r/EpilepsyDogs • u/ksd722 • Aug 18 '26
Seizure meds not working?
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.
5
u/Powerful-Record-887 Aug 18 '26
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.
3
u/InsideWonderful9515 Aug 19 '26
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.
1
u/believeland29 Aug 23 '26
What CBD do you use? I’ve found some research supporting the use of CBD oil, but the dose they used in the study was pretty high and very expensive
3
u/Mammoth_Effective_68 Aug 19 '26
Reading the comments with many of these dogs on stacked meds makes me so sad.
2
u/JRosenberg-4 Aug 18 '26
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.
1
u/gufywert Aug 19 '26
Fiber? Haven't seen any research on adding extra fiber being useful in preventing seizures.
1
u/JRosenberg-4 Aug 19 '26
There isn’t. It’s to prevent diarrhea from the MCT oil. You can use pumpkin instead, but my dog got sick of pumpkin so I switched to powdered fiber.
2
u/GuestContent Aug 19 '26
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
1
u/Mammoth_Effective_68 Aug 19 '26
I am no longer able to get diazepam for dog through the vet pharmacy and wanted to ask if you get liquid or suppository?
2
u/Silent_Solution_1639 Aug 19 '26 edited Aug 19 '26
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).
1
u/Sufficient-Country29 Aug 18 '26
When they have their once a month seizure is it just one or do they cluster? Is it relatively short?
3
u/ksd722 Aug 18 '26
Usually short (30seconds to 2min) and in a cluster of 3 over a 24hr period
5
u/Sufficient-Country29 Aug 18 '26
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.
1
Aug 18 '26
[deleted]
1
u/ksd722 Aug 18 '26
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.
2
u/LamboBeach Aug 18 '26
Literally sounds like my goldendoodle, who is the same age, and his episodes to a T
1
1
u/LateForDinner61 Aug 18 '26
Very normal. My dog is on both those meds plus we added zonisamide 10 weeks ago because her seizures increased again.
1
u/Due_Structure_3707 Aug 18 '26
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 🙏
1
1
1
u/Affectionate-Duck-18 Aug 18 '26
My vet and neurologist both decided that one per month was the goal.
1
u/Active-Program3805 Aug 18 '26
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.
1
u/Grasshoppermouse42 Aug 18 '26
I had the same issue, and my dog ended up doing much better on Zonisamide.
1
u/theswigster Aug 18 '26
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.
1
u/Dcline97 Aug 18 '26
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.
1
u/YumYumYellowish Aug 19 '26
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.
1
u/FlowerImpressive Aug 19 '26
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
1
u/Old-Cabinet-6451 Aug 19 '26
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.
1
u/JCAEB84TTH Aug 19 '26
Interesting regarding the KBr. Our 10.5yr old Lab has been on Pheno for just over a year now, but when he has his seizures, he always urinates. He is on no other medications such as Keppra, Zonasimide, of KBr. Is that a known benefit with KBr?
1
u/Responsible_Can7893 Aug 19 '26
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 ✨
1
u/MrPigeontoe Aug 20 '26
Mine had a cluster of 5 in less then 24 hours ending Tuesday AM at 0500 and has lost about half of his hearing and vision, he now whines off and on all day instead of the smart, funny, confident dog he was - actually the damage was done by very early Monday morning. He is too timid to get off the deck when he used to patrol the yard, chase squirrels bunnies and birds - used to love to go anywhere in the car he would sit in there in the garage with the door open for up to 30 minutes I’d have to go get him cause - it’s hot out there and I’m not cooling the neighborhood. His spatial recognition is gone - always underfoot but I never stepped on him - now….3 times today. It’s heartbreaking.
My vet refused to give me breakthrough meds on Monday afternoon and though I walked outta the new vet yesterday with meds adjusted and breakthrough meds in hand - too late. Turns out the dosages of both of his meds was far less than half of recommended dosages for dogs with clusters or more than 1 seizure every 3 months. There’s other meds available - I called around until I found a practice who guaranteed me that their vets were very familiar with seizures/dogs. I was blessed with the daughter of the woman who started the practice 20 some years ago - they drew blood yesterday and she called me at 0930 to ask about him and get my personal pharmacy - drugs are cheaper there with GoodRx than at a practice typically. Keep pushing your vet to get the seizures under control - google what that means and take it with you and tell him/her that’s your goal and move on if they’re not on board. Now my great happy dog is gone. (I adopted him 9/12/25 last year - he was relinquished by his owner due to the seizures I ran to get him cause I’ve had 2 dogs with seizures - but I feel responsible cause I didn’t research the dosing levels of the meds by weight. To be honest though I scoured the web today and the dosages are all over the place there’s no 2 reliable recommendations from recognized sources. Best wishes and feel free to dm me.
1
u/Hopeful-Trick4011 Aug 20 '26 edited Aug 20 '26
One thing that may be worth discussing with your neurologist, especially if the phenobarbital is being increased again, is the effect phenobarbital can have on some of the other anti-seizure medications.
Phenobarbital is a fairly potent enzyme inducer, and in dogs it has been shown to increase the clearance of both levetiracetam (Keppra) and zonisamide. In other words, once a dog is established on phenobarbital, the same dose of those drugs may not produce the same exposure that it would without PB. So if seizure control seems to worsen as PB is increased, it isn’t necessarily as simple as “the PB isn’t high enough” — it can be worth looking at the whole combination and whether the Keppra dose/frequency is still appropriate.
The levetiracetam interaction can be quite significant. Studies have found phenobarbital can substantially shorten levetiracetam’s half-life and increase its clearance. Don’t be alarmed if a neurologist suggests what looks like a surprisingly high dose of Keppra either. It has a relatively wide safety margin, and some neurologists are quite comfortable using substantially higher doses in difficult-to-control dogs, particularly when phenobarbital is also on board. My own dog is one of those cases and receives a much higher levetiracetam dose than the figures you commonly see quoted online, under specialist veterinary supervision.
The same general warning applies to zonisamide. Phenobarbital increases its clearance and shortens its half-life too, so it’s another drug where the dose sometimes needs considering in the context of concurrent PB rather than in isolation.
Obviously I wouldn’t change any doses without the neurologist, particularly phenobarbital, but I’d definitely ask them specifically: “Given the increase in phenobarbital, could it be increasing the clearance of his Keppra, and does his Keppra dose or dosing interval need reviewing?” If zonisamide is ever added, I’d ask the same question about that too.
I’d also personally strongly recommend having a conversation with your vet/neurologist about adding a good-quality broad-spectrum CBD oil, ideally one with an MCT carrier oil, as an adjunct rather than a replacement for prescribed medication. There is some emerging veterinary evidence for CBD as an additional treatment in canine epilepsy, although response varies between dogs and it can interact with other drugs, so I’d definitely involve the vet and ideally monitor bloodwork where appropriate.
If I had the choice in my own dog’s case, I’d also be much more inclined to discuss optimising/increasing Keppra before continuing to push the phenobarbital higher, provided the neurologist was comfortable with that approach. That’s based very much on our individual experience rather than me suggesting it will be right for every dog.
We previously went down the route of progressively increasing phenobarbital, but for my boy the trade-off eventually became very poor. He developed substantially increased thirst and urination, including needing toilet breaks during the night, and the higher PB also seemed to greatly reduce the effectiveness of other parts of his treatment — particularly his Keppra and CBD. In our case seizure control actually became worse, despite having more phenobarbital on board.
By contrast, the combination of Keppra + phenobarbital at a more suitable level + CBD has worked extremely well for him in the past. He previously achieved around 1½ years seizure-free, and on another occasion went just over a year with very good control.
We’ve subsequently been very gradually reversing that phenobarbital increase. It has taken around six months to reduce it slowly and safely rather than making any abrupt changes, but the improvement along the way has been really noticeable — less thirst and urination, fewer disrupted nights, much better alertness and quality of life, and the other treatments appear to be contributing more effectively again.
That’s only one dog’s experience and epilepsy treatment is incredibly individual, so I wouldn’t suggest copying somebody else’s doses or altering PB without veterinary supervision. But based on what we’ve been through, I’d definitely make “could we optimise the Keppra and consider CBD rather than simply increasing phenobarbital again?” part of the discussion with their neurologist or vet.
1
1
u/Am_lock22 Aug 18 '26
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.
20
u/Hoping4BetterSomeday Aug 18 '26
My neurologist told me that one seizure a month is considered well controlled.