Epilepsy
CURRENT EPILEPSY RESEARCH:
Canine Genetics Centre Appeal for ESS Candidates for Epilepsy Research
Facial Seizures in English Springer Spaniels - Appeal for Research Candidates
Click to see video of focal seizure affecting the face (shared with the owner's permission)
The researchers would like to hear from the owners of any English Springers that have had a seizure fitting the description - even if they've only had one episode.
Previous diagnostic tests aren't necessary - but if any tests have been done, this information would be useful if the owner is happy to send it. A video of an episode is ideal.
The researchers are focusing on ESS in the UK, but if there are candidates from other countries that fit the criteria, they will also consider them.
Only the investigators will access the data. Any data will be presented in anonymised format. If owners submit videos, they will be asked for permission to use them in any publication or presentation.
What is Epilepsy?
The word 'epilepsy' refers to repeated seizures (fits or convulsions) caused by excess electrical activity in the brain, which disrupt the normal communication between brain cells. The seizures indicate a sign of brain disease or disorder, much like a cough might be a sign of lung disease. In any event, it is a sign of a problem which unfortunately is usually not going to go away without further close investigation and/or treatment.
Epilepsy is one of the most common neurological diseases in dogs. It is the tendency for the disorder to be so unpredictable that makes it such a complex disease with which to deal. A seizure may occur as a one-off event from a variety of causes, but it is only if seizures repeat again and again over a period of time that it is called epilepsy.
Click on the link below to see a full recording of the KC webinar on CANINE EPILEPSY - presented by Professor Holger Volk
What causes seizures?
Seizures are caused by excitatory influences on nerve cells in the brain, although there can be other causes that might tip the balance from inhibition towards too much excitation in the brain. It has nothing to do with the dog's emotional state, so any animal might fit if pushed past that threshold of electrical stimulation. Other influences that may cause a seizure might be toxins (poisonous plants, chemicals & insecticides), metabolic disease (low blood sugar or heart disease), chemical or hormonal imbalance and direct damage to the brain (injury or tumour).
Therefore, trying to identify the cause of a seizure is the first biggest challenge, as anything which damages the brain can cause epilepsy. If the cause of the seizure can be established, it is easier to determine whether the problem is primary or secondary. For example, if we are able to determine that the seizures are a symptom of a disease process that has been identified (e.g a brain tumour, stroke, chemical/hormonal imbalance), it can be said that the dog is suffering from symptomatic or secondary epilepsy. If a cause cannot be found, then it has to be assumed that the dog is suffering from primary idiopathic (of unknown cause) epilepsy.
Seizures are divided broadly into two types: generalised and focal (or partial). Generalised is where the electrical storm in the brain arises everywhere at once. In a focal or partial seizure, the abnormal electrical activity arises in a particular region on one side of the brain only.
How will I know if my dog is having a seizure?
The most common time for a dog to have a seizure is when it is relaxed and quiet. In some instances, the dog can actually be sound asleep. However, seizures can occur at any time, but should they occur when the dog is exercising or excited, your Vet may look for another cause such a heart problem or low blood sugar.
Focal (partial) seizures can present as:
Episodic movements (‘motor’ signs) e.g. facial twitches, rhythmic blinking, head shaking or repeated muscle contractions of one extremity.
Autonomic signs (arising from the autonomic nervous system) e.g. excessive salivation, vomiting, dilated pupils.
Behavioural signs (episodic changes in the dogs behaviour) e.g. restlessness, anxiety, attention seeking, unexplainable fear behaviour.
Generalised seizures usually present as:
Loss of consciousness.
Salivation, urination and defecation.
Motor movement on both sides of the body.
Aspects of generalised seizures are often termed tonic, clonic, tonic-clonic and myoclonic. These are defined below:
Tonic: Increase in muscle contraction (stiffening) – this phase is usually brief, lasting from seconds to minutes.
Clonic: Involuntary rapid and rhythmic contractions of muscles (jerking).
Tonic-Clonic: A sequence of a tonic phase followed by a clonic phase.
Myoclonic: Sporadic jerks usually on both sides of the body.
The first phase, known as the aura, is the time when there is the earliest sign of a recognisable change in the dog's behaviour. The dog is likely at this stage to show confusion, fear, rage or even seek attention or withdraw from their owner and hide. This can alert the owner to an impending seizure. However, some dogs do not show aura, with the seizure just coming out of the blue.
Focal seizure evolving into generalised seizure:
The most common type of seizure observed in dogs is when a generalised seizure follows on from a focal seizure. The focal seizure may be difficult to detect due to its brief nature and it is important to tell your Vet what happened before convulsions started, to help them determine what type of seizure your dog is having.
The classic seizure (tonic-clonic) begins with rigid or jerky muscle spasms or paddling. Once the seizure has begun the animal will usually fall to its side with legs outstretched and head back and may also lose consciousness, even though its eyes appear to be open. This will be accompanied by autonomic activity (salivation, urination and defecation). Changes in sensory function may lead to pawing at the face, tail chasing, or biting at part of the body or the air.
The tonic phase is usually brief (about 30 seconds), but the clonic phase (rhythmic movements) can last up to 2 minutes. If the seizure goes on much longer and the dog goes into continuous seizure, it is a medical emergency requiring immediate veterinary attention.
It is important that during the clonic phase of the seizure, the owner ensures that all other pets and children are kept out of the way. Other than to give the dog plenty of space, make certain the dog is safe - that it cannot fall down the stairs, bang into a sharp edge, get tangled in an electric cord or otherwise cause injury to itself. It is not necessary to do anything, but keep a close eye on what is happening and keep a note of the time it takes for the seizure to abate.
Your dog may inadvertently bite during or immediately after a seizure, so it is vital to keep your hands well away from its mouth and not to attempt to put anything into its mouth.
Without a doubt, this is the most distressing time for owners, as a seizure can often be both frightening to watch and emotionally overwhelming.
Following the seizure, the dog will lie motionless for a while, eventually slowly returning to normal. Often the dog will appear not to be able to see and is disoriented, pacing or running about the house, bumping into furniture, doors, tables etc. Sometimes this phase sees the dog as ravenously hungry and wishing to devour any food available. Although the dog at this time is unlikely to show aggression, it is wise to recognise the possibility that they may not behave as normal. Some dogs can bounce back immediately following a seizure and behave as if nothing at all has happened, whilst others are disoriented for days.
Most seizures are brief and isolated but seizures can come in clusters where the dog has a fit, recovers, and then immediately has another seizure. This could be the danger point for a dog to lapse into a continuous seizure (status epilepticus) requiring urgent and immediate medical attention.
Status epilepticus is classed as either (a) a seizure that lasts longer than 5 minutes, or (b) where two or more individual epileptic seizures occur, between which the dog does not return to 'normal' and regain full consciousness. Immediate treatment is necessary because status epilepticus can cause permanent brain damage or even death. The seizure creates a tremendous stress on the heart and other organs, with the body temperature rising as a result of all the muscle activity.
If status epilepticus occurs in your dog, immediately contact your Vet for emergency treatment.
How is Epilepsy diagnosed?
Early evidence of primary epilepsy is usually seen within the first three or four years of a dog's life and it is acknowledged that several breeds (including English Springer Spaniels) can be predisposed to develop the condition. After those early years, seizures are more likely to be secondary, that is, caused by an active disease process such as infection, trauma, metabolic disorder or a tumour.
Since it is unlikely that Vets will directly witness a dog's seizures, they will be very dependent on the owner's description of what has happened. Early signs of a problem might have gone unnoticed, even by the owners themselves, and it is often not until the dog has a full blown seizure that it is seen by a Vet.
Should your dog ever experience a seizure, it is hoped that the information you are able to provide will help to give your Vet a better clinical understanding of what has taken place. Nowadays, many owners are able to help by using their mobile phone to take a video of their dog during a seizure.
Clinical diagnosis, for the most part, is made by an elimination process looking at the dog's history, by physical and neurological examination, blood and urine analysis, bile acid assay and thyroid function tests, MRI and CT scans, and analysis of cerebrospinal fluid (CSF). Determination of the type of seizure is critical to understanding the form of epilepsy from which the dog may be suffering.
How is Epilepsy treated?
In most cases, primary epilepsy in dogs cannot be cured, therefore the aim of medical treatment is to improve a dog's quality of life by minimising how frequently the attacks occur and how severe they are. Ideally, maintaining a seizure-free status, without the medication causing unacceptable side effects, is the ultimate goal of anti-epileptic drug (AED) therapy.
Treatment depends on factors such as the frequency, severity and type of seizures. There are many different anti-epileptic drugs available, each with certain side effects that can occur, particularly in the first few weeks of treatment. However, these typically decrease in severity over time, as dogs develop a tolerance to the drugs.
Commonly used AEDs include the following:
Phenobarbital (Epiphen) is the most commonly used ‘first line’ primary epilepsy medication because it is relatively inexpensive, easy to use and effective. It does have a sedative effect, so dogs can seem lethargic or unsteady on their feet particularly in the first few weeks of treatment. The other common side effect is an increase in thirst and appetite. Decreased activity plus increased food intake can add up to an overweight dog, so it is important to prevent this by adjusting the dog’s diet accordingly. Blood levels of Phenobarbital are usually measured periodically, as are indicators for liver and kidney function, with dosages adjusted if there are any changes in seizure frequency or severity, or to keep in balance with any other medications being taken.
Imepitoin (Pexion) is the other ‘first line’ licensed treatment for primary epilepsy in dogs. It is normally well tolerated, but as with all epilepsy drugs, it can have side effects such as increased hunger and thirst, sleepiness, hyperactivity, lack of co-ordination and gastrointestinal upsets. However, these are generally mild and short-lived.
Potassium Bromide (Libromide) is rarely given on its own and is normally used where first line drugs are not controlling the seizures. It works in conjunction with those drugs to enhance their effectiveness in reducing the chance of seizures. Side effects can include increased thirst and urination, lethargy, unsteady gait and vomiting, but these are usually only seen when given at high doses.
Levetiracetam (Keppra) is a newer generation drug for treating epilepsy and can be used either on its own or in conjunction with other drugs. It can be a good choice in cases where dogs are not able to tolerate Phenobarbital or Potassium Bromide. In addition, it does not have the same effect on liver enzymes (measured in the blood) as the other drugs can. Levetiracetam ‘pulse therapy’ is also used to try and prevent continued seizure activity in dogs having cluster fits.
Diazepam (Valium) is also an effective drug used in the treatment of epilepsy, but if it is given daily, there is the possibility it will lose its effectiveness. Therefore, it is usually reserved for administration to the dog during a seizure, in the hope of arresting it. It is given to the dog during an active seizure either by intravenous injection or, more usually, by suppository (via the rectum). This has proved particularly helpful as a preventative treatment against cluster fits.
What is the outlook for epileptic dogs?
The prognosis can generally be good, but much depends on the frequency and severity of seizures a dog has and how well they respond to medication. Some anti-epileptic drugs are metabolised by the liver, which may mean that, over time, higher drug dosages are required to maintain the same concentration of the drug in the blood. Some medications can also affect liver function over time and regular monitoring is therefore necessary.
In addition, the prognosis also very much depends on an owner’s ability to cope with an epileptic dog and, not least, in being able to adhere to a strict daily routine for giving medication (including planning ahead to ensure the drugs never run out) for the rest of the dog’s life. Treating epilepsy is not quite like treating many other conditions and missing even a single dose could have serious consequences.
Is there any evidence to indicate that Epilepsy is inherited?
Idiopathic epilepsy, in which no underlying cause for repeated seizures can be found, is often assumed to be due to a combination of genetic and environmental factors. Few breeds have yet to have proven hereditary epilepsy, but genetic studies and research projects continue to establish positive diagnoses of the hereditary form. When evidence is seen of multiple epileptics in a family, it has to be a major concern that it may be hereditary. The mode of inheritance is likely to be complex, involving multiple genes, and these may also vary between different breeds. There are several genes associated with epilepsy in humans and mice, and these are being investigated as possible candidates in canine epilepsy.
In January 2016, the Animal Health Trust Genetics Centre in Newmarket launched Give a Dog a Genome, a ground-breaking initiative aimed at dramatically improving the ability to identify mutations which cause many different inherited diseases in purebred dogs. The project involves sequencing the entire genomes of (initially) 77 dogs, each from a different breed. Some of those dogs (including an English Springer Spaniel) have been selected specifically because they have idiopathic epilepsy. By comparing the genomes of the affected dogs with the genomes of healthy non-epileptic dogs in other breeds, it is hoped that this might lead to a better understanding of the possible genetic causes of epilepsy in the affected breeds.
What is the best advice for living with an epileptic dog?
Try to plan ahead as best as you can to make sure that in the event of a seizure your dog is safe from hurting itself or being hurt by other dogs in the household.
Keep calm and relaxed as best you can at all times, to convey to your dog that you are in control and they have nothing to worry about.
Don’t stop having fun with your dog. Most epileptic dogs can live relatively normal lives, even though requiring a strict regime of daily medication to control their condition.
Always make sure you have enough medication available (especially if you are away from home, or have left the dog in someone else's care, bank holidays etc.).
Feed a high quality balanced diet to suit your dog's needs and which is in balance with its exercise and activity levels. Keep your dog on a consistent diet, as changes to what your dog eats can change blood levels of certain drugs. New diets are also currently being developed, based on published research studies, which might help to improve seizure control even further.
Establish a good, understanding relationship with your Vet. Ask if they are willing to treat your dog holistically and make sure they are happy to discuss your fears and concerns.
Do not breed from dogs that have experienced seizures and be extremely cautious about using their parents or siblings for breeding.
Keep a seizure diary for your dog, including the date/time, number of, duration, appearance and severity of the seizure(s), whether there was any obvious trigger, whether abnormal behaviour was seen immediately after the seizure. Sharing these diaries with your Vet or Neurology Clinician will greatly help them in assessing whether your dog’s treatment is reaching its goals. The Royal Veterinary College (RVC) has developed an app called ‘Pet Epilepsy Tracker’, which lets owners map their dog’s seizure activity and medication requirements on their mobile phone and tablet devices. As well as containing up-to-date veterinary knowledge on managing epilepsy, the app also allows owners to convert their dog’s up-to-date medical history, seizure diary and medication diary into a pdf file and send it directly to their Vet. RVC Pet Epilepsy Tracker is free to download on Android and Apple devices.
Join an Epilepsy Support Group (see links below), so that you can communicate with and seek extra support from others who are in a similar position to you, to help deal with both the medical and emotional aspect of living with an epileptic dog.
What other help and support is available?
Useful Links:
Phyllis Croft Foundation For Canine Epilepsy (PCFCE)
Facebook Groups:
Canine Epilepsy UK Facebook Group
Blu's Tale Foundation Canine Epilepsy Support Group
CANINE Epilepsy support encompassing different types of management
RVC Canine Epilepsy Research Facebook Page
If any ESS owner and/or breeder needs help or further information relating to your ESS being diagnosed with Epilepsy, we would be happy to hear from you. We would also be extremely grateful if ESS owners would help us to monitor Epilepsy in ESS by reporting online any confirmed diagnosis of Epilepsy or the death of your ESS from the condition. All information provided will be treated in the strictest confidence.
For further information or advice about Epilepsy, please contact