Increase In Seizures

[Ullaluv]

My 4 year old seizure boy has gone for over a year on the same dose of phenobarb, KBR, and milk thistle. The last time we did levels, his peak and trough phenobarb levels were almost the same, so I think we've been real stable on the dosage. Also very careful not to vary the chloride is his food. (I bought a popcorn popper so he can have unsalted popcorn.) Our pattern has been 3 week to 2 months between seizures, then anywhere between 2 gran mals with post ictals in 1 day to 2 or 3 in 2 days, then another 3 weeks to 2 months with no seizure activity.

 

Well, last night he had a seizure at 9:00 PM, another at 3:00 AM, then more today at 12:00, 1:00, 2:00 and 8:00 PM. I bumped up his phenobarb last night and will bump it up a little more tonight and maybe throw in an extra milk thistle.

 

Thinking of calling the vet in the morning and doing his phenobarb and KBr levels sooner than planned.

 

Thoughts or advice!

 

Thanks.

[Hollis]

I have neither thoughts nor advice as I have no experience. I do however have tons of well wishes for your baby...

[TheFullHouse]

Sounds like he's trying to cluster. I'd definitely have his levels checked asap and adjust the medication accordingly if necessary. Poor guy, that's a lot of seizures in a small amount of time. One of the new theories about seizures if that with every seizure, the brain "learns" how to have more, so the sooner you can get them under control the better.

 

If you can ask the vet to check his liver values, and if they're good, an increase in medication won't hurt him.

[Ullaluv]

Sounds like he's trying to cluster. I'd definitely have his levels checked asap and adjust the medication accordingly if necessary. Poor guy, that's a lot of seizures in a small amount of time. One of the new theories about seizures if that with every seizure, the brain "learns" how to have more, so the sooner you can get them under control the better.

 

Thanks. I now the theory and it makes sense. That's why I've already increased his phenobarb before even calling the vet.

 

Never knew whether to consider his typical 2 to 3 gran mals in 2 to 2 days as clusters or not. This is definitely more seizure activity since his early days here, when he would have gran mals several times a week and focal seizures (or behavior issues that I think were seizure equivalents) several times a day.

[TheFullHouse]

Clusters are usually several seizures in a short amount of time. Saint's last cluster was 4 seizures in 3 hours. That was several years ago though. He stopped on his own that time but we immediately added potassium bromide to his phenobarbital. He was on quite a high dose of both meds for about 3 years and we've just recently been able to cut his potassium bromide dose in half and he's still seizure free after 5 years.

 

Praying your sweetie doesn't have any more.

[Guest PreciousMom]

I have a seizure dog and he has gone along time with out a seizure, since we got them under control. When ever he has a break through of seizures we do his levels, just to check, make a little change in meds after drawing blood and always hope for the best. You may want to ask the vet about valium to keep at home.

 

Good luck and lots of well wishes.

 

Sue

[TheFullHouse]

Good point about the valium. We keep valium on hand for Saint. If you have a run of several seizures within just a few hours, you can break the cycle with the valium.

[Ullaluv]

I have valium but have never had to use it. Have given an extra phenobarb instead. Since I've had it around for 2 years now, I wouldn't trust it to still be good, even though it's been stored in a brown glass vial inside a paper bag.

[Guest Energy11]

I am sorry to hear about the increase in the seizures! Yes, your vet will probably increase his anti-seizure meds

 

I have injectable Valium here (liquid) I keep 15 mg drawn up in a syringe, and keep it, with KY Jelly, on top of my frig, just in case. We aren't sure exactly what Curfew has. I say mini strokes, vet, seizures. I do know, the Valium works to quiet him.

 

I would most definitely ask the vet about a vial of injectable Valium, and keep whatever dosage he/she recommends, and have it handy. During a seizure, it might be too much to worry about drawing it up, ...

 

The Valium is given trans-rectally (in the rectum), and works almost as quickly as IV. It should break a seizure in minutes.

 

Good Luck with this! We send you our love and many prayers! Dee, Curfew and the others.

 

 

[Ullaluv]

No problem drawing it up. My background is medical. The syringe is kept with it. Draw it up, remove the needle, and find a time that I'm able to give it rectally (The thing I've not done.) I guess my question is about the potency after being stored in a brown glass vila for 2 years.

[Guest Energy11]

I have valium but have never had to use it. Have given an extra phenobarb instead. Since I've had it around for 2 years now, I wouldn't trust it to still be good, even though it's been stored in a brown glass vial inside a paper bag.

 

I would definitely get a new vial for sure. It will definitely work to stop this cycle your boy is on. Hope there are no more seizures for a LONG time.

[CaliforniaGreys]

No experience here but wishing you the best

[Guest Energy11]

No problem drawing it up. My background is medical. The syringe is kept with it. Draw it up, remove the needle, and find a time that I'm able to give it rectally (The thing I've not done.) I guess my question is about the potency after being stored in a brown glass vila for 2 years.

 

My background, also medical :-) I was great at getting meds drawn quickly when I was a paramedic ... especially on the ambulance, but when my dogs are sick, I am jello, hence, the pre-drawn Valium. It is actually pretty easy to give rectally. I have done it in humans and with Curfew, once.

 

That two-yr-old bottle, I wouldn't trust. Is that two years AFTER the exipration date?

[Guest Energy11]

Apparently, the tablets last a lot longer than the liquid, which makes sense.

 

 

"Believe it or not, as long as you keep it dry, and regardless of the written expiration date, valium (diazepam) tablets do not degrade! The chemical is very stable when dry.

 

This fact was well known by pharmacists 30 years ago, and yet somehow it was conveniently forgotton by the manufacturers. And why can't the chemical simply be stable? This is not the case for liquid diazepam (valium) solutions which are less stable. Nor is it the case for all drugs, and many degrade or even turn toxic over time, including vitamin C. "

 

Edited March 15, 2010 by Energy11

[Ullaluv]

Thanks, everyone.

 

There's something else different this time around. Have no idea if it has anything to do with the recent seizures or is totally unrelated. Looking for a little collective GreyTalk wisdom here.

 

Normally, along with the seizures, we have both urinary and fecal incontinence. Vinyl floors, and I'd much rather clean up after my boy than risk him getting hurt having a seizure out in the potty area, which is concrete and has a couple of concrete steps. He may have had a bowel movement last night, when he had access to the potty area, but other than that, nothing. No accident while I was gone yesterday (before the 9:00 PM seizure) and nothing today. He's emptied his bladder several times (just lots of paper towels), but no for certain bowel movement sine Saturday morning - totally unlike my boy.

 

Again, it's hard to know if it has anything to do with anything, or just a wierd coincidence.

[Guest Energy11]

Poor Sweetie!

 

 

We surely do hope there are no more tonight. Neither of you need that. Sending you a quiet, peaceful night, if at all possible! And, hoping you get to the bottom of this, and get his meds leveled out.

 

 

[Ullaluv]

You know, he is really a sweetie.

[Ullaluv]

I'm even more worried and don't know what to do. He gobbled up his dinner in his usual "I know this is the last food on earth" manner. After he finished, he became so ataxic that he can't stand. No way that this is because of 2 extra phenobarb tabs in 24 hours (added to his usual 8 60 mg tabs per day.) He's kind of passed out on a dog bed right now. I have everyone else crated in case I decide I need to something drastic tonight. I think this is something more than just his seizure disorder, and I feel so helpless right now. Just don't know what I need to do to help my boy.

[Guest Stripeyfan]

Hope your boy is ok.

[LBass]

Oh dear. I'm just catching up on this thread now and I am sure you are frantic with worry. Fingers crossed for your boy. Let us know when you can what your vet says.

 

 

My Piper can cluster. When he does it is usually 10-12 seizures, one about every 3-4 hours over 2+ days. It is just awful for him and for me. For a long time I used liquid valium given rectally to try to break that cluster cycle. What I finally realized was that the value of the rectal valium is that it get into the system very quickly. Unfortunately, it is gone very quickly too. It is most effective with seizures that are coming one right on top of the other--w/in 30-45 minutes of each other or sooner. Piper's seizures were always farther apart so I finally realized that rectal valium probably wasn't helping him. My wonderful vet consulted with a neurologist and gave me a new plan to follow to stop those awful clusters. Now when Piper has a seizure I give him an additional Pb tablet and a 10 mg Valium tablet every 6 hours in addition to his normal 2 1/2 grains of Pb every 12 hours. That approach has kept him from having a cluster episode for over a year. In the past, I could always count on a big cluster episode each summer. At this point, he is still having single seizures but they are coming more frequently. I too am about to get his Pb and KBr levels checked again to see if he needs a change in his dosage.

 

This business of managing seizures keeps us constantly on our toes, doesn't it.

 

--Lucy

[Guest Energy11]

Sorry to hear about his being ataxic and all.

 

Just could be the "fallout" from all those seizures. I like the idea Lbass had about giving oral Valium along with the other antiseizure medications, with all the seizures your boys has been having.

 

Please let us know what the vet says! Sending your sweetie extra hugs, love and prayers! Dee and The Five

[Hollis]

Ulla this is the first chance I've had to check today. How is he? How are you?

[Guest LindsaySF]

Sorry to hear about this. I know what you're going through.

 

Sophie's neurologist considers more than one seizure in 24 hours to be a "cluster". The definition varies from vet to vet. I would consider your boy's current pattern to be a cluster, and I would get some new liquid valium on hand ASAP. The valium tablets are ok in a pinch, they don't work as fast as the rectal valium but they work far faster than phenobarbital.

 

Sophie's regular vet would always recommend giving her an extra phenobarb to prevent clusters, but she went through a bad cluster (over 7 seizures in 24 hours) and several extra pheno tablets didn't help at all. We brought her to a neurologist to get her stabilized on a valium drip. The neurologist told me that pheno takes too long to get into the system, she prefers valium to stop clusters. The extra pheno won't hurt and she still recommends it, but in addition to the valium.

 

Sophie's regular vet has said I can give her an entire day's worth of phenobarb if needed during a cluster. Don't be afraid to give more than 2 extra pheno tablets (you'll just want to check his liver and pheno levels in a week or two). If he normally takes 8 tablets a day just 2 more might not be enough to break the cluster. You might need to double his pheno dose to get him past this cluster. Be prepared for some bad ataxia as a result.

 

His current ataxia could be from the added pheno, the seizures, or both. Sophie was the same after her cluster in December, she could barely walk and had to be carried. Part of it was from the pheno, part of it was a lingering post-ictal state from the seizures. She was also simply exhausted from all the seizures. She was ravenous (she gets like that after a seizure) but once she got her food she went limp.

 

About the incontinence, are you sure he isn't having seizures while you are gone? He could be having incontinence during a seizure, or he could just be incontinent as a result of all the seizures, or from the increased meds. I wouldn't necessarily worry about the incontinence itself, I'd be more worried that he is continuing to seize when you aren't there.

 

ETA: I think I misread your post. Are you concerned that he hasn't had fecal incontinence during the seizures, or that he hasn't had a bowel movement? If it's the former, I wouldn't worry, all seizures are different. Sophie has never had fecal incontinence but she has had urinary incontinence during a seizure. It doesn't happen every time though, in fact her last few seizures have not involved any incontinence at all, but the seizure still seems just as violent. If it's the latter, I wouldn't worry that he hasn't had a bowel movement, as long as he is eating ok. He could be just simply exhausted and his digestive system is a little slow too. Sophie drinks a lot of water after a seizure, I would make sure he is hydrated well enough and not constipated, but he might skip a few potty breaks until he feels like himself.

 

Good luck.

 

 

 

 

~Lindsay~

Edited March 15, 2010 by LindsaySF

[Batmom]

Checking in on you and your pupper today.

[Ullaluv]

Thanks, everyone.

 

We had a rough night. After his 8:00 PM seizure, PM meds, dinner that he ate very enthusiastically, he never really came out of his post-ictal state. He crashed until 3:00 this morning - basically unresponsive. I stayed awake listening to his breathing. He managed to get to his feet around 3:00 and paced non-stop until after 7:00, running into things, and I could hear his feet dragging. Let him out to potty around 8:00 and he fell down in someone's last-night poop, so he's now adorned in a combo of slobber and poop. (Our winter dog bathing place is in the basement, and there' no way I would try to get him down there right now.) Hopefully it will warm enough to do the hose outside (it has both hot and cod), until then it's sponge bath time. Then he got wedged in the bathroom and I had to extricate him. (Clothes to launder)

 

We just got back from our 11:30 vet appointment: Liver and kidney functions all totally normal. Electrolytes basically OK (slightly elevated, along with hematocrit) because he was a little dehydrated. Urinalysis totally clear. Physical exam normal (except he's still somewhat post-ictal.) Gave him sub-Q fluids (and I have more here if I think he needs them.) Sent blood off for KBr levels, trough phenobarb levels, and a full Thyroid Profile 6. Thyroid was normal before, but that was over a year ago. For now, I've bumped his phenobarb from 8 (60mg) to 10 a day.

 

This episode is different from any of his previous ones. Don't know how many people consider 2 to 3 seizures in 1 to 2 days clustering, but I never considered it a real problem because they were short discreet seizures with a fairly brief post ictal period and resolved completely after each. That's not what has happened now. So far we have not come with anything that would explain the change. Maybe there will be a clue in the levels or thyroid panel. At least the liver profile is normal, so I'm comfortable increasing the phenobarb (and will increase it by more than 2 if I need to.)

 

Also very interested in learning more about the valium protocol with the oral valium in case we wind up in this situation again.

 

I do think the ataxia is due to the lingering post ictal state and exhaustion. He was never very ataxic on just phenobarb. Much more ataxic when the Kr started kicking in, but that mostly resolved with a slight decreas in the dose.

 

I wasn't worried about incontinence. Previously he's always been incontinent during seizures. I was worried about the lack of any bowel movement for much longer than is normal for him. I hadn't thought about his digestive system slowing down because of his exhaustion. BTW, he started to resolve that issue here this morning, and finished with a huge, grand poop puddle at the vet's office.

 

As far as him having seizures while I'm gone, there were a few times when I was crating him that I came home to a big,big mess in the crate, and a couple scraped on my boy. since I decided that he did better out of the crate (don't worry, the rest are crated), there has been one time that I'm sure he had a seizure while I was gone because I came home to not only diarrhea, but diarrhea tracked over every available inch of vinyl floor.

 

Well, my boy has finally settled down. Lying curled up on a dog bed, quiet but alert. I have a few things I have to take care and this might be my best chance to do it. Thanks again, everyone.