Canine seizure basics

So for the first monthly report of seizure updates I thought I would go “back to basics” with regard to canine epilepsy and particularly psychomotor seizures.

First thing to understand is that epilepsy is a neurological disease. It is like an electrical firestorm in the brain. Seizures are the consequence of that electrical firestorm. However, those electrical firestorms can occur from epilepsy, brain tumors, encephalitis, infection, head trauma, stroke, Alzheimer’s, and many other sources. Epilepsy happens to be the disease of repetition of seizures.

There is primary or secondary epilepsy. Primary epilepsy is essentially a diagnosis of exclusion. This is also referred to as genetic or idiopathic epilepsy. This is Reggie’s diagnosis (idiopathic epilepsy). It presents between the ages of 1-5 (Reggie was 3) and has no known reason or cause. Secondary epilepsy is a diagnosis for which there is a reason. For instance hypothyroidism, kidney or liver damage, or a brain tumor.

The most common types of seizures are grand mal and partial seizures.  Grand mal seizures are recognizable; your dog falls, stiffens as the muscles contract and spasm, there is a loss of consciousness, there can be chewing motions, paddling of the limbs, pupillary dilation, respiratory distress, and loss of bowel and bladder control. Partial seizures affect only a partial area of the body; a jerking or twitching of the head say, or the trunk, facial twitches, etc.

Rare types of seizures are petite mal (also called absence) seizures, and complex partial (formerly called psychomotor or behavioral) seizures. In humans, petite mal seizures are marked by brief periods of unconsciousness, blank stares, and looking skyward. Depending on the source, some articles indicate that petite mal seizures do not occur in dogs, or is a term misused by vets because it is actually a different disorder. Complex partial seizures is what Reggie has (the new terminology) and these are complex behaviors or actions that are repeated during a seizure episode. Depending on the area of the brain affected, the behavior or action can  be very different. For instance, humans can experience distortion of thought, emotion, perception (like fear, deja vu or jamais vu) and this can be accompanied by visual, auditory or olfactory sensations. While there is a lack of awareness, almost an amnesiac state, there is not usually a lack of consciousness. Translate this to a canine world and symptoms are fly-biting, lip smacking, pupillary dilation (temporary blindness or blurred vision), howling, whining, running, cowering, hiding, loss of bowel or bladder control, and sometimes aggression.

Cluster seizures or status epilepticus are both very serious situations that require emergency medical attention. Cluster seizures are multiple seizures occurring within a short time frame. Status epilepticus is essentially the same, with two tweaks. One seizure lasting 30 minutes or longer or multiple seizures in a short time frame without regaining consciousness. Reggie’s vet has a rule: no more than three seizures in one hour, then you are at a cluster threshold. When Reggie first presented he had 14 seizures in a little more than 12 hours. He has had one other cluster seizure episode. He had six seizures in about two hours- the time it took me to assess is he going to have another? and then call the ER and get him up there. The vets have to break that seizure cycle and determine if medications need to be adjusted.

There is a term called the “seizure threshold”. If your dog has a low seizure threshold, he is susceptible to triggers- missed or late meds, heat, certain foods, etc. that can potentially trigger a seizure. If your dog has a high seizure threshold, he can withstand more of these things than a low threshold dog can. Studies show that dogs with idiopathic epilepsy (like Reggie) have a distinctly low threshold.

Repetitive uncontrolled seizures can lower that threshold. Remember that electrical firestorm? The epileptic neurons in the brain recruit normal neurons back to epilepsy base camp, thereby enlarging the area of the brain that produces seizures. This larger base camp now has increased excitability (that firestorm) and increased ability to cause seizures, regardless of outside triggers. There is also a “mirror” phenomenon in the brain. Let’s say the seizures are occurring in a specific area in the left hemisphere of your dog’s brain. In an EEG, the abnormal brain wave patterns would show up. In a matter of weeks the right hemisphere will start to show similar brain wave abnormalities and would be capable of causing seizure activity on its own.

The seizure itself. There is the prodome (which can include the aura or be a separate stage), the seizure, and the post-ichtal stage. The prodome stage can last for hours or sometimes days. It can include mood changes, lethargy, and behavioral changes. Reggie will act very clingy and follow me around. I think he has that feeling that something is coming and he is scared, unsure, and follows me around for comfort. Once when we were walking we met two huskies and when the dogs met each other the huskies whimpered and backed away from Reggie. Reggie just stood there, unreactive. Later that night he had a seizure. Dogs know stuff. Most seizures occur when the brain is shifting into sleep/wake cycles. In other words, in the morning, at night, or during sleep. During the seizure keep your dog safe. Keep your dog away from stairs and pools. The post-ichtal phase can leave your dog disoriented, confused, the temporary blindness may not have worn off, and sleepy. Your dog is conscious but not really functioning- don’t go running. Reggie sleeps for several hours after a seizure.

Keep a seizure journal and call your vet every time your dog has a seizure. Note what works and what doesn’t- Reggie is comforted by my presence but I do not need to use my voice or my touch. I learned the very first time he can exhibit aggression if he is touched at all during a seizure, and really there is no reason to touch a seizing dog unless I need to grab him away from the stairs. Keep straight with your medications, never change dosages, skip doses, or stop without consent or knowledge of your vet. Reggie takes two separate meds four times a day, and yes it’s a burden on your schedule sometimes, but his health and longevity are far more important.

I will never forget the day that Reggie started having seizures at a friend’s house. I think this friend is scarred now because once you see this type of seizure you will never forget it. Epilepsy is a manageable disease. It seems daunting and terrifying but you can handle it!

Psychomotor seizures in dogs

Just two months before his fourth birthday, Reggie experienced his first seizure. The situation was so terrifying because he was having psychomotor seizures, something completely unknown to me at the time. He had cluster seizures- fourteen in less than a 24 hour period before the cycle was broken and the medication was correctly dosed in his system.

The weekend after Labor Day one of the county water parks opens the park for a dog swim. We arrived, parked the car and started walking towards the registration tables. Once on the sidewalk, Reggie started whimpering, backing up as if something spooked him and urinated. I looked around thinking there was another dog or animal that scared him and he was walked to the grass off the sidewalk to relieve himself. He seemed scared, frightened of something. His tail was curled underneath him and he was skittish.  We walked him back and forth to “shake it off” and after a few minutes he seemed ok so we proceeded to the registration tables.

While waiting in line, I heard Reggie whimper again. Before I continue you have to understand something- Reggie does not bark, growl, whimper, howl, anything. He only barks at the mailman (cliched I know, but true) so if he makes noise something is wrong.  As I looked down Reggie whimpered and howled and then backed up and pulled out of his collar and took off running. This is so out of his normal, well behaved self I cannot even express the stunned fear that was running through me. Thankfully he did not run backwards into the parking lot and ultimately into the street, but forwards past the registration table and into the locker rooms. We found him in the men’s room cowering

At home after water park

At home after water park

next to a toilet. When he calmed, he came out and he seemed, again, skittish, but fine. He seemed like he was spooked by something. We went into the pool/park area and walked around for a few minutes. He entered the zero-entry pool and then immediately bolted and started running again. He ran for the gate and tried to run out of the park, in the process shredding his nails to the quick and bleeding everywhere. He calmed after a minute and the mobile medic bandaged his feet and we went home.

Once at home, he was laying in his bed and we thought ok whatever this is it’s over, he’s resting when his head popped up he started howling and then started running for the front door. I jumped up and slammed the front door because he most certainly would have run through the screen. Instead he started running through the house, ultimately finding a hiding spot between the nightstand and the bed. In subsequent episodes, he squeezed between a kitchen cabinet and the wall, and underneath the desk. During one episode I made the mistake of trying to restrain Reggie and keep him from running around the house. I did this because he had already injured his leg and gotten a small cut. I got bit trying to restrain Reggie, not bad- just a scratch, but shocking nonetheless. When that happened I called the ER vet. They obviously couldn’t recommend or diagnose anything over the phone, but suggested that since it was not a singular incident and it was so out of normal that it was not behavioral and he should be brought in. Shortly after speaking to the ER vet Reggie had another incident in the house, only now he was urinating and defecating during the episode. This happened twice. Now we knew without a doubt something was medically wrong; he was not spooked by something and it was not behavioral.

So just a few hours after the ill-fated dog swim we took Reggie to the ER vet. He had an episode right in the lobby and defecated on the rug. They immediately took him back and began an examination. Their first concern was poisoning. We were absolutely sure this was not the case. Their second concern was neurological, but nobody mentioned seizures at this time. They wanted to run tests and keep him overnight and we of course agreed.

Because it was an ER clinic they are only open during off hours, so I had to pick Reggie up that next (Monday) morning and transport him to his regular vet for continuing care. When I arrived at the ER, they indicated that the bloodwork was fine, the ultrasound was fine (no tumors), and they had him on Valium to keep him calm. I remember thinking so…my dog is ok or not ok? I soon learned the answer was not ok. He still had the catheter in for the IV, which once we were in the car he pulled out and bled all over the car, all the way to the vet, turning the car into a massive haz mat situation. The vet had no idea what had happened because it happened on a Sunday, so I had to call and brief them on the whole situation on the car ride there and what was going to be arriving.

Reggie’s vet is awesome. They of course have already spent a lot of time with him at this point because of his allergies, and it was about to become a whole lot more. I arrived in tears at 8:00 am with a bloody dog that was still not quite right and they took him right back and told me they would call as soon as they had received the ER paperwork and had it figured out. Well they figured it out, and called me at lunch time. Reggie had idiopathic epilepsy. And not just any kind but psychomotor seizures. What??? I’ve never even heard of that. All of that strange behavior we saw- those were seizures. I can’t begin to tell you how awful I felt for not responding quicker to the behavior. The only excuse I can offer is that this isn’t common. These aren’t grand mal seizures and you wouldn’t recognize them for such if you didn’t specifically know what they were.

Reggie came home at the end of the day after (finally) the Valium broke the seizure cycle and a loading dose of phenobarbital was started. Phenobarbital has some significant side effects and he was very wobbly, sleepy, and “drunk” for a few days. The veterinary response was fantastic- I can’t stress that enough. We were sent to a specialty hospital two days later (Wednesday) for an MRI to rule out encephalitis and brain tumor. Even though Reggie was in the right age range to present with epilepsy, to have so many as an initial episode is highly unusual. The MRI was fine and we continued.

In the past two years, Reggie has been hospitalized only one other time for experiencing cluster seizures. This required an overnight stay and a readjustment of his phenobarbital dosage. This past year Keppra was added as a secondary medication. He was beginning to experience about one seizure a month, and our vet’s rule of thumb for good seizure control is no more than one every three months. In the past nine months, he has only had one seizure so the addition of the secondary medication is working well.

When Reggie was diagnosed I googled psychomotor seizures every which way you can think of to find information. There was precious little information, and any canine epilepsy information was about grand mal seizures. While writing this, there is way more information now than there was two years ago! From The Free Online Medical Dictionary psychomotor seizure is

motor seizures accompanied by a psychic stage. There are hallucinations, salivation, pupillary dilatation, mastication, fecal and urinary excretion, and wild running. Seen in dogs with lesions in the pyriform lobe or hippocampus and from poisoning with agenized flour (canine hysteria). Called also running fits.

There are a host of sites now that discuss canine epilepsy, and even mention psychomotor seizures. Some of the information I found misleading, and some videos on YouTube I found downright upsetting. Everything that I have learned in the past two years, from Reggie, his vet, and his neurologist is summed up here.

The definition above is pretty succinct. These seizures are typically no different than what can occur for a human in which there is a prodome or preliminary stage in which the dog might act strangely the day before, or hours before. Because of the area of the brain that is affected, there is a temporary blurred or loss of vision, or hallucinations. This is what’s happening when Reggie starts staring off into space or staring at the ceiling like there is something in the attic. There will also be pupil dilation. One trick we learned- if you can’t tell take a flashlight and shine it at his eyes to see if there is any pupillary response. One important distinction of a psychomotor seizure from a grand mal seizure is the animal does not lose consciousness.

Then the whimpering, whining, howling begins. As it was explained to us, this is a reaction because they don’t know what’s happening to their body at that moment. They are frightened, they may have just gone blind or seen a hallucination and now there are these sensations in their bodies they don’t understand. The instinct is flight. During flight, they are a danger to themselves and others. Don’t try to restrain them (that was how I got bit), keep them away from stairs and open water. Other common behaviors are tail chasing and biting the air. Just be around them to prevent them from hurting themselves and wait it out. That first day, Reggie shredded his feet, cut his leg, and got a cut over his eye. They will be non-responsive to you.

It will be over, and then the post-ichtal phase starts. It’s kind of a hangover. Reggie sleeps. When it’s over, he generally finds a safe spot (like my bed) and curls up and sleeps for a significant amount of time.

Rules to remember: one seizure longer than 5 minutes- go to the hospital; more than 3 seizures in one hour- go to the hospital; no more than one seizure every 3 months. Every seizure raises the body temperature. This is why it is important to get your dog to an ER if they having cluster seizures or an extended seizure. Normal body temperature for a dog is about 100-102 degrees, and a dangerous zone is 104 degrees with organ failure starting at 105 degrees. We were lucky that first day that Reggie’s body temperature never reached a danger zone; we never even knew better.

I have seen videos on YouTube while writing this of people who have taped their dogs having seizures. I get it- information sharing is helpful especially when there is so little of it on a topic like this. However, there was one video of a dog having a reported seizure in a video that was 4 minutes long. I won’t post the link but I will say this- if you already have the knowledge that your dog has seizures and you have the wherewithal to video this incident that lasts 4 minutes long, at a certain point you should realize this is abnormal and take the dog to the hospital instead of watching Wheel of Fortune. Other videos are informative and heart wrenching as they remind me of the confusion, fear, and disbelief during that time. You are the advocate for your dog.

One last thing learned: after Reggie’s Houdini act at the county park, he was switched to a Martingale collar (he was wearing a simple buckle collar). This collar is designed for dogs whose heads are smaller than their necks- greyhounds, Afghans, etc. It is a no-slip collar that can be adjusted to their neck size and tightens when the dog pulls but without the strain on the larynx and throat the way a choke chain would.

Psychomotor seizures are a serious, life-long thing Reggie deals with. If you deal with this with your pet, I encourage you to share your story, your resources, because there is precious little out there about this condition. I envision a resource page on Reggie’s House coming soon!