[music playing] Kelly: According to in dogs.

The disease is most and what can pet owners do to control the disorder?

On this episode of The Paw Report, we're joined by Dr. Kari Foss fro Veterinary Teaching Hospital to help us understand canine epilepsy.

Stay with us.

[music playing] Rameen: The Paw Report on WEIU is supported by Rural King, America's farm and home store, livestock feed, farm equipment, pet supplies and more.

You can find your store and more information regarding Rural King at rura Rob: Dave's Decorating Center is a proud supporter of The Paw Report on WEIU.

Dave's Decorating Center features the Mohawk Smartstrand Silk For Dave's Decorating Center, authorized Mohawk color center in Charleston.

Kelly: Well, we welcome back a former Paw Report guest to this episode.

We're joined by Dr. Kari F and today we're going to be talking about understanding canine epilepsy.

It's wonderful to see you again.

Kari: It's nice Kelly: We it's been, what?

Three years Kari: Ye Kelly: An Kari: Ye Kelly: We canine epileps to meet you the first time around.

Kari: Sure.

Kelly: Te U of I. Kari: So I am an a Medicine, and most of my work is in the veterinary teaching hospital.

And so a little background on me.

I actually did m from this wonderful, wonderful college.

Then, after, to get to where I am today, af medicines and surgery in Orange County, California.

Then, following that, made the trek back to the Midwest, and compl the Ohio State University in neurology and neurosurgery, concurrent with a master's degree in veterinary clinical sciences.

Following completion of my residency training, I th Ohio for about four years before making the decision to transition back into an academic setting, and so I've been here since 2016, and I'm thankful that I get to be here every day.

Kelly: Ye Kari: Yes.

Kelly: An of that, and that's why today we're talking about understandin I know a lot of pet owners out there have dogs that have episodes.

And so I guess, let's start off by saying, what is epilepsy and how does it differ from just having a seizure?

Kari: Sure.

That's a gre I'll start w Not all seizures are epileptic per se.

An epileptic seizure is an asynchronous event within the bra firing of the neurons or the cells within the brain.

Then, epilepsy by definition is multiple epileptic seizures that are isolated and un more than 24 hours apart, and I know there's some questions that we'll talk about later on of why that greater than 24 hours apart is really important.

Kelly: Are there different types or different ways to classify epilepsy, in general?

Kari: Yes, so in veterinary medicine and similar to human medicine, when we classify epilepsy, wh at the underlying cause might be in that patient.

So I kind of think about, first, when I classify the in the brain itself, or is the issue outside?

And so kind of that outside of the brain, and it's not really epilepsy.

We'll call those reactive seizures, and so reactive seizure brain's response to some kind of disturbance, and so that can be exposure to a metabolic issue, so kind of internal organ dysfunction.

With reactive seizures, those often will actually resolv cause or the disturbance, and so I put it as its own little category, because it's not in theory epilepsy per se, but they can be a type of seizure activity.

Then, as far as our epilepsy, then when I'm thinking about actually a disturbance within the brain itself, one category is going to be kind of primary or now what we refer to as idiopathic epilepsy, and as far as idiopathic epilepsy goes, that's kind of the general term that we use for many of our patients.

But if we want to get specific, that idiopathic ep called genetic, so there's actually been a gene mutation identified for that breed, suspected genetic.

So there has within a breed or some kind of familial predisposition.

Then, we have epilepsy of unknown cause, and so that's a an underlying cause for the seizure activity.

That's kind of the general, again, idiopathic epilepsy, because we'v and we've not found a reason for the patient, at least structural.

The other category is what we're going to call structural epilepsy, and so tha there's actually something physically disturbing the brain tissue.

Some of those causes can be a vascular event, so stroke.

Brain tumors can cause structural epilepsy.

We can see infections, so inflammation and under inflammation.

We can see infectious causes or immune mediated, which we call meningoencephalitis.

We can see congenital anomalies or birth defects.

Then, the last one can be something that we call degenerative So the cells aren't processing products properly, and so they're just storing them up inside.

That's the degenerative causes, are more rare.

Kelly: Let's expand upon the causes.

Maybe you could also talk about symptoms or triggers, and you did touch on some of but I think the list is probably pretty great on other factors that could lead into episodes.

Kari: Mm-hmm.

So with our cause for them to have their seizures.

You asked about maybe triggers or things like that.

So patients, if they had a stroke, maybe they have high blood pressure.

Kelly: Yeah.

Diabetic?

Kari: Ye Diabetic pat Patients with Cushings, so too much what, we cal in the body can be predisposed, because I love this part with vascular because it's kind of a circle of all these causes, because those patients with that Cushing's disease or hypercortisolism have high blood pressure.

They have protein loss in their kidneys, things like tha They have too much cortisol in their body.

We can see kidney disease predispose them underlying health issues could maybe predispose them to strokes.

As far as triggers, we do know that patients, if they're prone to having a seizure, stress or anxiety, can also go about bringing on seizure activity, so I think some people have known the dog that never has a seizure, except for when it sees the veterinarian in their white coat, that white coat syndrome, or when people come over to the house.

Yes, so we certainly know that stressful situations can also trigger this.

Not in a normal healthy dog, but a dog that's already predisposed to having seizures, so I'm not telling people to not let their dogs get stressed.

Not every single dog's going to have a seizure, Kelly: Isn't it amazing?

The things that you Kari: Yeah.

Mm-hmm.

Kelly: I human relatable.

Kari: Ye Kelly: No seizures, epilepsy?

If I come in and say, to- Kari: Yeah.

That's a gre And the firs of seizure activity too, so patients with heart disease, something called syncope, can look similar to a seizure.

Patients with muscular weakness, if they just suddenly collapse, can a a seizure.

So the clien a seizure, because we really need a good thorough history about what this event looked like and a good description of, "Was there a trigger?

How long did it last?

What was the What did they look like What did the event look like?

Were they unconscious?

Did they urinate, de Things that might trigger us So metimes it's not as straightforward as that, and these smartphones.

Pros and con People have In many of our cases, we also will have th happens so we can better further determine what the etiology is.

Kelly: What is the difference between a focalized seizure and a generalized seizure?

They're different?

Kari: They a actually arises from just a very specific region of the brain, so only one part of the brain is affected.

That being said, we can se of the cerebrum, and then lead to a more generalized, and that's actually a very common presentation of seizures in dogs, what we call focal to progressing to generalized seizures.

With focal seizures, again, it's going to be based off of the region that's affected, and we can see motor activity, behavioral signs, and potentially autonomics, so just maybe drooling, things like that.

With that, it can just be paddling of one limb o A lot of times the focal seizures might even just be in the facial region, so twitchi of the mouth, twitching of the ear.

You might see the eye blinking Th en, our generalized comes from abnormal acti the classic presentation, and they can be tonic-clonic, just tonic, so they kind of just will fall over and get rigid, or clonic, where they just stiffen their legs.

Then, generalized tonic-clonic is they have that motion combined, and again, the classic presentation is those patients typically lose consciousness.

They'll have that paddling.

They'll still have that focal facial mov So the jaw chattering and hyper salivating, and then they may urinate or defe the event as well.

Going back to foca just a very subtle movement, owners or even sometimes the veterinary nurses might not pick up on it unless we're really specific with saying, "Hey, this is what this patient does.

Really watch Kelly: As a pet owner, and I've had a pet that has been through a lot of the scenarios that you've just mentioned, but if somebody's out there watching for the first time, or maybe the second time their pet has a seizure, and so what should you tell them?

I mean, as a pet owner, what Sh ould you immediately call your vet?

Should you immediately go to an animal hospital?

What's the proper way to respond?

Kari: An Kelly: It's very terrifying.

Kari: You've witness say stay calm, but that's ju a seizure before.

It can be qu I think the first Most seizures last less than two minutes, although it seems like a lifetime to the client witnessing it.

Kelly: It Kari: Bu so during that time can injure itself on, so it's not getting stuck under furniture or near stairs or, God forbid, outside, near a pool or things like that, and let them recover.

A lot of people, the old wives' tale used to be, "Oh.

They're going to swallow their tongue, and they're going That is anatomically impossible to do, so also d of the pet, especially if they have that rapid jaw movement, because we don't want clients to get bit, trying to do that.

Then, once the seizure subsides, They could be a little bit in-coordinated, stumbling all over, seem a little disoriented, groggy, things like that.

And so, kind of just let them recover.

Let yourself recover as well.

If it's just one single seizure, I don't think ther room, but certainly I would still recommend having your veterinarian be cause this is something new that's going on, and so to try to make sure that everything's okay.

When we recommend pati a 24-hour period, so that's considered cluster seizure activity, or if they have status epilepticus.

Status epilepticus, by definition, is if the seizure activity lasts longer than five minutes, or if the pet has a seizure and really doesn't come to, so the actual kind of movement of the seizure stops, but they're really not regaining consciousness.

So those are scenarios where the pet should actually be presented to an emergenc to try to get those seizures to stop.

Because, especially with status epilepti epileptic and cluster seizures, five minutes is about where we still have that time point to intervene and hopefully get the anti-convulsant medications, the emergency treatments to work.

The longer the pet goes in that status epilepticus, the worse it's going to get.

About by 30 minutes, that's where we're probably not going to have any interventions happening.

Still not wrong to try, but when seizures are going on for more than 30 minutes, that's where we actually can start to see loss of the body's ability to correct itself.

They can become hyperthermic and elevated temperature, start to have their internal organs affected and things like that, so the second we start to see that prolonged seizure activity, we need to get them in right away.

Kelly: What does your dog feel?

When I was watching my, I had Are they hurting?

Kari: Th hard to answer because they cannot tell us Kelly: Right.

Kari: It I would imagine, kind of pulling from the fact, is they may again feel a little confused.

Some dogs get a little bit anxious.

Again, they might also be anxious, just because They have no idea.

The good news is general autonomy, if they lose consciousness, then they're not aware that's happening.

So that's a little peace of mind that they're not aware.

I would imagine they may be a little bit, an d paddling, could they be a little sore?

Possible.

I don't find The dogs don't need an I think the bigger things are just this kind of fee again like, "Whoa.

What happened?"

Kelly: Ri Kari: An a seizure too, that there is none of that postictal period where they Th ey'll just have their seizure, and they just pop back up like- Kelly: "Oh, what happened?"

Kari: Yeah Kelly: Le I mentioned Can you talk about the breeds or the different types of dogs that maybe are more prone to something to epilepsy or seizures?

Kari: Yeah, and we would love to say that there is a genetic predisposition.

A lot of the research and studies have not identified a specific this point in time, but they're certainly, from clinical experience and research, there are absolutely breeds that are very predisposed to having epilepsy.

More specifically, the idiopathic epilepsy that we talked about, and some of those are, like you said, Labrador Retrievers, Border Collies, Australian Cattle Vizslas, Beagles, [inaudible 00:16:10].

That's a fancy one.

Not a very common one.

Kelly: Wow.

Kari: Be I mean, the list goes on and on.

In theory, any dog breed can get idiopathic epilepsy, but those are certainly, like I said, the list goes on and on about some of those more predisposed, but there are definitely breeds that we see much more frequently to develop epilepsy than in other breeds.

One thing I will say is, if you notice of all those breeds I listed... Kelly: Large breeds.

Kari: Yes, exactly.

I don't think of Yorkshire Terriers, Chihuahuas Standard poodles are.

Miniature po So those breeds are ones that it if they're having seizures, maybe there's another underlying cause, not to frighten those owners.

It's still p to large breed dogs.

Kelly: So pet owners out there what are some of my treatment options?

How can I care for my dog if they're goin I'm sure there's a load of different options to look at.

Kari: There is and is not, unfortunately.

So the mainstay of treatment for seizures, regard them with an anti-convulsant or an anti-epileptic medication.

Unfortunately, we are limited to just a few options in our veterinary we can utilize.

But the kind of first line of treatment is wi th our goal of trying to reduce those seizures by about 50%, and so again, some patients will respond really well.

Some won't.

If there's a that underlying cause in addition to starting them on an anti-convulsant medication.

Kelly: Can that be costly?

I mean, is that something that a pet owner wo When you take on a pet, I think that's what you have to think about, regardle their health status is at that point, but I think when you look at long-term, you have to think about those things.

Kari: Exactl A lot of the seizure medications that we use nowadays can com fine as well, so it's not terribly expensive.

What can add up in those patients is not just the medications, but in some of those medications, we do need to have frequent monitoring of the pet, just due to side effects that the medications can have on their internal organs, such as the liver and things like that.

It's the medication and then the veterinary visits as well, to have the dog examined and have them have their blood work evaluated, and so over the long term, that can add up for the patient.

Kelly: Ri have to be t Kari: If or even a patient with underlying diseases in their brain, if they're left untreated, a lot of times what can happen in patients with epilepsy is they might have a seizure here or there, but over time, those seizures can start to become closer and closer together, so more frequent, and they can even become longer in duration.

Then, worst case scenario is they can go into clusters and then potentially status epilepticus if left untreated.

Kelly: Yo the power of cell phones and being able to capture, if your dog is havi How important is it for pet owners to keep a diary so that when they come to your office, they can say, "Well, I've got this, and I've tracked it, and here's all the days and times and lengths of things that have happened"?

Kari: This is really important, seizure diary.

I think, one but why it's really important for us as the veterinarian treating the patient is, like you mentioned, they can jot down patterns to the patient's seizures, and it helps us determine how well they're responding to a medication.

So the seizure log, seizure diary is really important, and the They can just write on a piece of paper, put it on a calendar.

I've had clients that, one was really cute.

They would put a happy face for seiz that they had a seizure, but it is really good for us to evaluate because the client kind of comes in and says, "Hey, I've noticed this is how frequently they're having it.

We changed this, and then I noticed that, hey, they did a lot better, and now we're kind of back in our same way," and so then I can take that information in Wh at's going on here?

Why are we h We added this medication.

Now we've gone Wonderful."

Kelly: Sp pet owners change in maybe their dog's everyday life that could help?

Is it diet?

Is it maybe Kari: So we don't really need to change their diet at all.

It's just being there for them.

I think, again, the things are, if you have an epileptic pet t is to at least have it set up that they are blocked from anything that could cause them injury during a seizure event, so potentially gating off stairs.

If they could have a seizure and fall on the stairs, not allowing them to the backyard, if you have a pool in the backyard and things like that.

No need to change the diet, but there are a couple diets on the market that are kind of targeted for dogs with epilepsy, because they have a lot of medium chain triglycerides in them.

I don't use those as a sol to the pet as well so there's Brain Diet by Hills.

Nestle Purina has Bright Minds, which that one was actually marketed more towards dogs that are getting older, but it still has some of those medium chain triglycerides in it, and then there's NeuroCare.

A lot of our epileptic patients, as indiscretion that's going to happen, they don't have allergies or things like that, we'll oftentimes send our clients home like, "Hey, if y neurocare, go ahead and and give it a try too."

Kelly: Let's talk about the future, because a lot of what you do currently, and something that's yo u've studied, what you've learned, and what you are continuing to do in your research, in our last couple of minutes in our discussion.

Kari: Yeah, so part of working up a dog with is performing an MRI.

The reason to perform the MRI after they've had their is to 100% say, "Hey, do I see something in the brain that could be causing this seizures?"

In a lot of our idiopathic epileptics, the good news is the brain's normal, so we don't see any abnormalities, and then they'll have a normal spinal fluid analysis as well, which is great, but that's about all we get from the MRI, is normal- Kelly: Normal.

Kari: ... Tissue.

So we're still at the po the cell level in these patients, and people, they can actually also better identify where the seizure's coming from with what's called electroencephalography.

That actually measures the brain activity.

We can do that in our veterinary patients.

It's just a lot more difficult.

They have a lot more muscle up here tha artifact and things like that.

It's also a really, really I mean, in human medicine you specifically that's all they do, all day long, is just read these EEGs, whereas veterinary n I kind of do it all.

So it's not as reliable.

It certainly can b would love to try to find a way with imaging and not so invasive per se of to see wha really happening in their brain in these epileptic patients, and so one of the studies that we're doing right now looks at magnetic resin spectroscopy.

What that evaluates is actually metabolites of the neurons or the cells in the brain, and so I'm trying to look at epileptic dogs and healthy dogs, and see, "Do these epileptic dogs have changes in these metabolites compared to the healthy dogs, and are those changes predominantly more noted in one area of the brain or one side than the other?"

And again, the reason for that is, in people, they know one of the most common forms of epilepsy in people is called temporal lobe epilepsy or mesial temporal lobe epilepsy.

And so we've not documented that in dogs, but some people say, "Well, is the problem with these epileptics coming from the hippocampus?

Is it the parietal lobe, different regi So again, basic MRI is not going to t So can this spectroscopy better identify it?

And so then can we provide more targeted t Can I get a better understanding and kind of have types of epilepsy in the patients as well?

And dos are a great model for epilepsy.

They are very similar in people, that they just spontaneously develop it, an have and continue to be used to help further treatments and guide diagnoses for themselves and in people, so I like to say that they really are man's best friend.

Kelly: Yeah, yeah.

And you ligh Kari: Thank you.

Kelly: An you, that ar episodes.

Kari: Ye This is why population, but our pet population can also help the humans.

Kelly: That's right.

Good way to end our Kari: Yeah.

Kelly: Dr Veterinary Teaching Hospital here in Champaign- Kari: It was a pleasure.

Kelly: We Kari: Yes, let's not.

Kelly: An Paw Report, for joining us for this Until then, we'll see you next time.

Rob: Dave's Decorating Center is a proud supporter of The Paw Report on WEIU.

Dave's Decorating Center features the Mohawk Smartstrand Silk For Dave's Decorating Center, authorized Mohawk color center in Charleston.

Rameen: The Paw Report on WEIU is supported by Rural King, America's farm and home store, livestock feed, farm equipment, pet supplies and more.

You can find your store and more information regarding Rural King at ruralking.com.

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