If We Should Ever Need To Add More Seizure Meds...

[Guest EmilyAnne]

Henry got a blood test last week to find out his Phenobarbitol level. His level is 149 and he cannot go over 160. The vet said this means we probably cannot increase his dose.

 

I have handled many different special needs with my pets over the years, and I like always having one more trick up my sleeve on what we can do if a condition worsens.

 

If Henry's seizures were to come back ( ing they never do!), what would be more tricks up my sleeve? Would I have to lower the Phenobarb in order to add Potassium Bromide? (I understand the level is supposed to be lower when combining the two) Or is there another med I could add where I would not have to change the Phenobarbitol dose? Anybody ever just go a little over the reccomended level? How did that go?

 

And no, I don't want to lower the Pheno now (or pretty much ever), because he has already had a few close calls. I have witnessed 21 Grand-mal seizures and have gained an intimate feel and knowledge for Henry and when he is about to seize. When he shivers and/or pants very hard for no known reason, I know a Grand-mal is coming up if I don't give an extra Pheno dose. And he has done this a few times even on the high dose of Pheno. So I really feel he needs this high level.

 

My desire to squash the stupid seizure monster and keep him squashed. The more seizures Henry has, the more frequent they become down the road. Henry has proven this.

 

So my hope is, since he is doing so well now and breaking the pattern, that he really is on the way to staying seizure free!(Provided he stays on his Pheno) But *just in case* what tricks up my sleeve would I have? I know all too well the dread of watching Henry go downhill, and it was a comfort to know we had the option of starting him on meds. I wouldn't jump on more meds at just one Grand-mal, but if they become too frequent or if he clusters, then definately I would want to increase seizure control somehow.

 

I know this is a question more for the vet, but I like to hear the experiences of others and what they have done when their hound needed more meds, and how it went.

 

Btw, Henry is 48 days Grand-Mal free today! (And he started Pheno 48 days ago!)

[ahicks51]

If Henry's seizures were to come back ( ing they never do!), what would be more tricks up my sleeve?

 

A ketogenic diet. Cut the dietary carbohydrates to an absolute minimum. In the canine, this is different than in the child, of course; one simply feeds raw meat and bone- no kibble.

 

Oddly, after two years on this diet, some children may resume eating "normally" without facing the return of seizures. For those that have been seizure-free, there is a 20% chance their seizures will return. While that doesn't constitute a "cure," it does mean that perhaps 80% do not have seizures again. Holy heck.

 

[Guest EmilyAnne]

If Henry's seizures were to come back ( ing they never do!), what would be more tricks up my sleeve?

 

A ketogenic diet. Cut the dietary carbohydrates to an absolute minimum. In the canine, this is different than in the child, of course; one simply feeds raw meat and bone- no kibble.

 

Oddly, after two years on this diet, some children may resume eating "normally" without facing the return of seizures. For those that have been seizure-free, there is a 20% chance their seizures will return. While that doesn't constitute a "cure," it does mean that perhaps 80% do not have seizures again. Holy heck.

 

Wow, 80% really is holy heck! I have Henry on homecooked, and he has been getting gluten free rice. I don't have a bag on hand to read the nutritional label, but I imagine that though it has gluten free it still doesn't qualify for the ketogenic diet? I've done raw, I'm afraid to go down that road again. It just did not work for Henry and he gained some food allergies out of it. (eggs and chicken, either cooked or raw)

 

[ahicks51]

Wow, 80% really is holy heck! I have Henry on homecooked, and he has been getting gluten free rice. I don't have a bag on hand to read the nutritional label, but I imagine that though it has gluten free it still doesn't qualify for the ketogenic diet? I've done raw, I'm afraid to go down that road again. It just did not work for Henry and he gained some food allergies out of it. (eggs and chicken, either cooked or raw)

 

It's a matter of percentage of calories from carbohydrates, not whether there are sensitizers such as gluten.

 

I'd have to re-read up on the subject again, but I think the general recommendation is <10% of calories from carbs. i think.

[Guest EmilyAnne]

This is Henry's current recipe. I've no idea how I would go about figurng out how many carbs are in the Veggie Goop?

 

3/4 cup gluten free brown rice

 

1 1/2 cups of boiled stew meat or steak

 

1 cup of Veggie Goop

 

1/4 cup cottage cheese in AM, 1/4 cup yogurt in PM

 

1 teaspoon Solid Gold Bonemeal

 

Milk thistle, alternating weeks.

 

 

 

[ahicks51]

Well, you could really do your homework and look up each component individually and do the math:

 

http://www.nal.usda.gov/fnic/foodcomp/search/

 

Or you could just cut out the sugary stuff, which is ultimately what you'll have to do anyway.

 

The geniuses at K9Kitchen (Yahoo! group) are very helpful folks. Tell them where you want to go, and where you're at now (in terms of allergies and a medical condition you wish to treat), and they may have some brilliant insights.

[Trudy]

We added KBr with Ryan maxed out on Pb

Waited for him to adjust on the new combo and then started reducing levels to get some quality life back.

We take the occasional seizure over the perpetually drunk dog that can't stand up or walk without bumping into things, but have also been able to drop both levels over the years.

[scullysmum]

We added KBr with Ryan maxed out on Pb

Waited for him to adjust on the new combo and then started reducing levels to get some quality life back.

We take the occasional seizure over the perpetually drunk dog that can't stand up or walk without bumping into things, but have also been able to drop both levels over the years.

Trudy beat me too it....KBr and Pheno combined work well for some puppers. The only side effect for my boy Scully was increased thirst and consequently increased peeing but that was not big deal.

[Guest EmilyAnne]

We added KBr with Ryan maxed out on Pb

Waited for him to adjust on the new combo and then started reducing levels to get some quality life back.

We take the occasional seizure over the perpetually drunk dog that can't stand up or walk without bumping into things, but have also been able to drop both levels over the years.

I hadn't though of lowering the Pheno *after* adding he new med. (sorry, 'Duh' moment for me) On just Pheno, Henry hasn't had hardly any drunkenness. I'm hoping our 3 mile walks and bonemeal supplements are helping to keep his rear legs strong. I too would choose the occasional seizure over perpetual drunkeness.

[GreyWrangler]

Emily Anne, good timing of this thread.

 

Red is going in three weeks to check his Pb level, while I don't think we are near

the upper level it is something to think about.

 

Last Seizure - 8/21

[tamborine]

I don't know much about seizures in dogs (as evidenced by my locked soapbox thread ) but can dogs take other meds like keppra, depakote, tegretol, etc.? Seems like the only ones I've ever seen mentioned are phenobarbital, potassium bromide and maybe dilantin, but there are so many others (for people, at least). Are these not options for dogs? Phenobarb and dilantin are very sedating, and where I've worked we always tried to transition the patient to another drug/combo for this reason. Just want to learn.....

[Guest simile]

I've been meaning to ask the above question, too. I know that there are different meds for different types of epilepsy, but I was wondering if there has been any research into the effectiveness on dogs of some of the more benign anti-seizure meds used for people.

[Guest EmilyAnne]

I don't know much about seizures in dogs (as evidenced by my locked soapbox thread ) but can dogs take other meds like keppra, depakote, tegretol, etc.? Seems like the only ones I've ever seen mentioned are phenobarbital, potassium bromide and maybe dilantin, but there are so many others (for people, at least). Are these not options for dogs? Phenobarb and dilantin are very sedating, and where I've worked we always tried to transition the patient to another drug/combo for this reason. Just want to learn.....

I would love to hear more about this. How effective it was for their hound, what were the advantages, and what was the cost? I have heard some of these are obscenely expensive. Is it $600 a month expensive, or more like $100-$200 a month expensive?

[RobinM]

Henry is one lucky pup to have you!

[Guest EmilyAnne]

Henry is one lucky pup to have you!

Me and Henry are both lucky to have each other.

[ahicks51]

The Merck Veterinary Manual lists the following first-line anticonvulsant drugs for use in dogs:

 

Phenobarbital

KBr

NaBr

Diazepam

 

It lists the following as second-line drugs, again for use with dogs:

 

Clonazepam (Klonopin)

Clorazepate (Tranxene and Tranxilium)

Felbamate (Felbatol)

Topiramate (Topamax)

Valproic acid (Depakene)- this is apparently Depakote minus the sodium valproate

Zonisamide (Zonegran)- same class as topiramate

 

[GreyWrangler]

I don't know much about seizures in dogs (as evidenced by my locked soapbox thread ) but can dogs take other meds like keppra, depakote, tegretol, etc.? Seems like the only ones I've ever seen mentioned are phenobarbital, potassium bromide and maybe dilantin, but there are so many others (for people, at least). Are these not options for dogs? Phenobarb and dilantin are very sedating, and where I've worked we always tried to transition the patient to another drug/combo for this reason. Just want to learn.....

 

 

I believe these others keppra, depakote, tegretol and other new ones aren't used in K9's due to their short half life and a K9's high metabolism the drug doesn't hang around the body long enough to do much good. And i know Keppra is expensive, depakote & tegretol, not so much.

 

Oh and Felbatol I think causes something bad in some humans, i think some form of serious Anemia.

 

It is still used because, again for some people, it works very well as an anti-epileptic.

 

Depakote - Enteric coated tables, works in the intestines, but again does digest quicker than us and the enteric caoting delays it too long to dissolve.

 

Depakene - gel capsule/let - dissolves in the stomach. It can be harsh on some sensitive stomachs.

 

Diazepam - I believe is used more to break the cycle of the seizures, Via oral tabs, or rectal suppositories, even the rectal gel (but these are very expensive)

Edited November 23, 2008 by GreyWrangler

[Guest EmilyAnne]

Oh yes, Diazepam! I feel silly I didn't recognize that one! We have been refering to it as Valium, and we give it rectally. It was extremely affective in breaking up Henry's cluster. We had to keep him on Valium continously until the Phenobarbital kicked in enough. The Valium saved Henry's life. About half a minute after the vet was pulled out the needle from administering the Valium, Henry almost started to go into a sixth Grand-Mal, and just started to paddle his legs about three times, and then stopped.

 

 

[ahicks51]

Oh yes, Diazepam! I feel silly I didn't recognize that one! We have been refering to it as Valium, and we give it rectally. It was extremely affective in breaking up Henry's cluster. We had to keep him on Valium continously until the Phenobarbital kicked in enough. The Valium saved Henry's life. About half a minute after the vet was pulled out the needle from administering the Valium, Henry almost started to go into a sixth Grand-Mal, and just started to paddle his legs about three times, and then stopped.

 

Not to digress too much off the thread- I've only ever seen status epilepticus once, and that's when I was an EMT and this guy would not stop seizing. We had to get him from the second floor of his home, drag him down to the landing, and then out of the house- moving him every time we could between seizures. There was no medic on board, so there wasn't a lot we could do for the guy except hustle. I recall quite distinctly my crew chief getting his hand smashed between the guy's head and the backboard.

 

I forget how much diazepam they gave him, but it was 5 mg at a time until he stopped and the doctor muttered something about it being enough to sedate a horse.

[Guest EmilyAnne]

Oh yes, Diazepam! I feel silly I didn't recognize that one! We have been refering to it as Valium, and we give it rectally. It was extremely affective in breaking up Henry's cluster. We had to keep him on Valium continously until the Phenobarbital kicked in enough. The Valium saved Henry's life. About half a minute after the vet was pulled out the needle from administering the Valium, Henry almost started to go into a sixth Grand-Mal, and just started to paddle his legs about three times, and then stopped.

 

Not to digress too much off the thread- I've only ever seen status epilepticus once, and that's when I was an EMT and this guy would not stop seizing. We had to get him from the second floor of his home, drag him down to the landing, and then out of the house- moving him every time we could between seizures. There was no medic on board, so there wasn't a lot we could do for the guy except hustle. I recall quite distinctly my crew chief getting his hand smashed between the guy's head and the backboard.

 

I forget how much diazepam they gave him, but it was 5 mg at a time until he stopped and the doctor muttered something about it being enough to sedate a horse.

Wow. That must have been very scary! My husband used to ride along on an ambulance back before they had paramedics on them. And he told me how awful it was that there was so much they could not do and the patient always had to wait till they got to the hospital before they could get any medical help at all. I think nowadays the ambulances always have paramedics who can do all kinds of things. (My husband says this depends on location, out in 'boondocks' some ambulances will not always have paramedics)

 

Diazepam is hefty stuff. Henry was completely incontinent when on it and was very drunk. But it did the job! Staus epilepticus is even worse than cluster. It's like one long seizure that never ends or only stops a few minutes at a time? Henry was fortunate to at least get a few hours break between seizures. One of them, he kept hitting his head on the closet so unbelievably hard, it sounded like a jackhammer. I was trying to get him away from the closet door, and got a nice little bruise from where one of or both of his back feet kept hitting my calf~ (pic. taken about 5 days later)

 

 

I'm sure lots of people with epi-dogs or epileptic skin family members have sustained their fair share of bruises!

 

OK, so now I'm guilty of hijacking my own thread!

[tamborine]

And i know Keppra is expensive, depakote & tegretol, not so much.

 

I had done a quick google of keppra for dogs & saw that it could be used....nobody here ever mentions that they do, though, and I wondered why. Must be SUPER expensive. Many, if not most, of my human seizure patients are on keppra, either alone or with something else.

 

And with some of the other drugs, I hadn't taken a dog's faster GI transit time into consideration, either.

 

Thanks for the info!

 

[ahicks51]

And i know Keppra is expensive, depakote & tegretol, not so much.

 

I had done a quick google of keppra for dogs & saw that it could be used....nobody here ever mentions that they do, though, and I wondered why. Must be SUPER expensive. Many, if not most, of my human seizure patients are on keppra, either alone or with something else.

 

Keppra's patent apparently expires in 2008, but they have exclusivity at least until 2010:

 

"Even though the patent for Keppra expires in 2008, UCB holds the exclusive rights to market Keppra until at least March 2010. By law, the manufacturers can be given extended periods of exclusivity if they choose to perform pediatric studies (studies of the medication in children). This is done to encourage manufacturers to adequately study medications in children (which was not done in the past). Additionally, there are other circumstances that could come up to extend the exclusivity period of Keppra beyond 2010."

 

One of Abbott's main patents on Depakote expired in July (I think), but Depakote ER is good until 2018 from what I can see.

 

One of the patents on Tegretol (carbamazepine) expired in 2007, but another goes until 2011.

[tamborine]

And i know Keppra is expensive, depakote & tegretol, not so much.

 

I had done a quick google of keppra for dogs & saw that it could be used....nobody here ever mentions that they do, though, and I wondered why. Must be SUPER expensive. Many, if not most, of my human seizure patients are on keppra, either alone or with something else.

 

Keppra's patent apparently expires in 2008, but they have exclusivity at least until 2010:

 

"Even though the patent for Keppra expires in 2008, UCB holds the exclusive rights to market Keppra until at least March 2010. By law, the manufacturers can be given extended periods of exclusivity if they choose to perform pediatric studies (studies of the medication in children). This is done to encourage manufacturers to adequately study medications in children (which was not done in the past). Additionally, there are other circumstances that could come up to extend the exclusivity period of Keppra beyond 2010."

 

One of Abbott's main patents on Depakote expired in July (I think), but Depakote ER is good until 2018 from what I can see.

 

One of the patents on Tegretol (carbamazepine) expired in 2007, but another goes until 2011.

 

Thanks!

 

[LBass]

Canine epilepsy drugs other then Pb and Kbr

 

Another site

 

The above sites give a good overview of the other meds that are being used to treat canine epilepsy. Most of these are given as add-ons to Pb and KBr.

 

In terms of expense, get pricing from many pharmacies. Drug price varies significantly. I was able to get the generic form of Gabapentin for ~$40 per month at Costco (via mail w/o a membership) vs. ~$120 at a local pharmacy. It did not have an impact on Piper's seizures, but does work for some dogs.

 

--Lucy