View Question

Multiple Seizures In A Dog

by drharris - August 21, 2024 View Case Report

I am working with a case currently that has me a bit puzzled and I could use some input.

Bella is a 3 y/o Australian Shepherd, FS, 50 lbs. O adopted as puppy and she had first grand mal seizure about 1 yr ago. Seizures last a minute or so, then post-ictal, she is blind, disoriented, and aggressive. Owners have been instructed to give oral valium post seizure. RDVM had her on phenobarbital and Keppra, but due to elevated liver values, reduced the dosage of phenobarbital to 64.8mg 1.5 tabs and increased the Keppra to 750mg BID. Over the past month, she has begun to go straight into post ictal behavior without a noticeable seizure preceding it. O says she will be sitting quietly with him, will get up and walk to the corner, and proceed to bolt down stairs and run into walls, become aggressive and apparently blind and disoriented. The interesting thing is that the seizures were occuring almost exclusively between 8-10pm (Triple Heater time?)

I saw her first on Aug 1. She was having a seizure approximately 1x/week. Diet is warm/hot (beef kibble-we are transitioning to fresh diet). Shen is good-she is outgoing but anxious. T=dark pink/reddish, P=thin and thready, good body condition, shiny full hair coat. I acupunctured at GV20/14, an shen, GB20, HT7, LI4, BL17/18/23, ST40, LIV3, started her on Conc. Shen Calmer (Jing Tang), 2 caps BID while I waited for Yang Yin Xi Feng to come, and put her on Rx-Hepato for liver.
-Aug 3 had 1 “post-ictal" episode with short recovery
-Aug 8-(Visit #2) T=dk pink, P=fuller, taut R>L. AP: GV20/14, da feng men, GB20, an shen, HT7, BL17/18/23, BH, ST40, KID3/6, LIV3. Added Concentrated Yang Yin Xi Feng (Jing Tang) -1.2g level scoop BID
-Aug 10-14 had seizure every day for past 5 days, 2 with only post-ictal signs, and 3 with visible seizure first. All seizures occurred between 8-10pm.
Aug 15 (Visit #3)- Acupuncture points same as visit #2. Will start tonight to d/c Shen Calmer and start Concentrated Di Tan Tang at 2 caps BID.
Aug 16 4 seizures in 1 day
Aug 17 2 seizures 6:30am/12pm
Aug 18 2 seizures morning/evening
Aug 19 1 “post-ictal” episode in am, then 3 seizures back to back
Aug 20 had seizure lasting over 5 mins, Went to ER. Stopped Di Tan Tang

This is a super sweet dog and a dedicated owner that I really want to help. What do you make of the timing of these episodes? Based on diagnostics, I thought liver and kidney yin deficiency with phlegm. Do I have it wrong? I knew we would have to wait until the herbs were on board for a couple of weeks to determine if they were effective,but now the owner has stopped both of them. I am at a loss for what to do now. I will be seeing her again tomorrow (Aug 22) and could use any advice!

Thank you for the input,

Wendy Harris, DVM, CVA

by naturevet

September 11, 2024

Hi there,
Hopefully you are still in a position to help this case. I apologize about the late reply but it’s super hard to respond to urgent situations sometimes, depending on whatever life happens to be throwing at me. Even if this client has moved on, you may be able to get them back. If you’re able to report the outcome, it will be an important teaching moment for all of us.
The worsening of the seizures this August, and their appearance in the latter half of last summer all signal a Shao Yang disharmony causing the seizure. Basically, the Shao Yang ‘pump’ has trouble internalizing Yang, likely aggravated by an associated Yin deficiency that worsens as summer progresses and Dry takes hold. You were detecting this in the pulse, just not the Shao Yang part. We need to treat the Shao Yang to see some immediate progress. The drugs help, but still leave the dog in a Yang rising state, where it’s now just stuporous and aggressive, instead of outright seizing.
The formula I would reach for is Chai Hu Jia Long Gu Mu Li Tang (Bupleurum, Dragon Bone and Oyster Shell Combination). I would pair it with Yi Guan Jian, because the latter moistens the Yang Ming and is a comprehensive body-wide Yin and Blood tonic. Use them in a 2:1 ratio, or introduce them one at a time, starting with CHJLGMLT.
Some bad Shao Yang cases have had to have Long Dan Xie Gan Tang given instead of a Yin tonic. Natural Path versions are adequately moistening to address associated Blood and Yin deficiency, but can help the CHJLGMLT more vigorously subdue Yang and clear Heat.
As for the worsening you saw, I don’t think it was due to a Dampening effect of the Yin tonics. Just a progressing of the condition given that we are right in the middle of the season when this kind of problem can go off the rails in its severity. If the owner gives you another shot, and you try this approach out, please let us know how things go!

Steve

by drharris

September 11, 2024

Thank you so much for this reply. With the worsening symptoms, I suggested that it was time for an MRI to be sure we weren’t dealing with a tumor. He saw a neurologist where she had an MRI and spinal tap-both WNL. CBC/chem also seemed good and liver enzymes were not overly elevated (I have not had a copy of the labwork yet), so the neurologist raised the dosage on the Keppra. For 2 weeks, she did not have any noticeable seizures, however, she was having the “post-ictal” episodes and they were increasing. They added clorazepate for 3 days and she has not had any episodes for the past 5 days. Assuming this remains stable, I suspect that this client won’t come back, but if things get worse again, maybe I can get him back. I am not sure if he believes that the AP or herbs triggered the onset of the worsening seizures, but hopefully I can suggest that the lowering of the dose of phenobarb may have contributed more (based on timing). I will certainly keep you posted and thank you again for the response.

Regards,
Wendy

by naturevet

September 11, 2024

Hi Wendy,

Yes, lowering phenobarb for sure lowers the seizure threshold, resulting in a worsening if the right formula is not yet in play.

However he gets there, I hope he feels better. I'm sorry I could not reply in a timely fashion

Steve

You must be logged in to reply

CuredCases.com