Bromide and salt levels in diet interaction

RE: Bromide and salt levels in diet interaction

Aine Seavers — Wed, 30 Jan 2019 03:27:45 GMT

The dog in question did very well on higher dose 5mg/kg/bid of phenobarb as we had plenty of room to move with the therapeutic blood levels as was only just inside normal on the reference interval.

Changed to Hills B/D diet so we could keep the salt level low,

was intending to add in bromide-

Dog went from 2 seizures a week every week for last year to none for 5 weeks-then we hit a day of huge afternoon storms followed by Fireworks in Dec on a very hot Australian summer day-Owner paramedical so at work-came home-dog dead.

The unaddressed behaviour noise and fear phobias in the inter-ictal period to me was the killer-not the epilepsy.

I have been working on convincing the owner the manic inter-ictal behaviour of phobia/ADHD/perpetual motion was not ‘normal’ for any dog even if the non-epileptic sister dog had the same pattern-and in the end it was the killer. You can’t be in perpetual motion and fear from noise phobia on a hot day regardless of any other co-morbidities.

The dog was not “Epileptic Drug-Resistant” in any way-even tho 2 vet clinics and owner thought that-it was just on too low a dose of the main AED (pheno) and not the correct adjunct AED(Zonisamide when should been Bromide) and also on a poor diet-another grain-free boutique food victim.

The Holger Holt free webinar http://www.thewebinarvet.com/ , feeding the epileptic brain touches on inter-ictal period But it is the recent paper by them and Rusbridge is to me a major game changer

“ Epilepsy is a condition not defined solely by seizures” is the gist and boy is that true.

F. Watson et al. / The Veterinary Journal 238 (2018) 1–9 A review of treatment options for behavioural manifestations of clinical anxiety as a comorbidity in dogs with idiopathic epilepsy.

For me as a frontline clinician-attending to the inter-ictal period is a Eureka moment that doesn’t come along so often after 3 decades + at the frontline.

If anyone has any other thoughts-happy to hear and learn on what appears to be a whole new world of approaching the epileptic patients.Apologies for the length of post and boring those who don’t see epileptic cases as part of their workload: but some things you have to share and Eureka moments like this for a clinician need to be shared.

Regards

RE: Bromide and salt levels in diet interaction

David Mills — Sat, 08 Dec 2018 00:57:27 GMT

[quote user="Anthony Dennison"]

[quote user="Martin Atkinson"]I will try to remember.[/quote]

Tricky at your age

[/quote]

It's all the bromide he's on.

RE: Bromide and salt levels in diet interaction

bevs2251 — Sat, 08 Dec 2018 00:49:13 GMT

What about Pexion (Imepitoin) ? I have a friend who's son is epileptic. She's had him on a ketogenic diet for years with added MCT oil. Very strict regime of protein/CHO balance and keeping ketone levels in a certain range. As he's growing (teenager now), getting this balance correct is tricky and he's not been very stable. I think he is on Keppra.

RE: Bromide and salt levels in diet interaction

Anthony Dennison — Fri, 07 Dec 2018 17:46:59 GMT

[quote user="Martin Atkinson"]I will try to remember.[/quote]

Tricky at your age

RE: Bromide and salt levels in diet interaction

Martin Atkinson — Fri, 07 Dec 2018 15:57:27 GMT

[quote user="Aine Seavers"]Could you get his opinion on the salt level and bromide if not answered by then?[/quote]I will try to remember.

RE: Bromide and salt levels in diet interaction

Aine Seavers — Fri, 07 Dec 2018 00:26:35 GMT

Hi Sammy, its a good lecture but doesn't spend as much time on diet as the title suggests and other than a passing comment on salt-no specifics given. I am aware of the 0.4% recommendation from elsewhere and yet this new diet with MCT is 1.8%-which is normal for purina, they are much higher salt than hills or rc in general-i just hoped they would remember this was an epilepsy diet and dogs would be on Bromide-sadly not it appears

RE: Bromide and salt levels in diet interaction

Sammy82 — Thu, 06 Dec 2018 23:35:07 GMT

There is a free webinar on TheWebinar vet by Holger Volk talking about this and other nutritional considerations with epilepsy, worth listening to. Because Br and Cl compete for the same receptors Br levels are lower if there is too much Cl, that's why diet should be low salt.

RE: Bromide and salt levels in diet interaction

Aine Seavers — Thu, 06 Dec 2018 22:36:04 GMT

Could you get his opinion on the salt level and bromide if not answered by then?-I am aware from other vets with their case having loss of control when diet salt level changed-so I am keen to see if there is even a rough equation to use with level of salt and dose/kg adjustment needs. HUGE thanks Aine

RE: Bromide and salt levels in diet interaction

Martin Atkinson — Thu, 06 Dec 2018 11:44:00 GMT

[quote user="Aine Seavers"] Purina Neurocare is favoured by client and does have the MCT oil added based on RCVS work with Holger [/quote]

[quote user="Iain Richards"]Epileptic food - is that science based? As an occasional locum, I accept I'm not at the forefront anymore, so can someone explain what's going on here please, [/quote]

[quote user="Richard Carter"]apparently coconut oil does have a measurable influence on epilepsy frequency and some fish oils make epilepsy worse[/quote]

Holger Volk is the main speaker at Congress in the Snow next month. I will report back then on his latest information on coconut oil if this thread hasn't reached a conclusion by then.

RE: Bromide and salt levels in diet interaction

Aine Seavers — Thu, 06 Dec 2018 11:11:17 GMT

What is the salt level and your br and phenobarb levels on it.? I only use Keppra for clusters to avoid the honeymooning effect if on it all the time-and the doses I use them given by neuro mate are larger-esp as if on phenobarb as well. I am considering gabapentin as my third AED given all this work on inter-ictal period and the heightened anxiety and hyper behaviour I see in some epileptics-not all but some are quite primary person dependent, clingy and anxious where I think gabapentin would help level out some of that behaviour

RE: Bromide and salt levels in diet interaction

Aine Seavers — Thu, 06 Dec 2018 11:06:53 GMT

The salt level is a stand alone issue related to the use of the drug Bromider regardless of the food claims with regardless to epilepsy or not. Br is a salt-can be displaced so even watch any salt water sea swimming and need to give with food preferably at a salt level at 0.4% Nacl to stop the higher salts clearing it, dropping the levels and allow seizure break through. Lasix can have an interaction as well. This is my concern in this case that the food the client wants to feed is 1.8% salt-so aside from any epilepsy control claims it may or may not make-I need to know what impact its salt level will have on my drug regime.

Re effect of diet per se-since 1992 when the derm guru Rosser spoke about dogs in a pure derm trial having some positive control on seizure frequency completely unanticipated-having already had a boss who changed diet in epileptics, I have usually changed the diet-and now work suggesting a variety of different foods may ameliorate or worsen seizure frequency seems to suggest we were always on the right path. The current diet from Purina based on work out of RCVS, some updates given by Holger in a recent free UK webinar talks about the MCT oil-and it is this oil that is now in Purina neuro diet. The B/D I was considering is 0.4% salt and would help with cognitive decline and other neuro isssues in the inter-ictal periods. This dog has major cognitive and behavioural issues that need addressing as much as the seizure period itself,

Hope that is not as clear as mud-huge consult day and my brain oozing out my ears at the moment so off to sleep.

Aine

RE: Bromide and salt levels in diet interaction

Richard Carter — Thu, 06 Dec 2018 09:46:11 GMT

apparently coconut oil does have a measurable influence on epilepsy frequency and some fish oils make epilepsy worse

RE: Bromide and salt levels in diet interaction

Iain Richards — Thu, 06 Dec 2018 09:35:48 GMT

Epileptic food - is that science based? As an occasional locum, I accept I'm not at the forefront anymore, so can someone explain what's going on here please, where does salt fit into this?

Iain

RE: Bromide and salt levels in diet interaction

Richard Carter — Thu, 06 Dec 2018 09:08:16 GMT

oooh - some clever people out there with a brain. I've never thought about it - just take bromide levels on bloods after three months

We have a couple on the Sanimed epileptic food, don't know if it has made a difference -one case is on KBr, Keppra and phenobarb and is still having cluster fitting