By Erica Tramuta-Drobnis, VMD, MPH, CPH
Differentiating seizures from vestibular disease, syncope (collapse), or other neurologic disorders can be challenging. Signs of one illness can look very similar to another. Always consult a veterinarian if your pet is showing any strange behaviors.
How do I know if it’s really a dog seizure?
Dogs can present with many signs that suggest neurological disease.
Many people lump these signs together and call them a seizure. However, unless obvious tonic-clonic activity is witnessed, a description alone may be enough for your vet to determine if the activity is, in fact, a seizure. Tonic-clonic activity is a stiffening alternating with jerky twitchy movements. It can be hard to describe and mimic other things.
During the seizure-like activity, time seems to slow to a crawl to the observer. But no matter what signs you are seeing, always remember to videotape it. Seizure activity often lasts only a few seconds to a minute, so time is of the essence. Getting that video and showing it to your veterinarian will help with diagnosis, testing recommendations, and determining when intervention is appropriate.
Clinical signs of seizures in dogs
Clinical signs of true seizures can be subtle or blatantly obvious. They may include
- Biting at nothing, chomping, fly-biting, or seeming to chew on the tongue
- Pacing, wandering aimlessly, sometimes circling
- Unsteadiness on the feet
- Standing and staring blankly at the wall or other object
- Collapsing to the floor
- Muscle tremoring and or twitching
- Stiff muscles
- Lack of focus, lack of response when called
- Paddling and swimming on the floor
- Going to the bathroom without being aware (urination/defecation)
- Loss of consciousness
- Less commonly seen are behaviors such as tail chasing or hyper-focusing on an object
- Sometimes the signs are very subtle such as a strange bark or other repetitive sound or movement
Seizures usually have 3 stages. The first or pre-ictal phase varies with each patient but may include staring into space, anxiety, drooling, even vomiting. The seizure phase or ictal phase is when the above signs occur. Finally, concluding with the post-ictal phase. This period can last a few minutes to longer depending on the dog and the severity of the seizure. During this phase, the pet may not recognize its owner. They can be aggressive, hide, run into walls, or have other abnormal behaviors such as pacing, panting, or urgently seeking out food or water.
Clinical signs of vestibular disease in dogs
The vestibular system works to maintain balance. It comprises portions of the brain and the inner and middle ear. Signs of a problem with the center of balance can mimic seizure-like activity. Causes may include cancer of the brain, inner or middle ear infections, old dog vestibular disease (an older dog problem with no known cause), among others. Signs may include
- A head tilt
- Head shaking
- Circling to one or both sides
- Abnormal eye movement side to side, up and down or rotational (nystagmus)
- Abnormal eye position (strabismus)
- Inability to right themselves (The pet may fall down and then have trouble getting up. When trying to get up, the dog can look like it is seizuring. The dog may struggle to get up, get frustrated, lose its balance again, and fall back over).
- Walking with a strange gait – wobbly, awkward, high stepping or other changes (ataxia)
- Broad-based stance
- Falling to one side or the other
- Rolling back and forth
- Head swaying
- Nausea +/- drooling
- Abnormalities with nerves of the face (cranial nerves)
Clinical signs of syncope (collapse) in dogs
Finally, fainting, aka syncope, can seem like seizure activity and is often described by owners to a veterinarian as a seizure. The event may have been preceded by exercise or exertion but can occur at any time.
With syncope, the pet simply loses all muscle tone and collapses. Once the episode passes, depending on the underlying cause, the pet may simply get back up and be 100% normal or may remain weak and unable to stand but become mentally alert. These pets can also experience muscle spasms that are jerky in nature, making them mimic seizure-like behavior.
Causes of syncope may include heart disease, abnormal heart rhythms (too fast heart or too slow heartbeats), cancer, stroke, blood loss, medications, low blood sugar, low red blood cells, coughing episodes, or having something blocking the airway.
One difference between syncope and seizures is that when a dog simply faints (doesn’t have a seizure), it usually has minimal to no abnormalities immediately before it collapses. Once the episode resolves, the dog often returns almost 100% to normal immediately after the event.
Common causes of seizures in dogs
So, you now think your dog indeed had a seizure. What could be the cause? Causes depend on the pet’s age and other factors such as breed, genetics, sex, predisposing illnesses, or traumas. And even if it looks like one, what you see still may not be a seizure.
Common causes of seizures in dogs include
- Low blood sugar (not enough energy)
- Brain trauma
- Cancer (brain tumors or cancer that has spread to the brain from another site)
- Toxins such as ingesting human medications
- Liver disease
- Low red blood cell count (anemia)
- Very elevated body temperature (hyperthermia; heatstroke)
- Low or high blood calcium levels
- Electrolyte abnormalities (problems regulating sodium, potassium, or chloride)
- Idiopathic (in other words, no known cause) Epilepsy: epilepsy itself just means 2 or more seizures occurring without a known trigger
- Genetic links have been identified in several breeds, though these are not the only breeds in which epilepsy is diagnosed.
- Dogs who have epilepsy should never be bred.
- Male dogs present with epilepsy more than female dogs.
- Breeds commonly associated with epilepsy may vary depending on where you live
Breeds with known mutations leading to seizure disorders or other widely recognized breeds
- American Staffordshire Terrier*
- Australian Shepherd*
- Belgian Shepherd*
- Bernese Mountain Dog*
- Border Collie*
- English Springer Spaniel*
- German Pointers
- German Shepherd*
- Golden Retriever*
- Huskies and other arctic breeds
- Labrador retrievers*
- Miniature Schnauzers
* a specific genetic link has been identified.
Regardless of the type of seizure, the triggers for the attacks vary and may never be determined. However, sometimes triggers can be identified.
Common seizure triggers in dogs:
- Stress – a change in the routine because of construction in the home or sudden noises made by fireworks
- New treats, people food, or an abrupt change in their everyday dog food
- Puppies – failure to eat for even just a few hours depending on the age and size of the puppy can lead to low blood sugar inducing seizures.
- Diabetics – Seizures occur when their blood sugars drop too low because of an insulin overdose or dysregulation in their diabetes for various reasons
- Excitement – Some dogs may seizure only with extreme stress, such as veterinary visits, car rides, or other stress-related stimulation.
- Other underlying diseases – Having another illness of any kind could lower the seizure threshold and increase the risk of seizures.
- Some medications – some of the flea/tick preventatives may increase the risk of seizures in dogs with an underlying seizure disorder.
How can your vet diagnose a seizure disorder?
Whether you want to know the actual underlying cause or you just want to medically treat and support your pet is entirely up to you. However, let’s discuss a few things that your vet will recommend doing to get to the root of the problem.
You’ll want to ensure your veterinarian gets a complete history and performs a physical exam, including a thorough evaluation of the ears, to evaluate the eardrums and the eyes.
Blood and urine should be evaluated to rule out underlying kidney disease, blood sugar, or electrolytes problems.
If no known trauma or toxin exposure exists, additional diagnostics depending on the owner’s need to know, finances, and availability may include
- Examination with a board-certified neurologist – This is always an option. Many general practice veterinarians are comfortable managing most seizure disorders. However, cluster seizures, the need for multiple medications, drug side effects, and other factors may make regulation a challenge. Board-certified neurologists can help both in the diagnosis of the type of seizures your pet is having and the overall management of them.
- Chest and belly radiographs
- An abdominal ultrasound
Idiopathic epilepsy is a diagnosis of exclusion, meaning we don’t find another reason for the behavior.
Epilepsy usually occurs in dogs up to 7 years of age, and some seizures may begin in puppyhood. With seizures starting after seven years of age, we become more suspicious of another underlying cause.
However, you don’t need a definite diagnosis to start preventative therapy.
Many owners, for assorted reasons, including cost concerns, elect not to do a full work-up. If the pet is < 7 years of age, epilepsy is a reasonable assumption, and therapy can be initiated without advanced testing.
Suppose the pet doesn’t respond to medications, additional signs develop, or the seizures become hard to control. In that case, diagnostics should be pursued as there could be something other than epilepsy causing the seizures.
Treatment for seizure disorders
We aim to treat the underlying problem when feasible. If low blood sugar causes a seizure, treating the low blood sugar should resolve the seizures.
However, seizures may continue or worsen despite medications and supportive care in some conditions, such as a portosystemic shunt (liver disease) or brain tumors.
Prescription medications used to prevent seizures in dogs include
We have several anti-seizure medication options for seizure prevention, including
- Keppra® (Levetiracetam) – This is this author’s first choice. It can be costly for large breed dogs when using the extended-release (ER) version. However, it has minimal side effects with only a rare chance of liver effects. It usually is well tolerated, with a short-lived wobbliness or sleepiness until they get used to it. It may be given every 8 hours (regular release) or every 12 hours (ER). Drug levels are not commonly evaluated unless there is a concern for toxicity, but monitoring liver and kidney values 1-2 x per year is recommended.13
- Phenobarbital – Many vets still reach for this medication first. Tried and true for sure, but commonly known to cause liver disease in many patients. It can be costly and is a controlled substance. Side effects include sedation, increased drinking, urination, and appetite. It requires routine drug therapeutic level monitoring in addition to routine bloodwork.14
- Potassium Bromide (KBr) – Side effects may include sedation, increased drinking, urination, and appetite, among other signs of constipation, pacing, or irritability. This also requires routine drug level monitoring and regular bloodwork.15
- Pregabalin – This can be costly for larger breed dogs, but a generic is now available. It is a newer drug, so fewer studies to date are available. Often, neurologists use this as an add-on medication.16
- Zonisamide – Veterinary neurologists and experienced general practitioners find this drug is insufficient as a first-line drug. Still, it may be helpful as an add-on. It may cause sedation, wobbliness, and decreased appetite. Additionally, liver side effects are not uncommonly reported.17
Note: Gabapentin was developed as an anti-seizure medication in people. However, ineffective for seizure control, it is now used for neurologic and general pain syndromes both in people and dogs. While good for pain management, for seizures, it is not considered an effective first-line single therapy in dogs. if this medication is used for pain management in a seizure patient, it should not be abruptly stopped but weaned to minimize the chance of seizure occurrence.
Factors to take into consideration when selecting a starting medication for dog seizures
- The side effects and risks of the medication
- The onset of action – some drugs, like Phenobarbital, can take 2-4 weeks to reach therapeutic levels in the blood, and so without hospitalization after severe seizure occurrences, this may not be the best first choice
- The cost of the medication
- The amount of bloodwork, frequency of bloodwork, and drug monitoring needed
- The frequency of administration of the med (1, 2, or 3 times daily)
- The owner’s ability to administer the medication (does it come as a liquid, capsule, or tablet)
- The severity and frequency of seizures
- Any other medications the pet is taking that could interact with the seizure drug
- Individual veterinarian preference
Know that once medications are started, they are for life! Missing a dose can lead to a seizure! Not following up with your vet for routine blood monitoring could lead to serious complications.
No medication is without risk. However, some are safer than others. Some dogs may be weaned off over time, but these dogs may not have needed the medications in the first place. That is why knowing when to begin therapy is essential.
Over-the-counter dog supplements or vitamins for epilepsy
Do not buy into the tons of products out there that claim to support neurologic function. Unless scientific studies are used to back up the claim, and the product is registered with the FDA, any claim that a product has is simply made to sell the product. Sadly, many products like this exist.
Many ask about marijuana/CBD oils and related products. Currently, research is ongoing in using various CBD-related products and the management of seizures. There are no veterinary-approved CBD products.
Legally, veterinarians cannot prescribe or recommend these products in most states because they are not federally approved or regulated. Early research suggests there may be a benefit in their use as an adjunct therapy but not as the sole preventative measure in seizure disorders.
Talk to your veterinarian about any supplements you already give or if you would like to consider additional products.
Diet for epileptic dogs
The biggest recommendation here is never abruptly change your dog’s food. This goes for any pet, seizure disorder or not.
Any sudden change in diet could trigger a seizure in some breeds.
Please do not change foods without discussing options with your veterinarian. Always ensure you feed a high-quality, well-balanced diet. Talk with your veterinarian about recommended brands and options.
One prescription diet is specifically designed for neurological disorders – seizures and cognitive dysfunction (doggy dementia). The formulation may help as an adjunct to preventative medications and works by using ketones and medium-chain fatty acids to provide additional energy sources for the brain.
This author has seen the addition of this food be very beneficial, especially in dogs on multiple drug therapies. However, alone, this diet is not enough to control seizures without medication. It all depends on the frequency and severity of your pet’s disorder. Neurologists seem to think it may help, and some reach for it while others do not! If your pet is having trouble on medications alone, it may be something to consider.
When is it time to start anti-seizure medications for my dog?
Starting preventative seizure medications should be considered when
- Seizures occur more than 1 x per month
- Seizures are extremely violent
- Seizures occur in clusters (more than 2-3 seizures in 24 hours)
If your dog only has a seizure when going to the vet’s office, preventative medications for life likely aren’t warranted. There can be medications to give for the vet visit to minimize anxiety and stress and lessen the chance of a seizure. This may include gabapentin and or trazodone.
But if your pet has any indications above, please see your veterinarian and discuss options.
Is a dog seizure an emergency?
When should you take your dog to the vet ASAP?
You will need to take your pet urgently to the vet, ideally a place with 24-hour care, when any of the following occur
- A seizure lasting more than 2-5 minutes without stopping
- Multiple seizures in 1 day (clusters)
- Failure to recover to baseline post seizure
You may have to take your pet to the vet while they are actively seizuring. Be careful. But suppose the seizure cycle and brain activity continue past 5 minutes. In that case, the brain becomes deprived of oxygen, and the pet’s temperature can rise to dangerous levels. This can lead to life-threatening consequences. So getting prompt veterinary care is crucial to your pet’s survival. Waiting too long could be the difference between life and death.
Steps to minimize dog seizures or dog harm during seizures
While there is no way to prevent a seizure, you can take a few steps to reduce the risk of an occurrence.
How to minimize dog seizure occurrences
- Keep things routine – Do not change schedules abruptly. Try to feed at the same time and with the same food.
- Always give any seizure medications at the same time every day. Even being late by 1 hour could potentially trigger a seizure.
- The timing of med administration can make pet care more difficult
- Thanks to modern phones, there are reminder apps or alarms that you can set to alert you when medications are due. This can be a lifesaver for you and your pet
- If you forget a dose, give it as soon as possible but never double up on doses unless directed by your veterinarian
- Make sure to have your pet confined to a crate or small room when you are not home or overnight. No access to stairs should be provided when unsupervised. Make the area as safe and free from clutter as possible.
- Think twice before taking your pet for a car ride or having a huge party. Anything could trigger a seizure. Some pets only have seizures when they go to the vet, which is not helpful, so a home-care vet may be needed.
What do I need to do when my dog is having a seizure?
- Keep calm!
- Talk calmly and quietly.
- Time the seizure – Record the length of the seizure and note the severity.
- Videotape the episode to show your veterinarian.
- Ensure your dog is in a safe area.
- Ensure you are safe from your dog’s mouth and claws
- During seizure activity, your pet is likely not aware.
- The dog could easily hurt you either during or immediately following a seizure.
- Stand clear until your pet seems to recognize you.
- Do NOT wrap them in towels or blankets. Even if they are shivering, this is unlikely due to a low body temperature. In fact, seizures usually elevate body temperature. Putting a towel or blanket on them will only prevent them from getting rid of excess heat. The seizure itself may not be life-threatening, but the heat stress-related illness that may follow can be!
- Food and water – Seizuring uses a lot of energy or glucose. So, if your dog wants to eat and has food available, that is fine. Make sure your pet is mentally back to normal before offering food or water.
- Do NOT put anything in the dog’s mouth – they will not swallow their tongue.
How long can dog seizures last?
Most seizure activity – focal or generalized – lasts seconds up to 1-2 minutes. We get concerned when seizure activity lasts greater than 2-5 minutes, and anything more than 5 minutes causes great concern.
How long the seizure lasts exactly isn’t critical, but knowing when they are lasting too long could be of vital importance to your pet’s survival.
Often there is a period after the seizure where your pet may be disoriented. The pet may walk into walls and not be fully visual right away. They may not recognize you or other family members or have other abnormal behaviors. This is normal. When these behaviors continue without a return to normal, that is cause for concern. Additionally, some animals may be sleepy for up to 24 hours after seizure activity.
How often do dog seizures occur?
This varies with each individual pet.
Sometimes triggers occur, such as a stressful event. However, many seizures start when a patient is sleeping.
Even for dogs on seizure preventative meds, seeing more than 1 seizure per month is too frequent. Meds should be readjusted, or an additional medication should be considered.
Is it ok to leave a dog with a seizure disorder home alone?
We hope to control seizures 100% in our pets in veterinary medicine. However, this isn’t always feasible for a vast number of reasons. Some pets take multiple medications, eat a special diet, and still have breakthrough seizures. Others may have 1 or 2 episodes, then never have any again.
No veterinarian expects you to spend 100% of the time with your pet.
By administering medications, we aim to control about 50% of dogs’ seizures9. Of course, the ideal is 100% control. But we usually never achieve 100% control unless we resolve the underlying condition.
What will my pet’s quality of life be with a seizure disorder?
Ultimately, the quality of life for your pet will depend on a few factors
- The underlying cause of the seizure
- The age of your pet when they begin
- Any other underlying diseases
- How severe the seizures are in duration, violence, recovery time
- Your commitment and ability to administer medications and adhere to a rigid schedule.
- Frequency of seizures even with medications
- Ability to hospitalize when a breakthrough seizure(s) occurs, clustering occurs, or other problems arise
- Financial constraints and considerations
- Frequency of drug monitoring and bloodwork screening
Many dogs live with seizures for years. While some do require a combination of medications, others may only need one drug. Still, others may only seizure 1-2 x year, and you may elect to minimize stress, maintain a routine and monitor them without medications.
When well-controlled, dogs with seizures and their owners can live an excellent quality of life.
Any abnormal behavior a pet demonstrates causes understandable alarm in pet parents. Seizures or seizure-like activity may be upsetting to watch. Knowing what to do when certain signs occur may help save your pet’s life and maintain your human-animal bond.
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