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Welcome to the Synaptic Tails podcast, where neurology meets practical tips in veterinary care. Hosted by Dr Emma Hancox, a Technical Vet Advisor at Dômes Pharma UK, alongside Dr Mark Lowrie of Movement Referrals.
In each episode, we explore the challenges of managing epilepsy cases in first-opinion practice - sharing clinical insights, lived experience, and practical strategies to support your patients and your team.
Season 1 introduced Dômes Pharma UK’s S.M.A.R.T. Approach to Epilepsy, offering step-by-step support on seizure management. In Season 2, we build on that foundation with even more focused conversations - tackling status epilepticus, seizure mimics, feline epilepsy, adjunctive therapies, and the power of teamwork in chronic care.
Join us as we unravel the complexities of veterinary neurology, share real-world stories, and empower you with knowledge. Together, let’s enhance the health and happiness of our canine and feline companions.
🌐 Learn more about Dômes Pharma UK: https://domespharma.co.uk
Access Vet Resources from Dômes Pharma UK at https://domespharma.co.uk/the-vet-vault/
🌐 Learn more about Movement Referrals: https://www.movementvets.co.uk
Movement Referrals is an independent, specialist veterinary hospital with practices in the North West and Midlands. Our aim is to provide high-quality but efficient Specialist referral services. We concentrate on orthopaedics and neurology, two of the most common reasons for referrals. We offer common referral procedures, such as TPLO, patellar luxation, and spinal surgery, at reasonable prices.
One of our fundamental philosophies is "getting it right first time." We not only provide more choice at better value, but we aim to objectively demonstrate our value through measuring and publishing our
Welcome back to the Synaptic Tails
podcast, where we discuss fascinating
topics in veterinary neurology.
I'm your host, Emma, and today we are
diving into a common and challenging area
of practice, mimics of seizures in dogs.
That is episodes that can look like
seizures, but might not actually be.
Joining me again as our
resident neurology expert, Mark.
Thanks for being here Mark.
Always a pleasure, Emma.
And I can't wait to talk about this today.
It's my absolute favourite subject.
When I was researching you earlier, you
do have a lot of things about movement
disorders, so I can see why this is
going to be your favourite topic.
It's probably because I walk funny.
but yeah.
So when it comes to seizures, it's
not uncommon for pet owners to come in
saying their pet has had a fit or a funny
turn, or might even call them a seizure.
Well, seizures are often obvious to many
of us, and I think we can all see a dog
having a seizure and recognise it as such.
However, with people increasingly able
to film these episodes, we've become
familiar with other conditions that are
often incorrectly labelled as seizures
or fits, and it's these conditions
I want to talk about more today.
So let's start by clarifying
what we mean by a seizure and
then we'll go into the mimics.
That's really important.
If we know what a seizure looks
like, we can then hopefully spot
things that aren't seizures.
So we've got generalised
seizures and focal seizures.
So generalised seizures are probably
the ones we're most familiar with.
The most common type would be
generalised tonic clonic seizures,
and they share common features such as
involving the whole body and usually
causing a complete loss of awareness.
The generalised tonic clonic
seizures involve a complete loss
of awareness, paddling of all four
limbs and severe autonomic signs
such as salivating and urinating.
So what do you actually mean
when we say tonic and clonic?
Well, tonic is characterised by
stiffening of the muscles, and clonic
involves rhythmic jerking of the muscles.
Most generalised seizures are
a mixture of both of these.
Hence the tonic clonic
Makes sense.
But there are also tonic seizures
and clonic seizures, which
may only be one or the other.
Another type of generalised seizure that's
less well known about, but is becoming
more recognised is a myoclonic seizure.
Now these are brief, generalised
seizures, lasting fractions of a second.
They're considered a bit different as
dogs don't seem to lose consciousness.
But it's my belief that this really
is, because the episodes are so
brief, it's hard to see whether
dogs are conscious or not, they're
over before they've really started.
And when I show videos of these to
owners and to vets, I'm often told
they look a little bit like a hiccup.
And that's because they effectively are.
Myoclonus, you get pathological myoclonus,
which is what we're talking about here.
But you get physiological myoclonus.
It's like a little, probably when you
see someone have a hiccup, it's like
they've had a little electric shock.
I get them all them all the time.
I'm going to feel like I've
got myoclonus epilepsy now.
And that's what's important to say because
people go, well am I having epilepsy?
But they're only really part of an
epileptic problem when they're associated
with other types of seizures commonly.
So generally you'll have
myoclonic fits frequently, but
you might have the occasional
generalised tonic-clonic seizure.
Okay, I don't have those, so that's fine.
Just hiccups.
Just hiccups.
The second time you have
it is, we all do this.
We may not be aware of it, but if
you go off to sleep, that little
jerk before you go to sleep.
And it's weird because you're lovely,
relaxed, it's the best part of the day.
If I could bottle that feeling and just
drink that drink all day, I'd love it.
But you have this little
jerk as you go off to sleep.
And that again, is perfectly normal.
It's myoclonus, you don't have epilepsy.
So these are the situations
when we encounter it in normal
everyday life and dogs have that
same jerk as they go to sleep.
But this is where we're talking about
them in the context of seizures.
Or it's the other person that jerks
as you're trying to get to sleep and
you get like punched in the side.
Absolutely.
Apparently.
I'm really bad at that.
So, yeah.
And the last type of generalised
seizure is an atonic seizure, which
you may have heard referred to in
the past as a petite mal seizure.
Now, in this case, there's a
loss of normal consciousness, but
there's no obvious motor activity.
So pets may appear frozen and lack
awareness, but potentially staring
into a corner or just not being aware.
And they're either lying down doing this,
but they can just stand on the spot and
not be rousable for a period of time.
Is that like absence seizures?
Absence is the other term we'd use here.
So absence, atonic and petite mal,
loss of awareness during a fit.
Goodness.
There's me thinking I know what I'm
doing when I'm dealing with generalised
seizures, but I didn't realise
actually there were so many types.
So how common are these
myoclonic or atonic seizures?
We don't really know how common
atonic seizures are because
they're really hard to spot.
So what I would say is, I suspect
they're a lot more common than we
realise, but myoclonic seizures
are actually quite common.
You may be most familiar with
them in older cats where they're
part of a syndrome called
Audiogenic reflex seizures.
But I think that's the
topic of a future podcast
I was going to say, spoiler alert,
you've got to tune into a epilepsy for
cats later on in the season for that.
But we also have, you mentioned the
focal or maybe people know them as
partial seizures as well, aren't there?
That's right.
There's the other category,
which is focal seizures, which,
well, as the name suggests, it
involves just one part of the body.
And these come in three types.
So the most common
would be motor seizures.
And they're often recognised as
episodic focal facial twitches or
rhythmic jerks of a single limb.
Autonomic seizures.
They can happen.
And these really just present with
what we call parasympathetic signs.
So maybe dilated pupils,
hypersalivation or vomiting.
And then you've got the behavioural
seizures, which used to be
called psychomotor seizures.
Now these are harder to characterise
and can sometimes resemble
obsessive compulsive disorders.
So common ones I see would be dogs
that are fly catching or excessive
licking, inexplicable fear, or maybe
just sudden and unprovoked aggression.
Now, that last one is a difficult one
because I'm not saying aggressive dogs
have fits, but there are certainly
scenarios where that happens.
And it's that untargeted aggression
where it's not surrounding food or
particular people or individuals.
It's just sporadic and comes about in
a variety of very different situations.
Is that like cocker rage?
Have you heard of this?
And people are wondering whether this is a
behavioural thing or a neurological thing.
Yeah, I don't know the answer to that
because cocker rage was discussed a
lot, in the eighties and nineties it
was quite a common, well recognised
condition and I suppose people
bring it up from time to time now.
I didn't think I was that
old Mark, to be honest, but
I'm so sorry.
I've made him feel awkward.
Cocker rage, I think it probably is
something to do with this, is my best
guess, but we don't know because we
don't know what people were seeing
then and what's happening now.
What I would say is if you've got a
dog with this kind of inexplicable
untargeted aggression and we've ruled
out pain as a focus for that cause.
Then I always think it's very
reasonable to try a course
of anti epileptic medication.
And my favourite one is
phenobarbital to see if those
episodes are managed with that.
And often we can see quite positive,
responses to that medication.
And when I say positive, sometimes
almost a complete eradication of
fits, which as you're all experts, as
listeners now, getting that kind of
response from epilepsy is very unusual.
But in these scenarios we can
sometimes come across that.
And do these focal seizures often
progress into more generalised seizures?
because I'm starting to feel like
they might be really hard to identify.
Well, yes.
Focal seizures can progress into
generalised seizures, but not always.
I think it's the behavioural seizures
that are harder to recognise.
So a dog that is sporadically aggressive
may simply be responding to some
external stimulus as a behavioural
response, but these episodes can
sometimes be seizure related.
Trialling anti-epileptics is
really interesting actually
because I think a lot of us are
hesitant to try these medications.
We are worrying about stopping
them potentially and maybe we don't
pick them up as often as we should.
Well actually I love using
phenobarbital and some of the other
medications as a diagnostic trial.
And I think if you give them in that
context and explain that to an owner and
say, we're actually trying this for a
period of four to six weeks, the timing
will vary depending on the frequency of
the episodes you're trying to manage.
But I find that's really effective
and can actually allow you to know.
So I say if you don't know if
they're fits, but you think
they could be, give it a go,
might work.
Yeah
You might find a good response.
That's really useful actually
to, to utilise those medications.
I can already see then that there's a
really wide array of epileptic seizures
or conditions that can look quite
different and added to this, there are
other conditions that aren't epilepsy
that can also look like a seizure.
Well, yes, exactly.
Mimics of seizures refer to
conditions that look like
seizures but are not related to
epileptic activity in the brain.
Now these include conditions and quite
common conditions like paroxysmal
movement disorders, which are also
known as paroxysmal dyskinesias.
But these are just movement
disorders happening intermittently.
So paroxysmal dyskinesia is a fancy name
to say abnormal movement, but they're
intermittent self-limiting episodes of
abnormal movements and the situation,
I think these come, well, they're
highlighted to me are those situations
when you're in a practice, you've had
a really busy day, your waiting room
is packed to the rafters with the next
patients coming in and you get that
dreaded phone call towards the end of the
day saying an owner clearly very concerned
because their dog's been fitting now
for two hours, and you think two hours.
That's awful.
Well, absolutely no question.
This dog needs to come in.
So you carry on with your
consult list waiting for the
emergency patient to come down.
And when that patient comes in,
it will look completely bright and
happy and will bounce around the
consult room like nothing's happened.
Now I always say in that situation,
obviously that's a bit, you feel a bit
like, oh, you know what's gone on here.
The fact that dog is normal and
the owner has reported abnormal
seizure activity for two hours.
In the previous episode we talked about
status epilepticus and we know that
dogs don't bounce back from seizure
activity back to normal after two hours.
So that should just raise the question of,
that dog probably didn't have a seizure.
And when an owner rushes in and says,
my dog is having a fit, we need to just
pause and check that what we're dealing
with really is a fit and isn't something
else because the scenario I mentioned
there, really that dog hasn't had a fit.
Yeah.
But it has had a problem and
that's the important thing.
And it's trying to establish
what that problem might be.
Definitely, and I think this is the
crux of this episode really, is that
a lot of owners will say, my dog's
had a fit or an episode or something.
And I've even had cases of things
like syncope caused by cardiovascular
disorders, for instance, being
called fits or seizures by owners.
And the syncopal episodes are
really difficult ones to pick out
and I don't think anyone really
has a great handle on when they
might be syncope versus seizures.
And the times, I think syncope episodes
are quite common when it's due to
underlying heart diseases when owners
might come home and first greet their dog,
the dog gets excited and then goes into
an episode that mimics a seizure, that,
for me, would be a more common situation
for some underlying cardiovascular cause.
That's actually, I had a really good
case once the owner came to me and said
he's having a seizure almost every day.
And I said, describe what happens to me.
And she goes, every time the postman
comes, he's having a seizure, he jumps
off of the sofa, he runs towards the
door and often collapses halfway there.
And I'm like, probably
isn't a seizure, but
Well, great spot because
that they're hard.
But you're right that constant
same trigger is just an alert that
maybe something else is going on.
Yeah.
It reminds me of the
bin men from season one.
If you haven't listened to season
one yet, I would definitely encourage
you to go back and have a listen.
And, one of the biggest challenges is
that these episodes are often sporadic.
So the dog may appear completely
normal between episodes and even
during your veterinary examination.
Dogs don't perform and give the
abnormalities to you in a consult like
a person would with a doctor's surgery.
So you might have a worried owner
describing something dramatic, but
without clinical signs to investigate
during the appointments, it can be
really difficult to pinpoint the issue.
It does sound tough, especially as
owners often already have an idea
about what they think is going on.
How do you approach these cases?
Well, the keys to gather as
much information as possible.
Owners should always be encouraged
to take videos of these episodes.
And I suppose an aside here is if you
are able to see a video of a dog having
something that looked like a seizure, we
might pick out different features when
we see that episode to describe as to
what we've seen, and I mean I'd bring
this right back to describing people.
If you're sort of saying, oh, John Smith?
No, let's not use John Smith.
because there'll be someone
called John Smith who's offended.
But you might we'll use me it but You
might say, do you know Mark Lowrie?
And then the two of you might chat
about Mark Lowrie And he might go, oh
yes, he's the one who's like, he's sort
of, well, he's quite tall, but Yes.
And he's got sort of
light, light coloured hair.
Yes.
And actually really, you're not getting
to the crux of the problem there.
That's not ruled out much of the
so what I find is you actually end
up having to be quite rude about
the person in order to make it very
clear who you're talking about.
So with Mark Lowrie say, he's a tall,
pasty white person, like as in pale white.
I'm talking like ghostly white, can't
get a suntan and goes pink in the sun.
He's blending into the white
background as we speak.
Joking!
So you, well, I did call
you old earlier, so.
It's true.
I'm getting my own back now.
But, you see, I think these things
are, you've got, I find you have
to actually sometimes pick up quite
obvious characteristics that might
not necessarily be favourable and
when it comes back to seizures, an
owner trying to describe what their
dog is doing can be very difficult.
So I would say a video speaks a
million words and it can really
provide important critical clues.
So from there we can
ask detailed questions.
We can ask, did the
dog lose consciousness?
Now you might be able to see
that on the video, but that can
be very difficult to pick up.
Really important question for me
is, to ask, were there any autonomic
signs like urination or salivation?
Salivation is a big one.
If a dog is salivating during one
of these episodes for me, that
all the time that's a seizure.
That's what we're dealing with.
And did
the episode stop abruptly.
And this really just helps us
differentiate between those
true seizures and mimics.
I agree.
I think these videos and the invention
of the smartphone, as it were,
are really invaluable resources.
You could really see for yourself exactly
what that kind of pet is doing, what
those owners are trying to describe,
because like you say, they might not
always describe things as we would.
So speaking of differentiating, are
there specific features that help
us distinguish between a seizure and
something like the paroxysmal dyskinesia?
Absolutely, for example, in dyskinesias,
the dog usually maintains normal
consciousness despite showing
generalised abnormal motor activity.
And if motor activity involves more
than one body part, what I'd say is
if you're seeing a dog that maybe
it involves all four legs, that dog
really needs to be having a generalised
seizure for it to be a seizure because
it's involving more than one limb.
And with that means those dogs
should be unaware of what's
going on and lose consciousness.
But if you see this dog is fully alert
with all four legs involved, that really
is telling you this is not a seizure.
And for me, it most commonly would
be a dyskinesia at this point.
And additionally, I touched on
this earlier, but there's no
postictal phase with dyskinesia.
So the dog doesn't show any
of the confusion, drunkenness,
blindness, or pacing afterwards.
So importantly, you typically
won't see autonomic signs like
drooling, or involuntary urination.
And you will find these dogs recover
very quickly after an episode, even
if it's gone on for a couple of hours.
And dyskinesia can last 30 seconds
up to two, maybe three hours.
Are there any particular breeds or
anything that are more likely to be
affected by these movement disorders?
Of course.
They all look the same.
Let me start by saying that.
So just to aid confusion for us really
Exactly.
So, if I see a particular breed of dog
having an episode, I only think it might
be a breed related movement disorder
given the type of breed having it.
But that movement may look the same as
all other movement disorders we see.
One classic example is episodic falling
in Cavalier King Charles Spaniels.
And that's linked to a genetic
mutation that we can test for.
So there's a brevican mutation,
we can test for, and that really
then lets us narrow down to that
movement disorder immediately.
If we get a positive test, we
know what we're dealing with.
And genetic testing is fairly inexpensive
nowadays, so it's a great way of getting
on top of that problem straight away.
You may be thinking, well that's
another condition that Cavaliers get.
Yeah, they are quite an inflicted breed,
but movement disorders are fairly benign.
So once we've diagnosed them, I'm not
necessarily that concerned about them.
It's all about recognition
in the first place.
And then Border Terriers,
they're one of my favourites.
So Border Terriers can develop
something that, well, it's been
given many names over the years.
Canine Epileptoid cramping syndrome.
And it, it was originally
called Spike's disease
That was a dog from Germany named
Spike, who developed the condition.
So it was Spike's disease for a very long
time until we understood more about it.
Now, I hate the term canine epileptoid
cramping syndrome because it
suggests, the epileptoid component
suggests seizures, which it isn't.
So it was named that before we
really understood it, but now
we know it's associated with
some form of gluten sensitivity.
We call it paroxysmal
gluten sensitive dyskinesia.
PGSD.
Yeah.
I think really these are all
names for conditions that we're
still not fully understanding.
I love that condition.
Because what we found is in people
that have celiac disease, obviously
they're hugely intolerant to gluten
and they have to completely avoid it.
But a very small subset of those
people can go on and develop unusual
neurological signs as well as the
gastrointestinal signs that are
commonly associated with celiac disease.
And some of those people will have
movement disorders and that's what
develops we found out with the border
Terriers, that they do also get some kind
of mild GI disturbance, should we say.
Now, I'm using the term mild
because, if you ask someone with
celiac disease, you'll appreciate
it's a very severe condition and
it can be really crippling in life.
These border terries aren't suffering
anything like the severe signs there,
but they do have occasional soft
stools, diarrhoea, intermittent vomiting
and I love that word, borborygmi.
Feel like I might be getting it
as we're midmorning now as well.
Absolutely.
So I think, borborygmi is
something that I think we all get,
but it seems Border terriers
get a bit more commonly.
So that's the noisy gut sounds, that,
that are just happening around the day.
Not necessarily associated
with feeding or meal times.
But what we found is when those
dogs were fed a gluten-free diet,
they actually improved significantly
and these episodes could go away.
We can even test for antibodies in
these dogs to gluten and that's a great
test to do because if you find those
antibodies are high and they have these
episodes and you put 'em on a gluten-free
diet, we find those antibody titres
should fall back to a normal level.
There was a great example of
a dog that had this condition.
The owners were brilliant.
They put him on a gluten-free
diet, but they came back to me sort
of eight weeks later and saying,
we've seen absolutely no response.
This dog's still having these
movement disorder episodes.
And when we looked into it a bit
more, we did blood tests and the
antibody levels were still high.
So given they were being very strict
with the diet, he'd like to have thought
they'd be low, but it was still high.
And it turned out they were
taking the dog every day to their
yard to muck out the horses.
Oh no.
The dog did like to feast on horse poop.
Oh no!
Well, this is the trouble with Border
terriers, but as soon as that was
then excluded from the diet, so to
speak, the dog completely responded.
So, dogs are scavengers and
we have to work around that.
We need a horse poo
exclusion diet for this dog.
I think it worked brilliantly
when they did that.
Fascinating actually.
We work with human neurologists
who were kind of experts in this
and that's what helped us come
down to work out what was going on.
I love that it was a great little
story of how a simple change in diet
could actually fix a dog's problem.
Does diet influence anything else?
Any of these other neurological issues?
Well, I think diet's becoming
a more and more important thing
to all of us all the time.
And I suppose the other one that I'm
really fascinated by, I mentioned a
little bit earlier on, about partial
seizures or focal seizures and we
talked about dogs with fly catching
and there was a great study from Canada
some years ago now where they looked at
dogs with fly catching and they found
that many of these dogs would have
underlying inflammatory bowel disease.
So IBD and they had the full workup,
which I don't want to go into
because I don't understand it being a
neurologist, but they had endoscopic
biopsies and a lot of work was done
on the medical side to diagnose IBD.
But when these dogs were actually put
onto a hypoallergenic diet, the episodes
of fly catching completely disappeared.
Wow!
These behavioural seizures, we
call 'em, whether that truly is a
behaviour we don't know, and the
jury is very much out on this, as
to whether their behaviour or not.
But a simple change in diet was great.
When I see those patients,
that's my management.
But sometimes the fly catching
is so incessant that owners
really want a quick fix.
So what I often do, I will give
them phenobarbital as well.
So the phenobarbital works quickly
to control the fly catching,
but they introduce the diet too.
And then of course once everything's
working together, we can then withdraw
the phenobarbital slowly and carefully and
then you hopefully end up with a dog that
manages without these problems long term.
So really fascinating link
that we don't fully understand.
That is fascinating and I think we'll
talk more about things like the MCT diets
as well in the later episode as well.
So if it's something you're
interested in, keep listening.
Mark, is there any other kind
of movement disorders out there?
Well one of the other ones I'd
mentioned would be Scotty Cramp.
So Scottish Terriers.
And this again is one of the early
ones that was kind of recognised,
although maybe it wasn't appreciated
exactly what it was that was going on.
But the reason I bring this one
up is this is something that
tends to be more triggered by
exercise or potentially stress.
Stress triggers off a lot of things
and it's hard to avoid stress.
But the exercise thing is important here.
So these Scottish terriers, they'll be
running along and they're develop like
a skipping and hopping type of gate.
They often sort of do, it's hard to
describe on a podcast, but they're
kind of crab like backend where it sort
of swings round as they're running.
They do have a bit of a skip to one or
both back legs, and they can enter into
these full movement disorders, which
are typical of the paroxysmal dyskinesia
where all four legs are affected.
But the reason I like this particular
condition is I think this is actually
affecting a lot of other breeds too.
And this seems to be a
condition that we see a lot in
Cockapoos, in young Cockapoos.
So they're sort of hopping, skipping,
crabbing when they're walking.
Yeah.
Again, it doesn't really
cause any pain or anything.
It's just something that affects movement.
I think these dogs run and jump
and do everything well, but once
it's recognised, it just allows
it to be boxed off and accepted.
That's what that dog does.
But it'll have a really good quality of
life and will be happy to exercise freely.
That's really interesting.
I think I would probably all also
mistake this for orthopaedic issues
and that's what happens.
Actually, quick plug, Movement
Referrals, we get a lot of dogs
coming into both orthopaedics and
neurology with these problems.
And I think, well, the orthopaedic
problem that I suppose is the first
one that springs to my mind as a
neurologist would be patella luxation.
When you said the hopping movement and
skipping movement, that's what I thought.
Exactly that.
So, when I've spoken to orthopaedic
surgeons about this, I've kind of said
to them, well, is there anything we
can kind of do to tell us about this?
Because of course, the obvious
answer is a clinical exam.
But the more I learn, the less I
examine dogs because I use a lot of
information to try and guide diagnoses.
And in doing so, it means
I examine dogs less.
And actually I become a bit
scared of dogs sometimes because
they're scared of me because I'm
less confident in handling them.
I will examine them of course, but
examining for patella luxation is
something that it can be difficult for
somebody who's not doing it all the time.
And what they say is if this dog is
hopping and skipping, it's happening
really like a switch, like, it's
coming and then they're sort of impeded
with their gait for a bit and then
it goes back to normal, then that
definitely fits patella luxation.
Makes sense
But these dogs with the Scotty
cramp to give it a term.
Yeah.
They're actually walking fine and
they're only actually showing these signs
during the trotting phase of the gait.
When you get them faster and
get them beyond the trot phase.
They actually develop a normal
sort of gallop or run if you like.
But when they're walking at a normal pace
or a fast pace, you don't see it either.
It's only in that trot phase
when it's evident and that
wouldn't fit an orthopaedic
problem such as patella luxation.
So I think that is a big key indicator.
This might well be what
we're dealing with.
And so these aren't seizures,
just to put that out there.
They're not epilepsy, so
therefore we just accept that
this is what these dogs do?
Well, that's a really good
point because I'm talking about
them as, yes, you're right.
They're not seizures, they're nothing
to do with seizures and they can end
up in these episodes that are quite
crippling and stopping them moving.
But these dogs, they are benign these
episodes and they don't cause any problem.
There are medications we can
try and use, but this comes back
to managing epilepsy as well.
If you've got a dog with epilepsy
that has infrequent seizures, then
often an owner may not tolerate a few
side effects from medication because
the seizures are so infrequent.
And the same's true here that
actually these dogs are getting
around without too much problem.
One drug we might consider is fluoxetine,
so that could be a medication.
It's been mentioned that, and selegiline
are the two that we try for Scotty cramp.
And we can get quite good results for some
of these dogs, but often you end up with
side effects that are more problematic
than the problem in the first place.
So I'm not dismissing it
saying it's nothing in the
sense that it isn't a problem.
It's there, but it's not necessarily
a problem that's causing any
issues to that long term.
Yeah.
I think once people recognise
it and understand it, there's
a lot more acceptance then that
they don't need to be concerned.
This is going to lead something
more concerning down the line.
Yeah.
It's not just suddenly going to go into
a full seizure or anything like that
And what about things like, I've heard
of idiopathic head bobbing and I'm
sure I've had a few cases of this and
like the young Bulldogs and things.
Is that another movement disorder?
It's, well, it's a type of, what I'd
say is a postural tremor, really.
So it's a tremor because
the bobbing is very fine.
High frequency, I just mean a fast tremor.
Very rhythmical really.
And this is another one that it
happens in all breeds of dog, so I
don't want to limit it to a breed,
but you are absolutely right in
saying that bulldogs are probably
the most common breed we see it in.
So these really fine tremors of the head,
which interestingly, you can actually
interrupt these tremors and stop them,
sort of distract the dog from them.
So I've got a great video where
a dog's doing this continually,
it's then fed a little treat, it
eats the treat, the tremor stops.
But once it swallows, it goes straight
back into tremoring and even taking the
dog out for a walk and things can do it.
And I've heard people say it might be
related to sort of boredom sometimes.
They're there and it's not a problem
that their bored, you know, it's fine,
but it, but that's when it comes on.
So by then just giving that dog
an activity, it seems to pass by
and we'll go away because if we
leave a dog to these episodes, they
can go on for a very long time.
I've known dogs go on for an hour or two.
And the common one that I've
seen myself would be dogs
recovering from anaesthetics.
So I remember a case we had many
years ago now, it was a doberman that
was recovering from a neck surgery.
It had a ventral slot.
And the nurses contacted me sort of about
30 minutes after we finished the surgery,
saying they were really worried about this
dog because it was tremoring its head.
But when I went to examine
the dog, that was exactly it.
It had this idiopathic head tremor
that had just come on as part of
stress, I think related to the
dog recovering from the surgery.
Now it wasn't a concern for the dog.
There was no problem with this having
happened, but that's when it happened.
And I suppose if you don't know what
this is, you could start to think
there's something quite serious going on.
So another thing with idiopathic
head tremors, I would simply say, I
like to call 'em idiopathic, benign
head tremors because they are benign.
Okay.
Once we've recognised
them, we leave them alone.
And I have seen dogs that are given
anti-epileptic medication to try
and control it, but that's useless.
It doesn't control these episodes at all.
And a particular English bulldog I
remember is one that was actually
loaded with phenobarbital and potassium
bromide and these tremors persisted.
So of course the vet not
recognising the condition, was
very concerned about the patient.
But then actually the bigger
problem was the sedation caused
by the anti epileptic medication.
I often see these in like
the young patients as well.
Is it more common in those?
Because I think then I get the very
concerned owner coming in and I'm
always a bit, oh no, it will be fine.
You don't need any treatment for this.
Is that right?
Or?
It is.
I mean it's definitely something that
happens more commonly in young dogs.
I can see them at any age and I
just reassure an owner not to worry.
I think the key point here is just
to reassure an owner that there's
nothing more concerning going on.
And that's reassuring for us as well
to know we're doing the right thing.
Sometimes I guide an owner to the
internet and ask them to Google a
condition and look at videos of dogs.
I'll show them that in the consult rooms
they see, but they'll find forums of
people who've got dogs with this and,
and that really reassures 'em, it's
nothing more to be concerned about
If we see it more in the young
patients, does it go away with age?
Does it stay the same?
Does it get worse with age?
Like what are we expecting out of this?
I would draw this back to
all movement disorders.
That, one of the key findings with
these movement disorders, these
dogs do tend to improve with age.
So they tend to get better in terms of
frequency or they may actually improve
and get rid of the episode completely.
So some of these paroxysmal
dyskinesias, like the one I
described in Cavaliers, very common
in Labrador and Jack Russells too.
But these dogs, when they get sort
of to 8, 9 years plus, they tend
to grow outta the condition and
they no longer have the episode.
Now that's a key difference to epilepsy
because we need to remember that
epilepsy is a progressive condition.
So we've got two similar appearing
conditions, but actually have
quite different prognosis in the
sense that one worsens with age
and the other actually improves.
And it's another reason why I'm fairly
laid back with managing, because with
a seizure we worry about the kindling
effect that we talked about in the
last episode where one seizure leads to
another, but these episodes certainly
don't have any triggering factor
where one episode leads to another.
And I guess with these it's videos,
again, must have been a game changer
for these episodes and maybe we're
seeing them more now than we used to.
We definitely are, and I think it's
given the impression they're more
common now than they ever were.
But I think as you say, it's
actually the advent of the
smartphone that's brought this out.
Because I certainly think back before
smartphones, we were still having these
consultations, we just weren't able to
shed as much light on what was going on.
I guess if I'm suspicious of a movement
disorder, so for example, this dog
doesn't lose consciousness or doesn't
have postictal signs, for instance, other
than looking at a video, is there actually
a way to definitively diagnose these?
Do we recommend referrals for advanced
imaging or anything like that?
Well, I think as we say, the video is
key and I think if you can get a video,
you can maybe look at it yourself
to interpret, but there's always a
friendly neurologist nearby or me,
Yeah, send it off to Mark
To have a look at it and I'd
be happy to evaluate and see.
But I've had people say, well, that's all
right, you in your ivory tower are looking
at that video and just labelling it.
What is it you're doing?
And I accept it is hard.
Sometimes it can be very
difficult to determine.
There isn't a key test for the
majority of these movement disorders.
And yes, we've talked
about genetic mutations.
So the Cavies is we can
test for a genetic mutation.
The Border terriers, we can look for
gluten antibodies, but actually it's
very much like idiopathic epilepsy.
There's no key test with idiopathic
epilepsy and it's about ruling out
other conditions that might mimic this.
One thing I would say is very important
in these patients, a big mimic of
paroxysmal dyskinesia is hypocalcemia.
So I would recommend checking calcium
and ionised calcium to make sure
that's not low, because sometimes
low calcium can trigger sort of
muscle twitches that can be quite
serious and develop more problems.
Particularly around pregnancy,
lactation, those sorts of times, if
you've got a dog having episodes,
then be very aware that is a factor.
But the simple answer is no, really we are
investigating these dogs in the same way
we investigate epileptic dogs, which is
to rule out all the causes in the blood
and then considering advanced imaging of
the brain with spinal fluid analysis to
make sure there's nothing else going on.
But our expectation there, if
this is a movement disorder, is
those results would all be normal.
I just wonder if you could sum
it up for us, what would be your
go-to advice for vets encountering
these kind of funny episodes?
First, always ask for a video,
it's invaluable for identifying
exactly what's going on.
And second, don't rush into
unnecessary diagnostic tests.
If the animal seems normal during
your exam, episodic conditions often
won't show up on routine tests.
And finally, client education is crucial.
Owners need to understand what's
happening and why these conditions,
whilst distressing to watch, aren't
typically life-threatening or concerning.
I think that's great advice
and, and really reassuring.
And I think I'd probably add to
this and say, don't forget to
do a full physical exam as well.
Even if the pet appears neurologically
normal during the consult, we
wouldn't of course want to miss
anything medical underlying.
So, that syncope we're talking
about or the calcium you
were talking about as well.
So before we wrap up,
Mark, any final thoughts?
Just to say, recognising mimics of
seizures takes a bit of experience,
but really a good partnership with the
owner, I mean, smartphones have been
an absolute game changer in neurology.
It's made the biggest difference
in our discipline in recent years.
So allowing us to observe and better
understand these conditions really
has become invaluable and never
underestimate the power of a good video.
Definitely we'll all be sending them to
you now, your inbox is going to be full.
Well, thank you so much Mark,
for shedding light on this topic.
And thank you again to our
listeners for tuning in.
Vets can also find many free
resources on our Dômes Pharma website,
including a seizure mimics chart that
helps summarise these differences.
So you can head to the Vet Vault
on the website in the link below.
And finally, don't forget to
subscribe and we'll see you next
time for some more fascinating
discussions on veterinary neurology.
I think next time is all about adjunctive
therapy, so maybe picking up about that
influence of diet and CBD oils, and what
to do when phenobarbital on its own is not
enough, so it's not one to miss out on.
So see you there.
Thanks again, Mark.
Looking forward to it.
Thanks very much.