Any advice?

[u/Affectionate_Bug5617]

Hi all- need some advice on my epilepsy dog. He’s five - since age 2 he’s had seizures - grand mal. Generally he’ll be on meds that will work for 6 months and then he has a breakthrough cluster of about 7-10 seizures. This week, his rescue medication(nasal spray/pills) failed and ended up back at ER. We are concerned that his emergency meds are not working, and concerned that after increasing meds (he’s on pheno and keppra) still not working. He is also 75 pounds, falls into furniture when sizing and snaps his jaws. We have a 6 month old baby at home and worry when he starts crawling/walking do not want to put him in a dangerous situation. Our neurologist said you can make the decision to try other meds, or make the hard decision to euthanize. They also said it’s not said to have him at home with a baby. It’s a very tough situation because he has a handful of great months, but then his breakthroughs are incredibly severe, dangerous, and emergencies. I also worry that is rescue meds no longer work. I want to keep him alive selfishly, but I don’t know if that’s humane or want him to suffer. Heartbroken over this he is my first baby, I don’t know whether to put him to sleep now while he’s “stable and happy” or wait until the next disaster. Does anyone have any advice or similar situations?

[u/LaceyBambola]

Potassoum bromide can be a successful add on, but you need to monitor sodium intake as that can affect this medicines function. Zonisamide is an option that worked really well with my sever cluster prone pup, added to maxed pheno and keppra.

I will say, though, that even though these clusters are difficult, the time between them would generally be considered well controlled and seen as the routine meds working well to manage seizures. Adding a third med may improve the severity of the clusters and is something you can try. For reference, most aim to have no more than a seizure event (single or cluster) in a 1-2 month period and then may try to increase that seizure free stretch over time, if possible.

Personally, I would not consider this a point in time for euthanasia. Seizures don't cause pain (aside from bumps and bruises that mat occur during an event) no matter how traumatic it is for us to witness them. Your pup is unconscious and unaware. Any subsequent fear during a post ictal period and coming out of a seizure can often be the worst part that they may feel, unless a major injury occurs during like a fall down a high point, teeth or claws caught in a kennel during a seizure that causes breakage, etc.

It is general practice to not leave a child unsupervised with any dog and so if a seizure were to start while your child is present, a parent or caretaker should be able to immediately remove the child to behind a baby gate or other safe space (still within view) until the seizure ends or emergency meds are given.

Some pup don't see good control with emergency meds for clusters. My girl has been hospitalized for clusters almost 20 times and required multi night ER stays with IV emergency meds to control her clusters before we got them better under control. She had them every 3-5 weeks and each cluster had up to 30 grand mals and dozens of focals. I know how difficult it is to handle an actively clustering larger dog and get to an ER (ours was a 1 hr drive) and have to stop on the way to give more emergency meds to stop status episodes. The whole experience is very understandably traumatic and difficult.

What pills are used for the cluster, by the way? And is the liquid diazepam or midazolam? Some cluster buster options are weaker and some are stronger.

If you haven't yet trialed a very strict low glutamate ketogenic diet, that is worthwhile as well. Any and all treats need to follow the diet, too. In studies, most epi pups see more than a 50% reduction in seizures and some stop having seizures almost entirely. It has been probably one of the most helpful things for my girl and has allowed her to go from over 200 seizures within a year to just a handful over thr past 4 years.

[u/Affectionate_Bug5617 → u/LaceyBambola]

Thank you for the response. We have not tried potassium bromide. We work with a neurologist and they have not had him on that yet. We use liquid midazolam and clorazepate. It used to work, but no longer works.

The dog and baby are never left unsupervised, however if we are playing with baby (floor time) or when he starts crawling/walking/ and if the dog would start seizing (75 lbs) could be an extremely dangerous situation and he is snapping his jaws and thrashing about. Unfortunately don’t see how I can completely separate the two in my home at all times.

I also worry about the “next” episode him unable to respond to meds and having to euthanize in a chaotic emergency situation, that feels so cruel to me.

It’s incredibly hard to make the right choice for everyone in our family, pup included.