odd

Re: odd

Rob Loxley — Thu, 07 Jun 2012 16:04:56 GMT

[quote user="Stephen Courtney"] The last time I discussed Keppra with a neuro lady, she suggested giving it for 4 days after a seizure, then stopping until the next one[/quote]

I have used it like this in cases that have nasty cluster seizures, despite pheno and KBr

Re: odd

Stephen Courtney — Thu, 07 Jun 2012 00:11:26 GMT

Alex, thanks for the input there. The last time I discussed Keppra with a neuro lady, she suggested giving it for 4 days after a seizure, then stopping until the next one - a protocol i am unfamiliar with -- this for a refractory case in a very young dog with insurance but no desire for a repeat referral, alas. though to be honest I doubt a referral would lead to a resolution , but a diagnosis would be nice! Owner has pretty much decided it will be PTS when his seizures become too much. i think given the poor outlook regardless of investigations this is fair enough - the neurologist did see him at the beginning, but the owners balked at the MRI which is a shame as they were already there.....pretty much the only fixable thing he could have is hydrocephalus, and i'm not sure how well the shunts do in dogs.

I don't have a lot of experience with keppra, and gabapentin I use mainly for analgesia in appropriate cases. my only keppra case was a wierd epileptic bulldog that was actually made worse with phenobarb, and stabilised on Keppra and libromide, and we were able to wean her off the keppra, and now she is just on libromide and gets rectal diazepam when the occasional breakthrough seizures come. Owner is happy, and as in many neuro cases, i think this is the best we are going to get!

Re: odd

Lorna McHardy — Wed, 06 Jun 2012 22:15:59 GMT

Ok, thank you for all responses. I have every intention of giving the owners the available options, it's what I always try to do. But I'm not about to leap in suggesting tests the only result of which will be to waste the owners' money... so my question was more about what options to give.

Neuro is high on the list although I've never seen one quite like this. It does look like some sort of slow-motion focal seizure, but what's putting me off deciding it's got to be is the oddness of the timing... it hasn't happened for months, and now he's been doing it for three days, and it's always pretty much the same every time... I didn't think seizure activity came in intermittent clusters that get no better or worse, at long intervals over years. And if it were a tumour, would it not have progressed by now? Or the whole thing generalized? Maybe I should re-check the history and make sure it's actually the same thing that's been happening occasionally over four years. He said it was, but something doesn't quite add up here. He described it before I saw it happen, and his description was spot-on.

My feeling is that bloods will give me nothing, although I take the point about the baseline prior to trial therapy, if that's what ends up happening. But should I really be trialling therapy for something I'm not even 100% sure is a seizure, and which happens rarely at huge intervals? Sigh. I don't really like neuro cases that much. Could he not have had a nice, fixable GDV instead??

Re: odd

Alex Gough — Wed, 06 Jun 2012 18:08:28 GMT

[quote user="Stephen Courtney"]( i'd save keppra for later - it is very expensive and has a pronounced honeymoon period that lasts about 6 months then seems to stop working)[/quote]

Stephen - I think the honeymoon period lasts longer than that, 1-2 years, but is variable. The randomness of seizures makes it hard to be sure I think. I discussed this with a vet who wrote his phd on the subject, and he wondered if some of the so-called honeymoon period was just regression to the mean anyway.
The advantage of Keppra is that, subjectively, it may have a better activity against partial seizures than phenobarbitone. A negative response to phenobarbitone doesn't prove it isn't seizures (nor does any negative response really). Keppra also has a much quicker onset than phenobarbitone, and can be stopped abrupty, so this makes is useful for a short term trial, even if the plan is to transition to phenobarb/KBr in the long term in order to preserve finances and drug efficacy.

Alex

Re: odd

Hannah Wynne Richards — Wed, 06 Jun 2012 17:39:45 GMT

Exactly You can go from wait and see right upto referral and MRI Put the options to the owners It's their dog and their decision Your job is to put all the options to them not make uptheir minds for them -cross ref to OOH thread

Wynne

Re: odd

Stephen Courtney — Wed, 06 Jun 2012 17:30:58 GMT

Sounds like seizure activity to me, and if you are going to do a phenobarb trial ( i'd save keppra for later - it is very expensive and has a pronounced honeymoon period that lasts about 6 months then seems to stop working) you need baseline bloods and some idea of liver activity anyway.

However if the activity spontaneously came to an end - as it appears to have done in the past - then I'd be more likely to wait and see, depending on how the owners felt.

Re: odd

Hannah Wynne Richards — Wed, 06 Jun 2012 17:19:11 GMT

Lorna Put tests to the owners in an open and honest manner Don't pretend that tests will give a definitive diagnosis unless you're absolutely certain they will-but also don't refuse to do fishing tests because YOU don't like doing so-give the owners the choice-many will be prepared to pay if there's even a slight possibility it will help a beloved animal It all comes down to informed consent

Wynne

Re: odd

James Laidlaw — Wed, 06 Jun 2012 17:18:58 GMT

Don't rule out dental stuff completely, we had an older boxer at my last practice that went to a specialist for epulis removal, and he found a dentigerous cyst on x-ray that wasn't far off pathological fracture. I couldn't really see any evidence of this prior to it being found on radiographs by the specialist. Having said that, it sounds more neuro... Good luck!

Re: odd

Alex Gough — Wed, 06 Jun 2012 16:24:30 GMT

Sounds like it could be partial seizure activity. The flexing of a leg, the change in mentation, the post-event behaviour are all suggestive of seizure. Also the chronicity would fit. Being a Boxer, there is always the possibility of a brain tumour, but with the four year history I suspect investigations would dra a blank. How about routine bloods, bile acid stimulation test, and therapeutic trial with phenobarbitone or levetiracetam (Keppra), depending on how far the owners want to go with investigation.

Alex