I was catching up with an episode of Madmen the other night –the series about Don Draper and the advertising firm on Madison Avenue in the 1960’s. I love this show for its historical authenticity and for the reminder of how much things have changed (although sometimes not enough!) since then. In this episode Danny Farrell is briefly introduced. Danny has epilepsy. It is the early sixties. There is no www. And although there are anti-epileptic drugs available there is little wide spread understanding and still a stigma associated with epilepsy. Danny, an articulate handsome young man, lives as a hobo because “people just don’t understand epilepsy”.
Now, thankfully, we know much about epilepsy and how to treat it, which of course is important for our pets as well as us people. Dogs and cats with epilepsy have repeated unpredictable seizure activity (where groups of brain cells become overactive all at the same time). It is a normal process gone haywire, and can be caused by inherited problems and also by brain injury, tumours or infections, as well as metabolic problems such as low blood glucose, hypercalcaemia and liver disorders.
What we see with our pets depends on which neurons are affected. We most often see animals with ‘grand mal’ seizures – these affect the whole body and cause the animal to fall over, “paddle” their limbs, and sometimes lose control of their body functions. ‘Petit mal’ seizures can also occur – these affect isolated areas of the body and can be harder to recognise in pets. The biggest danger for a pet with uncontrolled epilepsy is the risk of injury during the seizure – for example falling off the back deck or down the stairs. Luckily it is impossible for pets – or people – to swallow their tongues, although there is often a lot of saliva produced and this may block breathing passages in worst case scenarios. There is continuing discussion about whether repeated poorly controlled seizures can cause ongoing brain damage, and for the moment we have to assume that this is likely.
There are a lot of different treatment options for epilepsy these days depending on the needs of your pet. All involve daily tabletting. Our first job is to work out whether the seizures are “cranial” or “extracranial” and if “cranial” whether they are part of a bigger neurological problem or just isolated to seizure activity. Diagnosis involves getting a detailed history from you, and then performing a full physical examination. Blood tests are run and in serious cases we may refer your pet for an MRI scan. Primary epilepsy usually starts between 2 and 4 years of age and is the most common diagnosis of fitting in a young animal. Animals who start fitting at a later age are more likely to have a brain tumour or other intracranial pathology.
Dogs and cats do not suffer during fitting and will not remember it later – however there are phases both before and after the fit when they are vague, confused and often very “clingy”. It is important to be reassuring and aware at these times.
If seizures occur less than 2-3 times in a year it is generally accepted that the effects of treatment are worse than the occasional fit, and we do not normally recommend treating. Also, if your pet has gone more than 6 months without a seizure, it is worth SLOWLY withdrawing medication – he/she may have got better!
NB if your pet starts having a fit and it lasts longer than 5 minutes, this is called status epilepticus – it is very serious and possibly life threatening. Ring us!!!