Managing Epilepsy In Dogs
Anti-Epileptic Medication
Anti-epileptic medications are currently still the cornerstone in managing idiopathic epilepsy. These medications aim to reduce the frequency, severity, and duration of seizures, improving the quality of life for affected pets. The medications do not cure epilepsy but help control the condition.
Conventional Anti-Epileptic Medications for Pets in the UK:
Phenobarbital: This remains the first-line treatment for managing seizures in dogs in the UK. It's highly effective and widely available, but regular blood tests are essential to monitor therapeutic levels and liver function. Phenobarbital is available in tablet form and as a liquid.
Imepitoin (Pexion): Imepitoin is specifically licensed for the treatment of idiopathic epilepsy in dogs in the UK and Europe. It is often used for dogs that are newly diagnosed with infrequent seizures and can be an alternative to phenobarbital with generally fewer side effects. It is well-tolerated, with less impact on liver health, but usually not recommended on its own when multiple seizures are seen, or where seizure appear to be progressive.
Potassium Bromide: While effective, potassium bromide is generally used as an adjunctive treatment when phenobarbital alone does not provide adequate seizure control.
Levetiracetam (Keppra): Frequently used in the UK as an add-on medication, levetiracetam is valued for its minimal side effects and can be particularly useful in cases resistant to other medications. It is also used for emergency treatment during cluster seizures.
Zonisamide: Another add-on medication used in cases of refractory epilepsy, zonisamide is available through veterinary prescription and offers a relatively safe profile.
Gabapentin and Pregabalin: Used less frequently as primary anti-epileptic drugs but can be considered for pets with partial seizures or where pain management is also a concern. They are available on prescription in the UK.
Managing epilepsy in pets with anti-epileptic medications requires a balance between seizure control and minimizing side effects, with close veterinary supervision to tailor the best approach for each pet.
Common side effects:
Phenobarbital: sedation, lethargy, increased thirst and appetite, liver toxicity (long-term use), ataxia (wobbly gait)
Potassium bromide: sedation and ataxia, gastrointestinal upset (vomiting, diarrhea), pancreatitis (rare). Not recommended for cats (risk of asthma-like symptoms).
Levetiracetam (Keppra): generally well-tolerated, mild sedation or behaviour changes, short half-life — requires multiple doses per day
Zonisamide: lethargy, ataxia, possible liver or kidney effects, GI upset, especially at high doses
Gabapentin: sedation and incoordination, less commonly used as a primary AED
Imepitoin: mild sedation (early use), increased appetite, ataxia; generally well-tolerated
⚠️ Note
Side effects often appear during the initial weeks of treatment or dose adjustments. Monitoring and regular bloodwork are essential, especially for drugs like phenobarbital and Potassium Bromide.
Key points:
Monitoring and Adjustment: Regular veterinary check-ups are necessary to monitor drug levels in the blood, adjust dosages, and assess liver and kidney function.
Combination Therapy: In some cases, a combination of medications is needed to achieve optimal seizure control, especially if a pet does not respond well to a single medication.
Gradual Changes: Any adjustments to medication, whether starting, stopping, or changing dosages, should be done gradually and under veterinary supervision to prevent seizure escalation.
Dietary Considerations
MCT (Medium-Chain Triglycerides)
MCT oil is derived from coconut or palm oil and consists of medium-chain fatty acids, which are metabolized differently from long-chain fatty acids. These medium-chain fatty acids are quickly absorbed and converted into ketones, which can serve as an alternative energy source for the brain. The ketones may help stabilize neuronal activity and reduce the frequency or severity of seizures.
Studies suggest that adding MCT oil to a dog's diet can be beneficial in managing idiopathic epilepsy, either by itself or in conjunction with conventional anti-epileptic medications. Some research indicates that MCT oil can lead to a reduction in seizure frequency, improved quality of life, and fewer side effects compared to traditional drugs alone. It's important to introduce it gradually and monitor for any digestive upset or other adverse reactions. An example of a high-quality MCT is Aprylic Vetplus.
The NeuroCare diet
The NeuroCare diet is a specialized therapeutic diet designed for dogs, particularly those with neurological conditions like idiopathic epilepsy and cognitive dysfunction. Developed by Purina Pro Plan Veterinary Diets, NeuroCare is formulated to support brain health and manage neurological disorders through targeted nutrition. Key features of the NeuroCare diet include MCT oil, omega-3 fatty acids, antioxidants and B vitamins and high quality protein.
Cannabidiol (CBD) oil
CBD oil is gaining interest in the UK as a potential supplementary treatment for dogs with idiopathic epilepsy. While traditional anti-epileptic medications are often used, some dogs do not respond well or experience significant side effects, leading owners and veterinarians to explore alternative options like CBD oil.
CBD interacts with the endocannabinoid system, which plays a role in regulating various bodily functions, including neurological processes. While the exact mechanism is not fully understood, it is thought that CBD may help to reduce abnormal neuronal firing, which is a key feature of seizures. Preliminary research and anecdotal evidence suggest that CBD oil may help reduce seizure frequency and severity in some dogs with idiopathic epilepsy, the evidence for this is still sparse.
In the UK, CBD oil derived from hemp (with low or no THC) is legal and widely available; however, you need a prescription from a vet. Not all products are regulated or tested for quality, so it’s important for pet owners to choose reputable brands that provide third-party lab testing and certification of their products.
The correct dosage of CBD oil can vary depending on the dog's size, weight, and individual response. CBD oil is usually administered orally, either directly into the mouth or mixed with food. It's important to start with a low dose and gradually adjust under veterinary guidance. CBD is generally well tolerated in dogs, with potential side effects being mild and including drowsiness, dry mouth, and occasional gastrointestinal upset. However, interactions with existing medications should be considered. At this stage, CBD oil is considered a complementary option and should not replace conventional anti-epileptic medications.
Vagal Nerve Stimulation
The aim of treating epilepsy in dogs is to stop seizures if possible, or to reduce how often they happen, how long they last, and how severe they are. Treatment should also minimise side effects and help your dog maintain a good quality of life.
Every dog is different, so treatment is tailored to their individual needs, including the type of seizures they have, their underlying cause, any other health conditions and what is practical for you and your family.
Long-term management may involve anti-seizure medication, regular monitoring, and adjustments to treatment as needed. If seizures are caused by an underlying brain condition, treating that condition may also be important where possible.
Other Management Strategies
A vagal nerve stimulator (VNS) is a device used as an alternative or adjunctive treatment for managing refractory epilepsy in dogs—those whose seizures are not adequately controlled by anti-epileptic medications alone. The device is similar to those used in humans and involves electrical stimulation of the vagus nerve, which plays a role in regulating brain activity.
The VNS device consists of a small pulse generator implanted under the skin, usually in the neck or chest area, connected to electrodes that are wrapped around the vagus nerve. The device sends mild electrical impulses to the vagus nerve, which then sends signals to the brain that can help reduce seizures tolerated by dogs. After implantation, the device is programmed and periodically adjusted to find the optimal settings for seizure control.
Regular follow-up appointments are necessary to monitor the device's performance and make any needed adjustments. VNS is generally considered safe, but potential side effects include voice changes (hoarseness), coughing, swallowing difficulties, or discomfort at the implant site. Serious complications are rare.
Efficacy
Studies and clinical experience suggest that VNS can reduce the frequency and severity of seizures in some dogs, though the response varies. It is not a cure but can significantly improve the quality of life in dogs with difficult-to-control epilepsy. Overall, vagal nerve stimulation offers a promising option for dogs with refractory epilepsy, providing another tool for managing seizures when medication alone is insufficient. It should be considered as part of a comprehensive treatment plan.
Where available, and how much does it cost?
The Milo Vagal Nerve Stimulator is currently only available in selected hospitals, including the Glasgow Small Animal Hospital. It involves a day procedure. The estimate for the procedure, software, and two sets of collars is 3000-3500 pounds.
Is my dog eligible?
Is your dog suffering from recurrent and frequent seizures and not responding sufficiently to medication? Feel free to reach out to us to discuss via vet-seizureclinic@glasgow.ac.uk or info@northumberlandreferrals.co.uk
Environmental Management: Reducing stress and maintaining a calm, stable environment can help lower seizure triggers in some pets. Minimizing exposure to loud noises, sudden changes in routine, and stressful situations can contribute to better seizure control.
Avoiding Triggers: Identifying and avoiding seizure triggers, such as certain foods, flashing lights, or intense exercise, can help manage seizure frequency. Keeping a seizure diary can help owners identify patterns and potential triggers.
Regular Routine: Maintaining a consistent daily routine, including feeding times, exercise, and medication schedules, can help reduce stress and stabilize seizure activity in epileptic pets.
Pet cameras: cameras can be a valuable tool in managing and monitoring seizures in pets. They can provide critical insights into seizure patterns, triggers, and the effectiveness of treatment, helping both pet owners and veterinarians make more informed decisions about care. However, please also be mindful that constant monitoring a pet through a. camera can lead to heightened anxiety for some owners, which could translate to increase stress in pets.
Epilepsy Surgery
Corpus callosotomy is a form of major brain surgery that has been used in a very small number of dogs with severe, drug-resistant epilepsy. It does not cure epilepsy.
The corpus callosum is a thick bundle of nerve fibers that connects the left and right hemispheres of the brain and allows seizure activity to spread from one side to the other. In severe epilepsy, seizures often worsen because abnormal electrical signals rapidly propagate through this structure. Surgery that partially or completely cuts the corpus callosum does not cure epilepsy but limits seizure spread, reducing the frequency and severity of generalized seizures by keeping them confined to one hemisphere.
Published pilot studies report that some dogs experience a marked reduction in seizure frequency and severity, in some cases by around eighty percent. Improvements can be sustained for a year or longer. Although seizures usually continue, quality of life has been reported to improve for both dogs and their owners.
There are important limitations and risks. No dog has been reported to become seizure-free following this surgery. It is major brain surgery with a real risk of serious complications or death, and recovery requires intensive postoperative care and long-term commitment. The procedure is only available in a small number of specialist centres.
Because of these risks and limitations, corpus callosotomy is considered a last resort treatment. It is only considered for dogs with severe, uncontrolled epilepsy where all other reasonable medical and surgical options have failed, and where owners fully understand the risks, uncertainties, and realistic goals of treatment.
Where available, and how much does it cost?
This surgical procedure is performed at the Glasgow Small Animal Hospital and at Northumberland Referrals in Amble. Dogs will be hospitalised for at least one week following surgery. The estimate for the procedure and hospitalisation is 5000-5500 pounds.
Is my dog eligible?
Is your dog suffering from recurrent, frequent seizures and not responding sufficiently to medication? Feel free to reach out to us to discuss via vet-seizureclinic@glasgow.ac.uk.