all! So happy that you all understand.


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## glo77 (Feb 10, 2015)

I am so very concerned. This dog needs some help. Please tell the neurologist what you are reading on here. sigh,


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## maggieh (Dec 16, 2007)

Not to alarm you, but based on the symptoms and values, your dog is critically ill and needs treatment as quickly as possible. Many vets are not familiar with liver shunt and may not know what to do. You need an expert - now.

How close are you to a major university? University of WI, MN, and IA all have veterinary colleges. They should have experts who can provide you with the appropriate treatment to help your dog. Dr. Sharon Center at Cornell is considered the expert, and many universities consult with each other on treatment plans.

Please be a strong advocate for Daisy and insist she get the treatment she needs.


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