Gosh we’ve had more than our share of seizure cases these last two months. These are interesting cases because by the time the parent or owner of the child or dog gets to the emergency room, the seizure is over. Ultimately it seems like it is the driver of the vehicle that would actually benefit more from the injection of valium as they are the ones that are usually upset and shaking with anxiety after viewing the seizure. If you’ve experienced seeing a human or animal with seizures, you know exactly what I mean.
A seizure is defined as a sudden, involuntary, time-limited alteration in behavior where the body’s motor activity, consciousness, sensation or autonomic functions are temporarily out of control and the brain’s electrical activity is out of rhythm. The body will be rigid with the head back (called opisthotonas). Tremors, unconsciousness, running, paddling limb movements and sometimes chewing movements occur along with SLUD signs (Salivation, Lacrimation, Urination and Defecation). Seizures usually last from 2-3 minutes but can last up to 15 minutes in severe and advanced cases.
Categorizing Seizure Activity: There are more than 30 specific types of epileptic seizures which we won’t go into here because I am not an expert on the subject, but generally seizures fall into two general categories–partial and generalized.
Partial seizures can be simple or complex.
- In simple partial seizures the patient seems conscious but exhibits sudden jerking motions with visual or hearing disturbances. These are the most common.
- Complex partial seizures originate in the temporal lobes of the brain, are involuntary and manifest as repetitive behaviors, random movements and are not remembered by the patient after the event ends. The human or animal appears dazed and unresponsive at the time of the seizure.
Generalized seizures involve many parts of the brain. Generalized seizures are further categorized into petit mal (absence seizures) and grand mal (tonic-clonic) seizures.
- Petit mal seizures usually happen in younger patients, last for shorter times and involve brief lapses of consciousness, staring, blinking, rolling of the eyes and arm movements. Return to full awareness happens quickly.
- Grand mal or tonic-clonic seizures manifest as a stiffening of the body progressing into jerking movements and a loss of consciousness. These types of seizures are often accompanied with loss of bowel/bladder control and shallow breathing.
Status epilepticus is a generalized seizure lasting longer than 15 minutes without recovery into consciousness. These are life threatening.
Common triggers: Often a trigger or aura will accompany the seizure. Common triggers are: Lack of sleep, hormonal or menstrual cycles, alcohol, smoking, stress and flashing or flickering lights. I once had a student with seizures affected by the light ballasts going out in the florescent lights of our classroom—as they flickered it triggered a seizure.
The Pre-ictal phase: Some people experience an unusual physical sensation before the onset of a seizure. This aura, which varies by individual, can be a strange taste or odor, a tense feeling, or even a sound.
In addition, not all seizures are the result of epilepsy. Other rule-outs (non-epileptic events in this case) that cause seizure activity include: narcolepsy, heat stroke, tetanus, cardiac arrhythmias, pre-eclampsia and low blood sugar. Getting a good history on the seizure victim will help eliminate most of these rule-outs.
The Seizure Diary: One helpful thing that can be done to help diagnose the core cause of seizure activity is to keep a record of seizure activity. Log onto a calendar:
- When the seizure occurred
- How long it lasted
- If the bladder/bowels were evacuated
- If a pre-ictal aura was detected
- What time of day it occurred
- How close to a meal the seizure was and
- Any environmental or other activities that may have been different.
This information will help us rule in or rule out the core cause or causes of the seizure.
Finding the Core Cause of a Seizure: In both the medical and veterinary field the doctor will want to ask a litany of questions, perform a neurological exam, get a temperature, run blood work to check liver/kidney/pancreas and electrolyte functions or to see if there are indications of infections/parasites or cancer, perform a urinalysis, possibly do skull radiographs, an Electro Encephalogram (EEG) or even extract some cerebral spinal fluid from the spine to check for infection/parasites or cancer antibodies.
Even checking the animals toe nails to see if there is abnormal wear or shredding may tell us if the seizure was caused from chronic disease (wear on just one or two nails or feet) or the animal has just been hit by a car (nails will often be shredded as the animal tries to run away from being hit by a car so the likelihood of trauma-induced injury would be higher).
With these tests a practitioner should be able to narrow down the field to determine if this is a case of epilepsy, narcolepsy, fainting, behavioral disorder or something as rare as a transient vestibular attack.
I once had a beagle in my practice who belonged to a pharmacist that went into spasms when you touched its fur. His hair follicles were so sensitive and painful we thought it might be a form of epilepsy. He was maintained with nutritional support for quite some time but it was a dog you’d never want to trust around an infant.
Most times what these tests actually do is tell you what the seizure is NOT caused from which can be quite aggravating because you’re putting out a lot of money on cases like these and they usually don’t happen during office hours so emergency fees are also involved, but that’s the way it works.
So let’s go over some core causes of seizures and let me take you through the thinking process in a doctor’s mind, shall we?
Core causes of seizures can include congenital, infectious, metabolic, toxic, traumatic or environmental components:
Congenital causes of seizures:
- Primary epilepsy (also known as idiopathic which means we don’t know what causes it)
- Water on the brain- Down’s syndrome in humans and dogs with larger heads such as the Chihuahua, Pekingese, Poodle and Boston Terrier breeds have a higher incidence
- Lissencephaly (A rare brain formation disorder characterized by the lack of normal convolutions (folds) in the brain)—Lhasa apso is a predisposed breed for this
- Vascular malformation: Genetic defects in the liver (portal-caval shunts)
- Fat storage diseases
- Breeds of dogs susceptible to seizures include: German shepherds, beagles, Keeshonds, Tervuren shepherds, miniature poodles, cocker spaniels, golden retrievers, Labrador retrievers, Irish setters and highly inbred animals or animals having a father with only one testicle.
I once had several cases of epilepsy in a line of Pomeranians where the father of the dogs was an unneutered cryptorchid (only one teste had descended). He often bred his daughters and other relatives “accidentally.” He carried a weak gene that was passed to his siblings so we had many generations of pups with epilepsy. This is totally irresponsible by the way and any animal with epilepsy should be neutered in my opinion.
Congenital causes usually manifest in seizure activity at an early age so knowing the age of the animal/human is important.
- Bacterial: High fevers for extended periods of time can cause seizure activity
- Viral: Canine distemper (licking gum fits is a form of seizures), feline infectious peritonitis, meningitis, rabies
- Fungal: Cryptococcosis (more common in Southern states)
- Protozoal/Parasitic: Toxoplasmosis–passed by cats, severe cases of roundworms, Baylisascaris from exposure to raccoon feces, and Echinococcus tapeworms from the sheep-dog-human lifecycle
- Cancers—primary brain tumors or metastatic cancers
- Hypoglycemia: Diabetes, sepsis, starvation, endocrine disorders, liver disorders, over-exertion like in hunting dogs and some cancers that use up lots of sugar
- End stage liver disease
- Low blood calcium: Also called eclampsia or milk fever. This happens when a very pregnant animal or human does not get enough sugar in the system for duration of the birthing process-malnutrition pre-birth.
- Parathyroid problems
- Antifreeze toxicity causes secondary metabolic disorders within 24 hours
- Acute Pancreatitis
- Renal disease (increased creatinine or blood urea nitrogen)
- Intestinal malabsorption
- Acid/base electrolyte disorders
- Lack of oxygen to the brain
- Too much lipoprotein in the blood affecting the brain
Toxins: Lead, organophophates, carbamate, chlorinated hydrocarbons, strychnine, slug bait (metaldehyde), alcohol (delirium tremors), xanthenes like theorbromine, diet pills, mood elevators, tea, coffee beans and chocolate or other forms of caffeine overdose, nicotine or tobacco overdose
Foolish or uneducated owners force their pets to ingest a wad of tobacco for worming purposes but nicotine and it overdoses their nervous system. Nicotine is also in some insecticide sprays.
Alcohol/drug withdrawal: Even taking away alcohol or drugs can cause the body to have a seizure when it’s not done correctly. It’s good to tell all your secrets (no matter how embarrassing that may be) to your doctor so we can help you.
Trauma to the head: Trauma to the head can instigate damage the electrical pathways (primary cause) or be responsible for secondary vascular problems.
Vascular problems and disorders: Inflammation of the arteries, blood clots, plaque or hardening of the arteries.
Environmental influences can decrease seizure thresholds.
Idiopathic–meaning we don’t really know what caused the seizure to occur. Unfortunately for most practitioners most of the seizures fall into this category after running the gambit of tests which is why I like muscle testing. It seems to give us more answers and something we can DO to attend to the core cause.
Treatment of Seizures:
Most medical doctors and allopathic vets are taught to control seizure activity with medications. Many of the medications are damaging to the liver so several blood tests are usually done to monitor the dose of anti-seizure medications. The medications and blood testing are continued for the life of the animal or human. I prefer this as a last resort.
We like to find the core cause of the seizure and eliminate what we can, minimize what we can or send the patient/client for the correct procedures to overcome the whole seizure thing altogether.
Often just some well-placed wormers, herbs, detoxifiers (like carob, dark leafy green vegetables, burdock or other liver cleansers), or fats (like a half piece of bacon each day for dogs and some people or some extra fats in the diet—saturated or unsaturated depends on the patient’s needs) will do the trick. Sometimes we will dispense a product called Min Chex (a Standard Process Product) which helps the brain repair the electrical pathways between the left and right sides of the brain.
A well-balanced food is always in order here. Dogs and humans who are epileptics can’t miss too many days of the diet that works for them and still stay in remission in some instances.
I always recommend that the person or owner see the movie First Do No Harm. This movie discusses the Ketogenic diet which is often so helpful for epileptics. We believe that the body knows what it needs and most of the time it can tell us what it wants and how it wants to be treated through the use of muscle testing. For more on the ketogenic diet see the link at the bottom.
Every once in a while one of these cases will have to be managed with light doses of anticonvulsants such as Phenobarbital, primidone, phenytoin, valproic acid, Clonazepam or valium but if we can find that core cause and take care of that we aim to keep these drugs at a minimum and for short periods of time.
Helpful Links and References:
- Seizure categories: http://www.theuniversityhospital.com/epilepsy/html/aboutepilepsy/seizures.htm
- This is a wonderful must see TED talk (18 mins) discussing The Realm of Caring organization out of Colorado and the use of medical marijuana (cannabadiol) for the use of chronic epilepsy. the strain of the marijuana is called Charlotte’s Web and is named after a 6 year ol little girl whofor the first time in her life is nearly seizure free. this organizations if fielding over 4000 calls/month. http://www.upworthy.com/think-marijuana-is-for-stoners-meet-a-6-year-old-girl-who-might-just-disagree-with-you-on-that?c=reccon3