Fall management in dogs - here with a difficult to treat animal

The hanger for this post is an article by Michaela Beasley, DVM, MS, MBA, CCRP, DACVIM (neurology), Mississippi State University

Anamnesis & signalement

Bully , a 5-year-old castrated male Labrador Retriever, was presented due to an increasing frequency of generalized seizures. Two years ago, idiopathic/primary epilepsy was diagnosed-based on the age of the first seizures (1–6 years), normal physical and neurological examinations between the seizures and unobtrusive metabolic laboratory values ​​(e.g. large blood count, clinical-chemical profile, bile acids, urine examination).
The maximum recommended dose of Levetiracetam in extended release (60 mg/kg orally every 12 hours) was administered.

Bully was often difficult to use when visiting vet visits, which caused stress for him, his owner and the practice team. Several employees were necessary for the investigation; The owner was previously asked to create a muzzle and a ruff.

📌 What is "signalement"?

The signalement is an integral part of the clinical description of an animal. It includes the basic identification features that can be important for the assessment, diagnosis and therapy of a patient - that is, the animal's "profile"

One could also say: The signalement is the first important component in assessing an animal patient.

🔍 Which information belongs to the signalement?

A complete signalement usually includes:

1. Animal species (e.g. dog, cat, rabbits, horse etc.)
2. Breed (e.g. Labrador Retriever, Maine Coon, European shorthair)
3. Gender (male/female; intact or neutered/sterilized)
4. Age (e.g. 4 years, senior, puppy)
5. Weight (for doses and assessment of nutritional status)
6. Fell color & special license plates (optional, e.g. Black spots, tattoo, chip number)

👉 Example of a complete signalement:

"Milo is a 7-year-old castrated male border collie with a body weight of 19 kg."

🧠 Why is the signalement important?

The signalement immediately provides important medical references to possible diseases without already mentioned symptoms. Because many diseases are related to age, gender or breed .

Here are a few examples:

• Age:
  • Young animals = frequent infectious diseases, parasites, genetic diseases
  • Older animals = more frequent tumors, arthrosis, metabolic diseases
• Gender:
  • Female = hormonal diseases such as pyometra (uterine dilation)
  • Male = prostate diseases, testicular tumors (for uncastrated male)
• Race:
  • French bulldog = often breathing problems (brachyzephaly)
  • Doberman = genetically related heart disease
  • Dachshund = tendency to herniated discs

💬 Why is the signalement often mentioned at the beginning of case reports?

In medical reports, specialist articles or patient files, one often reads at the beginning:

"Luna, a 3-year-old sterilized bitch, mixed breed, was introduced because of ..."

There is a good reason for this: the signalement contextualizes the entire case . An epileptic seizure in a 6-month-old Chihuahua is evaluated medically very differently than the same attack in a 9-year-old German German Shepherd.

📎 Signalement vs. Anamnesis - the difference

These two terms often appear together, but do not mean the same thing:

• Signalement = who is the animal? (Basic data, "profile")
• Anamnesis = what has happened so far? (Disease history, symptoms, course)

Both together form the basis for any clinical assessment.

The signalement is the medical profile of an animal and contains all the basic data that is important for the correct classification of an illness or an case. It helps veterinarian to narrow down diseases , to recognize typical problems and to create treatment plans more specifically.

Sometimes it looks inconspicuous - but without a signaling, the red thread is missing in veterinary evaluation. 🩺🐶🐱

Clinical examination

The physical examination was mostly unobtrusive. Temperature, pulse and respiratory rate were normal. Heart and lungs were palpable without abnormalities, no enlarged lymph nodes or abdominal organs. A limited neurological examination showed normal proprioception and trim reflexes in all limbs, normal eyelids and pupil reflexes, normal threat reaction as well as normal muscles of the baisus clays. The stranger reflex could not be tested for safety reasons.

Diagnosis

A new, large blood count, clinical-chemical profile and urine examination were carried out in order to rule out metabolic causes for the increased frequency of stroke. The alkaline phosphatase (ALP) was slightly increased, otherwise there were no significant changes in red and white blood cells, thrombocytes, electrolytes or liver and kidney values. The alp increase was attributed to hypoxia during a recent generalized attack.
The Levetiracetam serum mirror was not determined, since there are no established therapeutic target values ​​in dogs due to the high safety margin.

diagnosis

The diagnosis of idiopathic/primary epilepsy was maintained, since there were no significant abnormalities in the physical nor in the neurological examination or in the laboratory.

Treatment & management

Levetiracetam was a good first election due to the low risk of side effects and the lack of need for medication mirror monitoring - especially at Bully, which was difficult to use in the clinic. Due to the increase in the frequency of seizures despite maximum dosage, additional medication was required.
Phenobarbital , zonisamide and potassium bromide were discussed with the owner . Ultimately, zonisamide (5–10 mg/kg orally every 12 hours) was chosen as an additional anticonvulsivum.

🧠 What does attack management mean?

Fall management includes all measures that aim to recognize epileptic seizures in dogs (or other animals), treat, reduce their frequency and to maintain or improve the quality of life of the animal affected. So there is much more than "just a medication" - it is a holistic, individually adapted therapy approach.

🔍 Goal of seizure management

The main goal is not always the complete freedom of seizure (even if this is desirable), but:

• Reduction of seizure frequency
• Shortening of the seizure length and postal phase (the time after the attack)
• Minimization of side effects of medication
• Improvement of quality of life - for animals and owners

⚠️ Why is that so important?

Repeated seizures can burden the brain and cause long -term damage. Stress, fear, violation of injury or changes in behavior (e.g. aggression or uncertainty) can also be consequences of poorly controlled epilepsy.

Therefore, good management is so crucial - also to avoid sudden death through a status epileptic or cluster attacks

🧩 What is good seizure management from?

Here several building blocks come into play:

1. Diagnosis & seizure classification

• Differentiation between idiopathic epilepsy (without recognizable cause) and symptomatic epilepsy (e.g. by tumors, inflammation, poisoning, etc.)
• Anamnesis: When did it start? How often? How long do the seizures last? What exactly happens?

2. Medical therapy

• Depending on the dog and the attack type, one or a combination of the following medication is selected:
  • phenobarbital
  • Potassium bromide
  • Levetiracetam
  • Zonisamide
  • (possibly CBD or special diets)

3. Therapy control & monitoring

• Regular blood tests (va liver, medication mirror)
• Lead the seizure diary (e.g. when, how strong, for how long)
• Close communication with the vet

4. Individual adaptation of the therapy

• Every dog ​​reacts differently: dose adjustment, change or combinations are often necessary
• Observe side effects (e.g. fatigue, feeding behavior, liver damage)

5. Behavior management

• Epilepsy can go hand in hand with fear, uncertainty or even aggression
• Medicines like Gabapentin, Trazodone or Clorazepat can help you visit the vet when you visit the vet
• A quiet, stable environment reduces stress -related trigger for seizures

💡 Additional options in management

➕ Additional measures:

• Special diets with medium -chain triglycerides (MCT) can help
• CBD in consultation with the veterinarian, since studying situation is still inconsistent
• Avoidance of trigger (stress, lack of sleep, overexcitation)

🐶 And what about difficult to treat ("fractibous") dogs?

In dogs that can hardly be examined or treated in practice, seizure management is particularly challenging. Here is preferred with medication that:

• have few side effects
• do not require frequent blood monitoring (e.g. Levetiracetam),
• And mean as little stress as possible for dogs and owners.

Sometimes soothing pretreatment with medication can help to enable blood -taking or clinic visits.

Good seizure management is a tailor -made timetable that combines medical knowledge, experience and compassion.
It's not just about suppressing seizures - but about enabling the animal a safe, normal and fear -free life. ❤️🐕

If you want, I can also put together a guide for driving a attack or an overview of the common medication with advantages and disadvantages. Just let me know!

Let us take a deeper look at the treatment options for epilepsy in the dog . Medicine therapy is a central part of seizure management, but every medication has its special features, advantages and disadvantages. I explain everything to you so that you are well informed - regardless of whether you work in or in veterinary medicine.

💊 Overview: treatment goals

The aim of the treatment is not always complete freedom of seizure , but:

• Make seizures rarer, shorter and less violent
• Minimize side effects
• Improve the
• the postal phase (recovery phase after a seizure)

Several medications are available for this - sometimes one is enough, in other cases a combination is needed.

🧠 At a glance at the most important medication:

1. phenobarbital

🟣 One of the oldest and most frequently used anti -epileptics in dogs.

• Working method: increases the threshold from which the brain triggers a seizure.
• Start dose: 2.5–3 mg/kg orally every 12 hours
• Entry: after 1–2 weeks (Steady State reached)
• Therapy mirror: Goal: 15–35 µg/ml in the blood

🔍 Monitoring:

• Blood count, liver values ​​and bile acids every 6 months
• Medicinal mirror every 6–12 months or if there is suspected side effects

⚠️ Side effects:

• Polyphagia (increased appetite)
• Polydipsia/polyuria (drink a lot/pee)
• Sedation, coordination problems
• Liver pollution possible with long -term application

👎 Caution at: aggressive dogs - feeding aggression can result from increased appetite.

2. Potassium bromide (KBR)

🟡 Long half -life - ideal for keepers who can only give 1 × daily.

• Dose: 20–40 mg/kg orally every 24 hours
• Special feature: extremely long half -life (approx. 3–4 weeks)
• Steady State: After about 3–4 months (can be shortened by so-called "charging dose")

🔍 Monitoring:

• Blood mirrors every 6–12 months
• Control at every dose change

⚠️ Side effects:

• Sedation, ataxia (coordination disorders)
• Polyuria, polydipsia, polyphagia
• Hypertriglyceridaemia (high blood lipid, va at station wagon with phenobarbital)
• Aggression possible - should therefore only be used with caution in the case of behavioral dogs

💡 Important: keep nutrition stable - chloride content in the feed influences the bromide output.

3. Levetiracetam

🟢 Very well tolerated - ideal for sensitive or difficult to handle patients.

• Dose:
  • Ir (immediate release): 20–30 mg/kg every 8 hours
  • He (delayed release): 30 mg/kg every 12 hours

💚 Advantages:

• Hardly any side effects
• No liver metabolization → ideal for liver problems
• No regular blood level control required

⚠️ Disadvantage: must be given relatively frequently (3 × daily with IR shape)
👀 Note: With the simultaneous administration of phenobarbital, a higher dose is necessary.

4. Zonisamide

🔵 Modern drug with sulfonamide structure-good additional option.

• Dose: 5–10 mg/kg orally every 12 hours
• Form: capsules (25, 50 or 100 mg)

💡 Advantages:

• Easy to combine with other antiepileptics
• No influence on water intake or appetite

⚠️ Possible side effects:

• Keratoconjunctivitis sicca (dry eyes)
• Hepatotoxicity (liver pollution)
• Vomiting, lethargy, lameness
• Tubular acidosis (rare)

🔍 Monitoring:

• Blood count, liver values, urine status before and about 2 weeks after the start
• Then every 6–12 months

👀 Note: Different manufacturers = different bioavailability - preferably with you.

🌿 Supplementary & alternative therapy approaches

✅ Medium -chain triglycerides (MCT) - diet support

• MC-containing diets (e.g. "Neuro Support" feed) can improve the seizure control
• Effect: influence neurotransmitters in the brain (more inhibition, less excitement)
• Positive effects on behavior and cognitive performance possible

✅ Cannabidiol (CBD)

• Dose (depending on the study): 2–4.5 mg/kg orally every 12 hours
• Effect on attack control partly confirmed - but not yet concluded
• Attention: Quality and dosage of the product vary strongly - only use tested preparations
• Side effect: Alp increase possible (liver value)

🔁 combination treatment

Sometimes a medication alone is not enough. In such cases, it is common to combine two or more antiepileptics - e.g. B.:

• Phenobarbital + potassium bromide
• Levetiracetam + zonisamide
• or other combinations

💡 Important: In combination therapies, the risk of side effects → regular checks are essential!

🐾 What therapy is the right one?

That depends on:

• The type and frequency of the seizures
• Age, breed and state of health of the dog
• Already existing organic diseases (e.g. liver, kidney)
• Behavior of the dog (e.g. fear, aggression, stress in the clinic)
• And very important: living conditions and possibilities of the owner

Good seizure management is always individual !

The treatment options for epilepsy in the dog are diverse - and no medication is equally suitable for everyone. A careful selection, regular control and the close cooperation between the vet and owners are the key to success.

If you want, I can create a table or overview to print out - with doses, advantages and possible side effects of the individual medication. Just let me know! 😊

Course

The liver values ​​were checked a week after the beginning of zonisamide therapy. There were no significant changes, so the treatment continued. Two weeks after the start of therapy (after reaching the Steady State), the owner reported by phone that Bully had no seizures in the past 12 days.

discussion

Time of treatment & medication selection

Antiepileptic drugs are recommended if:

• ≥2 seizures occur within 6 months,
• Status epilepticus or serial attacks,
• the postal phase is extended or heavy,
• or seizure or bad.

If the initial therapy is unsuccessful and an additional medication is achieved, the first medication can be slowly felled out - but only after consultation with the owner about the risk of renewed seizures.

When choosing a drug, comorbidities, existing medication and the circumstances of the owner should be taken into account (e.g. administration of administration, financial possibilities, side effects tolerance) .² Certain medication require the monitoring of medication levels and blood values.

Treatment options

phenobarbital

• Dose: 2.5–3 mg/kg orally every 12 hours
• Therapy mirror: 15–35 µg/ml (after 10–14 days)
• Monitoring: CBC, liver values, bile acids every 6 months
• Side effects: polyuria, polydipsia, polyphagia, possible medication interactions
• Beware of: aggressive dogs - polyphagia can promote feeding aggression

Potassium bromide

• Dose: 20–40 mg/kg orally every 24 hours
• Steady State: 4 months (without saturation)
• Serum mirror: 1000–3000 mg/l
• Side effects: polyuria, polydipsia, polyphagia, hypertriglyceridemia (VA with phenobarbital), aggression possible
• Note: Do not change nutrition (CL intake influences excretion)

Levetiracetam

• Dose: 20–30 mg/kg every 8 hours (IR), 30 mg/kg every 12 hours (er)
• Effect: few side effects, no liver metabolization
• Monitoring: Medicine mirror is not routinely determined
• Note: Good option in difficult patients

Zonisamide

• Dose: 5–10 mg/kg orally every 12 hours
• Side effects: KCS, vomiting, lameness, hepatotoxicity, tubular acidosis
• Monitoring: blood values ​​before and 1–2 weeks after the start of therapy, then every 6–12 months
• Note: No influence on drinking/feeding behavior

Medium -chain triglycerides (MCT)

• Supplement to 9 % of the energy requirement can be made via certain diets
• Improving cognitive function, behavior and seizure control possible

Cannabidiol (CBD)

• Dose: 2–4.5 mg/kg orally every 12 hours (depending on the study)
• Effect: Possible reduction in seizure, but inconsistent study situation
• Side effect: increase in the alp

Treatment at a glance

• Usual medication: phenobarbital , potassium bromide , leavetiracetam , zonisamide
• Polyuria, polydipsia, polyphagia in phenobarbital and potassium bromide
• Liver enzymes can be increased in phenobarbital, zonisamide, cbd
• Medicine mirror control recommended for phenobarbital and potassium bromide

Dealing with patients to be treated

Dogs with idiopathic epilepsy have an increased risk of changes in behavior such as fear, aggression or hyper reactivity.
Potassium bromide should only be selected as the last option in aggressive dogs. Medicines with polyphagia risk (e.g. Phenobarbital) can promote feeding aggression.

For patients who are difficult to handle, medication should be preferred with the lowest possible surveillance need - e.g. B. Levetiracetam.

To reduce stress during visits to the clinic:

• Gabapentin: 10–50 mg/kg the evening before and 2 hours before the appointment
• Clorazepat: 0.5–2 mg/kg (optional)
• Trazodone: 5 mg/kg 1–2 hours before the appointment (caution with simultaneous anticonvulsiva gift)
• If necessary: ​​in/IV sedation with dexmedetomidine (5–10 µg/kg) ± butorphanol (0.2–0.4 mg/kg)

Forecast & result

Dogs with idiopathic epilepsy can have normal life expectancy and good quality of life with good seizure control and minimal side effects.
If the quality of life is perceived by the owner as poor (e.g. through aggression), this can lead to earlier sleep.
There is a certain risk of status epilepticus, serial attacks or sudden death - especially in brachycephalia breeds or frequent serial attacks.

The aim of therapy: minimizing the seizures and postal phase without side effects.

Central knowledge

• Gabapentin (high -dose) with/without clorazepat can make handling easier
• Dexmedetomidine + Butorphanol for sedation, if necessary
• Potassium bromide can cause aggression → Last option in aggressive dogs
• Epileptic dogs may develop behavioral changes due to the disease or medication

Frequently asked questions about seizure management in dogs

Summary: attack management in dogs

In trouble management in dogs is a central topic in small -tunerology and affects many animal owners because epilepsy is one of the most common neurological diseases in the dog. A systematic, individual and holistic seizure management in dogs can make a decisive contribution to the quality of life of the affected animal and its person.

Fall management in dogs already begins with the exact medical history. In addition to the description of the seizures, information about age, breed, state of health and environment is crucial in order to create seizure management in dogs

An important component in attack management in dogs is the distinction between individual seizures and actual epilepsy. While an isolated seizure can have many causes, such as poisoning or metabolic disorders, one speaks in at least two unprovoked seizures of epilepsy - which requires structured seizure management in dogs .

The diagnosis of "idiopathic epilepsy" - ie epilepsy without a recognizable cause - is an exclusion diagnosis and significantly influences the strategy for seizure management in dogs . Modern diagnostics (e.g. blood testing, MRI, liquor analysis) supports a well -founded therapy decision in the context of seizure management in dogs .

In therapy, the goal of seizure management in dogs not necessarily the complete freedom of seizure, but the reduction of frequency, severity and duration of the seizures while minimizing the side effects.

This includes medication such as phenobarbital , potassium bromide , leavetiracetam or zonisamide , which are used or combined depending on the case. The choice of drug depends on many factors in dogs management in dogs : age, liver function, behavior, life situation and tolerance.

Monitoring is also important in attack management in dogs Depending on the drug used, blood values ​​and medication levels are regularly checked. In this way, side effects can be seen early - an essential component in safe seizure management in dogs .

In addition to drug treatment, nutrition and lifestyle are also important columns in seizure management in dogs . Studies show that special diets with medium -chain triglycerides (MCT) can have a positive impact on seizures. A stable environment, stress prevention and regulated daily routines contribute to the success of seizure management in dogs .

For dogs that cannot be treated well in practice, seizure management in dogs important as possible. Medicines such as Levetiracetam, which does not require frequent monitoring, are well suited. In addition, fear -solving preparations such as Gabapentin or Trazodone help to make studies more stress -free - this is also part of modern seizure management in dogs .

A valuable instrument in attack management in dogs is the attack diary . It helps to recognize changes and to evaluate the effectiveness of the therapy. Documentation from time, duration, triggering and behavior during and after the attack is an indispensable tool in seizure management in dogs .

Also alternative or complementary therapies such as cannabidiol (CBD) or behavioral therapy can also seizure management in dogs - always under veterinary control and with evidence -based assessment.

Changes in behavior such as fear or aggression can occur both through the underlying disease and through the medication. A sensitive, holistic seizure management in dogs therefore takes into account not only the neurological but also the emotional needs of the animal.

A good seizure management among dogs means teamwork between the veterinarian, owner and, if necessary, veterinary practitioners or behavioral therapist. Only through open communication, regular follow -up checks and a feel for the animal succeed in stable seizure management in dogs .

Modern seizure management in dogs is dynamic - therapy plans must be checked and adapted regularly. If a medication no longer works or new symptoms occur, quick action is required.

In many cases, the forecast with idiopathic epilepsy is good if seizure management in dogs is consistently, individually and with a sense of proportion. Many affected dogs live with good quality of life and a normal everyday life.

Fall management in dogs also includes education about emergency situations. Animal owners should know how they react in the event of a seizure, which is dangerous (e.g. seizures> 5 minutes) and when an immediate vet visit is necessary.

In particularly severe cases, combined seizure management in dogs with several anticonvulsants may also be necessary. Close -meshed monitoring is particularly important here to control side effects and interactions.

Ultimately attack management in dogs always means seeing the dog as a whole - physically, mentally and emotional. This is the only way to achieve a quality of life that satisfies animals and humans in the long term.

🏁 Conclusion:

Fall management in dogs is a complex but easily controllable field of veterinary medicine. With knowledge, patience, cooperation and an individual approach, veterinarians can inside and owners . With a well thought -out, regular and adapted seizure management in dogs, not only can the disease be controlled - but also enable the animal to have a good, safe and happy life

Sources:

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10. Rozental AJ, Weisbeck BG, Corsato Alvarenga I, et al. The Efficacy and Safety of Cannabidiol as adjunct Treatment for Drug-Resistant Idiopathic Epilepsy in 51 Dogs: A Double-Blinded Crossover Study. J VET intern . 2023; 37 (6): 2291-2300. DOI: 10.1111/JVIM.16912
11. Potschka H, ​​Fischer A, Löscher W, et al. International Veterinary Epilepsy Task Force Consensus Proposal: Outace of Therapeutic Interventions in Canine and Feline Epilepsy. BMC Vet Res . 2015; 11: 177. DOI: 10.1186/S12917-015-0465-Y
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Literature proposal

• Thomas WB, Dewey CW. Seizures and narcolepsy. In: Dewey CW, da Costa RC, Eds. A Practical Guide to Canine and Feline Neurology . 3rd ed. Wiley-Blackwell; 2016: 249-268.