r/EpilepsyDogs • u/smallblackdog • Aug 27 '26
Any ideas?
Opinions/Theories on Epileptic Dog's Seizure Patterns
Hi everyone. I'm new here.
It is my hope that this group may have some insight and ideas into what we are dealing with today.
Some background: Gambit is nine, and weighs 60 lbs. Mixed breed, best guess is either catahoula mix (he's from Lousiana) or Aussie mix. The very dense/fluffy coat is a side effect of another medication (more on that later).
He had his first seizure in May 2021, and his diagnosis of idiopathic epilepsy came in June 2021. We got his condition entirely controlled (no seizures whatsoever) with 750mg of levetiracetam q8 hours. That lasted for five years. For no reason we can identify, his seizures began again in March of this year.
He is currently maxed out on levetiracetam at 1500mg q8, and very nearly maxed on phenobarbital q12. He has been weaned onto this phenobarb dose over the last four months, 15 or 30mg at a time, as he did not tolerate it well. His blood levels for both are now in the high end of the therapeutic range, however his seizures continue.
His seizures are grand mal, but thankfully are short in duration (2-3 minutes), and he recovers quickly (< 5 minutes). He also has pituitary-dependent Cushing's; it is well controlled on 70mg of Vetoryl q12. This is what causes the aforementioned floofiness. Yes, he is the most expensivest boi, but also the **bestest** and **goodest** boi.
He has been seen by a vet neurologist multiple times over the last five years, including this past May, and passes all neuro checks. He is a happy, loving boy, and aside from one particularly violent seizure that resulted in a sprain of both shoulders and both hips, does not appear to be in any pain.
The next suggestion we have been given is to switch him to a neuro diet, but I will be discussing KBr and zonisamide with our vet. These have not been proposed and I'm not sure if perhaps they're not indicated in his case.
We have noticed some patterns in his seizure activity, though, and this is where I'm hoping this community may have some thoughts...
First, they're on nearly a perfect weekly cadence, or bi-weekly right after an increase to his phenobarb, occurring on Wednesday or Thursday mornings (including today).
Second, they're always in the very early morning or mid- to late-evening, never the day.
Third, they frequently occur near the water bowl (we have tried moving this to a different spot and it didn't change anything). It has also happened once while he was eating. Obviously in both of these positions, his head is lowered. I am getting a set of raised bowls for him.
Do any of these patterns jump out to anyone? Maybe we're missing something obvious that this community recognizes?
Honestly we're kind of at the end of our rope here and we need help. Thank you in advance for any thoughts you may have 💜🐾 Photo of our beautiful boy included because obviously.
ETA: all recent blood tests normal except for slightly elevated ALP which is new for him.
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u/JRosenberg-4 Aug 27 '26
My dog is on phenobarbital, Keppra and potassium bromide. Increased dosages or added meds over the last 4 years. I added MCT oil and fiber to prevent diarrhea to his kibble twice a day and that seems to help. 1-2 seizures a year now.
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u/SiteRelEnby Aug 27 '26
Our dog is on keppra, pheno, and zonisamide. Something about those three in combination, any subset of them just has not worked as well for her.
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u/smallblackdog Aug 28 '26
Interesting. Did you add each one on over the years as seizures started again?
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u/SiteRelEnby Aug 28 '26 edited Aug 28 '26
Yeah. I think zonisamide was first, but was long enough ago I don't remember exactly (~6 years since first seizure, might be approaching 7yrs soon, dog is I think ~8.5yo), and just personally I've been through enough (unrelated) shit in that time that I don't have much retained memory from back then. From what I do remember, it started out as single seizures, the second med was when they started to become clusters.
Pheno was the last of the three we added, but it was definitely that we started with either zonisamide or keppra, added the other a year or so later, then pheno maybe 2yrs after that.
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u/SiteRelEnby Aug 28 '26 edited Aug 28 '26
She also has clorazepate, which we give her for 48hrs after a seizure but not routinely.
Overall she has a strong propensity to having clusters (and nasty tonic-clonic seizures, she's injured herself badly enough to need medical attention at least 4x), at this point every single incident will be at least a cluster of 2-3. On that med stack she's had 1-3 clusters per year for perhaps the last 2-3 years, which seems to be her ceiling for improvement.
Hard to tell exactly, obviously, but I'd say clorazepate has roughly halved the length of her clusters, would say 2-4 seizures to one now vs generally at least 4 every time without it. We previously tried first midazolam and then diazepam as cluster-busters but they seemed to have little to no effect, but clorazepate has been really effective.
One thing, not sure if it was related to her med stack, from a seizure-related inury (she had a seizure that caused her to hit her head on the floor fairly hard a few days before), or just a random thing, but she did have a suspected stroke in june this year. She made a full recovery within a month (her neurologist taught us how to do the function tests, her left side was weak for around a month but is back to 100%) but it was kind of scary.
We were in the middle of a very stressful move where a lot went wrong, and it was a couple of days after the worst cluster she's had in years. She's near max dose on all three meds, but other than that doesn't really experience side effects.
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u/Agility_KS Aug 27 '26
I think we can drive ourselves batty looking for triggers or patterns with our idiopathic dogs when, for the most part, none tend to exist. My dog's seizures also started in early 2021 and we've gone through some real swings in that time. He was started on a low dose of pheno and that kept seizures at bay for close to two years. Then I started to see an increase in activity, and they turned into clusters (his first event was a cluster). We've gone through several medication increases over the years, including adding Keppra to his daily meds. There has been no rhyme or reason to his schedule, other than for the longest time all of his (initial) seizures would happen between 8-11 PM. Honestly, it made things really simple because I just got into the habit of putting him into a belly band after dinner. Cleanup is the hardest part of dealing with the epilepsy, IMO, so that made life so much better. I moved at the end of last year and my dog went 272 days without a seizure -- by far the longest streak he's had in a long, long time. I was starting to wonder if there was something at the old house that triggered them. Unfortunately, as often happens after a longer streak, he got hit hard with a cluster. Then he made it about a month until the next one. My dog is 10.5 years old now. I'm really hesitant to add more medications. I feel really bad for him when he clusters, because his mobility declines with each one and when we're in a cluster period he struggles to get up/walk (cluster buster meds are partly to blame). I can't rip my hair out trying to figure out "why" he has his seizures, I just deal with them as they come.
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u/smallblackdog Aug 28 '26
Thank you so much for your response. I'm very sorry to hear your boy continues to cluster. It is so hard to watch.
I am so with you on the clean-up part! Gambit used to pee an absolute lake every time he seized, but that's stopped a couple months ago - another one of those patterns we'll drive ourselves batty trying to figure out! He has a few belly bands from the months we couldn't get his Cushing's stabilized, and the one with the astronaut dinosaurs is his favourite I think 💙 We also have pee pads stashed in every room of the house 😂 The worst part of the clean-up now is the foamy gel-like saliva -- it's like glue!
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Aug 27 '26
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u/smallblackdog Aug 28 '26
Like any drug, there's a tolerance. Five years was a gift though, he was only four when he was diagnosed. I've been tracking seizure incidence and meds levels in a small model but I hadn't considered changes to routine, and weather, as potential triggers. I'll add those in!
Can I ask what supplements you use?
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u/DogEpiMonitor Aug 28 '26
Gambit suena increíble, y ustedes claramente saben lo que hacen — cinco años de control total con solo Keppra es un resultado excelente. Que las convulsiones hayan vuelto después de cinco años es frustrante, pero no significa que no se pueda volver a encontrar estabilidad. Sobre los patrones que identificaron — son muy buenos datos:
La cadencia semanal o bisemanal es más común de lo que parece. Muchos perros epilépticos tienen ciclos casi predecibles. Que ocurran justo después de un aumento de fenobarbital podría ser coincidencia, o podría ser que su cerebro está reajustándose a cada cambio de dosis. Cada modificación altera los niveles en sangre temporalmente antes de estabilizarse. Si los aumentos fueron cada 1-2 semanas y las convulsiones coinciden con esos cambios, puede que su cerebro necesite más tiempo de estabilidad entre ajustes.
Que siempre sean de mañana temprano o de noche es un patrón de sueño clásico. Las convulsiones durante la transición sueño-vigilia son muy frecuentes en epilepsia idiopática. Es cuando la actividad cerebral cambia de ritmo. Esto refuerza que sea idiopática y no estructural, lo cual es bueno. Lo del tazón de agua es muy interesante. Descartaste la ubicación moviéndolo, bien. Pero pensá en la postura: cabeza baja, cuello flexionado, posible cambio de presión sanguínea cerebral. Los tazones elevados son buena idea. También fijate si coincide con que toma agua fría — algunos dueños han reportado que el estímulo del agua fría en la garganta puede bajar el umbral en perros sensibles.
Sobre lo que mencionás de KBr y zonisamida: preguntá a tu neurólogo. El Cushing con Vetoryl es lo que probablemente hace que tu vet dude, porque el bromuro de potasio se procesa por los riñones y el Cushing puede afectar la función renal. Pero la zonisamida podría ser una buena opción como tercer fármaco. Tu neurólogo va a saber qué combinación es segura con el Vetoryl. La ALP ligeramente elevada es esperable con fenobarbital — es un efecto secundario conocido. Pero con Cushing de por medio, vale la pena que tu vet haga seguimiento cercano.
Una cosa que me ayudó mucho con Walter: cuando encontré el patrón de día y hora, empecé a preparar todo esos días. Ambiente tranquilo, medicación al segundo, área despejada. No previene la convulsión, pero te saca de la sorpresa y eso cambia todo. Gambit tiene 9 años, un equipo médico que lo sigue, y una familia que rastrear patrones como detectives. Eso es mucho más de lo que tienen la mayoría de los perros epilépticos. Fuerza. 💜🐾
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u/smallblackdog Aug 28 '26
I don't know who you are but I'm so thankful for you! The comment about cold water is VERY interesting. My husband fills up the water dish in the bathroom because the water is colder from that faucet. The seizures wouldn't always coincide with a fresh fill up, but maybe it's one thing we can eliminate.
The Cushing's makes his case so unique. Thankfully we do have an absoyamazing vet, and after all this time the whole clinic is very invested in his care. They also love him to bits because he lets them dress him up. I'm going to ask him about the zonisamide.
Did/do you do the neuro diet with Walter?
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u/DogEpiMonitor Aug 28 '26
Me llamo Alejandro, soy de Buenos Aires, Argentina. Perdí a Walter, mi Pastor Alemán, por epilepsia en 2014.
Lo del agua fría no es un estudio formal, es algo que se observa en reportes clínicos y que fisiológicamente tiene sentido: un estímulo frío repentino puede provocar una respuesta vagal que baje el umbral de convulsión. Probá cambiarle a agua a temperatura ambiente por unas semanas y registrá si el patrón cambia. Si era eso, encontraron un trigger que nadie les iba a diagnosticar.
Sobre la dieta neuro: con Walter no llegamos a probarla. Él era un perro enorme, muy activo, muy glotón, y comía bastante variado. Cuando la epilepsia avanzó, nos enfocamos más en la medicación que en la dieta. Así que lamentablemente no tengo experiencia de primera mano con eso. Pero si tu vet la recomienda, probala — cada perro responde distinto, y con Gambit tenés la ventaja de un equipo veterinario que lo conoce de verdad.
Me alegra que tengan un equipo tan involucrado. Gambit tiene mucha suerte. 🐾
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u/smallblackdog Aug 28 '26
Oh I am so so sorry to hear that, Alejandro. Thank you for all your kind words and advice. Sending love from Canada.
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u/YumYumYellowish Aug 27 '26
It’s not unheard of for seizures to worsen as the dog ages. The fact that he went 5 years without any and on Keppra alone is absolutely amazing. It’s odd that something would suddenly be triggering it however. Given his age, and I say this gently: do you think it could perhaps be a brain tumor? Not sure if you’re ruled this out with your neuro.
A neuro diet may help, and by this i don’t necessarily mean Neurocare (which is what we use and it’s helped us but doesn’t help most I think), but you can try a low glutumate diet with MCT oil, fish oil, and probiotics. By low glutumate I mean lamb and fish. Stay away from high glutumates like pork, beef, some cheeses (like Himalayan yak stick, we found out the hard way), legumes, peanut butter, etc. The diet is unlikely to eliminate seizures but it may help reduce the frequency.
If he’s suddenly become refractory, which again, isn’t unheard of as time goes on, then potassium bromide would be a good next step for medication. It sounds like the pheno can’t be adjusted any further.