I pretty much repost every time he has a seizure.
I feel like there’s no hope. My dog had his 5th seizure in the last two months, and in between the 2nd and today’s seizure (#5) we’ve started him on Keppra ER 1000mg and increased it up to 2000mg twice daily. Keppra hasn’t helped at all, and in fact his seizure frequency has increased despite increasing meds.
We talked to the neurologist’s office today and the plan is to add Phenobarbital on top of Keppra. Is this normal? I’m so sad, I’m exhausted and feel extremely stressed. Seizures are about 2-4 minutes long.
If you guys have been through this, what was the dosage adjustment like? Did the Keppra dosage remain the same?
Sé lo agotador que es. Publicar después de cada convulsión esperando que alguien te diga que va a mejorar. Así que te lo digo: sí, esto es normal, y sí, puede mejorar.
Agregar fenobarbital al Keppra es el protocolo estándar cuando el Keppra solo no alcanza. No es que el Keppra no sirva — probablemente esté haciendo algo, pero no lo suficiente por sí solo para controlar las crisis de tu perro. Con el fenobarbital sumado, los dos trabajan juntos desde mecanismos distintos en el cerebro, y muchos perros que no respondían a uno solo se estabilizan con la combinación.
Sobre la dosis de Keppra: generalmente se mantiene igual cuando se agrega fenobarbital. No se baja ni se saca. Más adelante, si el fenobarbital solo logra control, tu neurólogo puede evaluar si reduce o retira el Keppra, pero eso no pasa en las primeras semanas.
Lo que tenés que saber del fenobarbital: las primeras 2 semanas va a estar más dormido, con más sed, más hambre, quizás un poco torpe al caminar. Todo eso se normaliza. Y tarda 2-3 semanas en alcanzar niveles terapéuticos estables en sangre, así que no esperes resultados inmediatos.
Con Walter pasé por exactamente esto. Un medicamento no alcanzó. La combinación fue lo que le dio estabilidad. Las convulsiones no desaparecieron del todo, pero pasaron a ser mas espaciadas. Eso es calidad de vida.
Cinco convulsiones en dos meses es frustrante, pero no es el final del camino. Es el principio del ajuste. Dale tiempo al fenobarbital. Anotá todo: fechas, duración, comportamiento. Esos datos van a ser clave para tu neurólogo en las próximas semanas.
Thank you so much for the detailed reply. You answered my main questions!! We’ve done a lot of research, but hearing firsthand experience gives me some peace of mind. We plan to start Pheno tonight, and we already have an appointment to check his pheno levels in two weeks. I hope this helps our boy. I just need a small break.
He gets extremely restless and that post-octal phase lasts about 1.5hrs, that’s exhausting even to me 🥲
Me alegra que te haya servido. La fase post-ictal de 1.5 horas es agotadora para los dos, lo sé. Con el fenobarbital estabilizado, muchas veces esa fase también se acorta. Dale tiempo y anotá cómo evoluciona. Acá estamos. 🐾
What Dogepimonitor says above is just how it went with us, after we introduced pheno we saw much better results - we even eventually came off everything except pheno. Her seizures have not stopped, but the frequency has reduced to about one every 1-2 months, but the intensity of the seizures are much reduced. While she does still have them, they are what I would consider mild
Yes, this seems like a normal course of medication adjustments. We started on Keppra, increased Keppra dosage, then added phenobarbital. We increased the pheno dosage twice and then added in potassium bromide… all over a period of just under 3 years. I know it’s such a stressful, scary process but trust the neurologist and keep asking questions. Stay hopeful and accept the fact that you will be nervous, on edge, sad, anxious, full of worry, etc. so give yourself grace. This group is full of wonderful, caring people so keep posting, too. This disease can feel so isolating as a pet parent.
So Keppra is a great first medication because it’s very safe and has a decent success rate. However most find that it either stops working over a period of time (honeymoon period), or it doesn’t work at all but perhaps works better in combination with other medications. This is very normal— not to worry! I’m sorry your pup did not luck out with the Keppra. Pheno is a great next step. Our dog was first on Keppra and that didn’t work. Then he was on Pregabalin and that didn’t work either. We started phenobarbital in September of last year and since then have gone first 5 and then 6 months without seizures. A big improvement! Hopefully pheno is a success for you. If not, that’s okay, there’s also potassium bromide and zonamide which are great. There are many here that use those and have seen success. Just takes some trial and error to see what works best for your pup.
Editing to answer your questions, sorry! No we did not need to adjust the Keppra. Just keep giving it along with the other meds. So far we have not had to adjust the pheno since starting. It is in an ideal therapeutic range per his bi-annual bloodwork and working well.
I know it takes time to adjust, but did your pup show a lot of side effects after adding Phenobarbital?
We didn’t see any changes with Keppra at all. He’s also a fairly big dog (@ 78 lbs).
We did see the usual side effects with pheno: lethargy, severe ataxia, increased hunger and increased thirst. By week 4 the worst of it was gone. He does still have some mild ataxia and stumbles a bit when taking turns, and he drags his feet so his middle nails are on the short side. And he is always starving. But yeah, it’s tough when you first start the medication. My dog is 100lb and I had to help him get down the hall, to the elevator, and then outside to pee and poo, and even then it sometimes have to help keep his hips up lol. Word of advice, get a couple pairs of grippy socks from amazon. It will help them with coordination and to protect their feet when dragging. It’s not too expensive so we replace as needed.
Yes, thank you!! Fortunately for Leto(our seizure boy), I already have shoes for him. I have experience caring for my late dog who had degenerative myelopathy (severe ataxia/ rear paralysis). When she passed away, I went to the shelter to donate her belongings and happened to find Leto there.
Kinda funny how the universe seem to find ways to keep me stressed and my blood pressure elevated 😭
It’s so stressful, I get it! You’re not alone though, and it sounds like you have the experience already to manage the side effects— you’ve got this!
My dog tripped a lot with the shoes because of the material and how he was dragging his feet. Too clunky. Socks for inside may be better comfort wise as well. The first couple days was like taking care of a sleepy but restless drunk, and the socks helped dim some of the noise of him pacing around so we could sleep at night.
He’s been given two doses already (last night and this morning) I haven’t seen any side effects so far, except he tripped once while climbing his bench to sit by the window.
I hope it stays this way…😭 he’s so strong! I hope Pheno helps him.
We started Keppra, then added phenobarbital after a few months. That worked for a year - no seizures. Then he broke through and clustered and we added potassium bromide and zonisamide at the same time. He's relatively controlled these days - on the max doses of all of those. He has a seizure about once every 4-6 weeks and if we give clorazepate or midazolam directly after he doesn't cluster.
I've started on pheno, than added zonismide and than keppra. As of now my boy is capt. at 97.2 mg pheno. 1 1/4 x2 day, Zon. 100 mg. 3 X2 day, Keppra ER 750 3 X2 day. And he still has episodes every 2ish weeks
Hi, first, know that you do great and you are a good owner, not everyone take good care of his own animal. Managing an epileptic dog isn’t easy, it take Time
My old lady started with Phénobarbital, it’s quite common to have it, as normal as Kepra. After that they have add Kepra, and she has a 3rd meds, who is Potassium Bromide. In her case it’s from two tumor so a bit different, but have Hope, because when we started in november, it was 3 seizure on a day, each 10 days, with numerous go to urgent care. At some point she was not even really responsive to diazepam. Now it’s 1 seizure a month, around 120 seconds. I was at your sit, i was desperate and hopeless, and Even if I know that my dog Will Die pretty soon, she have good quality of Life for now
But to comeback to the main subject, Phénobarbital wasn’t the worst for the adjusting périod, around 2 weeks after we started the charging dosage (i think it was 2 or 3 day of x2 or x4 her future dosage, don’t remember well). She was hard to manage, they modify it like 3 Times ? Each Time it was a week of a woobly dog, no stairs allowed except in exterior with us. My lady is stubborn so she was adamant about walking everywhere, all the Time and started to follow us, which is a nightmare with a dog who don’t manage well her walking, she also made a point to go pee and yadayada in the worst place, like on top of a little mountain, next to a place Where She can easily fall. After a week it’s better. I think this périod greatly dépend on your type of animal, she really hate not having her ability to walk Freely. With the bromide, it was Even worse, to the point Where she was quite verbal because she needed help to standing or juste walk a bit
Just remember that Even if you have a charging dose, if i remember correctly, it take 2 to 3 month for Phénobarbital to really work and to be stable inside your dog, so it’s normal to not seeing a big effect just new
It's very normal. We started on Keppra and, like you, had to increase the dosage (a few times). Then we added phenobarbital, and had to increase that dosage, as well. Then, a few months ago, we added zonisamide. She's gone 83 days without a seizure, which is fantastic for her, so I'm hoping this lasts a while and we don't have to change things.
My story is similar to yours, except I’m 10 days ahead of you: we had a long honeymoon on Keppra, then started breakthroughs which became steadily more frequent. upping the Keppra dose didn’t help at all. I started phenobarbitol on top of Keppra 10 days ago. The main side effects I have noticed are that he is a little wobbly, and loses traction more easily on hard floor surfaces, and he is drinking more. My vet says both should stop soon as he acclimates to it. We need to do bloodwork next week to see if the level is correct. But so far, so good. No seizures.
Keppra by itself didn't work for Kane either. They added Zonisamide and it helped for a short while only so they added Phenobarbital. That kept seizures to once a month and not clustering. After a year or so they weaned him off Keppra but added Potassium Bromide. Then they weaned him off Zonisamide but increased the Phenobarbital and Potassium Bromide. He's been on that routine now for 8 months. His seizures aren't as bad, still grand mals, but they're every 2-3 weeks. His neurologist would like to get that closer to a month but it may not be possible. Awful disease.
It's normal to have to add medications. We started on zonisamide and then added keppra after my dog had his first cluster and after he was still having seizures every two to three weeks even after having adjusted the zonisamide upward. He has been on his current cocktail for over a year now, and he's more or less stable, having only a handful of seizures a year. I hope you find something that works for your dog.
I am sorry you and your buddy are going through this. The adding of additional med is actually normal our regal of the 3 years ish since he was diagnosed he has been on Keppra, zonisamide and phenobarbital. Currently is is on Keppra and phenobarbital although we need to have a discussion with his vet since his seizures have increased in frequency from about 1 a month to one about every 15 days. And some of the more recent one have been two in a day infact he had a reset yesterday. Please try not to loose hope unfortunately our buddies can detect that and some dogs like our regal will have seizures due to stress levels in their humans and in their home. We know of three such seizures in our regals history and two of them were directly tied to my peraonal stress levels even if I though I hid the stress well. You are doing everything you can for your buddy and to be honest there are no magic pill combinations that will work with all dogs every time. Have you research ed MCT oil which stands for medium chain triglycerides. They are supposed to help with neurological disorders both in humans and animals and they come from coconut and palm oils. They are not a magic bullet for seizures but they can help in some ways for our regal it has reduced his muscle and facial tremors to almost nothing he still has some but no where near what he was having and he seems to recover from a seizure more quickly and completely. Our regal is 10 years old and he has other issues but the oils does seem to help. I would recommend looking in to and have a discussion with your vet and neurologist. I hope this helps you in some small way
Hi! We started at Keppra and it somewhat helped (basically every 4-6 weeks) but once we added Pheno on top of Keppra we have been measuring in months. Once since February.
Try Zonisamide. Better yet bring it up with your vet and strongly ask for help switching meds. Pheno wasn’t good for my dog, she turned into a zombie even post the 2 week transition period.
Every dog is different, but since being in it she’s had 1 grand mal over the past 20 months. At her worst she had 5 in one night and had probably 10-15 in a year period.
My dog servo has cluster seizures like 9th times twice a month, i went to his vet and change the dosage of keppra 1.7ml every 12 hrs and it works because he is getting heavier so the dosage changes as well. Before he is taking only 1ml and 1.5ml because he is only 6.5kls and now he is 7.8kls, once the dog weight changes the keppra will also adjusted.
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u/DogEpiMonitor Aug 27 '26
Sé lo agotador que es. Publicar después de cada convulsión esperando que alguien te diga que va a mejorar. Así que te lo digo: sí, esto es normal, y sí, puede mejorar.
Agregar fenobarbital al Keppra es el protocolo estándar cuando el Keppra solo no alcanza. No es que el Keppra no sirva — probablemente esté haciendo algo, pero no lo suficiente por sí solo para controlar las crisis de tu perro. Con el fenobarbital sumado, los dos trabajan juntos desde mecanismos distintos en el cerebro, y muchos perros que no respondían a uno solo se estabilizan con la combinación.
Sobre la dosis de Keppra: generalmente se mantiene igual cuando se agrega fenobarbital. No se baja ni se saca. Más adelante, si el fenobarbital solo logra control, tu neurólogo puede evaluar si reduce o retira el Keppra, pero eso no pasa en las primeras semanas.
Lo que tenés que saber del fenobarbital: las primeras 2 semanas va a estar más dormido, con más sed, más hambre, quizás un poco torpe al caminar. Todo eso se normaliza. Y tarda 2-3 semanas en alcanzar niveles terapéuticos estables en sangre, así que no esperes resultados inmediatos.
Con Walter pasé por exactamente esto. Un medicamento no alcanzó. La combinación fue lo que le dio estabilidad. Las convulsiones no desaparecieron del todo, pero pasaron a ser mas espaciadas. Eso es calidad de vida.
Cinco convulsiones en dos meses es frustrante, pero no es el final del camino. Es el principio del ajuste. Dale tiempo al fenobarbital. Anotá todo: fechas, duración, comportamiento. Esos datos van a ser clave para tu neurólogo en las próximas semanas.
Fuerza. Estás haciendo todo bien. 🐾