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non-stop twitching/paddling and unable to stand after repeated seizures - what now?

nu432
April 25th, 2009, 07:03 PM
Hello,

(yes - she is hospitalised!)

This is my first post here, asking please for any help, advice or thoughts.

Summary: Our 2 year old bitch has a 15 month history of epilepsy controlled with 240mg/day PB, usually fitting every 4 weeks with 1 to 4 seizures in a 48 hour period. A few seizures in the last fornight meant the vet in addition prescribed 300mg KBr/day. She began chattering/paddling for several hours yesterday, while still quite aware, and with 3 or 4 full seizures within a 40 minute period. At the vets she was administered some sedative stopping the symptoms for a while and allowing her to peacefully eat. But the symptoms recurred throughout today whenever she was allowed to recover from sedation, she had 3 further seizures, and she cannot stand. I unfortunately do not have detail on what drugs she has been administered. She's still hospitalised, and the vet has recommended euthanasia if no progress by tomorrow morning. We feel this is too soon.

- What protocol should I ensure the vet has followed? Guidelines presented at WSAVA 2001 < http://www.vin.com/VINDBPub/SearchPB/Proceedings/PR05000/PR00163.htm > mention diazepam and PB/KBr in the first instance, then propofol, then a period of general anaesthesia. Clonazepam is mentioned elsewhere. I'm not sure she's even been on constant drip - we're in an isolated area, he's 90 minutes away, and a one man operation until this evening.

- Could the recent KBr be responsible for this state, and if so would there be a benefit withdrawing that and waiting (a few days? given long half life) for [KBr]s to decrease?

- What else should be tried?

Thank you very much for taking the time to read this. Some extra detail on her history/the last couple of days below, in case it helps. I apologise for any errors.

Detail:

I am writing from the United Kingdom about our 22 month old border collie bitch. She has been prescribed phenobarbital since her first fit 15 months ago, with doses occasionally increased, now 240mg/day split into two doses, therapeutic serum level 35 mcg/ml (recommended range 20-40) tested last week soon after a seizure, with glucose and liver enzyme (which?) near upper reference range. She had fitting episodes once every 4 weeks on average, where each episode might involve 1 to 4 seizures over a 48 hour period. This was accompanied by occasional facial twitching and slight malcoordination between seizures and in the few days after, with recovery between seizures except on the rare occasion that they were only a minute or two apart.

However, after the usual period the episode of last week did not end. A stand-in vet prescribed 1 300mg potassium bromide tablet/day in 2 doses in addition to the PB, which she took until Friday morning. Although she seemed slightly malcoordinated, she was playing, active and alert until Friday afternoon, when she started gently chattering her teeth and paddling back legs, although remaining alert and responsive, for about 15 minutes. 2 full fits followed, from which she returned to the chattering/paddling, but less responsive. Our usual vet was on vacation. The stand-in vet was called, and recommended a half tablet of KBr in the hope that it would stop the symptom within 30 minutes. He did not recommend immediate hospitalisation, although we are in a remote area and he is 90 minutes away. We did not have diazepam. One or two more seizures occurred, but within the first 20 minutes of administering KBr - there were no more full seizures on that day.

With more calls to the vet over the course of the afternoon, she ended up with 1/2 tablet of KBr every 40 minutes for a total of three half-tablets, plus two 60mg doses of PB a couple of hours apart. She was kept cool with wet towels, and half of the time seemed semi-aware, taking drinks from a bowl and eating some ham, though she could not stand. Throughout this, the chattering continued, though the paddling slowed.

By the early evening the vet agreed that she must be taken in. Unfortuantely, I do not have detail on the drugs used from this point (communication has been a problem but that's a non-medical issue...), but a call received later that evening confirmed that she had been administered something sufficient to stop the chattering/paddling and to eat. But calls today indicate that the symptoms recur whenever she recovers from the sedative, she had 3 further seizures, and she is not able to stand, and that she cries. The vet recommended euthanasia tomorrow morning, but we want to make sure that every avenue has been followed.

mummummum
April 28th, 2009, 07:47 AM
You need a second opinion from a Vet, not from us. It's too late, too serious and too complicated.

By the way, your "bitch" is a thinking and feeling being ~ just like you and me.

Iggette
April 28th, 2009, 08:19 AM
You need a second opinion from a Vet, not from us. It's too late, too serious and too complicated.

By the way, your "bitch" is a thinking and feeling being ~ just like you and me.


I have to agree....I too felt a little uneasy about the "Bitch " reference all I can see is Bitch/She......does this poor dog not have a name:cry:

I too would get a second opinion tho

satchelp
April 29th, 2009, 12:41 PM
Come on people. This person obviously cares about her dog, who is ill enough that euthanization is a consideration. In the UK is it commonplace for people to refer to their female dogs as a 'bitch'. This is all more than a little insensitive.