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Epilepsy Seizures In A Dog

by Heather1 - August 15, 2024 View Case Report

It's been awhile...and this case is baffling me. She's a 6 year 9 month old female spayed Border Collie weighing 31 lbs with a history of Liver Blood Deficiency signs (anxiety, digestive disturbances of licking her lips and licking surfaces after eating, and dry hair coat with alopecia) successfully treated with Xiao Yao San (XYS) and Si Wu Xiao Feng Yin (SWXFY). She has always been given a whole food diet (raw or cooked).

At 2 years of age, she was given Paxil (SSRI Paroxetine) for anxiety. Three years later, she developed seizures of which 2/3 of them happen in the morning and 1/3 in the afternoon. All of her seizures happen at times of transition from sleep to wakening or from calm to acute activity.

2022: 2 seizures (July, December)
2023: 4 seizures (April, September, October, December)/
2024: 12 seizures so far (March, April, May, June, July, August)

One year ago, Keppra (1,000 mg BID) was started. At about the same time, she developed a "throat clearing" behavior and San Ren Tang (SRT) was prescribed which helped initially. KBr was given for 2 months, but the dog developed restlessness, irritability and started eating leaves and grass after her seizures (development of ST Heat). She is currently still taking SRT.

Four months ago, Dr. Katie Kangas consulted my client to help with systemic inflammation (particularly GI and Lung). The diet change to a ketogenic diet and addition of various supplements have helped with the throat clearing and systemic inflammation. Dr. Kangas also prescribed Calm Repose and I intended to add a Tonic formula if the seizure activity improved with the diet change and Calm Repose. But the seizures have obviously continued...

My client recently read Steve's Facebook posts and 3-4 weeks ago, she discontinued the Calm Repose and started Halscion (1/4 tsp twice daily) and Adoptrex (1/4 tsp twice daily) along with GABA (750 mg in evening). The dog was having diarrhea and the GABA dosage seemed high to me, so I have managed to get my client to decrease the GABA to 175 mg BID since her dog is having seizures in the morning and the afternoon. The diarrhea seems to be improving.

So, with this dog's history, recent symptoms, and mostly morning seizures, the most likely patterns would include:

1) Liver Blood Deficiency
2) Shao Yang Disharmony
3) Dampness and Phlegm

I have recommended some food therapy for ST Cooling and Damp Draining effects. With no improvement in the seizure activity so far, I'm thinking that the current pattern is that of Dampness & Phlegm. I would like to add Ban Xia Bai Zhu Tian Ma Tang (BXBZTMT) and discontinue the Halscion and Adoptrex formulas. I've never used BXBZTMT and I'm wondering if I need to add a Tonic formula such at XYS? I am also planning to continue the SRT.

Her tongue is generally medium to pale pink with mild lavender/purple, normal to slightly thick, +/- thin white coating and pulse is medium position, good rate and rhythm, slightly thin and faint

Thoughts? If the imbalance is due to Dampness and Phlegm, could that be why feeding a whole food diet with minimal to no grain hasn't helped?

Any words of wisdom are appreciated!

Heather

by naturevet

August 17, 2024

Hi Heather,

If a dog is on a real food diet, and especially a ketogenic diet, with no improvement in symptoms, we can often rule out Damp. Dampness is almost invariably caused by eating processed foods, starch in particular. I'm thinking a combination of Shao Yang disharmony and Blood deficiency is at work here. Shao Yang disharmony explains the morning and evening seizure tendency (since Yang moves back and forth twice daily) and the spring fall tendency (at least early on before things got more serious) when troubles moving Yang in and out are accentuated as the seasons change.

That can be challenging to treat. Halscion in combination with Tian Ma Gou Teng Yin (Calm Repose) can help, but in this case, it seems the Yang energy is pent up internally, and being released erratically. That will tend to cause the Stomach Heat symptoms, since that is where the Yang is pent up when not being released. It will also cause (conceivably) the seizures when the dog is moving from inactive to active (i.e., from a Yang internalized to a Yang mobilized state). When the Yang is trapped internally like that, we need a more pure Minor Bupleurum formula as the core treatment, I think.

I see the Blood deficiency there, too, for sure - in the prior response to XYS and in the pulse and tongue. Inadequate Blood and Yin reserves can aggravate erratic Yang movements, since Yin acts almost like a 'sea anchor' on Yang.

Despite the picture seeming reasonably clear, these cases can be hard to treat. One reason may be that the microbiome is playing a role, so ensuring that carb dependent species are present is important. Raw and ketogenic diets kill off carb dependent bacteria, which are important for maintaining the integrity of the gut wall, and producing compounds like propionate that can help regulate the system. Accordingly, make sure that 1/3 to 1/6 of this dogs diet is some mix of fruits, veg, whole grains or beans. Also supplement with a good Lactobacillus and Bifidobacterium probiotic. The worsening on the ketogenic diet may be explained by a microbiome disruption.

As for herbs, I have had some success with Chai Hu Si Wu Tang (Xiao Chai Hu Tang plus Si Wu Tang), maybe enough to bring the seizures down to a level that Keppra can help control.

Even better, potentially, is to combine Xiao Chai Hu Tang (which regulates the Shao Yang, preventing Yang entrapment) with Long Dan Xie Gan Tang. If you use Natural Path versions, the latter is moistening enough to nourish Blood and Yin, but can help grab and descend erratically rising Yang.

Chai Hu Jia Long Gu Mu Li Tang would normally be what I would reach for (or Halscion), but the tendency of minerals (i.e., KBr) in this dog to aggravate restlessness and Stomach Heat tell us that the attempt to internalize Yang as a means of combating the seizures is unlikely to work. The secret is not to pack Yang away, but give it the opportunity to safely vent. Given that, I would try the XCHT + LDXGT +/- a Blood and Yin tonic like Yi Guan Jian as your strategy here. That, and the recommended diet change.

Hopefully this helps you out! Please let us know how things go!

Steve

by Heather1

January 14, 2025

We went 12 weeks between seizures...!!! That's the longest this dog has gone since her seizures initially started in 2022. Yay! However, the intensity of the seizures remain the same.

The seizures no longer occur at times of transition between rest and activity, so I think the XCHT has helped immensely to bring harmony to the Yin & Yang. The past two seizures happened around midnight and again during the night around 2 am. The owner states that the seizures come on almost like a "dream state." So, I'm thinking that we're still dealing with an underlying Blood Deficiency.

Currently:
Raw meat diet with Honest Kitchen Whole Grain Veggie & Fruit Mix
Visbiome probiotic
XCHT (NP) 1/2 tsp BID
LDXGT (NP)1/2 tsp BID
Glehnia & Rehmannia (Kan) 1 1/2 tablets BID
Adoptrex (PWS) 1/4 tsp BID
Keppra 500 mg in am, 1000 mg pm
Gaba BID

After her most recent seizure, the dog has begun to shake her head and hold one ear strangely. She had also begun her cough/throat clearing symptoms again. I was interpreting this as an Internal Wind sign, so we added a small amount of Calm Repose (TMGTY) 1/2 tablet twice daily. I was thinking that perhaps we could start to decrease the amount of LDXGT in the near future. When we started the Calm Repose, the head shaking, ear placement and cough all improved.

Then, starting on 1/8/2025, her appetite started to trail off and she has vomited food and bile a few times. She also has loose stool with mucous. She was also looking up when she ate and did some wrenching like she was nauseous when eating. We stopped the Honest Kitchen grain formula and started her on white rice with pumpkin. She is now gobbling it up, but continues to have loose stool with mucous. I interpreted this as Spleen Deficiency. With these symptoms and the lack of herbal support for her Spleen, I'm wondering if I need to add a Spleen Tonic. I chose rice and pumpkin because they are Spleen Tonic foods. In the past, she's responded well to Happy Wanderer (XYS). I'm waiting to see if her stools improve. We have also added a small amount of slippery elm and RX Clay by RX Vitamins for Pets.

Overall, I am happy with the direction we're headed. Any words of wisdom and clinical experience in how to move forward it greatly appreciated!

Heather

by Heather1

January 14, 2025

We went 12 weeks between seizures...!!! That's the longest this dog has gone since her seizures initially started in 2022. Yay! However, the intensity of the seizures remain the same.

The seizures no longer occur at times of transition between rest and activity, so I think the XCHT has helped immensely to bring harmony to the Yin & Yang. The past two seizures happened around midnight and again during the night around 2 am. The owner states that the seizures come on almost like a "dream state." So, I'm thinking that we're still dealing with an underlying Blood Deficiency.

Currently:
Raw meat diet with Honest Kitchen Whole Grain Veggie & Fruit Mix
Visbiome probiotic
XCHT (NP) 1/2 tsp BID
LDXGT (NP)1/2 tsp BID
Glehnia & Rehmannia (Kan) 1 1/2 tablets BID
Adoptrex (PWS) 1/4 tsp BID
Keppra 500 mg in am, 1000 mg pm
Gaba BID

After her most recent seizure, the dog has begun to shake her head and hold one ear strangely. She had also begun her cough/throat clearing symptoms again. I was interpreting this as an Internal Wind sign, so we added a small amount of Calm Repose (TMGTY) 1/2 tablet twice daily. I was thinking that perhaps we could start to decrease the amount of LDXGT in the near future. When we started the Calm Repose, the head shaking, ear placement and cough all improved.

Then, starting on 1/8/2025, her appetite started to trail off and she has vomited food and bile a few times. She also has loose stool with mucous. She was also looking up when she ate and did some wrenching like she was nauseous when eating. We stopped the Honest Kitchen grain formula and started her on white rice with pumpkin. She is now gobbling it up, but continues to have loose stool with mucous. I interpreted this as Spleen Deficiency. With these symptoms and the lack of herbal support for her Spleen, I'm wondering if I need to add a Spleen Tonic. I chose rice and pumpkin because they are Spleen Tonic foods. In the past, she's responded well to Happy Wanderer (XYS). I'm waiting to see if her stools improve. We have also added a small amount of slippery elm and RX Clay by RX Vitamins for Pets.

Overall, I am happy with the direction we're headed. Any words of wisdom and clinical experience in how to move forward it greatly appreciated!

Heather

by naturevet

January 20, 2025

Hi Heather!

I'm glad things have been going well. I would continue with the Tian Ma Gou Teng Yin if it seems to be helpful. Long Dan Xie Gan Tang is less important if you move to a non-Dampening (lower carb meat and vegetable diet), and could increase Spleen deficiency and the propensity to diarrhea.

Meanwhile, Yi Guan Jian and Adoptrex are kind of working at cross purposes, given that Adotrex contains WLT (warming and drying herbs) while YGJ is cooling and moistening. A way to have everything align would be maybe to sub out Adoptrex for a formula called Wu Mei Wan.

WMW treats Jue Yin excess, which occurs at the winter solstice and causes Yang to rise. Meanwhile, the patient is prone to diarrhea because Yang is not being internalized into the lower burner, where it can support the Spleen. Vomiting and regurgitation are common side effects, as well as potentially seizures.

I thus think I would make the new protocol: WMW, TMGTY, YGJ, and XCHT. All of those will work perfectly together, hopefully getting an even better response, but continue trying to veer the diet towards a real food meat-and-vegetable diet of your choosing.

Hopefully this helps you out! Please continue to let us know how things are going!

Steve

by Heather1

January 20, 2025

Thank you, Steve. It's been difficult to convince this dog's caregiver to stop the Adoptrex. Your explanation will be helpful in this endeavor.

Heather

by Heather1

November 13, 2025

No seizures in 10 months! Yay! (none since 1/15/2025)

However, this 8 year old 30 lb Border Collie has some additional symptoms:

1) Weight loss despite excellent appetite and normal stools (Yin Deficiency)
2) Grade 3-4 mitral heart murmur, Grade 2-3 tricuspid murmur
3) Slightly increased movement and restlessness (unsettled Yang, Blood Deficiency)
4) Licking the floor and grabbing leaves outside, “huffing” and coughing at times of transition (these symptoms have improved with the addition of Cessorex)

Currently:
Raw meat diet (Raw Bistro) with Honest Kitchen Whole Grain Veggie & Fruit Mix
Rotating probiotics, fish oil
XCHT (Kan) 2 tablets BID
YGJ (Kan) 2 tablets BID
TMGTY (Kan) 1 tablet BID
Cessorex 1/4 tsp BID
Gaba 50 mg SID (in pm)

Fera Pets Cardiac Support 1 soft chew BID (provides 100 mg CoQ10)
CoQ10 100 mg SID
12 drops dandelion root tincture BID

Enalapril 5 mg 1 tablet in am, 1/2 tablet in pm
Keppra 500 mg 1 tablet in am, 2 tablets in pm

This dog’s tongue and pulse continue to be consistent with Blood Deficiency along with her history of responding positively to XYS and SWXFY. I think we still need to support Yin and Blood along with settling Yang. Without rocking the “herbal boat” since she’s been 10 months seizure free, I’m tempted to increase the TMGTY to 2 tablets BID to further support Blood and Yin. YGJ seems like a good source of continued Blood and Yin support.

In working with the herbal formulas that I’m most familiar with, I think the addition of XFZYT could be beneficial because it Moves & Tonifies Blood, and encourages movement from the Lung to periphery. With the positive response to Cessorex, it seems that increasing peripheral circulation is still desirable. Steve…is there a pattern that I’m missing or misinterpreting? Are there other formulas that come to mind? The only other concern I have is that we’re not providing Spleen support for her. I don’t see any symptoms that indicate she needs it, but I don’t want to neglect it!

by naturevet

November 16, 2025

Hi Heather,

I think you're bang on target with your thinking. Note that for a dog that size, a bare minimum dose of a Kan product for me would be 4 tablets twice daily as a starting dose. If she hasn't yet explored those higher doses and is seeing an incomplete improvement, then she could go up further.

If you go with granules, use 1/4 tsp of each as a starting dose, and give that twice daily. You're doing that with Cessorex, so this would apply if you were going to try Xue Fu Zhu Yu Tang.

There's some redundancy here. If you use Nat Path XFZYT as a granular extract, you could add in Nat Path XCHT, and that would allow you to stop Cessorex (assuming it's just in use for the heart) and the Kan XCHT tablets. Increasing TMGTY is fine, and if you want to get more bang for the buck, you could look at using the granular extract there as well. 1/4 tsp again. Same with YGJ.

Using the granular extracts would give you a stronger effect of each formula, maybe enough to address these new issues while not giving up any of the improvements you're seeing.

Like you, I'm not seeing any Spleen symptoms, so no need to go down that path. Supporting the Liver takes the pressure off the Spleen, so you're not neglecting it.

Anyway, all in all, I'm right there with you in your analysis, and your recommendations of products and new dosages. I don't think you will end up upsetting the apple cart with those changes.

Continued good luck!

Steve

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