Goals of Treating Epilepsy
Epileptic seizures – especially status epilepticus and serial cluster seizures - can be life-threatening and become a true medical emergency. They should be treated quickly and aggressively. The primary therapeutic goals for any epileptic dog are to reduce the frequency and severity of seizure activity and increase the seizure-free interval to a point that the dog and its owners can maintain and enjoy an acceptable quality of life. Depending on the particular animal, daily medication may or may not be necessary to effectively control the disorder.
When a dog presents with an acute, active seizure, the usual initial treatment is intravenous administration of diazepam (Valium) or another drug to effect. Diazepam is a tranquilizer used as an antianxiety medication, a skeletal muscle relaxant, an anticonvulsant and an appetite stimulant. If this does not stop the seizure, most veterinarians turn next to intravenous administration of either propofol or pentobarbital. Propofol is a quick-acting anesthetic agent that lasts a very short period of time. Pentobarbital is a short to medium-acting barbiturate that acts as a hypnotic sedative. Phenobarbital may be used along with fluids to manage recurring or acute seizures as well; it is a hypnotic, sedative and anticonvulsant agent. Obviously, both the condition and its treatment must be managed extremely carefully by a skilled medical team in-hospital, and the attending veterinarian is the only person who can best determine the appropriate treatment regimen.
Chronic treatment may include administration of phenobarbital or potassium bromide. If these do not successfully manage the seizure activity, a second drug or drugs can be added to the treatment protocol depending on the treating veterinarian’s preference and recommendation. In refractory cases where a dog has intermittent cluster seizures, it may be possible for the owner to administer diazepam per rectum at home under a veterinarian’s supervision.
Any drug can have potentially adverse consequences and/or adverse interactions with other drugs in a given patient. Owners should discuss the potential side effects of any drugs prescribed for use in their epileptic dog. Periodic blood draws to assess serum concentrations of prescription drugs and to make any necessary dosage or drug adjustments are essential to ensure that the medications are reaching but not exceeding their target range. Many dogs on medication for chronic epilepsy tend to put on weight; their diets should be carefully managed.
Non-traditional adjuncts to medical treatment of epilepsy may include acupuncture, dietary changes, massage therapy, homeopathic or herbal “remedies” or other alternative methods that may or may not be helpful for epileptic dogs. Again, a veterinarian is the best one to address all potential treatment and management options, including those that may provide temporary relaxation or comfort rather than effective management or cure.
Most dogs with idiopathic epilepsy can be well-managed medically with phenobarbital and/or potassium bromide and can live a long, essentially normal life. It is quite helpful to veterinarians if owners keep track of the date, time, length and severity of their dogs’ epileptic episodes. Life-long treatment usually is necessary. Unfortunately, dogs with recurrent status epilepticus seizures that last more than 5 minutes have a poor prognosis.