Epilepsy in Spitz

Epilepsy is a collective term for seizures, in which the nerve cells in the brain send out too many signals at once. A distinction is made between primary and secondary epilepsy.

The primary or idiopathic epilepsy includes all forms for which there is no clear cause, it occurs "for no apparent reason".

Epilepsy can occur with or without a pre-existing ancestor. Under certain conditions, once it has broken out, it can be hereditary.

Unfortunately, the disease is still very little researched and the cause is mostly unclear. The only thing that is certain is that it can never be cured.⁠

A cause can be identified for secondary, symptomatic epilepsy. Triggers can be, for example, brain tumors, deficiency symptoms, various diseases or other factors.

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Some breeds are more prone to this condition than others. Endangered dog breeds include: Australian Shepard, Basset Hound, Beagle, Bernese Mountain Dog, St. Bernard, Border Collie, Boxer, Chihuahua, Cocker Spaniel, Collie, Dalmatian, German and Belgian Shepherd Dog, Golden Retriever, Greater Swiss Mountain Dog, Irish Setter, Irish Terrier, Labrador Retriever, Maltese, Pug, Pekingese, Poodle, Schnauzer, Siberian Husky, Spitz, Teckel, Yorkshire Terrier. And mixed breed dogs make up a not inconsiderable proportion.

Types and characteristics of epileptic seizures

Epileptic seizures are divided into two main groups according to the quality of their propagation:

Partial (focal) seizures only occur in a very specific part of the brain, they are also known as localization-related seizures. This means that there are locally limited symptoms such as twitching, mouth movements or running in circles, which often last only for a short time.

In this type of seizure, consciousness is usually retained, only rarely does loss of consciousness occur. There is a risk of misdiagnosis, since the symptoms can allow conclusions to be drawn about other diseases. Intensive examinations and careful observation are very important for a correct diagnosis, since larger and larger areas of the brain can be affected over time. As seizure intensity increases, targeted treatment is needed.

Second group seizures, which are referred to as generalized seizures, are significantly more intense. Many parts of the brain are already affected and no specific location can be identified from which the seizure originates. Such seizures are often accompanied by loss of consciousness, massive muscle spasms, falls, etc.

Due to the severity of a seizure, no conclusions can be drawn as to the type of seizure (partial or generalized).

An epileptic seizure is divided into 3 phases:

Preictal(period before a seizure, called the prodromal phase)
Iktal(period during a seizure)
Postictal(period after a seizure)

The preictal phase describes the preliminary stage of a seizure. Many animals show moderate behavioral problems such as restlessness/nervousness, perception disorders/dizziness, anxiety, attachment, withdrawal, etc., which many pet owners often hardly notice and is inconspicuous. The phase can be very short (a few minutes) but also very long (many hours).

The ictal phase includes the period of the actual seizure, in which excessive discharge processes take place in the brain (thunderstorms in the head). For the owner, this phase is extremely worrying and causes panic when your own animal lies twitching on its side and convulses, salivates heavily, loses feces and urine or even faints. So it happens that afterwards it is not possible to make any subjective assessments regarding the severity and duration of the seizure. This self-limiting phase should only last a few minutes. Prolonged seizures can be life-threatening.

In the ictal phase there are visible symptoms, but they should only last a few minutes, but unfortunately they can last up to a few hours.

Complications - clusters, status epilepticus

Several epileptic seizures occurring within 24 hours are called clusters or serial seizures (from 2 seizures with normal consciousness in between). A status epilepticus is a seizure that lasts more than 5 minutes.

Failing to fully regain consciousness between a series of seizures is also referred to as status epilepticus. There is an acute danger to life!

A life-threatening situation arises from the accompanying physical overheating (body temperature rises massively due to spasms) and important bodily functions (breathing, blood pressure and temperature) can fail due to the impairment of the control of the central nervous system.

In addition, the long-lasting electrical discharges of the nerve cells can lead to massive damage to the brain.

Diagnostics

An exact diagnosis is crucial for animals with epileptic seizures in order to provide the patient with the right therapy. By means of exclusion diagnostics, it is possible to distinguish primary epileptic seizures from secondary seizures, which are triggered by another underlying disease.

In addition to a detailed anamnesis (preliminary report - collection of the medical history) and the precise description of the course of the seizure, a comprehensive clinical and neurological examination is necessary. The preliminary report already gives indications as to whether it is a "typical" seizure.

Video recording the seizures can also be very helpful. A comprehensive blood test gives, among other things, indications of a possible internal disease or functional disorder and a heart check (ECG, X-ray, ultrasound) excludes cardiovascular problems.

In some cases, only a magnetic resonance imaging (MRI) and/or cerebrospinal fluid puncture (examination of the cerebrospinal fluid) leads to a clear diagnosis of the epilepsy form. MRI can be used to identify causes in the brain that trigger symptomatic epilepsy (e.g. tumor, trauma, deformity). And since the composition of the liquor changes, especially in the case of inflammation, bleeding and tumor infestation, a liquor examination can be revealing in these cases. If all these examinations are unremarkable, primary (idiopathic) epilepsy can be assumed.

In principle, a complete diagnosis is always useful. Also the (expensive) imaging procedures with MRT. There is not always a concrete result, but there are many diseases that can trigger seizures and which can only be diagnosed by this. These are therefore to be treated differently, even if it only results in the administration of painkillers to spare the dog unnecessary suffering. Unfortunately, there are often voices against this approach because it is more expensive and it is said to be useless. It definitely brings something: certainty.

Therapy: goals and necessity

In secondary epilepsy, therapy aims to get the underlying disease under control as the cause. Once this resolves the trigger for the seizures, the seizures usually stop.

Unfortunately, the cause cannot always be eliminated. If this is the case, attempts are made to stop the epilepsy with medication. Usually, however, there is a combination in the treatment.

In idiopathic epilepsy, on the other hand, the following applies: "A seizure is not a seizure!" - but as soon as dogs have had more than 2 seizures in six months, cluster seizures or status epilepticus, they should be treated with antiepileptic drugs. The longer epilepsy goes untreated, the harder it is to get a grip on. Every epileptic seizure leads to damage to nerve cells, which means that the seizures occur more frequently and more severely without treatment.

Epilepsy cannot be cured

Antiepileptic drugs are able to prevent the occurrence of epileptic seizures or to reduce their frequency, severity and duration. Even if every pet owner naturally wants their pet to be free of seizures, a reduction in the frequency of seizures and a reduction in the severity and duration of seizures can already be seen as a therapeutic success. Antiepileptic drugs have a different stabilizing effect on the resting membrane potential, which counteracts the easier excitability of nerve cells in epileptics - the seizure threshold is increased.

Epilepsy should be treated

In very mild cases, something can be achieved through diet, CBD oil and other measures, stronger forms should definitely be stopped by conventional medical care. Since untreated progression usually worsens the disease, experiments should not be attempted.

Epilepsy belongs in expert hands

Most veterinarians are overwhelmed with the disease and do not initiate the complete and necessary diagnosis. It makes more sense to contact certified neurologists here:

http://www.tier-neurologe.de

Case study: Large spitz male Juki

First seizures

Juki's first attack was on a Friday afternoon after work. We wanted to go from the balcony into the living room. Suddenly he stopped, ran backwards, crashed into a flower table and fell over. With his mouth wide open and his legs stretched out, at first we thought he had swallowed something and was going to suffocate. So we grabbed his neck first and then raced him to the vet. On the way to the car he went limp and then woke up. At that time, nothing looked like epilepsy, so we dismissed it as a stupid incident.⁠⁠Unfortunately, only nine weeks later, the second attack came from the rest in his box. It was pretty clear that it was epilepsy and we immediately made an appointment with a neurologist in the nearest clinic. The third seizure came right on the evening before the appointment, only 1.5 weeks later. With all three, Juki salivated a lot and also urinated. The medication that was then used gave us a few weeks of rest, but on Christmas Eve the fourth attack overtook us. Since then we have been constantly busy with the right medication.⁠

Diagnostics

Right after Juki's first seizure, we did an ultrasound of the heart because he had slight arrhythmias. Cardiovascular seizures, however, tend to be associated with a flaccid body rather than a rigid body, so this is not necessarily typical.⁠⁠During our first visit to the clinic with the neurologist, the correct diagnostics started. A full blood count to rule out any toxins, MRI and cerebrospinal fluid puncture to rule out brain damage and inflammation. A complete diagnosis also includes a thyroid check, a test for Mediterranean and tick diseases, deficiencies in certain nutritional and vitamin values and, of course, a neurological examination.⁠Either a cause for secondary epilepsy is found in these examinations or idiopathic epilepsy is determined by exclusion.⁠

Medication

Since it is said that every seizure paves the way for the next, one starts with the medication after 2-3 seizures in six months. There are basically two different purposes of medication: seizure control and seizure interruption.There are primary medications and so-called add-on medications for seizure control, which only work in combination with other medications. ⁠⁠Phenobarbital or Pexion are usually given first. Phenobarbital is a so-called mirror drug and takes about 2 weeks to take full effect. Pexion is a newer drug, works faster, but is not recommended for serial seizures. Potassium bromide and/or levetiracetam are often added to this. Potassium bromide is a salt, which is why the feeding must be kept constant under the dose in order to stabilize the salt balance. The full effect only occurs after 2-3 months. Levetiracetam acts very quickly and does not build up levels. However, a honeymoon effect, i.e. a decreasing effectiveness after some time, is often reported. It should have the fewest side effects.⁠⁠Diazepam is usually given rectally or midozelam nasally to stop seizures. This immobilizes the dogs and relaxes the muscles, allowing longer seizures to be interrupted and not causing lasting damage.⁠

Side effects of medication

As if the disease itself weren't bad enough, every action has a reaction, of course - including the epilepsy medication. In the case of the mirror drugs, there are very intensive side effects, especially in the phase of adjustment, which is why this period is also referred to as the "valley of tears". ⁠⁠Fatigue, tiredness, hindquarter weakness, incontinence, restlessness, increased hunger and thirst are the most common side effects. Most of them disappear again as soon as the mirror is stable. However, some dogs also struggle with the medication in the long term.⁠⁠Of course, there are also the effects on the organs. The liver and pancreas in particular are often affected. Pexion and Levetiracetam are said to have fewer side effects, but there is no effect without any effect. So each medication is a walk on the knife edge between seizure control and effects on the rest of the system. Once established, seizure control is typically maintained on the appropriate medication for life, so most dogs will eventually experience organ effects that will also need to be treated.⁠

Critical moments of epilepsy

In fact, epilepsy is basically not critical or even fatal. More than 20% of dogs will probably have an epileptic seizure at some point in their lives and in fact they say "a seizure is not a seizure". In general, singular seizures, even if they occur regularly, are not in themselves critical. But since each seizure paves the way for the next, they can lead there.⁠⁠It becomes critical when so-called clusters/series occur or the dog falls into status epilepticus. The former refers to multiple seizures within 24 hours. The danger here is that the seizures weaken the dog's body so much that the organism can no longer withstand it. A status epilepticus, on the other hand, refers to a seizure from which the dog can no longer get out. The cramps don't stop even under emergency medication and unfortunately the seizure can also be fatal here.⁠⁠In addition to the seizures themselves, the medication can also lead to liver failure or pancreatitis, for example, which can be fatal.⁠⁠And in the end, under the medication for seizure control and the seizures themselves, there is always the question of how worth living life is for the dog and when you have to make even the hardest of all decisions. But in addition to all the bad thoughts and stories, there are also very, very many dogs who grow old with epilepsy and lead happy lives and of course we always hold on to that.⁠

Cost of Epilepsy

Epilepsy is a nasty disease that cannot be cured. In addition, the diagnosis in the dog is done as a process of elimination. Both together cause costs that I would like to shed some light on. ⁠⁠First of all, after the first seizures that occur, a diagnostic odyssey takes place. Since they specialize in this, it is best to go to a neurologist with epilepsy, ideally an ECVN-certified veterinary neurologist. There, a neurological examination is carried out, a blood and urine test, an MRI and a cerebrospinal fluid puncture and, in some cases, an ultrasound. An MRI with anesthesia and usually a simultaneous CSF examination is around €1,000-1,500, a complete thyroid profile alone around €200, ultrasound €200-400, urinary status €30 and a normal full blood count around €100. The neurological examination can add up to €100-200. If you then do tests for tick and Mediterranean diseases, this is also added.⁠⁠A dog should be stopped with medication from 2‑3 seizures in six months. Depending on the medication, a blood test to measure the level is required at least every six months. The medication depends on the weight.⁠Juki gets three different medications at 20 kg, which cost us around €80 a month. The check-up with the level determination and the organ test costs about €200 every six months - if nothing comes up.⁠⁠If the dog falls into a status epilepticus or can't get out of a series, the hospital costs for inpatient admission must also be considered. In addition, there are costs for the treatment of consequential damage to the organs or changes in feed, etc. After about a year of epilepsy with Juki, we have now reached costs of around €4,500. I can only advise you to get good health insurance. Unfortunately, we didn't have any and are now no longer accepted by anyone.⁠

Epilepsy in breeding

A question that came up more frequently in the course of this series was the question of inheritance of epilepsy and thus also of breeding. The simple answer here is that the exact inheritance of epilepsy is unclear - also in humans, by the way. There are different forms of epilepsy, each affecting one or a combination of genomes. To date, only very few of these forms and thus heredities have been researched and can then also be determined using genetic tests. For example, there is a genetic test for a certain form of epilepsy in Ridgebacks.In any case, it is known that epilepsy, once established, is inherited. Not every descendant has to be affected and generations can also be skipped. Nevertheless, epilepsy in any form immediately excludes breeding for the dog in question. If several cases occur in one litter or in litters related to the line, the entire line should also be closed for breeding.Unfortunately, a lot is swept under the table and kept secret here. I've heard of cases where the breeders have threatened to sue if the dog's epilepsy is made public. This is one of the reasons why epilepsy occurs more frequently in some lines and is even considered a breed-typical disease for some. If it becomes known that breeding was done knowingly with epilepsy carriers, legal action can be taken against it. From my own experience I can say that this disease is really terrible for dogs and humans and has a lot to do with lost joy of life and destroyed hope. Any breeder who accepts this or even takes active action to prevent it from becoming known has little to do with animal welfare.In general, a lot of research still needs to be done here in order to clearly recognize inheritance and thus be able to keep breeding healthy without taking too many dogs out of breeding, especially in narrow gene pools. Originally, the path to breeding was also planned for Juki and he had already mastered the breeding suitability test with flying colours. Unfortunately, there will be no little Juki babies now.