Though idiopathic epilepsy in dogs is a serious and common neurologic disease, new therapy options and ongoing research have improved our ability to provide a personalized approach for each patient.
For many of us in practice, whether general, emergency, or specialty, seizure disorders are one of the most common neurologic diseases we see in dogs. And epilepsy remains one of the most common causes. Idiopathic epilepsy in dogs needs a lot of attention.
For decades, there were few options for treating canine seizures. We relied on phenobarbital and hoped for the best. The good news is that therapeutic options for dogs with epilepsy have exploded in the last ten years. We’re learning more about the pathophysiology of epilepsy, which in turn can lead to improved and refined treatments.
In this article, we’ll review some new developments in seizure management, focusing on idiopathic epilepsy in dogs.
Medical treatment options for idiopathic epilepsy in dogs
The most significant recent advances in treatment for IE in dogs are the large number of new treatment modalities now available to veterinarians.
Only 20 years ago, the drugs available for treatment were limited to phenobarbital and bromide (and the occasional use of phenytoin and diazepam). However, our veterinary patients have benefited from drug development for people with epilepsy. We now have many options when it comes to therapeutic options for dogs, and more are in development.
Some of the more common medications now available for use in dogs with IE include:
- Phenobarbital
- Bromide
- Imepitoin
- Levetiracetam
- Zonisamide
A benefit of the newer drugs available for seizure control is their wide safety profile, which means safer medications with fewer side effects.
It’s beyond the scope of this article to make treatment recommendations. Excellent reviews that discuss how to choose and customize therapy for dogs with IE are listed in the resource section at the end of this article.
One final medical therapeutic that merits discussion is the use of CBD to treat IE in dogs. It’s now widely accepted that CBD is a very effective treatment for epilepsy in people, especially children with specific forms of the disease. There also is evidence that CBD is effective in dogs as well.3 Research is ongoing but it’s reasonable for veterinarians to consider adding CBD as an adjunct therapy for seizure management in selected patients.
Other therapies — devices and diet
Beyond medication, researchers have explored other options for treating seizures, many adopted from human medicine.
Neurostimulation involves using electric, magnetic or ultrasound signals to modulate nervous system signals. It’s been used successfully in dogs and people with IE. Unfortunately, the device used in these foundational canine studies is prohibitively expensive for our veterinary patients – although this could change.
Dietary manipulation is one treatment area that has dramatically changed in the last 20 years when it comes to treating IE in dogs. For nearly a century, we know that a ketogenic diet can reduce seizure frequency in children with seizures.
Unfortunately, ketogenic diets didn’t work in dogs with IE, but there is compelling evidence that supplementing the diet with medium-chain triglycerides has a beneficial effect on dogs with drug-resistant IE.4,5 Medium-chain triglyceride (MCT) oil is now included in some commercial diets marketed for neurologic diseases.
Cameras and cell Phones – tools for diagnosis and monitoring
For those old enough to be in practice before the advent of smartphones, security cameras and “nanny cams,” something as simple as confirming a diagnosis of IE could be challenging. The use of electronic devices has changed how we diagnose IE, but these same devices are also valuable tools for monitoring response to therapy and simply monitoring a patient for seizures.
In a paper supported by Morris Animal Foundation-funded research,6 Dr. Karen Muñana reported on the use of accelerometers to detect seizure activity in dogs. Although the accelerometers fell short in their ability to detect seizure activity, Dr. Muñana and her team noted something unexpected: a significant improvement in caregiver-reported quality of life throughout the study.
One of the proposed reasons for this observation was the placement of cameras in the home as part of the study. The cameras captured seizure activity and correlated the activity with the accelerometers. However, simply having the cameras present could have helped owners feel more secure about leaving their dogs. Veterinarians should consider discussing this technology as another form of therapy with their clients.
“I believe it is very important to take a holistic approach to the management of epilepsy in dogs,” said Dr. Muñana. “This includes acknowledgement and consideration of the burden placed on the caregiver. Caring for a dog with epilepsy has been shown to have a negative impact on the caregiver’s quality of life. This is attributed to the unpredictability of seizures and the constant worry that their dog will have a seizure while left unattended. Anything the veterinary team can do to alleviate caregivers’ concerns and improve their quality of life, such as recommending the use of video monitoring when dogs are left alone, is likely to contribute to a positive overall outcome.”
In the next section, we’ll discuss other areas of active research that could change the landscape for dogs with IE.
What’s on the horizon?
As mentioned earlier, finding a single gene that causes IE in dogs is unlikely, but uncovering genes associated with a higher risk of disease is an area yet to be explored.
Another intriguing area of new research is using advances in MRI to better understand the pathogenesis of seizures and drug resistance. MRI can rule out structural abnormalities that lead to seizures. However, finding an additional use for this type of imaging is another reason for veterinarians to consider MRI in their seizure patients.
The importance of gut microbiome
The gut microbiome impacts neurologic diseases in people, such as Alzheimer’s, Parkinson’s and schizophrenia. There is mounting evidence it also plays a role in canine IE. Earlier, we mentioned the effect of adding MCT oil to the diets of dogs with IE. The effect happens by changing the microbiome.
As researchers establish what constitutes a normal microbiome, veterinary scientists are exploring ways to manipulate the gut microbiome to contain a particular mix of bacteria. These include oral administration of probiotics, dietary manipulation known to influence gut microbes, and fecal transplantation. Some microbiome experts are now moving away from simply studying the microbiome and looking at the metabolites produced in the gut and how these products influence the host’s health.
Behavioral modification and MCTs
Another area of interest in human medicine is the link between certain psychiatric and behavioral disorders, such as mood disorders, anxiety and ADD/ADHD, just to name a few. In people, cognitive behavioral therapy and medication aimed at treating these disorders can have a positive effect on seizure frequency.
Although less well described, there is evidence of similar comorbidities in dogs. Veterinarians can consider behavioral modification, and decreasing stress and anxiety in dogs with IE could be a beneficial adjunct therapy. Research also suggests that in addition to helping with seizures, adding MCTs to the diet can improve behavioral changes and cognitive abilities in dogs with IE.5
Holistic approach
There are many options available to veterinarians for treating IE in dogs. Medication remains a mainstay of therapy, but veterinarians should consider taking a more holistic approach to IE control. Diet change, behavior modification, and video monitoring can not only improve seizure control but also have a positive impact on the quality of life for a dog and the owner.
Conclusion
Idiopathic epilepsy is a serious and common neurologic disease affecting dogs. The good news for veterinarians and pet parents is that new therapy options have improved our ability to provide a personalized approach for each patient, taking into consideration lifestyle and finances. Ongoing research points to a brighter future for dogs diagnosed with IE!
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References
1Wielander F, Sarviaho R, James F, et al. Generalized myoclonic epilepsy with photosensitivity in juvenile dogs caused by a defective DIRAS family GTPase 1. Proc Natl Acad Sci USA. 2017;114:2669-2674.
2Seppälä EH, Jokinen TS, Fukata M, et al. LGI2 truncation causes a remitting focal epilepsy in dogs. PLOS Genet. 2011;7:e1002194.
3McGrath S, Bartner LR, Rao S, et al. Randomized blinded controlled clinical trial to assess the effect of oral cannabidiol administration in the addition to conventional antiepileptic treatment on seizure frequency in dogs with intractable idiopathic epilepsy. J Am Vet Med Assoc. 2019;254:1301-1308.
4Law TH, Davies ESS, Pan Y, et al. A randomized trial of a medium-chain TAG diet as treatment for dogs with idiopathic epilepsy. Br J Nutr. 2015;114:1438-1447.
5Berk BA, Law TH, Packer RMA, et al. A multicenter randomized controlled trial of medium-chain triglyceride dietary supplementation on epilepsy in dogs. J Vet Intern Med. 2020;34:1248-1259.
6Muñana KR, Nettifee JA, Griffith EH, et al. Evaluation of a collar-mounted accelerometer for detecting seizure activity in dogs. J Vet Intern Med. 2020;34:1239-1247.
AUTHOR PROFILE
Dr. Kelly Diehl received her DVM from the University of Tennessee and started her practice career in an emergency clinic in New Jersey. She then completed an internship at the prestigious Animal Medical Center in New York City, after which she moved west, completing a residency in small animal medicine at Colorado State University. Dr. Diehl joined the staff of the Veterinary Referral Center of Colorado as the co-owner of the internal medicine section. After 14 years, she left private practice to pursue a career in medical communication and joined the Morris Animal Foundation team in 2013. Dr. Diehl is a board-certified small animal internal medicine specialist and a Certified Veterinary Journalist.
