Partial seizure in a border terrier?

Re: Partial seizure in a border terrier?

Anthony Dennison — Wed, 30 Jul 2014 04:51:25 GMT

Sorry I didn't get a chance to update this case; before I went away he was in for the day starved, all day glucose didn't drop below 3.7mmol/L and so my colleague didn't retest insulin as idexx say there is no point testing unless it goes below 3.7mmol/L. Will see how things are when I get back next week

Re: Partial seizure in a border terrier?

Roger Meacock — Thu, 17 Jul 2014 00:17:15 GMT

[quote user="Mark Lowrie"]Firstly I should say this definitely is not canine epileptoid cramping syndrome[/quote]

Hi Mark

I'm interested to hear why you don't think this is CECS - I've only ever encountered it once before and I understand Border Terriers are more prone? Thanks for the back-up on the gluten-free diet effect. It was a genuine observation and with n=1 all I can report is the result and to obviously state n=1. It's a shame that some people automatically disregard any positive observations associated with RMB.

Of more concern, is that I ticked the box to be notified of replies to my post. This is not the first time I have failed to receive the requested notifications and I can only assume that Arlo has taken it on himself to limit my ability to take part in discussions because of my support for RMB ...

Hopefully I'll receive notification of any response ...

Best wishes

Roger

Re: Partial seizure in a border terrier?

Mark Lowrie — Thu, 03 Jul 2014 09:27:53 GMT

[quote user="Roger Meacock"] It could be Canine Epileptoid Cramping Syndrome by the sound of it. [/quote]

[quote user="Roger Meacock"] I put it on RMB and it never did it again except for one occasion when it stole a visiting dog's commercial pet food when it had another seizure within 2 hours of eating the food. [/quote]

Firstly I should say this definitely is not canine epileptoid cramping syndrome (which is not an epilepsy syndrome but a dyskinesia or movement disorder). However, in this disease we have found that gluten-free diets do have an effect (so RMB diets would fit this description). We are not sure of the pathogenesis but it may be that this movement disorder is a manifestation of a GI disease similar to Coeliac disease in people (which also can result in movement disorders). The paper we published on this is available as open access on JSAP. See link below:

http://onlinelibrary.wiley.com/doi/10.1111/jsap.12170/pdf

Re: Partial seizure in a border terrier?

Mark Lowrie — Thu, 03 Jul 2014 09:23:20 GMT

[quote user="Virginia Campbell"]are you not tempted to do a trial of Pexion first, then Epiphen if that doesn't work[/quote]

I suppose it is important to say that fly-catching is not idiopathic epilepsy – if fly-catching is neurological then it would represent a psychomotor seizure. Phenobarbitone has some historical use with psychomotor seizures, Pexion is a NEW drug with no known efficacy outside of standard generalised tonic-clonic seizures in dogs. They are both metabolised by the liver and really have similar effects although via different mechanisms (Pexion can actually result in hypersxcitability which may make the problem worse). I really see no advantage in trying Pexion. If Pexion was trialled and it failed then I would still want to trial phenobarbitone as this is the drug we know is effective in psychomotor seizures. Anything can be trialled for psychomotor seizures (phenobarbitone, Pexion, NSAIDs, placing a crystal in a north facing window etc) and I am sure a proportion of patients would respond due to the waxing and waning nature of epilepsy. However, the one drug we know has efficacy against psychomotor seizures I phenobarbitone and so it is for the reason we always use this and not some other alternative.

Re: Partial seizure in a border terrier?

Mark Lowrie — Thu, 03 Jul 2014 09:20:01 GMT

[quote user="Anthony Dennison"]

Update - bloods sent to Idexx for glucose and insulin levels came back today.

Glucose: 5.1mmol/L

Insulin: 31.5 uIU/ml (ref range 5-40).

Normoglycaemic, no evidence of an insulinoma. So what next, trial treatment with phenobarbitone?

[/quote]

I would personally do a fasted glucose and a concurrent fasted insulin concentration before writing off hypoglycaemia. The initial fasting glucose was low but taking post-prandial samples can give spurious results. The fly-catching doesn’t really fit hypoglycaemia but I would never exclude it completely. If you do this and it is normal then going down the route of trial with phenobarbitone would be my next step.

Re: Partial seizure in a border terrier?

Anthony Dennison — Thu, 03 Jul 2014 00:06:36 GMT

[quote user="Andrew Kent"]There is some interest in dietary management of epilepsy and I believe an ongoing trial at the RVC looking at hypoallergenic diets in this disease so I wouldn't completely write it off. I wouldn't go straight for RMB personally but it is an option.[/quote]

Fair point, my post may seem overly harsh. Hypoallergenic or low CHO diets are used in management for Lafora's disease, as it is a CHO storage disease; I'm afraid all I've got is anecdotes from the mini wire haired dachshund society but it seems to make a difference.

Re: Partial seizure in a border terrier?

Andrew Kent — Wed, 02 Jul 2014 22:18:48 GMT

[quote user="Anthony Dennison"]

[quote user="Roger Meacock"]

It could be Canine Epileptoid Cramping Syndrome by the sound of it. I've only ever treated one case. Based on anecdotal reports of epilepsy sometimes responding favourably to a raw diet, I put it on RMB and it never did it again except for one occasion when it stole a visiting dog's commercial pet food when it had another seizure within 2 hours of eating the food.

Best wishes

Roger

[/quote]

Give me more than anecdotes and I may listen to you more Roger. I have discussed raw diets with clients that have dogs with poor skin or sensitive guts, but curing epilepsy with RMB?! Give me strength. How on earth could that possibly work, seriously?

NB: Those clients I discuss raw diets with (not just RMB) still go for a commercial diet, and they improve.

[/quote]

There is some interest in dietary management of epilepsy and I believe an ongoing trial at the RVC looking at hypoallergenic diets in this disease so I wouldn't completely write it off. I wouldn't go straight for RMB personally but it is an option.

I am not convince the description sounds like epileptoid cramping syndrome but that too can have some response to diet. In fact (and again I am not a supporter in any way of RMB) we saw a client last year who decided to use a raw diet after a diagnosis of CECS and the dog did improve significantly.

So on this occasion I don't think we can completely write off Roger's input.

Andy

Re: Partial seizure in a border terrier?

Anthony Dennison — Wed, 02 Jul 2014 22:04:46 GMT

[quote user="Roger Meacock"]

Best wishes

Roger

[/quote]

NB: Those clients I discuss raw diets with (not just RMB) still go for a commercial diet, and they improve.

Re: Partial seizure in a border terrier?

Roger Meacock — Wed, 02 Jul 2014 19:58:17 GMT

Best wishes

Roger

Re: Partial seizure in a border terrier?

Virginia Campbell — Wed, 02 Jul 2014 19:08:52 GMT

[quote user="Mark Lowrie"]Imepitoin is only licensed for use with idiopathic epilepsy[/quote]

Does Epiphen come above Pexion in the cascade here? Epiphen datasheet just says "epilepsy" rather than "idiopathic epilepsy" but I would have thought that both drugs would have equal status under the cascade in this case.

[quote user="Mark Lowrie"]I have no experience with its use and efficacy in psychomotor seizures. I would therefore avoid it in this case.[/quote]

Fair enough to stick with what you know has a decent chance of working. But given [quote user="Mark Lowrie"]trialling phenobarbital at therapeutic concentrations to see if this controls the episodes – provided .... ... ...that they understand this will have the potential for some adverse effects).[/quote] and the fact that it probably isn't life threatening just now so you have a little leeway to tinker about to see what works best, are you not tempted to do a trial of Pexion first, then Epiphen if that doesn't work, then think more along the lines of OCD -type behaviour if that doesn't work? On the grounds that its liver might be happier with Pexion than with Epiphen. And also to avoid the sedative effects that you sometimes get with pheno that might muffle the behaviour a bit and make it harder to work out if it's genuinely seizure-related vs OCD-behaviour related.

(my knowledge of pharmacology, neuorology disease mechanisms and behaviour medicine is pretty ropy though - if my reasoning is a bit rubbish please feel free to explain ).

Re: Partial seizure in a border terrier?

Richard Carter — Wed, 02 Jul 2014 17:46:57 GMT

sounds a bit like as person with arteriosclerosis with pins and needles from hypoxia - has it always done this or is this a developing condition?

Re: Partial seizure in a border terrier?

Anthony Dennison — Wed, 02 Jul 2014 14:12:48 GMT

Update - bloods sent to Idexx for glucose and insulin levels came back today.

Glucose: 5.1mmol/L

Insulin: 31.5 uIU/ml (ref range 5-40).

Normoglycaemic, no evidence of an insulinoma. So what next, trial treatment with phenobarbitone?

Re: Partial seizure in a border terrier?

Anthony Dennison — Fri, 27 Jun 2014 16:22:50 GMT

Thanks for that helpful info Mark. The dog's non-fasted BG this morning was 3.7mmol/L, so I have sent off a sample to check insulin levels.

Will update with results.

Re: Partial seizure in a border terrier?

Mark Lowrie — Fri, 27 Jun 2014 14:28:35 GMT

Hi Emma,

Imepitoin is only licensed for use with idiopathic epilepsy and I have no experience with its use and efficacy in psychomotor seizures. I would therefore avoid it in this case.

Re: Partial seizure in a border terrier?

emma_j — Fri, 27 Jun 2014 13:35:42 GMT

Mark, would you have any opinion on trialling imepitoin rather than phenobarb for a case like this?

Thanks in advance!

Re: Partial seizure in a border terrier?

Mark Lowrie — Fri, 27 Jun 2014 10:14:47 GMT

A bit late to this one I’m afraid.

I agree the glucose sounds suspiciously low so definitely follow this up with a fasted sample plus serum insulin concentration (if glucose is still <3).

Taking the episodes as described and shown in the video then this looks like typical fly-catching. It is very controversial what fly-catching truly represents. Some believe this represents a type of partial seizure called psychomotor seizure. Others believe this is more of a behavioural condition similar to an obsessive-compulsive disorder. Either way, it would seem unlikely to represent anything intra-cranial and so MRI and the like would seem a big step to take at this stage. Therefore once you have ruled-out metabolic problems there is little harm in trialling phenobarbital at therapeutic concentrations to see if this controls the episodes – provided the owner perceives this to be a problem/affecting their dog’s QoL and that they understand this will have the potential for some adverse effects). If control is achieved it supports the idea of a psychomotor seizure, if control is not achieved then an OCD -type is more likely.

Would be interesting to hear any follow-up.

Re: Partial seizure in a border terrier?

Anthony Dennison — Thu, 26 Jun 2014 17:46:51 GMT

Thanks, this sample was starved so I'm seeing him again tomorrow after being fed and we'll re-check then. If it's still low I'll send off to check insulin levels.

Re: Partial seizure in a border terrier?

emma_j — Thu, 26 Jun 2014 17:23:37 GMT

I diagnosed an insulinoma recently, and the hypoglycaemia on the initial profile was at a similar level (possibly higher actually, I think) with the only other significant abnormality being a raised CK. The history was similar vague seizure-like episodes. As the initial profile wasn't starved, we got him back in starved the next morning, glucose on the in-house glucometer then was 1.9 I think, so sent off a paired glucose/insulin which came back consistent with insulinoma and imaging confirmed a nodular pancreatic mass.

So perhaps worth rechecking the glucose if there's nothing else?

Re: Partial seizure in a border terrier?

Jo Dyer — Thu, 26 Jun 2014 15:51:46 GMT

Spike's disease?

http://www.canineepilepsy.co.uk/Research/genetic_cecs.html amongst various other descriptions found on Google.

Re: Partial seizure in a border terrier?

Anthony Dennison — Thu, 26 Jun 2014 15:40:16 GMT

Sorry to keep posting to this thread, but bloods this morning were unremarkable except Aymlase just under the ref range (498, rr 500-1500) and hypoglycaemia at 2.17mmol/L. I'm unsure whether the low glucose is due to high numbers of seizures or the fact our VetTest machine had a paddy and I had to update, reboot and QC it.

Re: Partial seizure in a border terrier?

Anthony Dennison — Thu, 26 Jun 2014 09:13:27 GMT

The owner sent me this video last night: