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Seizures In A Dog

by SPRJones - February 3, 2025 View Case Report

The patient is an 8 year old NM lab mix, originally presented to me for rehabilitation services after becoming significantly weaker in his left pelvic limb after starting Potassium Bromide for adjunct seizure control. History includes a non-functional right pelvic limb since a puppy after trauma induced fracture and poor healing resulted in fusion of bone/tendon and in ability to use the limb correctly. The leg has not caused much of an issue for him, which is why it was never amputated. He is primarily 3 legged and only occasionally uses his left pelvic limb for balance. He also has a history of suspected CCL injury of the right stifle 2 years ago, which was conservatively managed.

His seizures developed around 2-3 years of age and had been well managed on Keppra. Until earlier this year, he started having more frequent seizures, and then cluster seizures. The neurologist added in Potassium Bromide, which resulted in better frequency between seizure clusters, but increased appetite, drowsiness and weakness of his left pelvic limb, where his leg would give out and he was dragging his back end frequently. Seizures usually in morning, but can be other times of the day. Acupuncture started about 3 months ago has resulted in faster recovery from seizures, however, no improvement in frequency between seizure days, which is about every 18-28 days. Owner wanted to try decreasing KBr due to affecting his mobility due to weakness. She started with a small dose reduction about 6 weeks ago. And we started Tian Ma Gou Teng Yin about 1 week ago. The patient had a seizure a couple days after starting the herbal and then again 8 days later. I of course am suspicious decreasing the KBr is causing the worsening frequency, but wondering your thoughts on if the herbal I chose could be making things worse, rather than helping.

My TCM pattern diagnosis at this time is
KI Jing Deficiency, Bone Bi, Liver Blood Deficiency vs Liver Yin Deficiency

I have had a hard time determining any temperature preferences as he spends a lot of time outside, which he always has. He also has a history of intermittent loose stools, related to diet according to owner. Great appetite. Tongue is usually pink/pale pink, Pulse is weak and deep bilaterally. Around the time he started seizures he also developed some anxiety and mild aggression towards other dog in household. His coat is dry and he has cracked paw pads.

Thanks for your help!

by naturevet

February 9, 2025

Hi there!

I see the Blood deficiency symptoms and think Tian Ma Gou Teng Yin was a good call. It's virtually unheard of for TMGTY to aggravate seizure tendencies, so the worsening is probably due to the KBr reduction in my estimation.

The deep pulse suggests Yang is very internalized (perhaps setting it up for being too pressurized and occasionally releasing uncontrollably, producing a seizure). The increased appetite on KBr supports that notion. Yang is being driven from the Tai Yang (upper and outer body) into the Yang Ming (Stomach and Large Intestine), producing a build up of heat and Dryness there, driving appetite. The damage to Blood and Yin from the Dryness raises the predisposition to uncontrolled Yang movements and further seizures. At the same time, the lack of Blood and the driving of Yang internally is aggravating Qi and Blood flow to the hind limbs, producing weakness.

The goals then would seem to be to (1) nourish Blood and Yin; (2) find a replacement for KBr that still internalizes Yang, but without side effects; and (3) harmonize the flow of Yang between the interior and the periphery so that it is less erratic and less conducive to seizures while supporting mobility.

Given all that, I would first add Chai Hu Jia Long Gu Mu Li Tang and change nothing else. If the seizures revert to the more improved state, you'll know you've found your replacement for KBr.

Assuming that is what happens, I would next add Yi Guan Jian to moisturize the Yang Ming and support Blood and Yin.

Then I would add something like Benefit Hips and Knees (i.e., Xiao Chai Hu Tang with Qin Jiao added) to see if I could target the left hind leg weakness and pain a bit. Consider chiropractic as well unless you're already doing that. Although this formula will increase the flow of Yang to the upper and outer body, it should not be aggravating. The simultaneous use of CHJLGMLT and the harnonizing effect of XCHT should balance the flow of Yang so that you don't see a worsening.

Assuming THAT all happens, you can start exploring to find the lowest required dose of KBr (and if the dog becomes seizure-free) even Keppra, lowering the dose of one drug at a time 15 to 20% at a time.

If you want to do steps one and two at the same time, you can get a hold of Halscion from Gold Standard Herbs. They sell wholesale to vets or the owner can just purchase it herself at www.goldstandardherbs.com

Hopefully this progression is what happens. Let us know how things are going. Seizures are always challenging so there is always interest.

Steve

by SPRJones

March 27, 2025

Thank you so much for the detailed and helpful response. I wanted to give an update on how things are going.

I discussed the herbal recommendations with the owner, and she was willing to give Chai Hu Jia Long Gu Mu Li a try. However, she was concerned about the seizure frequency and elected to also increase the KBr to the previous dose before the slight reduction she had made.

With the higher KBr dose, and Tian Ma Gou Teng Yin as well as Chai Hu Jia Long Gu Mu Li on board, Rio had cluster seizures 26 days later (about 10 days after being on full dose of herbals) and then again another 26 days later (having been on herbals for 36 days at this point). The owner reports a change in the seizure activity from a clear pattern of stiffness to paddling vs now changing between stiffness and paddling throughout the 30-40 second seizure.

We have not gotten to the point of considering adding additional herbals due to no major improvement in seizure frequency. Additionally, with the higher KBr dose still on board, his mobility has suffered significantly. Still working to decide next best steps for this guy.

Sidney

by naturevet

March 30, 2025

Hi Sidney,

Sorry it's such a frustrating case for you. I have two suggestions:
One is to add the Yin tonic (Yi Guan Jian), in case it is needed for the other two Chinese herbal formulas to have maximum effect.
The second is to use instead Long Dan Xie Gan Tang (Natural Path) along with the two formulas in current use.
If the former is to be useful, I would expect the pulse to be somewhat thin. If the latter is to be useful, I would expect the pulse to feel more broad and full and excessive.

The last cluster case I had needed ALL of CHJLGMLT, LDXGT AND a real food diet to stop the seizures. If the owner hasn't changed the diet and the pulse seems excessive, I would say that is a critical step

Hopefully that helps you.

Steve

by SPRJones

March 30, 2025

Thanks for the quick response. I used to describe his pulse as weak and deep, but the last few rechecks I have found it to be more forceful and excessive, so I will look Long Dan Xie Gan Tang. His last recheck he also had a slight purple to his tongue, which is new. He is on a primarily whole food diet.

Any thoughts on dosage for the two herbals already in use? Was a thought that I may not have a high enough dose for maximum effect. He is about 85lb.

Thanks again for all the help!

Sidney

by naturevet

March 31, 2025

Hi again,

I would start with at least 3/4 tsp of each of them, giving them at least twice a day. Hopefully you see some success!

Steve

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