Question Details
Cluster Seizures In A Dog
by LJH - October 5, 2023    View Case Report
Hi Steve,
I've seen a 3 yr M(N) (cryptorchid) Shep x border collie Rescue dog who in Mar./23 developed cluster seizures 2 days after being treated with Simparica Trio. This dog has always been very anxious/ nervous, lean body weight, good appetite and energy with normal stool(no soft stool or mucous), good digestion, no history of ear, anal gland, or skin issues. He had no temperature preferences/intolerance and great energy during even hot, humid weather. would have a big drink when had one but not a thirsty dog, good haircoat with a few small white flakes of dandruff, and slightly flakey nails.
His first seizure occurred just before midnight, his second at 6:30 a.m. but subsequent ones happened at various times throughout the day. He initially presented at the ER with petit mal seizure, foaming at the mouth, twitching and fly biting. He was neg on Snap 4D and bloodwork normal. Treated with diazepam, and started on Phenobarb which was weaned down, almost off by mid July, as tick med cleared and seizures stopped. With his age idiopathic epilepsy was considered.
Living in tick /Lyme endemic area rDVM recommended treating with Advantix as safest flea/tick product where history of seizures.
7 days after treatment dog presented with grand mal cluster seizures with loss of consciousness, foaming at the mouth, opisthotonos and rigidity. If he had 1 seizure he would have 2 more in the next day. He lost sight and hearing for a short period before some seizures, and hearing after some. He might not get back to being himself for a day or so. Phenobarb dose increased to 30 mg BID again, Gabapentin included .After one treatment with Diazepam had bloody stool. In August had a period again with no seizures while on meds then seizured after eating cat litter( a couple of times included urine/ feces, but at least once ate the litter in a just cleaned box). Two weeks ago had a single seizure with no obvious trigger. Recent grand mal seizures have usually occurred between 6:00 - 8:00 a.m. Would be off food the day before, and seizures often occurred when he was asleep, would suddenly sit up and start to seizure. Recent bloodwork good though slightly elevated eosinophils.
When I examined him he was very nervous and tense in an unfamiliar location. Currently getting Phenobarb and Gabapentin, CBD, Milk thistle, omega 3's and on Purina NeuroCare diet. Tongue pale pink with slight lavender tinge, moist, with slight froth on surface caudally. I thought the edge maybe looked slightly swollen. Pulse was rapid, a bit weak, deep, thin and wiry. During exam the pulse varied sometimes being much stronger and more superficial but still toned/wiry. Improved some with massage/acupressure of GB points and sed. BL-40 but then improved more with tonifying BL-20 and BL-23. No acupuncture or even laser was done as he suddenly got very still and had a few twitches before going to sleep. Owner reports he didn't later progress to seizuring.
I have discussed working to change to a less processed homemade, balanced, low/no grain diet ( even raw if could tolerate though pulse on weak side)with some of the supplements included in the Neuro care diet. Titre test not vaccinate (he is "due"), no tick meds, avoid chemical/ toxin exposure. Could even consider microbiome restoration with fecal transplant capsules. Owner is willing to try herbs. With his history, PE , initial seizure nature, I thought Liver Blood def generating internal wind and Tian Ma Gou Teng Yin, but more recent grand mal seizures in the morning , reduced appetite just before, with sensory loss, and that bit of froth +/- slight swollen edge on the tongue made me wonder if Ban Xia Bai Zhu Tian Ma Tang was a consideration. Starting in March and flare in September along with GB points response is Shao Yang a factor beyond the tick meds? Are you seeing any particular patterns in seizures associated with tick meds? Would Phenobarb use bring on more Damp/Phlegm signs? Any thoughts or suggestions you might have would be greatly appreciated. Many thanks, Llewanda
by LJH
October 12, 2023
Hi, Sorry, I don't know why this posted twice. I heard from the owner that yesterday the dog had 2 seizures. The first at 3:30 a.m. which she had to give diazepam for. The second at 8:30 a.m. which he came out of ok. Thank you for any clarifying thoughts you may have, Llewanda
by LJH
October 13, 2023
Heard again from owner so thought to include the info. Had a third seizure in that cluster at 11:30 pm that day. Not off food the day before like he has typically been, so no warning, though was somewhat restless that night before the first seizure, Has been very hungry after these seizures and drinking alot. All grand mal lasting around 2 min. Urinated during one, Just laid for a minute or so after each like his sight and hearing was off. Shakey legs after. Many thanks, Llewanda
by naturevet
October 19, 2023
Hi Llewanda,

Damp is certainly a consideration given the seizures are happening during the time of day when we would expect Tai Yin excess. As you noted, though, there's not a lot else there in the history to suggest Dampness, including the pulse which suggests more a Stasis condition.

Another thing that happens at that time of day is that Yang Ming dryness can increase if the dog has a Shao Yang disharmony. That creates a Stomach Heat that can transfer to the Heart, creating Heart Fire. The extreme anxiety fits that scenario, as does the response to GB point massage, since it is the Shao Yang that traps the Heat in the Yang Ming (Stomach) in the first place. It also fits the spring and fall aggravations, and the onset of seizures even before midnight (when Tai Yin is still in abeyance). We normally treat this with Yi Guan Jian. You have a typical Yi Guan Jian tongue there (pale, signalling Blood and Yin deficiency, with tinges of secondary Stasis).

I would try three things all at once: Tian Ma Gou Teng Yin, which you're using already; Yi Guan Jian; and Xiao Chai Hu Tang. That should cover all the bases. I would use full doses of all three. If it's helpful, the dog's anxiety should decrease, serving as a proxy for a decline in seizure potential.

As to whether this is a typical pattern for insecticide-induced seizures, I can't say as they are somewhat sporadic. It sounds like the dog is prone (given the Heart Fire signaled by the anxiety). If we can get that resolved, future treatments might be tolerated. Otherwise, if it's primarily ticks that are the issue, simply conducting a daily visual inspection for ticks might be the better way to go

Hope that helps!

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