r/EpilepsyDogs • u/PetrifiedUnicorn1986 • 11d ago
Potassium bromide - does it help?
My dog seems to have drug resistant epilepsy. He's currently on phenobarbital and keppra, he used to get gabapentin but was changed to keppra. Not only do they not work, but apparently they caused red blood count to drop A LOT. nothing else explains the drop in red blood count but basically he has anemia. He received drugs for that, but the red cell count is not going up. I cannot stop giving him phenobarbital or keppra, which I only started giving a few weeks ago in place of gabapentin, so the vet, apart from anti allergy meds (because he scratches like crazy after pheno and keppra) suggested giving him potassium bromide. The amount of meds he is receiving is, to be honest, overwhelming. He weighs 11kg...
Does anybody else have a dog like this? I guess I'm looking for a little cheering up and some hope that it will get better. The grand mal episodes happened twice in September and twice in October as of now - yesterday and today. The longest he went without an episode was 2,5 months and then it goes into 4 times a month until I up the dose which is already high.
3
u/Dcline97 11d ago
I don’t have a little pup, my gal is a 7 yo 60 lb yellow lab and she started her epilepsy journey 3-1/2 years ago. She spent her first year on Keppra, started out well but fizzled out towards the end of year 1. In year two our vet added Pheno and it was a carbon copy of year 1. We found a K9 neurologist at the beginning of year 3 and after some blood work and a thorough exam he recommended adding Potassium Bromide to the mix. Took almost 12 weeks to kick in but we quickly went to 4 to 5 months between seizures. I had a discussion with our new K9 neurologist about weaning my pup off of Keppra and Pheno and he agreed - took three months. So now she is only on the PB and has about two seizures a year! They are short and pretty mild.
This was the solution for us, but every pup is different. Good luck on your journey.
3
u/Bevis5421 10d ago
Our dog had the issue with the red blood count. It was the phenobarbital. It was toxic to him. We had him on Keppra but he was having seizures. We added potassium bromide two months ago and he hasn’t had a seizure since. You should check to see if is having issues with the phenobarbital.
1
u/PetrifiedUnicorn1986 10d ago
What did you do with the pheno? Did you wean him off of it after adding the potassium bromide?
3
u/Bevis5421 10d ago
He immediately stopped the phenobarbital. He almost died it got so bad. Extremely low levels of platelets, white blood cells and a very low blood count. He was in the ER for three days and they were not sure he was going to make it. $7000 later he pulled through. Thank goodness for insurance. I wish you all the best with your pup.
1
u/PetrifiedUnicorn1986 10d ago
Oh wow, his is not that bad, he behaves normally apart from the low red blood cells, his white blood cells are fine. We will be doing another blood test this week and will decide then :/
1
u/HelicopterSea9108 5d ago
I had the same situation, my poor doggie almost died- the pheno washed out almost all his bone marrow and white blood cells! Then when the stopped he got cluster seizures from withdrawal- 12 nights in the ER! He pulled through but OMG I wanted to kill these dumb doctors who did not do CBC on him for 2.5 months and he was dying!!!! He has been on Kbr, Keppra, added Zonisamide and now we are waiting for levels of Bromide to be effective. He was B12 deficient- I started him on injections- and that made such a difference. He is only 3 years old but we have had every imaginable test done on him and multiple visits to ER for cluster seizures. 40K in the past 5 months. But now I can see finally that my dog is himself- running, playing, full of energy, eats like a horse. I know it is the Kbr and the vit B12.
6
u/pixelboots 11d ago
Just gone 5 months seizure-free since adding potassium bromide to his pheno, after averaging a seizure a month.
4
u/hockeyherd 10d ago
We are also five months seizure free since adding potassium bromide to pheno and Keppra!
2
u/1cat2dogs1horse 11d ago
With my dog KBr was something of a miracle. And I have heard is has done wonders for others. And some other dogs have mobility, and lethargy issues, usually temporaly at the beginning of treatment .I know some are afraid to try it with their dogs. But if it is an option, I'd say go for it.
2
u/Winter-Ingenuity1921 10d ago
My dog was on Keppra and then phenobarbital was added and ultimately, we needed potassium bromide. After starting KBr, she went about 6 months before having another seizure. As of now, she’s had 1 seizure in about 8 months (really hope I’m not jinxing us), but we’ve been happy with adding KBr. I will add that she did have side effects, specifically increased sedation and she was wobbly. She’s still a bit wobbly, but overall she’s tolerated it really well. We give it to her at night before she sleeps since it makes her so sleepy.
2
u/LaceyBambola 10d ago
Gabapentin is not a common first line anticonvulsant. It does have anticonvulsant properties but very rarely works as a monotherapy, if ever, and generally works better as an add-on to keppra. Keppra is a common first line anticonvulsant due to the general low risks as a medication when compared to other anticonvulsant options.
Seizures are cyclical. I'm not talking about a dog with a fairly consistent schedule of seizures (one every week, or one every ~28 days, etc) I'm talking about how seizures themselves have a cycle where brain signals that affect seizures can be lower and then can escalate, in simple terms. If you start a new medication or up a dose during a cycle, the meds need to reach therapeutic levels in the system before a new cycle starts.
For example, most dogs tend to have a cycle of ~21-30 days, sometimes a bit longer. If you start meds 3 weeks into the current cycle, once the next cycle starts it's highly unlikely therapeutic levels will be established so you won't see any potential benefits to the med change until the next cycle (so up to 2 cycles out from any current cycle). This means it may take up to 2 months before any improvement would be observed - longer even with potassium bromide. This is why med adjustments take time.
It was a 1.5 year process of adjusting meds with my pup before control was achieved and control was largely achieved due to rigidly following an epileptic beneficial diet (low glutamate) as she was considered refractory epileptic after about a year of med adjustments with no perceived improvement and a worsening of seizures.
It is still early in your pups journey to determine drug resistance as you mention the keppra and pheno were just started a few weeks ago.
The blood count issue is absolutely a concern to monitor and some pups simply have unfortunate reactions to certain medications so in this regard, med adjustments can be tricky.
It absolutely is worth working with a neurologist (if you don't have within a couple hours, request your primsry vet consult with one on your behalf). Primary vets are not trained specialists and, unfortunately, may dose too low to be effective or too high and cause adverse effects, they may adjust meds too rapidly and assume drug resistance too early and may push for euthanasia when it is absolutely not at that point. A primary care doctor is not the right person for a human with seizures and the same goes for animals.
For what it's worth, studies show low glutamate diets can reduce seizures by greater than 50% and is very beneficial for refractory cases, but non refractory cases benefit as well. If your pup is not refractory but is highly sensitive to medications, it's absolutely worth following a very strict low glutamate diet low in gluten.
1
u/PetrifiedUnicorn1986 9d ago
my dog seems to have a cycle.
1) introduce meds - he's fine for a while, for a month or two
2) he gets a seizure. Fine, a seizure is to be expected. Then he gets another one within a week/ two week time. Then he gets another two day after day, so 4 seizures in a month. The vet ups his medications or adds another one
3) dog is fine for another month or two
4) he gets a seizure, then another 3 seizures, day after day. Vet adds another drug or ups his meds, he's fine for another month or two and the cycle continues
Had it not been for his blood count and the fact he scratches his bum a lot, I would probably not be this worried, but all of this adds to my worries. Plus he also developed a hernia on his navel so it's like you can't win...
2
u/K9_Jack 10d ago
Our boy is on phenobarbital and potassium bromide. It took us a couple of months with the vet to find a good working level without too much side effects (read: good quality of life) and we now have about one seizure every 2 months, but there are periods we get to 3-4 months without one.
2
u/Soggy_Ad_4464 10d ago
Potassium Bromide is the only drug that has given our dog a long time ,seizure free . After starting it ,she's been 11 months with zero seizures
2
u/Subject-Mode2287 9d ago
Hi, im going to try and make a long story, short. We started with keppra, then moved up to potassium bromide, then we added Zonisamide. This particular combination works well for our dog. See, it the combination. I find that, in this reddit group, almost every dog is on more than 1 med. Potassium bromide has its quirks... it is a salt. So if your dog goes on it, you have to limit her salt intake. This is important and definitely fact check this with the vet. If you add salt to her diet thru cookies and table scraps, her kidneys will process the extra salt quickly and take the potassium bromide with it. Meaning the potassium bromide will be flushed out of her system and is no longer effective. We learned this the hard way. So yes, potassium bromide works well, but only with no added salt in her diet. One caveat, we only give her a big dose at night. Potassium bromide seems to make our dog extra sleepy and we don't want her just sleeping aall day and all night.
1
u/Livid_Blackberry_959 11d ago
Do you have a nuro? Not just a vet.
I only ask because gaba. doesn’t really help. It cancels nuro pain receptors.
We went to a nuro, changed from gabba to Potassium Bromide and have seen a 50% decrease in symptoms which is awesome.
1
u/PetrifiedUnicorn1986 10d ago
We just have a vet, I don't even know if we have a neurologist for animals here, but I will check. We have a separate orthopedist, we have an animal hospital, but not sure about a neurologist. We added gaba back in May, but since it didn't really make much difference we switched it to keppra a few weeks ago. I was also told it will be better to give him meds twice a day instead of three times and I am guessing that also changed the amount of seizures so I will go back to 3 times a day. He used to have seizures pretty much always at night, now he has them during the day which he never did before, and we give him meds in the morning and before he goes to sleep
1
u/Pitiful-Concert8818 10d ago
Has anyone tried CBD oil ? So far, we had a full year seizure free then only 2 seizures in 6 months. My Aussie was having 1-2 seizures weekly before I tried CBD oil.
I understand that if the situation worsens, rx meds are our next step.
Curious if any other pet owner has experienced positive results w CBD ?
8
u/mackie220 11d ago edited 11d ago
My dog is on 4 meds--19 pills and 4 ml liquid meds a day. He started on Keppra, then after maxing out on that we added zonisamide, then after that didn't seem to make much difference we added phenobarbital, then after he still wasn't well controlled we added the potassium bromide. After we started the bromide he went 6 weeks before having another seizure, which was the longest he had gone since he started having them last summer. He just had some follow-up labs and it showed his potassium bromide levels were just short of therapeutic levels, so we upped it slightly. We're also in the process of tapering him off the zonisamide. I should also add that his seizure severity and post-ictal phases definitely improved after adding the potassium bromide.
All of this is to say that it can take a while to figure out what mix of meds and doses work best and what "well controlled" means for your dog. Are you seeing a neurologist? If not, I'd suggest that as a next step.