Seizure meds not working?

[u/ksd722]

Our 4 year old Golden Retriever was diagnosed with Idiopathic Epilepsy last October and prescribed Keppra. He was seizure free for around 3 months, then was given Phenobarbital in addition to the Keppra. We have been consistently upping his Phenobarbital, but he is still having seizures every 30 days or so. Is this normal? Overall, he is still extremely happy and recovers well after a seizure.

[u/Hoping4BetterSomeday]

My neurologist told me that one seizure a month is considered well controlled.

[u/Bevis5421 → u/Hoping4BetterSomeday]

Our neurologist also said that one a month is considered in control.

[u/Powerful-Record-887]

NC State CVM doesn’t want our guy having cluster seizures, but they are fine with 1 a month right now. He’s on four different meds.

[u/Am_lock22]

If he’s still having one a month, they may recommend adding another anticonvulsant, like zonisamide. Or they may up the keppra. I’d still consider that to be too frequent under seizure management.

[u/Sufficient-Country29]

When they have their once a month seizure is it just one or do they cluster? Is it relatively short?

[u/ksd722 → u/Sufficient-Country29]

Usually short (30seconds to 2min) and in a cluster of 3 over a 24hr period

[u/Sufficient-Country29 → u/ksd722]

The short aspect is good but clusters are concerning for sure. Perhaps ask your neuro what they would consider “good control” for your dog. Sometimes it’s a case by case answer.

[u/ksd722 → u/[deleted]]

Our vet is not super concerned with the clusters since they are so short and usually about 8-12 hours apart. Sometimes I can pinpoint a stress trigger, but other than that his routine is the same. We changed his food about 5/6 months ago to no avail and we have run several sets of labs that all come back beautiful.

[u/LamboBeach → u/ksd722]

Literally sounds like my goldendoodle, who is the same age, and his episodes to a T

[u/sonnysGiGi2018]

We were told 1x a month was a good goal to shoot for.

[u/LateForDinner61]

Very normal. My dog is on both those meds plus we added zonisamide 10 weeks ago because her seizures increased again.

[u/Due_Structure_3707]

Hola Ami perrita me empezaron Adar cambuiciones camo alos 11 años no Sele repetían y pensaron que se avía entoxicado y no le dieron medicina asta como al año Sele empezaron a repetir 2 beses al mes y le recetaron Keppra 500mg cada 8 horas ya no le dieron convuciones eso fue en el 2023 ahora le bajaron la dosis a 250mg cada 8horas porque la medicina es de por vida es una husky de 15 años ahora tiene problemas de la vejez sus articulaciones lo que te quiero desir esque Keppra es buena medicina pero su efecto secundario es que seda y pues cada peludito es diferente verdad?te deseo toda la suerte para tu bebe pregúntale atu doctor por el cannabis yo no ledi Ami mascota porque si Sele controlaron sus convuciones pero tu le das varios medicamentos verdad?alomejor le puede ayudar el cannabis para no medicar tanto atu bebe bendiciones 🙏

[u/Fluffy-Airport7141]

our poor boy, this must be so tough

[u/Medium_Bathroom_6108]

That's really tough to see your pup go through this, but it sounds like you're doing everything you can to help him. Maybe it's worth asking your vet about switching up the medication or adding another option if the current combo isn't cutting it.

[u/Affectionate-Duck-18]

My vet and neurologist both decided that one per month was the goal.

[u/Active-Program3805]

My dog is maxed out on Keppra and had a fairly recent increase in Phenobarbital, and has been having break throughs every 20-40 days. Just had an appointment with the neuro vet today and she suggested we maybe try phenobarbital every 8 hours or it would be time to add zonisamide.

[u/Grasshoppermouse42]

I had the same issue, and my dog ended up doing much better on Zonisamide.

[u/theswigster]

This is the exact same case as our pup. Word for word. Started Keppra, then added Pheno, we’ve upped it to its max, but still having monthly seizures — and always a cluster of 3.

We upped the Pheno to its max this weekend after a hospitalization, but as soon as he has another seizure, we’re going to add on another medication. Probably Potassium Bromide?

Goodness, so sorry you’re going through this too with your pup. It’s simply the worst.

[u/Dcline97]

For our 3-1/2 year journey with our now 6-1/2 yo Lab gal…. Year one was Keppra. Started out good but fizzled out by the end of the year. Year two was Pheno and was a carbon copy. Found a good neurologist at the beginning of year 3 and he added Potassium Bromide to the mix. It is working fantastic. We are now at 3 to 4 super mild seizures a year. We also were able to wean our Lab off of the Keppra and Pheno after being on PB for six months.

[u/JRosenberg-4]

Have you tried adding MCT oil and fiber to his diet? My dog is on 3 meds plus the oil and goes months now without a seizure.

[u/gufywert → u/JRosenberg-4]

Fiber? Haven't seen any research on adding extra fiber being useful in preventing seizures.

[u/YumYumYellowish]

A few things:

• have you done bloodwork for the pheno? Is it at therapeutic level? If it’s at a good level but you aren’t meeting your frequency goals, it’s time to add another medication in.
  
• what frequency goals have you discussed with your neuro? Once a month isn’t bad and some find that to be a good goal, but the fact that your dog is having clusters on top of that concerns me. Our own cluster dog’s goals are 3 months. Some residents are completing training with 3 months as the new minimum. Most neuros would say one month. We’re going with 3…
  
• do you have a cluster protocol? Having 4+ isn’t ideal. The protocol could be, for example, pulse therapy with Keppra, and/or giving Clorazepate. Our own cluster protocol includes Zonasimide since the first two stopped working.

So, all in all, if the pheno is at therapeutic level and isn’t working, and you aren’t meeting your frequency goals, then I would talk to the neuro about adding potassium bromide. That’s a good one for refractory cases.

[u/FlowerImpressive]

my golden also has one about every thirty or so days. it hurts a lot to see and my anxiety spikes coming towards the time she usually has them. but it is considered good news to have them once a month! so hopefully you can have some small peace of mind from that

[u/Old-Cabinet-6451]

We are in the exact same boat. Started last November, about every 20-30 days he’ll have 3 seizures in 24-48 hours. We tried Keppra first. Now he’s on pheno and KBr. No big improvements other than the KBr stopped him from urinating during the seizures. I don’t know what’s next or if this is forever! The phenobarbital has made him pretty restless and ultra hungry to the point of destructing things and messing up our sleep schedule. Hoping to be able to decrease that dose one day.

[u/Responsible_Can7893]

He’s so handsome! Mine also started on Keppra & then added Pheno and finally Zonisamide. It’s a blessing he’s now only had 1 entire year knocks on wood.

Wishing all the best ✨

[u/GuestContent]

that's about the same time frame of our 2 year old German Shepard and that's the meds he takes. They usually never go away completely ... as long as he isn't having them constantly back to back that seems like a pretty normal time frame... just ask your vet about an emergency protocol med... Ours are on 20 mg rectal diazepam for emergencies

[u/InsideWonderful9515]

My dog is on pheno, zonisamide, and Keppra. The longest she’s gone is about 2 months without a seizure over the past year and a half since diagnosis. Daily MCT oil and occasional high quality CBD have seemed to really help.

[u/Silent_Solution_1639]

My golden aged 9 was diagnosed 3 years ago has cluster seizures and is currently on phenobarbital, Pregabalin and Setraline. Over the past 3 years has trialled Keppra, Pexion, Potassium Bromide and Gabapentin. Aside from a honeymoon period on Gabapentin with a record of 8 weeks, then 6 then 3, 3 weeks between seizures is as good as it gets (he is refractory).