Question Details
Seizures In A Dog
by ajerger - October 25, 2023    View Case Report
Lily is a 4.5 yr old Lab, with a history of seizures since January 2020. The seizures started after she had been spayed and concurrently diagnosed with hip dysplasia.
Adopted from a breeder ~ 3months old.
Past Diet: Canned and Kibble,
Vaccine: Had all required vaccines on time per owner.

Hx from prior vet:
Seizures began 2/2020 multiple seizures and patient was placed on Phenobarbital.
Seizures averaged 1-3 per month
Hip dysplasia diagnosed March 2020, owner noted difficulty running, Adequan injections seemed to help.

Farmers Dog food started December 2020.

May 2021- Owner said she was having adverse reactions to Phenobarbital, at one point she needed to be hospitalized, for “drunk” like behavior and could not stand/walk. Patient was weaned off of phenobarbital and patient improved dramatically. She was much better after stopping phenobarbital and was put on Keppra 2,200mg TID and Zonisamide BID
( side note- the owner notes urine leakage almost every day, he says once he started the keppra he noted that, if there is a day or dose he misses the keppra, she does not leak urine per the owner)

She had 1-2 seizures per month until 5/2022.

May 2022- She was overfed one evening and was given avocado, she vomitied multiple times and had ~9 seizures which was stabilized at an ER.

Recently they have have increased in frequency but the intensity has lessened at bit, but just today she has had 4 small seizures between 5-7:30pm.

The days she has seizures she becomes very quiet, lethargic and often drools.

The seizures used to be in the early mornings but now have been in the later part of the day.

The only other history is that she has a very sensitive stomach, many times the days she has seizures she has had soft stool or diarrhea. The owner has made a correlation between Gi upset and seizures.

Currently, she is on a home made diet. Supplements, Probiotics..etc..

Another side note- 2 weeks ago she presented with a limber tail, could not move the tail and she was very painful just caudal to the base of the tail and it seemed to be slightly swollen. She was given metacam orally, which helped but she had a seizure after the second dose so that was discontinued. Her tail is now normal. Apparently this happened a couple of years ago, same presentation, resolved with anti inflammatories.

Physical exam:

70lbs,
(I can needle her and she is the calmest, most quiet demeanor, does not move at all)
She sleeps during acupuncture and physical exam
She initially had a smell around her anus for months and recently this has gone away, but today I smelled it again. Smells like maybe anal sac ? But not as potent. )

Pulse:
- [ ] superficial to mid depth
- [ ] Resists compression
- [ ] Highly toned
- [ ] Normal to slight increase in diameter
- [ ] Moderate finger lift
- [ ] Normal rate and rhythm

Tongue: Dark pink to Red

Labs: non regenerative anemia, very slight. Cause unknown, everything else is normal.

Acupuncture: pulse seems to moderate with GB34, GB20 and LI 4. I sedated SP 9 and maybe a slight change in pulse.

Herbs:
- [ ] Chai hu jig long gu mu Li Tang (1/2 tsp BID)
- [ ] Dang gui and Peony support
I had her on Spleen support but stopped since she is warm-hot.

8 parameters:
Internal
Excess ( seizures)
Deficient ( soft/loose stools, leaking urine?, hind limb weakness, flaccid tail)
Hot
Some dampness- perianal odor, some improvement with diet.

Western Diagnosis- Epilepsy

TCM- Shao yang disharmony?

Despite my current treatment plan, she remains warm to hot and persistent seizures

Not sure where to go from here…

Thanks so much…..
Replies
by ajerger
October 27, 2023
One more thing...Last few weeks she has been coughing/hacking as if she 'has something in her throat sounds slightly moist per the owner. nothing comes up....
Thank you again!
by naturevet
November 2, 2023
Hi there!

Another challenging case, I see.

I'm wondering if this is a case of Damp Heat, leading to Phlegm Obstructing the Orifices of the Heart; and to Upward Disturbance of Wind Phlegm. The pathogenesis would be Spleen deficiency (evidenced by digestive weakness) leading to Dampness accumulation and Damp Heat. Damp Heat is the only cause of Wei Syndrome referenced in the classics, and Si Miao San the only treatment they cite. Sometimes SMS cases have a big pulse like you palpated.

Simultaneously, Dampness and Phlegm has moved into the upper burner, obscuring the orifices of the Heart and creating that disconnection and lassitude you're seeing. That's why vomiting seemed to bring on an attack.

May aggravations and onset are consistent with Dampness and Phlegm causing the problem.

All that being said, the pulse also fits a Shao Yang disharmony, as does the January onset of the problem, and the response to your points. If you try to disperse however, using Minor Bupleurum derivatives, you could make things worse.

I can remember one of the first seizure cases I treated years ago was started with Long Dan Xie Gan Tang, and then once the excess was stripped away, was finished with Ban Xia Bai Zhu Tian Ma Tang. It may worsen the incontinence, however, and could be excessively sedating if we are wrong.

My temptation would be to try Si Miao San and BXBZTMT together, to see what happens. I'd give full doses of each, and see if the interval between seizures can start to increase and/or the severity of the seizures decrease

Hopefully that helps you out! Let us know how it goes!

Steve
by ajerger
December 19, 2023
Update:
Patient initially had a 3 week span of no seizures since adding the Ban Xia, with good energy. She is on highest doses of SMS and Ban Xia Bai Zhu Tian Ma Tang. ( 72lbs 8ml's divided BID SMS, Ban XIa -1.25tsp BID), Keppra Extended release 1000mg TID( 31mg/kg) and Zonisamide 270mg BID 8.4mg/kg), CBD twice daily.
Recently she has reverted back to having seizures more often (some less intense) but often still intense and lasting from 30 sec - 2 minutes. I had mentioned previously that she had been leaking urine and that is now more often as well as excessive licking of vulva. Her appetite has also increased dramatically, she is ravenous. Stools are good, no vomiting. The perianal odor is gone.
Her last labs on 11/1/23 her ALK spiked to 1414( 23-212), and baseline cortisol was 1.3 ( 1-5) ( we are going to go ahead and stim her today or tomorrow. Her HCT is always on the low end or just below normal, and her total t4 is 0.9 (1-4).
Should I discontinue the Ban Xia and Start Long Dan Xie Gan Tang? Thanks so much!
by naturevet
December 21, 2023
Hi there!

It's not clear to me that the anti-Damp approach produced any real meaningful change, since you haven't been able to get back to the once a month or less seizure frequency.

I'd wonder, then, about the Shao Yang approach. Shao Yang disharmony fits:
- a fall aggravation
- burgeoning Stomach Heat (from dryness) as we drain and dry Damp (which may not actually be there if seizures haven't markedly improved)
- a Heart Kidney disconnect, resulting in incontinence

To explore that, I'd probably suggest trying Minor Bupleurum with Tian Ma Gou Teng Yin. I'd do full doses of each of those two. If you see things start to improve, then you'll know you're on the right track, and that the seizures are arising from Shao Yang disharmony, compounded by Yin deficiency.

I'd look for the incontinence to improve, but you might have to add a Yin tonic or something like Sang Piao Xiao San (or HRUI Formula) for that to resolve completely. I wouldn't add any Blood or Yin tonics yet, though, until the ALP is back down. XCHT has the capacity to achieve that for you.

Hopefully this nets you more obvious improvements in such a challenging case!

Steve
by ajerger
January 24, 2024
Hi there,
Lily's Incontinence is worse on the Tian Ma Gou Teng Yin/SMS and Minor Blupleurum. Seizure frequency is the same. Appetite is Revenous, no polydipsia, just urinary incontinence, formed stools, no vomiting.

Energy levels are good, I have been tracking her heart rate at home is 60's -70's. I attribute this to the high doses of Keppra and zonisamide?

Her ACTH stim pre was 1.2 ( 1-5ug/dl) and post was 7.8 ( 8-17ug/dl), she is currently on Adrenal Support.

Pulse: somewhat superficial, toned, resists compression, somewhat full, normal rhythm and rate.
Tongue : Dark pink to red, somewhat wide.
My thoughts were that she may have a hormonal/endocrine component to her presentation (onset after spay) and low cortisol with little stimulation. I am stuck on what herbal formulas to choose with so much to consider.
Thanks in advance!
by naturevet
February 2, 2024
Well, we can try adding in a Yin tonic. Besides internalizing, the only other thing all the three formulas that are aggravating Lily do is dry (or at least offer no Yin support) The tongue suggests Heat. That pulse can be seen with Empty Fire. Zhi Bai Di Huang Wan is a possibility, or even Tian Wang Bu Xin Dan, which has more adaptogens to help with the adrenals.

It would be rare for a seizure dog not to have Yin deficiency, so maybe that is the next thing to address
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