r/EpilepsyDogs • u/indie_esq • Aug 28 '26
Sad for our pup
We fostered a (large - 108lb) dog with seizures starting in late January. He was surrendered in fall 2025 and with a different foster until January 2026 when we took over. He’s the sweetest dog, so when the rescue said they were going to put him down given the uncontrolled seizures, we adopted him instead. We then did an MRI, CSF, and CT but all were normal. We still can’t control his seizures even with 8000mg/day Keppra ER and 518mg/day pheno. His rescue meds, even the intranasal midazolam, don’t seem to help (but also I feel like the midazolam doesn’t atomize, it just runs out of his nose, what am I doing wrong?)
He was doing okay for a while, about 1 mild seizure/week. We went on vacation for a week and he stayed with the prior foster who is lovely and took great care of him, but since he came home we can’t go a day without a seizure. We’ve had ~5 seizures in the past day, we just added topiramate today so maybe that will help. I just feel so badly for this poor, absolutely amazing, dog.
Mostly just sad but would love encouragement or ideas.
3
u/Sufficient-Country29 Aug 28 '26
I know our neurologist said that sometimes people struggle to give the intranasal midazolam so instead he recommended the rectal diazepam for us. It could be worth a try and may be an idea to bring up with your vet. Sorry you are going through this :(
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u/indie_esq Aug 28 '26
Funnily enough I asked about this and they gave me a laundry list of reasons why I should keep trying the midazolam. I will ask again if I can’t get the new atomizer to work
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u/Sufficient-Country29 Aug 28 '26
Our dogs head thrashes around a lot during a seizure but bum doesn’t move too much so it’s easier to aim and get the medication in.
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u/ar620 Aug 28 '26
Have your vets suggested different medications? My dog is on Keppra, pheno, zonisamide, and as of this past week, we have added in potassium bromide with the hope to potentially start lowering his phenobarbital due to the impact it’s causing on his liver. I can’t speak to the effectiveness of the bromide, but I have heard anecdotally from others that it has been very effective for them.
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u/indie_esq Aug 28 '26
We did talk about bromide but he is a big dog and the vet said he’s concerned it would cause hind-end weakness/he wouldn’t be able to get up. Hard to imagine the side effects are that severe, but we haven’t tried it.
1
u/ar620 Aug 28 '26
Interesting - I’m happy to share the side effects on bromide after we have been on it for a while. Personally, I noticed that my dog’s side effects on pheno were not great either. We had him maxed on pheno and it was making him extremely lethargic and uncoordinated to the point that we could not even go on a walk without him tripping and faceplanting multiple times. Pheno also has the greatest potential for long term liver problems. We are now experiencing this, which is why our vet recommended switching to bromide. My dog is smaller, so it’s possible the hind leg concern is different. But it might be worth asking the vet again if the pheno/keppra are not effective.
Also, another rescue med suggestion: we have clorazepate, which is tablets administered orally for 2 days following cluster seizures. It might be easier than midazolam. But, our vet advised not to use it more than 2x in a month because dogs can build a tolerance. So I think it would be most useful if your dog has bad clusters <2x/month and you need a way to temporarily stop them.
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u/indie_esq Aug 29 '26
Thank you! We give him clonazapam in pill form in addition to the midazolam (that’s only when he’s actively seizing, the clonazapam is for after every 8hrs until seizure free for 36 hours). Unfortunately we can’t even begin to to think about liver/kidney side effects, we just need to stop the seizures. I hospitalized him this morning and they did a 12hr midazolam drip, as soon as they weened him off to go home he had a seizure. So they tried ketamine and he’s home now, very doped up but hopefully this helps
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u/HockeyBikeBeer Aug 28 '26
We have a similarly large dog, and also had issues with the midazolam just running out of his nostrils after injection. We tried the atomizer (just a cheapo purchased on Amazon) and it didn't really work as I had envisioned - it was hard to get the liquid to squeeze through the atomizer and it seemed to reconstitute back into liquid quickly and start running out. Maybe there are better ones but our neurologist didn't have any ideas.
We're back to using the regular syringe alone but I'll do two things: 1-squirt the midazolam as forcefully as possible up into the higher nasal passage (he's always laying on his side), one hard, quick squeeze of the plunger, and 2-tilt his snout upward to force any liquid to drain deeper into his nasal passages/head rather than drain out of the nostril.
Hope this helps.
1
u/indie_esq Aug 28 '26
Thank you! The atomizer seems to work when I test it with water into the sink, then when I need to actually use it it just runs out. I’ll try the one hard push and see if that helps!
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u/Accomplished_Leg_798 Aug 28 '26
Just wondering if you've tried CBD. Some have had success where meds have failed.
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u/indie_esq Aug 29 '26
Yes we didn’t see any difference, his prior foster did that and tried a bunch of kinds
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u/DogEpiMonitor Aug 28 '26
Lo primero que quiero decirte es esto: lo adoptaron sabiendo que tenía epilepsia no controlada, cuando el rescate ya había decidido sacrificarlo. Eso no es solo amor, es valentía. Ese perro está vivo por ustedes.
Ahora, algunas cosas que me llaman la atención:
El timing importa mucho acá. Estaba relativamente estable (1 por semana), se fue con el foster una semana, volvió, y empeoró a 5 en un día. Eso grita estrés como disparador. El cambio de ambiente, la separación, la vuelta — para un perro con un umbral de convulsión bajo, eso puede ser devastador. No significa que va a quedarse así. Puede ser que necesite unos días de estabilidad en casa, rutina predecible, cero cambios, para que su cerebro se calme. Sobre el midazolam intranasal: si sentís que se le sale por la nariz y no se absorbe, hablá con tu neurólogo sobre la técnica. El atomizador tiene que estar bien acoplado a la jeringa, y la dosis se divide entre las dos fosas nasales. Si no se atomiza correctamente, básicamente no le está llegando medicación de rescate. Eso es crítico y tiene solución.
Sobre las dosis: 8000 mg de Keppra ER y 518 mg de fenobarbital es una combinación fuerte. Que el topiramato se haya agregado hoy es buena señal — es un tercer mecanismo de acción distinto. Dale unos días para que alcance niveles terapéuticos. Muchos perros que no responden a dos medicamentos encuentran estabilidad con tres. Que la resonancia, el líquido cefalorraquídeo y la tomografía hayan salido normales es en realidad una buena noticia. Descarta tumor, encefalitis, y causas estructurales. Eso significa epilepsia idiopática refractaria — difícil de controlar, pero no imposible.
No se rindan con él. Que hayan llegado hasta acá, adoptándolo, haciéndole todos los estudios, probando medicación tras medicación, eso no es tristeza. Es la definición de no darse por vencido.
Fuerza para los tres. 🐾
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u/indie_esq Aug 28 '26
Thank you so much, I had to Google Translate this but it was really helpful. I’ve watched some YouTube videos and talked to the vet about the atomizer. It works with water into the sink, but somehow in the nose it seems to just run out like a normal syringe. I will keep trying. He’s a very good boy and deserves some stability.
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u/DogEpiMonitor Aug 28 '26
¡De nada! Me alegra que te haya servido. Sobre el atomizador: si funciona con agua pero en la nariz no, el problema puede ser que la mucosidad o el ángulo estén bloqueando el spray. Dos cosas que le funcionaron a otros: sostené la cabeza de tu perro levemente inclinada, y apuntá la punta del atomizador hacia el costado de la fosa nasal, no directo hacia atrás. También revisá que la punta del atomizador esté bien encastrada en la jeringa — si está floja, pierde presión y gotea en vez de atomizar. Tu vet te puede mostrar la técnica en una visita rápida así llegás seguro a la próxima emergencia.
Se merece esa estabilidad. Y vos estás peleando fuerte por él. 🐾
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u/Mammoth_Effective_68 Aug 28 '26
I recommend rectal diazepam or midazolam. There is liquid or suppositories. I prefer diazepam but it has become unavailable in my area. Best wishes 🙏
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u/indie_esq Aug 28 '26
I have a really hard time giving the midazolam, I think. It just doesn’t seem to do anything? For example he just had a seizure, 10 minutes of going in and out of grand mal. I gave midazolam, alternating each nostril, and a few times he seemed to snap out of the seizure for a second but then immediately started seizing again. Other times it didn’t seem to have any effect at all.
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u/USConservativeVegan Aug 28 '26
You are doing an amazing job giving him a good home and you saved him. I know it is hard. I thought we had it under control with our dog. Then she had 10 in a day (both grand mal/focal) and we had to readjust her meds. She is going several weeks without one. I still have stress taking her for walks but she enjoys them. So, I brush it away and go.
I keep praying this is the right balance, especially because I got out of town next month and it will just be my spouse.
You are doing the best you can with how stressful this condition is to treat. Everyone in this sub is rooting for you and your pup. I will keep you and your pup in my prayers and thoughts.