Idiopathic epilepsy in dogs: living with seizures over the long term

Idiopathic epilepsy is a diagnosis of exclusion: it is reached after reasonably ruling out the other causes of seizures, such as poisoning, metabolic disease, malformations, inflammation and tumours. For that reason a first seizure does not automatically equal a diagnosis of epilepsy, and the diagnostic path depends on the dog's age, on whether there are signs between seizures and on how often episodes occur.

Some breeds have a documented predisposition, a sign of an inherited component, but the diagnosis remains clinical rather than genetic. The crucial distinction for the owner is a different one: an isolated seizure in a dog that is well between episodes means something very different from seizures that recur close together. Knowing which scenario you are in is the first step in deciding, together with the vet, whether and when to start treatment.

Not every dog that has had a seizure is put on medication, and not everyone is started straight away. The decision weighs the risk of the seizures against the commitment and possible effects of a treatment that, once begun, usually continues for life. There are situations, though, where most neurologists agree it is worth starting without waiting.

• More than one seizure within a six month window, or seizures that become progressively more frequent.
• Cluster seizures, meaning two or more episodes within twenty four hours with a return to consciousness in between.
• Status epilepticus, meaning a seizure lasting beyond a few minutes or one that will not stop: this is an emergency that must be handled at the clinic and changes the later approach.
• Particularly violent or prolonged seizures, or ones followed by a long, exhausting recovery phase.
• An identified underlying cause that itself calls for specific treatment.

Choosing the molecule, the dose and the blood tests needed to monitor it is the vet's job, ideally with a neurologist's support in the more complex cases. The owner's role begins afterwards: it is the owner who makes the treatment effective day after day.

Antiepileptic drugs work by keeping a steady concentration in the blood. Missing a dose or giving it at widely varying times makes that concentration swing and can favour a seizure. Regularity, then, is not a matter of tidiness: it is an integral part of the treatment, as much as the chosen molecule.

1. 1

   Set precise times and keep to them

   If the drug is given twice a day, choose two times a constant interval apart and keep them even on holidays and while travelling. A recurring reminder cuts missed doses almost to zero.

2. 2

   Prepare a rule for the missed dose

   Agree in advance with the vet what to do if a dose is missed: the rule varies with the molecule and with how much time has passed. Having it written down avoids improvised decisions at the wrong moment.

3. 3

   Never stop abruptly

   Stopping an antiepileptic suddenly can trigger seizures, sometimes severe ones. Any dose change or switch of drug should be done only on instruction and gradually.

4. 4

   Keep to the blood tests

   Drug level testing and monitoring of liver and kidney function keep the treatment in the useful window and prevent build up. Note the dates and do not put them off.

5. 5

   Keep a supply and check expiry dates

   Running out even for a day is an avoidable risk. Order the refill in good time and check the expiry date on each new pack.

Many early side effects, such as drowsiness, increased hunger and a slightly unsteady gait, tend to ease as the dog adapts. They should still be reported to the vet, because they sometimes signal a dose that needs reviewing. The rule is simple: report everything, change nothing on your own.

The vet makes decisions based on what happens between visits, which almost never coincides with a visit. A well kept seizure diary is the most valuable thing an owner can bring, far more than a vague memory along the lines of she had a seizure last week. Every episode should be logged at once, not from memory.

Recording everything in one place, with dates next to medication times, turns scattered impressions into a readable trend. That is how you notice that the intervals between seizures are shortening, or that episodes tend to follow a change in routine, information that escapes the naked eye and yet guides the next treatment decision.

A well managed epileptic dog can do almost everything it did before: walks, play, social time. A few precautions reduce the risks tied to unpredictable seizures and make the overall picture more stable.

• Keep the routine as regular as possible: meals, sleep and activity at consistent times seem to help stability in many dogs.
• Avoid situations where a sudden seizure would be dangerous, such as swimming alone or ledges to fall from.
• Do not dismiss stress and extreme tiredness as possible triggers, while still not living in dread of the next episode.
• Check any new drug, parasite treatment or supplement with the vet, since some substances can lower the threshold or interfere with the treatment.
• Involve the whole household: anyone who gives the medication must know the times, doses and what to do during a seizure.
• Do not chase the perfect dose on your own after every single seizure: decisions are made on trends over weeks, not on an isolated episode.

It helps to know in advance when a seizure becomes a true emergency: an episode that will not stop within a few minutes, several seizures close together without full recovery in between, or persistent breathing difficulty all call for the clinic at once. Knowing where to go and the number to call removes precious time lost to hesitation.