When Should My Pet Start Anti-Seizure Medication?
If your pet has been diagnosed with idiopathic epilepsy, you're not alone — and it's completely okay to feel unsure about what comes next. Deciding whether or not to start anti-seizure medication is a deeply personal choice that should take into account both your pet’s needs and your life as their caregiver.
Understanding When Treatment Makes Sense
There’s currently no definitive, evidence-based rulebook that tells us exactly when to start anti-seizure treatment in pets based solely on seizure frequency or type. Because of this, veterinary professionals often look to guidelines from human medicine to help shape their recommendations, while still tailoring decisions to each individual pet.
Recognizing the need for clearer direction, a group of veterinary neurologists have created consensus guidelines for dogs to help pet carers and veterinarians make informed decisions together. These aren't rigid rules, but they do offer a helpful starting point.
Veterinarians generally recommend starting anti-seizure medication if your pet:
Has two or more epileptic seizures within a 6-month period
Experiences cluster seizures (more than one in 24 hours)
Has had a seizure lasting longer than 5 minutes (status epilepticus)
Has severe or prolonged post-seizure signs (confusion, pacing, aggression, blindness)
Shows signs that seizures are increasing in frequency or intensity
Poses a high risk of injury to themselves during seizures (e.g., falling downstairs)
While we don’t have clear evidence that pets benefit from medication after a single seizure, studies in humans suggest there is value in starting treatment after a second seizure to prevent sensitization of the brain over time.
For dogs, especially those with frequent or severe seizures, early and appropriate treatment is believed to offer the best chance at long-term control. This is particularly true for dogs who experience cluster seizures or have very short recovery times between episodes. It’s also important for certain breeds, where epilepsy tends to be more difficult to manage.
Does Breed Matter?
Yes — breed can influence how severe or treatment-resistant epilepsy might be. For example, a more moderate to severe course of the disease has been observed in Australian Shepherds, Border Collies, Italian Spinoni, German Shepherds, and Staffordshire Bull Terriers. In contrast, a milder form of epilepsy has been reported in Rough-Coated Collies, Labrador Retrievers, and Belgian Shepherds. While these patterns don’t guarantee how your dog’s epilepsy will behave, they can help guide early decisions around medication.
What Is Kindling — And Should You Worry About It?
You may have read about something called kindling, a neurological process where the brain becomes increasingly sensitive to seizure activity after repeated exposure to small triggers. Over time, this can lead to more frequent or more intense seizures.
Kindling is well-documented in experimental models, especially in rats, and there's some debate about whether it also plays a role in human epilepsy. In dogs, however, the evidence is much weaker. While kindling can be artificially induced in laboratory settings, there’s no strong proof it happens naturally in pets with epilepsy. So while it’s an interesting theory, it isn’t currently a deciding factor in most treatment plans.
Common Medications and What to Expect
When you do start medication, your vet will walk you through the options. Some of the most common drugs include phenobarbital, imepitoin (marketed as Pexion), levetiracetam (often called Keppra), and potassium bromide (dogs only). Most of these are well tolerated, although some can cause side effects such as sedation, increased thirst, or wobbly movement, especially in the first few weeks. Fortunately, many of these effects fade as your pet adjusts.
Caring for Your Pet — and Yourself
It’s easy to focus only on the medical side of epilepsy, but your own experience matters too. Some owners feel comfortable managing mild or occasional seizures without medication, while others feel a sense of dread or helplessness each time an episode happens. If you’re losing sleep, constantly worrying about your pet being alone, or struggling with the emotional toll of uncertainty, those are important factors to consider when discussing treatment options.
You also need to think about logistics: can you give medication once or twice a day? Are you comfortable attending regular vet visits for check-ups and possible blood tests? Will long-term treatment fit your budget?
Your pet’s quality of life matters — but so does yours. Being honest with your veterinarian about what you can realistically manage will help them support you better.
Talk to Your Vet With Confidence
If you’re still unsure, try keeping a detailed seizure diary. Write down the date, time, duration, and any unusual behaviours before or after each seizure. This record can give your vet critical insights and help guide treatment decisions. During appointments, it can also help to talk through your goals. What outcome would make you feel like things are under control? Fewer seizures? Shorter recovery times? Peace of mind?
Your vet isn’t just there to treat your pet, they’re there to support you through the journey, too.
In Summary
You don’t have to start anti-seizure medication after just one seizure.
If seizures are frequent, long-lasting, or dangerous, treatment is usually the best step.
Breed, seizure pattern, and your own peace of mind all matter in the decision.
There’s no solid evidence that kindling happens in pets, but early treatment can still be beneficial.
Keep a seizure log and talk openly with your vet, you're in this together.
References
Löscher W. (2022). Dogs as a Natural Animal Model of Epilepsy. Front. Vet. Sci. 10.3389/fvets.2022.928009
Bhatti, S.F., De Risio, L., Muñana, K. et al. (2015). International Veterinary Epilepsy Task Force consensus proposal: medical treatment of canine epilepsy in Europe. BMC Vet Res 11, 176. https://doi.org/10.1186/s12917-015-0464-z
