“My girlfriend at the time really wanted a dog,” relates Dylan Grams, an auditor from Massachusetts. At first Mr. Grams considered adopting an adult dog from out of state. But he knew that would make it somewhat difficult to learn the dog’s history and temperament. “My sister was pregnant at the time,” he says. “I could never live with myself if the dog ever did anything to her or the baby.” So Mr. Gramsdecided to buy a newborn puppy from a breeder instead.
“Louis was the only male puppy out of the entire litter,” says Mr. Grams of the Boston terrier he ended up choosing. “He was born September 1st, 2012. My nephew was born on the 7th. Since my sister was on maternity leave, she basically helped me housebreak him.
“The first year, he was the perfect little dog. He never showed any signs. He was just a playful little guy — fetch, catch, things like that.
“Then, in November of 2013, when Lou was a little more than a year old, my roommate and I came home one night and the dog was all excited. I threw the ball with him, playing fetch, and then he fell asleep on the couch. It was late — we had been out to a bar — and we were still talking when Lou proceeded to convulse; his body started shaking violently. It was extremely scary because we had no idea what was happening. It lasted for a minute or two.
“After the seizure, he was fine for a little bit. Then 15 to 20 minutes later, again. The second one was a little shorter.
“My roommate went to bed, and I pretty much just spent the night in the bathroom with Lou. We have a cat, too, and I didn’t want Lou to bite him or my roommate. He was foaming at the mouth during the convulsing and his tongue was hanging out, so I thought he might have had rabies even though he had had his rabies shot.
“I watched him all night, never letting myself fall asleep. He ended up having three or four seizures during the night and then another one toward 6 or 7 in the morning. I thought he was going to die. That’s when I was like, ‘Okay, I have to take him to the emergency room. We went to the Foster Hospital for Small Animals at Tufts.”
Lou was admitted to the hospital, and unfortunately, Mr. Grams wasn’t able to stay close by while he went through testing. “I had to leave him at the emergency room because my uncle had passed away. I was flying out to Michigan for my uncle’s funeral. But they called me twice a day. They kept updating me on how he was doing.”
Lou’s workup and diagnosis
Because Lou was having seizures, he was seen by various members of the veterinary neurology team. His initial visit was with neurology/neurosurgery resident Kathryn Weiss, MS, DVM. Veterinary neurologists, like those for people, specialize in diseases of the nervous system. Dr. Weiss suspected epilepsy, which simply put, is a situation in which there are repeated seizures. Seizures are a kind of electrical storm in the brain. Normal brain cells, called neurons, use electrical as well as chemical signals to communicate with each other. Communication can be either excitatory, which means the next neuron tends to become activated, or they can be inhibitory, in which the next neuron in a chain will tend to shut off. If the balance in the brain shifts too far toward excitation, brain cells in the grey matter become “synchronized,” and a seizure can result.
The word “epilepsy” doesn’t get to the underlying problem — the reason for the seizures. If a reason cannot be identified, we call it idiopathic epilepsy. If you can identify it — perhaps it’s a brain tumor or a stroke, an infection in the brain, a metabolic problem, or even head trauma due to an accident — the dog has what is called secondary epilepsy. Treat the cause, and theoretically at least, the epilepsy will be easier to treat.
Lou appeared to have what is known as idiopathic epilepsy — seizures whose cause can’t be found. Sometimes the unidentified cause could be something like a stroke too small to detect with a routine brain scan. But very frequently, idiopathic epilepsy comes about because of a genetic predisposition. Dogs with a breed or family history of seizures frequently begin seizing between one and three years of age. Lou was one year and two months. For that reason, the neurology team understood Mr. Grams’s decision not to have Lou undergo MRI and other very expensive diagnostic testing. “In an ideal world we’d like to do all the diagnostics,” Dr. Weiss says.
Even so, before treatment began, Lou did go through a workup. “We look at the whole body,” comments Dr. Weiss,” because sometimes the brain is affected by something going on in other body tissues and sometimes the seizures occur because of something going on in the brain itself.
Mr. Grams had to give Lou’s history by describing the episode, and Lou also underwent a physical exam to rule out various diseases that could have caused seizures. A neurologic exam was included as well, specifically, an evaluation of his behavior, coordination, and reflexes. In some cases, a dog will also have a blood draw for a complete blood count as well as a urine analysis. These help determine whether the seizures have a metabolic cause.
It’s also important to determine whether what looks like a seizure really is a seizure. Some dogs may have such a severe ear infection affecting the balance system in the inner ear that they can have dizzy spells resembling seizures. Fainting spells resulting from heart disease can also be mistaken for seizures. And disorders such as narcolepsy can cause episodes of collapse or excess movements during dreaming.
Lou’s symptoms, after ruling out various causes, seemed a classic case of juvenile-onset idiopathic epileptic seizures.
Epilepsy is not as rare as you might suppose. It’s one of the most common neurologic diseases of dogs, affecting up to 4 percent of them — one in 25 — by some estimates. Which types of dogs tend to be affected? “Boston terriers are a breed we see seizures in” — one of the reasons Dr. Weiss didn’t press for an MRI — “but they are not the typical idiopathic epileptic,” she says. “We also see them in Labrador retrievers and golden retrievers,” she adds. We see them in border collies, dachshunds, beagles, Australian and other shepherds, and we see them in mastiffs as well. But it could be any breed.” Seizures don’t discriminate.
The prognosis
Mr. Grams recalls being told right off, “you’re not going to cure it. It’s about controlling the disease and giving your dog a good quality of life.” It’s true. A veterinary neurologist can’t take away the epilepsy. Lifelong therapy is necessary to decrease the number and severity of the seizures. That’s critical. If left untreated, epilepsy tends to get worse over time. Even seizures that last just a short time create tremendous stress on the brain, lungs, and other organs. The body temperature can rise very high from all the muscle activity of the tremors.
Having said all that, not every dog with epilepsy requires treatment. Dogs that have only occasional, mild seizures may never progress to a point where the seizures become frequent or severe. For these dogs, the risk of side effects from anticonvulsant medications may not be warranted. The option of not treating should always be part of your discussion with your veterinarian.
But severe seizures are certainly “a reason to get a dog into the vet’s office,” Dr. Weiss comments. “When the dog has one, it starts in a particular area of the brain that then gets overloaded, and it spreads everywhere else. The original area — the focus — gets more ‘irritable’ and is more likely to have them in the future.”
Treatment
Among the most commonly prescribed drugs for epilepsy is phenobarbital. Lou was put on phenobarbital right away, and Mr. Grams was told his dog would have to have blood work every four to six months. “We don’t just put a dog on medication and send him on his way,” Dr. Weiss says. “We monitor his blood levels and make sure the medicine isn’t too hard on the body — and also make sure the medication is at a therapeutic level,” that is, enough to control the seizures.
“Fast forward five weeks,” Mr. Grams says. “We’re now at the very end of December, between Christmas and New Year’s. Lou had been doing fine. No episodes. I was giving him one pill every 12 hours. They told me the timing of the doses had to be consistent, within a one-hour window. But that day, his seizures were even worse than the first time. One lasted five minutes, another, like a minute or two. He had maybe three or four more seizures during the course of the night.
“They bumped up the phenobarbital and added zonisamide, a sulfa drug.” That isn’t surprising. The medications — and their dosages — need to be individualized to tackle a dog’s specific needs, and there’s often trial and error involved. Then, too, what’s “right” for a dog may change over time.
Again, “Lou was good — for a month,” Mr. Grams remarks. “On January 30th, he had another bout of seizures. But that time they lasted, like, 15 seconds, 10 seconds, and 20 seconds.
“I called another doctor at Tufts, and she said that if he doesn’t have any more seizures, don’t bother bringing him in other than for his blood work.”
All things considered, Lou is doing remarkably well. Even a dog whose epilepsy is well controlled is going to have a seizure now and then, which is why the neurology team was not overly concerned about a rare instance of short-lived seizures. If you can decrease the frequency of the seizures and also their duration without letting the side effects of the medication create a whole other set of problems, treatment is considered successful. Fortunately, like Lou, two out of three dogs diagnosed with epilepsy are treated with success.
Lou is particularly lucky because his drugs haven’t caused noticeable sedation. In a person with epilepsy, that’s a side effect of concern. But a dog doesn’t need to stay awake behind the wheel. It’s not a problem if he naps a little more than he used to. Even so, Lou is as energetic as ever.
Going forward
The veterinary neurology team at Tufts has asked Mr. Grams to keep a log of any seizures Lou may have. “That way, we can look at frequency — is it increasing, is it decreasing? — and adjust treatment if necessary,” Dr. Weiss says.
Since January, Mr. Grams reports, his dog has had “a small seizure here and there, but nothing severe — up until May 24th. He had a pretty bad one that day — two or three minutes. But the last time I brought him to the emergency room, a woman with a shih tzu said her dog had five- to 10-minute seizures.” Lou’s didn’t seem so bad by comparison, although Mr. Grams notes that when your dog is going through it, “even a minute seems like a long time.”
Fortunately, on just about all days, life goes on normally. “In between times, he’s still his happy, bouncy self,” Dr. Weiss says. Mr. Grams agrees. “The seizures completely don’t affect Lou,” he says. “He bounces back every time.
“When Lou first had his seizures,” Mr. Grams adds, “I was like, oh, you can’t play too rough. But a friend of my mother’s has a daughter with epilepsy, and she told me, ‘just let him live a normal life.'”
The doctors agree. You don’t need to restrict exercise or otherwise change the dog’s routine, although, Dr. Weiss says, “we do talk to owners about the dog perhaps not going swimming, and perhaps being confined to a crate when the owner is not home or at least an area where the dog is not going to fall down the stairs — managing the environment” so the dog doesn’t hurt himself if he has a seizure in his owner’s absence. But otherwise, a dog pretty much goes on as he always has.
Interestingly, while the epilepsy hasn’t changed Lou’s life much, it has changed Mr. Grams’s. When all this began, Mr. Grams notes, “in my family, no one had ever had a serious illness or injury. This is the first time I’ve ever had to take care of someone in a medical sense. It opens your eyes a little bit and gives you perspective. It kind of made me a more compassionate person.
“The night all this started, sitting on the bathroom floor, I told him, ‘I promise you, Louis, if you make it through this, I’ll give you the best quality of life. I’ll take you on a long walk every day. You’ll have the best life in the world.’ This ordeal has absolutely made Lou and me closer. I feel more bonded to him. And I know he feels more bonded to me.”
All of which gives us the feeling that Mr. Grams was probably kind of a compassionate person to begin with. n
