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Cluster Seizures In A Dog

by jandvm - September 26, 2016 View Case Report

Bella
cc cluster seizures about every 24 days, on phenobarb but dozy, levitiracetam didn't work, owners don't want conventional meds and want to get her off them. Seizures at various times during day/night, maybe more from 11pm-5 am, but also in morning around 10 am.

I have started her on TMGTY (after being on XCHT/YGJ with the pancreatitis). She is a little quieter than when on phenobarb alone, and doesn’t move much at night. She doesn’t want her first meal in the morning, seems to eat it later in the day. This seems to be a pattern on and off with her according to owner, but owner has mentioned it a couple of times recently. Also they mention lip smacking and I have noticed that more in the office lately. Not sure if that means Yin def or Phlegm.

Tongue is thin dry cracked at front, a little swollen edges caudal ½, pink, a bit lavender, dry white phlegm on top. Pulse thin, slight tone, superficial slight slippery rate 102, a little irregular and reactive to stress. Not much different from when she was on phenobarbital before formulas.

She has been on the formula for about 7-10 days. Owners feel she is much better on it, more interested and playful and wanting to chase squirrels and defend her back yard from other animals. I saw her Friday 23 Aug, did acupuncture expel Wind, tonify Blood/Yin, SP Qi, GV20, GB20, BL17, BL18, BL20, BL23, ST36, SP6, GB41, pulse a bit more toned after.
– her eyes were far away and I sensed she was pre ictal, she did seizure one mild seizure on Sat 10 am, but not again over weekend. Normally she clusters about every 24 days – this was 17th day.

So I am not sure yet about TMGTY – I have also thought of BXBZTMT. Since she came to me on phenobarb I don’t know what she is like without it. I have had the sense of SP Qi def – the recent pancreatitis could have been a result of phenobarb or underlying tendency to Damp Heat. She is overall deficient SP Qi def, and Blood/Yin deficient but what she looks like off pheno I don’t know.

I was going to use the TMGTY for 2 more weeks then reassess.

Can you use BXBZTMT in the morning and TMGTY in the evening?

How soon/fast can I start reducing phenobarb? I don't know what her pattern would be without it? I understand it can affect the SP and her pulse has always been a bit slippery.

(We had discussed her pancreatitis earlier)

Thanks
Janet

by naturevet

September 30, 2016

Hi Janet,

As mentioned in the email I sent you, I'd give things another few weeks, if the dog appears to be feeling better.

Regarding when to ease off PB, you have lots of time there. I'd try to greatly exceed the typical inter-seizure period before assuming that the herbs are sufficiently effective. Then I would lower the dose only gradually, perhaps by 10 to 15% at a time, every several weeks

Side effects of drugs are always best considered symptoms of the patient, as far as Chinese medicine is concerned. They are a response to a stimulus, and so tell us something of the patient's make up. The increased sedation she is seeing may be because the PB is working more effectively now that TMGTY is on board, so a small reduction in another two to four weeks may be advisable. But I wouldn't do that yet. Let's get to a point where seizures are much less common first.

Ban Xia Bai Zhu Tian Ma Tang can easily be used with TMGTY, in the manner you suggested

Steve

by jandvm

October 3, 2016

Thank you, Steve

Bella had only one seizure on day 24 (vs clusters for the last 1-2 years). I had suggested 3/8 tsp TMGTY bid but owner thought that was less than 1/4 tsp so that is all Bella was getting. Something is working – diet change, acupuncture, formula... She had incontinence of urine a day or two before the seizure and the night before she had to go out to urinate around 2-3 am, also strained for a watery bowel movement, didn’t eat breakfast a couple of days. SP Qi def

So I suggested to owner to keep on 3/8 tsp TMGTY or another 10 days. Then I will see her.

I could switch to BXBZTMT in the morning – would I add extra Tian Ma, and if so how much?

I also thought of keeping on TMGTY and adding LJZT at 1/2 dose am and pm – would this be reasonable?

thanks
Janet

by jandvm

October 3, 2016

Thank you, Steve

Bella had only one seizure on day 24 (vs clusters for the last 1-2 years). I had suggested 3/8 tsp TMGTY bid but owner thought that was less than 1/4 tsp so that is all Bella was getting. Something is working – diet change, acupuncture, formula... She had incontinence of urine a day or two before the seizure and the night before she had to go out to urinate around 2-3 am, also strained for a watery bowel movement, didn’t eat breakfast a couple of days. SP Qi def

So I suggested to owner to keep on 3/8 tsp TMGTY or another 10 days. Then I will see her.

I could switch to BXBZTMT in the morning – would I add extra Tian Ma, and if so how much?

I also thought of keeping on TMGTY and adding LJZT at 1/2 dose am and pm – would this be reasonable?

thanks
Janet

by naturevet

October 12, 2016

The nocturnal dysuria and diarrhea, together with the effectiveness of TMGTY, have me wondering if this is a Jue Yin (or Liver) issue. TMGTY is of most benefit when there is Liver Blood or Yin deficiency.

I'd add Wu Mei Wan in at night and continue your current protocol. Jo knows how to make the modification we use for seizures, I believe. I'd order that and give it a try

Steve

Wu Mei Wan

by jandvm

November 9, 2016

Hi, Steve
Bella has been doing fairly well on TMGTY, on it since 12 Sep, so almost 2 months. Decreasing clusters, only odd single mild seizure. Til this week - 2 days ago she clustered big time - 18 seizures in 36 h, mostly between 10 pm and 1 am, and some 9:30 am to 11 am. At one point owners gave an extra 15 mg phenobarb, and then valium via rectum. Also gave an extra dose of TMGTY.
I saw her today,
T muddy brick red all over, smaller and thinner at front, no coating, but wet on top, slight swollen edges (similar to previous visits but moreso)
P varies; toned thin r>l, superficial to mid, can feel a bit at deep level; at times is softer and a bit erratic/ irregular
Gums reddish pink, red line around
Nose dry and warm, all feet warm
Mild scleral injection, periocular erythema
Hr about 80, gr 1 murmur,
Abd light palpation slight tension
Trembling of forelimbs and head jerking a bit while lying with needles
Energy very low
Possible warmth swelling BL19, 22, GB34, hip area? I AM NOT GOOD AT ACTIVE POINTS.
I took blood for CBC, Clin chem including T4, phenobarb levels. It clotted fast and when spun down was almost pure white fat - very lipemic....., so also cPLI
TCM Dx Because of the acute onset and time of year I wondered about TBO, but not sure if what I see clinically is TBO or
more KI/LIV Yin deficiency with some Heat. Or both.
And Qi deficiency - she is very tired, both from the seizures and the extra drugs, and maybe Qi not generated because of TBO.
Heat from deficiency and stasis warm feet, tongue, pulse varies
Blood/Yin def reddish tongue, pulse superficial and slight tone,
Internal Wind with Heat seizures, trembling, jerking
Stagnation in MJ lipemic serum?
Qi deficiency low energy
Acup: GV2
0, GB20, GB34*, BL18, 19, 20, 22, SP6, SP9, LI4, GV14, ST36* (GB34, ST36 may have helped pulse, but not sure, it varies a lot)
What am I seeing here? Not sure how to interpret the tcm dx?
Would I continue with TMGTY she is on 1/2 tsp bid (total dose could be 3/4 tsp)
a little afraid to use CHJLGMLT or XCHT because of possible Yin deficiency
would I use YGJ ?
all 3 formulas?
I am kind of afraid I am losing this dog, and would so like to help her.
Thanks for your guidance.
Janet

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