1 00:00:00,050 --> 00:00:04,460 Welcome back to the Synaptic Tails podcast, where we discuss fascinating 2 00:00:04,510 --> 00:00:06,160 topics in veterinary neurology. 3 00:00:06,640 --> 00:00:10,900 I'm your host, Emma, and today we are diving into a common and challenging area 4 00:00:10,900 --> 00:00:13,570 of practice, mimics of seizures in dogs. 5 00:00:14,020 --> 00:00:18,700 That is episodes that can look like seizures, but might not actually be. 6 00:00:19,450 --> 00:00:22,770 Joining me again as our resident neurology expert, Mark. 7 00:00:23,010 --> 00:00:24,150 Thanks for being here Mark. 8 00:00:24,540 --> 00:00:25,560 Always a pleasure, Emma. 9 00:00:25,560 --> 00:00:27,840 And I can't wait to talk about this today. 10 00:00:27,900 --> 00:00:29,470 It's my absolute favourite subject. 11 00:00:30,155 --> 00:00:33,620 When I was researching you earlier, you do have a lot of things about movement 12 00:00:33,620 --> 00:00:36,620 disorders, so I can see why this is going to be your favourite topic. 13 00:00:36,695 --> 00:00:37,815 It's probably because I walk funny. 14 00:00:37,885 --> 00:00:38,305 but yeah. 15 00:00:39,371 --> 00:00:43,271 So when it comes to seizures, it's not uncommon for pet owners to come in 16 00:00:43,271 --> 00:00:48,101 saying their pet has had a fit or a funny turn, or might even call them a seizure. 17 00:00:48,101 --> 00:00:52,841 Well, seizures are often obvious to many of us, and I think we can all see a dog 18 00:00:52,871 --> 00:00:55,451 having a seizure and recognise it as such. 19 00:00:56,021 --> 00:01:00,041 However, with people increasingly able to film these episodes, we've become 20 00:01:00,041 --> 00:01:03,621 familiar with other conditions that are often incorrectly labelled as seizures 21 00:01:03,651 --> 00:01:06,771 or fits, and it's these conditions I want to talk about more today. 22 00:01:07,281 --> 00:01:10,251 So let's start by clarifying what we mean by a seizure and 23 00:01:10,251 --> 00:01:11,311 then we'll go into the mimics. 24 00:01:11,601 --> 00:01:12,681 That's really important. 25 00:01:12,681 --> 00:01:15,591 If we know what a seizure looks like, we can then hopefully spot 26 00:01:15,591 --> 00:01:17,451 things that aren't seizures. 27 00:01:17,871 --> 00:01:21,471 So we've got generalised seizures and focal seizures. 28 00:01:22,131 --> 00:01:25,251 So generalised seizures are probably the ones we're most familiar with. 29 00:01:25,281 --> 00:01:29,211 The most common type would be generalised tonic clonic seizures, 30 00:01:29,691 --> 00:01:33,501 and they share common features such as involving the whole body and usually 31 00:01:33,501 --> 00:01:35,481 causing a complete loss of awareness. 32 00:01:36,036 --> 00:01:38,736 The generalised tonic clonic seizures involve a complete loss 33 00:01:38,736 --> 00:01:42,546 of awareness, paddling of all four limbs and severe autonomic signs 34 00:01:42,546 --> 00:01:44,946 such as salivating and urinating. 35 00:01:45,936 --> 00:01:49,176 So what do you actually mean when we say tonic and clonic? 36 00:01:49,226 --> 00:01:53,966 Well, tonic is characterised by stiffening of the muscles, and clonic 37 00:01:54,056 --> 00:01:56,456 involves rhythmic jerking of the muscles. 38 00:01:56,456 --> 00:01:58,856 Most generalised seizures are a mixture of both of these. 39 00:01:58,856 --> 00:02:00,386 Hence the tonic clonic 40 00:02:00,596 --> 00:02:01,256 Makes sense. 41 00:02:01,886 --> 00:02:06,086 But there are also tonic seizures and clonic seizures, which 42 00:02:06,086 --> 00:02:08,066 may only be one or the other. 43 00:02:09,116 --> 00:02:13,076 Another type of generalised seizure that's less well known about, but is becoming 44 00:02:13,076 --> 00:02:15,506 more recognised is a myoclonic seizure. 45 00:02:16,556 --> 00:02:21,386 Now these are brief, generalised seizures, lasting fractions of a second. 46 00:02:22,196 --> 00:02:26,606 They're considered a bit different as dogs don't seem to lose consciousness. 47 00:02:26,906 --> 00:02:29,666 But it's my belief that this really is, because the episodes are so 48 00:02:29,726 --> 00:02:34,151 brief, it's hard to see whether dogs are conscious or not, they're 49 00:02:34,151 --> 00:02:35,861 over before they've really started. 50 00:02:36,671 --> 00:02:40,661 And when I show videos of these to owners and to vets, I'm often told 51 00:02:40,661 --> 00:02:42,311 they look a little bit like a hiccup. 52 00:02:43,091 --> 00:02:44,651 And that's because they effectively are. 53 00:02:45,161 --> 00:02:49,691 Myoclonus, you get pathological myoclonus, which is what we're talking about here. 54 00:02:50,111 --> 00:02:51,941 But you get physiological myoclonus. 55 00:02:52,031 --> 00:02:55,091 It's like a little, probably when you see someone have a hiccup, it's like 56 00:02:55,091 --> 00:02:56,351 they've had a little electric shock. 57 00:02:56,506 --> 00:02:57,656 I get them all them all the time. 58 00:02:57,796 --> 00:02:59,876 I'm going to feel like I've got myoclonus epilepsy now. 59 00:03:00,086 --> 00:03:03,154 And that's what's important to say because people go, well am I having epilepsy? 60 00:03:03,334 --> 00:03:07,414 But they're only really part of an epileptic problem when they're associated 61 00:03:07,414 --> 00:03:09,544 with other types of seizures commonly. 62 00:03:09,604 --> 00:03:13,234 So generally you'll have myoclonic fits frequently, but 63 00:03:13,234 --> 00:03:15,994 you might have the occasional generalised tonic-clonic seizure. 64 00:03:16,484 --> 00:03:18,379 Okay, I don't have those, so that's fine. 65 00:03:18,949 --> 00:03:19,639 Just hiccups. 66 00:03:19,834 --> 00:03:20,584 Just hiccups. 67 00:03:20,714 --> 00:03:23,339 The second time you have it is, we all do this. 68 00:03:23,369 --> 00:03:27,499 We may not be aware of it, but if you go off to sleep, that little 69 00:03:27,499 --> 00:03:28,914 jerk before you go to sleep. 70 00:03:29,544 --> 00:03:32,624 And it's weird because you're lovely, relaxed, it's the best part of the day. 71 00:03:32,714 --> 00:03:37,664 If I could bottle that feeling and just drink that drink all day, I'd love it. 72 00:03:38,204 --> 00:03:40,304 But you have this little jerk as you go off to sleep. 73 00:03:40,664 --> 00:03:42,644 And that again, is perfectly normal. 74 00:03:42,704 --> 00:03:45,254 It's myoclonus, you don't have epilepsy. 75 00:03:46,304 --> 00:03:49,594 So these are the situations when we encounter it in normal 76 00:03:49,594 --> 00:03:52,594 everyday life and dogs have that same jerk as they go to sleep. 77 00:03:52,954 --> 00:03:55,954 But this is where we're talking about them in the context of seizures. 78 00:03:56,374 --> 00:03:59,074 Or it's the other person that jerks as you're trying to get to sleep and 79 00:03:59,074 --> 00:04:00,514 you get like punched in the side. 80 00:04:00,664 --> 00:04:01,144 Absolutely. 81 00:04:01,144 --> 00:04:01,474 Apparently. 82 00:04:01,474 --> 00:04:02,554 I'm really bad at that. 83 00:04:02,614 --> 00:04:03,264 So, yeah. 84 00:04:04,499 --> 00:04:09,184 And the last type of generalised seizure is an atonic seizure, which 85 00:04:09,184 --> 00:04:12,634 you may have heard referred to in the past as a petite mal seizure. 86 00:04:13,624 --> 00:04:17,074 Now, in this case, there's a loss of normal consciousness, but 87 00:04:17,074 --> 00:04:19,114 there's no obvious motor activity. 88 00:04:19,114 --> 00:04:23,254 So pets may appear frozen and lack awareness, but potentially staring 89 00:04:23,254 --> 00:04:26,084 into a corner or just not being aware. 90 00:04:26,114 --> 00:04:29,864 And they're either lying down doing this, but they can just stand on the spot and 91 00:04:29,864 --> 00:04:31,634 not be rousable for a period of time. 92 00:04:32,969 --> 00:04:36,284 Is that like absence seizures? 93 00:04:36,574 --> 00:04:38,674 Absence is the other term we'd use here. 94 00:04:38,674 --> 00:04:44,264 So absence, atonic and petite mal, loss of awareness during a fit. 95 00:04:45,239 --> 00:04:45,779 Goodness. 96 00:04:45,859 --> 00:04:49,469 There's me thinking I know what I'm doing when I'm dealing with generalised 97 00:04:49,489 --> 00:04:52,849 seizures, but I didn't realise actually there were so many types. 98 00:04:53,239 --> 00:04:57,679 So how common are these myoclonic or atonic seizures? 99 00:04:58,489 --> 00:05:01,999 We don't really know how common atonic seizures are because 100 00:05:01,999 --> 00:05:03,529 they're really hard to spot. 101 00:05:03,799 --> 00:05:07,339 So what I would say is, I suspect they're a lot more common than we 102 00:05:07,339 --> 00:05:11,629 realise, but myoclonic seizures are actually quite common. 103 00:05:12,009 --> 00:05:14,809 You may be most familiar with them in older cats where they're 104 00:05:14,809 --> 00:05:18,319 part of a syndrome called Audiogenic reflex seizures. 105 00:05:18,889 --> 00:05:20,689 But I think that's the topic of a future podcast 106 00:05:20,689 --> 00:05:25,709 I was going to say, spoiler alert, you've got to tune into a epilepsy for 107 00:05:25,709 --> 00:05:27,419 cats later on in the season for that. 108 00:05:29,279 --> 00:05:34,139 But we also have, you mentioned the focal or maybe people know them as 109 00:05:34,139 --> 00:05:36,149 partial seizures as well, aren't there? 110 00:05:36,749 --> 00:05:37,259 That's right. 111 00:05:37,259 --> 00:05:40,289 There's the other category, which is focal seizures, which, 112 00:05:40,529 --> 00:05:43,919 well, as the name suggests, it involves just one part of the body. 113 00:05:44,579 --> 00:05:45,959 And these come in three types. 114 00:05:45,959 --> 00:05:48,869 So the most common would be motor seizures. 115 00:05:48,869 --> 00:05:52,799 And they're often recognised as episodic focal facial twitches or 116 00:05:53,129 --> 00:05:54,969 rhythmic jerks of a single limb. 117 00:05:56,499 --> 00:05:57,759 Autonomic seizures. 118 00:05:57,759 --> 00:05:58,479 They can happen. 119 00:05:58,479 --> 00:06:01,719 And these really just present with what we call parasympathetic signs. 120 00:06:01,719 --> 00:06:06,099 So maybe dilated pupils, hypersalivation or vomiting. 121 00:06:07,509 --> 00:06:09,879 And then you've got the behavioural seizures, which used to be 122 00:06:09,879 --> 00:06:11,679 called psychomotor seizures. 123 00:06:11,679 --> 00:06:15,759 Now these are harder to characterise and can sometimes resemble 124 00:06:15,789 --> 00:06:17,529 obsessive compulsive disorders. 125 00:06:18,639 --> 00:06:23,259 So common ones I see would be dogs that are fly catching or excessive 126 00:06:23,259 --> 00:06:29,724 licking, inexplicable fear, or maybe just sudden and unprovoked aggression. 127 00:06:30,504 --> 00:06:35,944 Now, that last one is a difficult one because I'm not saying aggressive dogs 128 00:06:35,944 --> 00:06:38,254 have fits, but there are certainly scenarios where that happens. 129 00:06:38,254 --> 00:06:41,674 And it's that untargeted aggression where it's not surrounding food or 130 00:06:41,674 --> 00:06:43,174 particular people or individuals. 131 00:06:43,174 --> 00:06:48,394 It's just sporadic and comes about in a variety of very different situations. 132 00:06:49,759 --> 00:06:51,709 Is that like cocker rage? 133 00:06:52,369 --> 00:06:54,019 Have you heard of this? 134 00:06:54,019 --> 00:06:58,969 And people are wondering whether this is a behavioural thing or a neurological thing. 135 00:06:59,074 --> 00:07:02,104 Yeah, I don't know the answer to that because cocker rage was discussed a 136 00:07:02,104 --> 00:07:05,794 lot, in the eighties and nineties it was quite a common, well recognised 137 00:07:05,814 --> 00:07:08,874 condition and I suppose people bring it up from time to time now. 138 00:07:09,339 --> 00:07:11,769 I didn't think I was that old Mark, to be honest, but 139 00:07:11,769 --> 00:07:11,974 I'm so sorry. 140 00:07:14,502 --> 00:07:15,432 I've made him feel awkward. 141 00:07:15,532 --> 00:07:19,492 Cocker rage, I think it probably is something to do with this, is my best 142 00:07:19,492 --> 00:07:22,042 guess, but we don't know because we don't know what people were seeing 143 00:07:22,042 --> 00:07:23,902 then and what's happening now. 144 00:07:24,142 --> 00:07:27,802 What I would say is if you've got a dog with this kind of inexplicable 145 00:07:28,282 --> 00:07:34,012 untargeted aggression and we've ruled out pain as a focus for that cause. 146 00:07:34,012 --> 00:07:37,012 Then I always think it's very reasonable to try a course 147 00:07:37,012 --> 00:07:38,482 of anti epileptic medication. 148 00:07:38,662 --> 00:07:41,932 And my favourite one is phenobarbital to see if those 149 00:07:41,932 --> 00:07:43,372 episodes are managed with that. 150 00:07:44,092 --> 00:07:47,942 And often we can see quite positive, responses to that medication. 151 00:07:48,272 --> 00:07:52,142 And when I say positive, sometimes almost a complete eradication of 152 00:07:52,142 --> 00:07:56,342 fits, which as you're all experts, as listeners now, getting that kind of 153 00:07:56,372 --> 00:07:58,832 response from epilepsy is very unusual. 154 00:07:59,162 --> 00:08:01,442 But in these scenarios we can sometimes come across that. 155 00:08:02,462 --> 00:08:08,312 And do these focal seizures often progress into more generalised seizures? 156 00:08:08,312 --> 00:08:11,882 because I'm starting to feel like they might be really hard to identify. 157 00:08:13,292 --> 00:08:14,042 Well, yes. 158 00:08:14,042 --> 00:08:18,842 Focal seizures can progress into generalised seizures, but not always. 159 00:08:19,412 --> 00:08:22,542 I think it's the behavioural seizures that are harder to recognise. 160 00:08:22,562 --> 00:08:27,512 So a dog that is sporadically aggressive may simply be responding to some 161 00:08:27,512 --> 00:08:31,262 external stimulus as a behavioural response, but these episodes can 162 00:08:31,262 --> 00:08:33,572 sometimes be seizure related. 163 00:08:34,392 --> 00:08:37,322 Trialling anti-epileptics is really interesting actually 164 00:08:37,322 --> 00:08:41,822 because I think a lot of us are hesitant to try these medications. 165 00:08:41,822 --> 00:08:45,602 We are worrying about stopping them potentially and maybe we don't 166 00:08:45,602 --> 00:08:47,682 pick them up as often as we should. 167 00:08:48,432 --> 00:08:51,312 Well actually I love using phenobarbital and some of the other 168 00:08:51,312 --> 00:08:53,232 medications as a diagnostic trial. 169 00:08:53,712 --> 00:08:56,712 And I think if you give them in that context and explain that to an owner and 170 00:08:56,712 --> 00:09:00,672 say, we're actually trying this for a period of four to six weeks, the timing 171 00:09:00,672 --> 00:09:03,372 will vary depending on the frequency of the episodes you're trying to manage. 172 00:09:03,822 --> 00:09:06,372 But I find that's really effective and can actually allow you to know. 173 00:09:06,372 --> 00:09:08,382 So I say if you don't know if they're fits, but you think 174 00:09:08,382 --> 00:09:10,002 they could be, give it a go, 175 00:09:10,392 --> 00:09:10,852 might work. 176 00:09:10,852 --> 00:09:10,912 Yeah 177 00:09:10,992 --> 00:09:12,307 You might find a good response. 178 00:09:13,722 --> 00:09:17,172 That's really useful actually to, to utilise those medications. 179 00:09:17,412 --> 00:09:21,942 I can already see then that there's a really wide array of epileptic seizures 180 00:09:21,942 --> 00:09:26,052 or conditions that can look quite different and added to this, there are 181 00:09:26,112 --> 00:09:30,282 other conditions that aren't epilepsy that can also look like a seizure. 182 00:09:31,797 --> 00:09:32,907 Well, yes, exactly. 183 00:09:32,907 --> 00:09:35,637 Mimics of seizures refer to conditions that look like 184 00:09:35,637 --> 00:09:39,417 seizures but are not related to epileptic activity in the brain. 185 00:09:39,897 --> 00:09:44,007 Now these include conditions and quite common conditions like paroxysmal 186 00:09:44,007 --> 00:09:48,088 movement disorders, which are also known as paroxysmal dyskinesias. 187 00:09:48,477 --> 00:09:51,297 But these are just movement disorders happening intermittently. 188 00:09:51,297 --> 00:09:56,887 So paroxysmal dyskinesia is a fancy name to say abnormal movement, but they're 189 00:09:57,037 --> 00:10:03,127 intermittent self-limiting episodes of abnormal movements and the situation, 190 00:10:03,127 --> 00:10:06,127 I think these come, well, they're highlighted to me are those situations 191 00:10:06,127 --> 00:10:09,827 when you're in a practice, you've had a really busy day, your waiting room 192 00:10:09,827 --> 00:10:13,277 is packed to the rafters with the next patients coming in and you get that 193 00:10:13,277 --> 00:10:17,907 dreaded phone call towards the end of the day saying an owner clearly very concerned 194 00:10:17,907 --> 00:10:21,497 because their dog's been fitting now for two hours, and you think two hours. 195 00:10:21,497 --> 00:10:22,007 That's awful. 196 00:10:22,007 --> 00:10:23,237 Well, absolutely no question. 197 00:10:23,237 --> 00:10:24,317 This dog needs to come in. 198 00:10:25,097 --> 00:10:27,287 So you carry on with your consult list waiting for the 199 00:10:27,287 --> 00:10:28,757 emergency patient to come down. 200 00:10:29,297 --> 00:10:32,957 And when that patient comes in, it will look completely bright and 201 00:10:32,957 --> 00:10:35,747 happy and will bounce around the consult room like nothing's happened. 202 00:10:36,497 --> 00:10:41,237 Now I always say in that situation, obviously that's a bit, you feel a bit 203 00:10:41,237 --> 00:10:42,647 like, oh, you know what's gone on here. 204 00:10:42,957 --> 00:10:45,957 The fact that dog is normal and the owner has reported abnormal 205 00:10:45,957 --> 00:10:47,577 seizure activity for two hours. 206 00:10:48,177 --> 00:10:51,327 In the previous episode we talked about status epilepticus and we know that 207 00:10:51,327 --> 00:10:55,017 dogs don't bounce back from seizure activity back to normal after two hours. 208 00:10:55,467 --> 00:10:58,917 So that should just raise the question of, that dog probably didn't have a seizure. 209 00:10:59,307 --> 00:11:03,117 And when an owner rushes in and says, my dog is having a fit, we need to just 210 00:11:03,117 --> 00:11:06,927 pause and check that what we're dealing with really is a fit and isn't something 211 00:11:06,927 --> 00:11:11,432 else because the scenario I mentioned there, really that dog hasn't had a fit. 212 00:11:11,582 --> 00:11:11,852 Yeah. 213 00:11:11,972 --> 00:11:14,252 But it has had a problem and that's the important thing. 214 00:11:14,252 --> 00:11:16,352 And it's trying to establish what that problem might be. 215 00:11:16,982 --> 00:11:21,182 Definitely, and I think this is the crux of this episode really, is that 216 00:11:21,272 --> 00:11:25,112 a lot of owners will say, my dog's had a fit or an episode or something. 217 00:11:25,112 --> 00:11:30,162 And I've even had cases of things like syncope caused by cardiovascular 218 00:11:30,162 --> 00:11:33,732 disorders, for instance, being called fits or seizures by owners. 219 00:11:33,732 --> 00:11:37,077 And the syncopal episodes are really difficult ones to pick out 220 00:11:37,077 --> 00:11:39,807 and I don't think anyone really has a great handle on when they 221 00:11:39,807 --> 00:11:41,637 might be syncope versus seizures. 222 00:11:42,057 --> 00:11:45,597 And the times, I think syncope episodes are quite common when it's due to 223 00:11:45,597 --> 00:11:48,507 underlying heart diseases when owners might come home and first greet their dog, 224 00:11:48,567 --> 00:11:53,247 the dog gets excited and then goes into an episode that mimics a seizure, that, 225 00:11:53,247 --> 00:11:57,562 for me, would be a more common situation for some underlying cardiovascular cause. 226 00:11:57,807 --> 00:12:01,227 That's actually, I had a really good case once the owner came to me and said 227 00:12:01,947 --> 00:12:03,987 he's having a seizure almost every day. 228 00:12:04,857 --> 00:12:06,987 And I said, describe what happens to me. 229 00:12:07,107 --> 00:12:11,667 And she goes, every time the postman comes, he's having a seizure, he jumps 230 00:12:11,667 --> 00:12:15,477 off of the sofa, he runs towards the door and often collapses halfway there. 231 00:12:15,867 --> 00:12:18,287 And I'm like, probably isn't a seizure, but 232 00:12:19,532 --> 00:12:21,062 Well, great spot because that they're hard. 233 00:12:21,062 --> 00:12:25,542 But you're right that constant same trigger is just an alert that 234 00:12:25,542 --> 00:12:26,952 maybe something else is going on. 235 00:12:27,033 --> 00:12:27,212 Yeah. 236 00:12:27,612 --> 00:12:30,312 It reminds me of the bin men from season one. 237 00:12:30,762 --> 00:12:33,642 If you haven't listened to season one yet, I would definitely encourage 238 00:12:33,642 --> 00:12:34,782 you to go back and have a listen. 239 00:12:36,672 --> 00:12:40,182 And, one of the biggest challenges is that these episodes are often sporadic. 240 00:12:40,212 --> 00:12:43,932 So the dog may appear completely normal between episodes and even 241 00:12:43,932 --> 00:12:45,432 during your veterinary examination. 242 00:12:45,482 --> 00:12:48,612 Dogs don't perform and give the abnormalities to you in a consult like 243 00:12:48,612 --> 00:12:50,712 a person would with a doctor's surgery. 244 00:12:50,922 --> 00:12:54,552 So you might have a worried owner describing something dramatic, but 245 00:12:54,552 --> 00:12:57,492 without clinical signs to investigate during the appointments, it can be 246 00:12:57,492 --> 00:12:59,472 really difficult to pinpoint the issue. 247 00:13:00,372 --> 00:13:05,052 It does sound tough, especially as owners often already have an idea 248 00:13:05,052 --> 00:13:07,122 about what they think is going on. 249 00:13:07,342 --> 00:13:09,202 How do you approach these cases? 250 00:13:09,772 --> 00:13:12,832 Well, the keys to gather as much information as possible. 251 00:13:12,832 --> 00:13:16,402 Owners should always be encouraged to take videos of these episodes. 252 00:13:16,942 --> 00:13:21,052 And I suppose an aside here is if you are able to see a video of a dog having 253 00:13:21,052 --> 00:13:25,282 something that looked like a seizure, we might pick out different features when 254 00:13:25,282 --> 00:13:30,292 we see that episode to describe as to what we've seen, and I mean I'd bring 255 00:13:30,292 --> 00:13:31,942 this right back to describing people. 256 00:13:32,062 --> 00:13:33,682 If you're sort of saying, oh, John Smith? 257 00:13:33,742 --> 00:13:34,782 No, let's not use John Smith. 258 00:13:34,782 --> 00:13:36,742 because there'll be someone called John Smith who's offended. 259 00:13:37,522 --> 00:13:42,107 But you might we'll use me it but You might say, do you know Mark Lowrie? 260 00:13:42,107 --> 00:13:44,572 And then the two of you might chat about Mark Lowrie And he might go, oh 261 00:13:44,572 --> 00:13:48,412 yes, he's the one who's like, he's sort of, well, he's quite tall, but Yes. 262 00:13:48,412 --> 00:13:50,332 And he's got sort of light, light coloured hair. 263 00:13:50,332 --> 00:13:50,632 Yes. 264 00:13:51,082 --> 00:13:53,092 And actually really, you're not getting to the crux of the problem there. 265 00:13:53,152 --> 00:13:56,410 That's not ruled out much of the so what I find is you actually end 266 00:13:56,410 --> 00:13:59,260 up having to be quite rude about the person in order to make it very 267 00:13:59,260 --> 00:14:00,280 clear who you're talking about. 268 00:14:00,280 --> 00:14:05,720 So with Mark Lowrie say, he's a tall, pasty white person, like as in pale white. 269 00:14:05,720 --> 00:14:09,450 I'm talking like ghostly white, can't get a suntan and goes pink in the sun. 270 00:14:09,810 --> 00:14:11,780 He's blending into the white background as we speak. 271 00:14:12,070 --> 00:14:12,240 Joking! 272 00:14:12,670 --> 00:14:16,035 So you, well, I did call you old earlier, so. 273 00:14:16,075 --> 00:14:16,435 It's true. 274 00:14:16,455 --> 00:14:17,440 I'm getting my own back now. 275 00:14:18,520 --> 00:14:21,540 But, you see, I think these things are, you've got, I find you have 276 00:14:21,540 --> 00:14:24,700 to actually sometimes pick up quite obvious characteristics that might 277 00:14:24,700 --> 00:14:28,020 not necessarily be favourable and when it comes back to seizures, an 278 00:14:28,020 --> 00:14:30,540 owner trying to describe what their dog is doing can be very difficult. 279 00:14:30,540 --> 00:14:34,710 So I would say a video speaks a million words and it can really 280 00:14:34,770 --> 00:14:37,020 provide important critical clues. 281 00:14:37,500 --> 00:14:39,600 So from there we can ask detailed questions. 282 00:14:39,600 --> 00:14:41,730 We can ask, did the dog lose consciousness? 283 00:14:41,730 --> 00:14:43,950 Now you might be able to see that on the video, but that can 284 00:14:43,950 --> 00:14:45,180 be very difficult to pick up. 285 00:14:45,840 --> 00:14:49,290 Really important question for me is, to ask, were there any autonomic 286 00:14:49,290 --> 00:14:51,930 signs like urination or salivation? 287 00:14:52,470 --> 00:14:53,490 Salivation is a big one. 288 00:14:53,490 --> 00:14:56,520 If a dog is salivating during one of these episodes for me, that 289 00:14:56,700 --> 00:14:58,050 all the time that's a seizure. 290 00:14:58,100 --> 00:14:59,030 That's what we're dealing with. 291 00:14:59,080 --> 00:14:59,530 And did 292 00:14:59,530 --> 00:15:00,880 the episode stop abruptly. 293 00:15:01,480 --> 00:15:03,880 And this really just helps us differentiate between those 294 00:15:03,880 --> 00:15:05,445 true seizures and mimics. 295 00:15:06,445 --> 00:15:07,015 I agree. 296 00:15:07,015 --> 00:15:10,645 I think these videos and the invention of the smartphone, as it were, 297 00:15:10,975 --> 00:15:13,015 are really invaluable resources. 298 00:15:13,375 --> 00:15:17,515 You could really see for yourself exactly what that kind of pet is doing, what 299 00:15:17,515 --> 00:15:21,235 those owners are trying to describe, because like you say, they might not 300 00:15:21,235 --> 00:15:23,395 always describe things as we would. 301 00:15:23,575 --> 00:15:28,135 So speaking of differentiating, are there specific features that help 302 00:15:28,135 --> 00:15:32,275 us distinguish between a seizure and something like the paroxysmal dyskinesia? 303 00:15:32,980 --> 00:15:37,330 Absolutely, for example, in dyskinesias, the dog usually maintains normal 304 00:15:37,330 --> 00:15:41,200 consciousness despite showing generalised abnormal motor activity. 305 00:15:41,950 --> 00:15:45,940 And if motor activity involves more than one body part, what I'd say is 306 00:15:45,940 --> 00:15:49,150 if you're seeing a dog that maybe it involves all four legs, that dog 307 00:15:49,150 --> 00:15:52,490 really needs to be having a generalised seizure for it to be a seizure because 308 00:15:52,510 --> 00:15:53,740 it's involving more than one limb. 309 00:15:54,280 --> 00:15:56,710 And with that means those dogs should be unaware of what's 310 00:15:56,710 --> 00:15:58,690 going on and lose consciousness. 311 00:15:58,900 --> 00:16:02,610 But if you see this dog is fully alert with all four legs involved, that really 312 00:16:02,610 --> 00:16:04,290 is telling you this is not a seizure. 313 00:16:04,410 --> 00:16:08,035 And for me, it most commonly would be a dyskinesia at this point. 314 00:16:08,850 --> 00:16:11,370 And additionally, I touched on this earlier, but there's no 315 00:16:11,400 --> 00:16:13,170 postictal phase with dyskinesia. 316 00:16:13,170 --> 00:16:16,650 So the dog doesn't show any of the confusion, drunkenness, 317 00:16:16,650 --> 00:16:18,510 blindness, or pacing afterwards. 318 00:16:19,050 --> 00:16:22,425 So importantly, you typically won't see autonomic signs like 319 00:16:22,425 --> 00:16:24,855 drooling, or involuntary urination. 320 00:16:25,155 --> 00:16:29,115 And you will find these dogs recover very quickly after an episode, even 321 00:16:29,145 --> 00:16:30,765 if it's gone on for a couple of hours. 322 00:16:31,005 --> 00:16:34,885 And dyskinesia can last 30 seconds up to two, maybe three hours. 323 00:16:34,995 --> 00:16:38,325 Are there any particular breeds or anything that are more likely to be 324 00:16:38,325 --> 00:16:40,305 affected by these movement disorders? 325 00:16:40,980 --> 00:16:41,670 Of course. 326 00:16:41,670 --> 00:16:42,660 They all look the same. 327 00:16:42,810 --> 00:16:44,280 Let me start by saying that. 328 00:16:44,340 --> 00:16:46,695 So just to aid confusion for us really 329 00:16:46,740 --> 00:16:47,430 Exactly. 330 00:16:47,430 --> 00:16:52,280 So, if I see a particular breed of dog having an episode, I only think it might 331 00:16:52,280 --> 00:16:55,940 be a breed related movement disorder given the type of breed having it. 332 00:16:56,300 --> 00:16:59,390 But that movement may look the same as all other movement disorders we see. 333 00:16:59,940 --> 00:17:04,920 One classic example is episodic falling in Cavalier King Charles Spaniels. 334 00:17:04,970 --> 00:17:08,510 And that's linked to a genetic mutation that we can test for. 335 00:17:08,510 --> 00:17:12,270 So there's a brevican mutation, we can test for, and that really 336 00:17:12,270 --> 00:17:15,930 then lets us narrow down to that movement disorder immediately. 337 00:17:15,990 --> 00:17:18,150 If we get a positive test, we know what we're dealing with. 338 00:17:18,570 --> 00:17:21,930 And genetic testing is fairly inexpensive nowadays, so it's a great way of getting 339 00:17:21,930 --> 00:17:23,700 on top of that problem straight away. 340 00:17:24,510 --> 00:17:27,780 You may be thinking, well that's another condition that Cavaliers get. 341 00:17:28,170 --> 00:17:32,610 Yeah, they are quite an inflicted breed, but movement disorders are fairly benign. 342 00:17:32,670 --> 00:17:36,390 So once we've diagnosed them, I'm not necessarily that concerned about them. 343 00:17:36,600 --> 00:17:38,900 It's all about recognition in the first place. 344 00:17:39,840 --> 00:17:42,430 And then Border Terriers, they're one of my favourites. 345 00:17:42,450 --> 00:17:45,240 So Border Terriers can develop something that, well, it's been 346 00:17:45,240 --> 00:17:47,400 given many names over the years. 347 00:17:47,500 --> 00:17:49,705 Canine Epileptoid cramping syndrome. 348 00:17:49,825 --> 00:17:52,075 And it, it was originally called Spike's disease 349 00:17:52,075 --> 00:17:55,345 That was a dog from Germany named Spike, who developed the condition. 350 00:17:55,345 --> 00:17:59,065 So it was Spike's disease for a very long time until we understood more about it. 351 00:17:59,545 --> 00:18:04,465 Now, I hate the term canine epileptoid cramping syndrome because it 352 00:18:04,465 --> 00:18:07,945 suggests, the epileptoid component suggests seizures, which it isn't. 353 00:18:07,945 --> 00:18:11,005 So it was named that before we really understood it, but now 354 00:18:11,005 --> 00:18:14,095 we know it's associated with some form of gluten sensitivity. 355 00:18:14,095 --> 00:18:17,185 We call it paroxysmal gluten sensitive dyskinesia. 356 00:18:17,265 --> 00:18:17,875 PGSD. 357 00:18:17,900 --> 00:18:17,901 Yeah. 358 00:18:18,358 --> 00:18:20,248 I think really these are all names for conditions that we're 359 00:18:20,248 --> 00:18:21,358 still not fully understanding. 360 00:18:21,598 --> 00:18:22,588 I love that condition. 361 00:18:22,648 --> 00:18:27,568 Because what we found is in people that have celiac disease, obviously 362 00:18:27,568 --> 00:18:31,408 they're hugely intolerant to gluten and they have to completely avoid it. 363 00:18:32,008 --> 00:18:35,128 But a very small subset of those people can go on and develop unusual 364 00:18:35,128 --> 00:18:39,308 neurological signs as well as the gastrointestinal signs that are 365 00:18:39,343 --> 00:18:41,173 commonly associated with celiac disease. 366 00:18:42,133 --> 00:18:45,073 And some of those people will have movement disorders and that's what 367 00:18:45,073 --> 00:18:48,513 develops we found out with the border Terriers, that they do also get some kind 368 00:18:48,513 --> 00:18:50,943 of mild GI disturbance, should we say. 369 00:18:50,973 --> 00:18:53,783 Now, I'm using the term mild because, if you ask someone with 370 00:18:53,783 --> 00:18:57,053 celiac disease, you'll appreciate it's a very severe condition and 371 00:18:57,113 --> 00:18:58,973 it can be really crippling in life. 372 00:18:59,603 --> 00:19:02,843 These border terries aren't suffering anything like the severe signs there, 373 00:19:02,873 --> 00:19:06,673 but they do have occasional soft stools, diarrhoea, intermittent vomiting 374 00:19:07,153 --> 00:19:08,703 and I love that word, borborygmi. 375 00:19:08,953 --> 00:19:11,743 Feel like I might be getting it as we're midmorning now as well. 376 00:19:11,793 --> 00:19:12,033 Absolutely. 377 00:19:12,093 --> 00:19:14,972 So I think, borborygmi is something that I think we all get, 378 00:19:14,972 --> 00:19:17,282 but it seems Border terriers get a bit more commonly. 379 00:19:17,282 --> 00:19:21,692 So that's the noisy gut sounds, that, that are just happening around the day. 380 00:19:21,902 --> 00:19:24,332 Not necessarily associated with feeding or meal times. 381 00:19:24,602 --> 00:19:27,302 But what we found is when those dogs were fed a gluten-free diet, 382 00:19:27,312 --> 00:19:30,282 they actually improved significantly and these episodes could go away. 383 00:19:30,582 --> 00:19:35,472 We can even test for antibodies in these dogs to gluten and that's a great 384 00:19:35,472 --> 00:19:39,212 test to do because if you find those antibodies are high and they have these 385 00:19:39,212 --> 00:19:42,522 episodes and you put 'em on a gluten-free diet, we find those antibody titres 386 00:19:42,542 --> 00:19:44,072 should fall back to a normal level. 387 00:19:44,702 --> 00:19:47,532 There was a great example of a dog that had this condition. 388 00:19:47,532 --> 00:19:48,372 The owners were brilliant. 389 00:19:48,422 --> 00:19:51,017 They put him on a gluten-free diet, but they came back to me sort 390 00:19:51,017 --> 00:19:53,897 of eight weeks later and saying, we've seen absolutely no response. 391 00:19:53,957 --> 00:19:57,047 This dog's still having these movement disorder episodes. 392 00:19:57,917 --> 00:20:00,197 And when we looked into it a bit more, we did blood tests and the 393 00:20:00,197 --> 00:20:01,847 antibody levels were still high. 394 00:20:01,937 --> 00:20:05,027 So given they were being very strict with the diet, he'd like to have thought 395 00:20:05,027 --> 00:20:06,407 they'd be low, but it was still high. 396 00:20:06,887 --> 00:20:09,257 And it turned out they were taking the dog every day to their 397 00:20:09,257 --> 00:20:10,887 yard to muck out the horses. 398 00:20:11,027 --> 00:20:11,342 Oh no. 399 00:20:12,047 --> 00:20:14,177 The dog did like to feast on horse poop. 400 00:20:14,537 --> 00:20:15,107 Oh no! 401 00:20:15,807 --> 00:20:17,817 Well, this is the trouble with Border terriers, but as soon as that was 402 00:20:17,817 --> 00:20:21,177 then excluded from the diet, so to speak, the dog completely responded. 403 00:20:21,177 --> 00:20:23,617 So, dogs are scavengers and we have to work around that. 404 00:20:23,617 --> 00:20:26,517 We need a horse poo exclusion diet for this dog. 405 00:20:26,607 --> 00:20:28,407 I think it worked brilliantly when they did that. 406 00:20:28,457 --> 00:20:29,687 Fascinating actually. 407 00:20:30,087 --> 00:20:33,217 We work with human neurologists who were kind of experts in this 408 00:20:33,217 --> 00:20:35,637 and that's what helped us come down to work out what was going on. 409 00:20:35,637 --> 00:20:39,037 I love that it was a great little story of how a simple change in diet 410 00:20:39,037 --> 00:20:40,477 could actually fix a dog's problem. 411 00:20:41,662 --> 00:20:43,672 Does diet influence anything else? 412 00:20:43,672 --> 00:20:45,712 Any of these other neurological issues? 413 00:20:46,432 --> 00:20:48,742 Well, I think diet's becoming a more and more important thing 414 00:20:48,772 --> 00:20:50,452 to all of us all the time. 415 00:20:51,082 --> 00:20:53,962 And I suppose the other one that I'm really fascinated by, I mentioned a 416 00:20:53,962 --> 00:20:58,862 little bit earlier on, about partial seizures or focal seizures and we 417 00:20:58,862 --> 00:21:03,032 talked about dogs with fly catching and there was a great study from Canada 418 00:21:03,032 --> 00:21:08,042 some years ago now where they looked at dogs with fly catching and they found 419 00:21:08,042 --> 00:21:11,672 that many of these dogs would have underlying inflammatory bowel disease. 420 00:21:11,672 --> 00:21:15,452 So IBD and they had the full workup, which I don't want to go into 421 00:21:15,512 --> 00:21:19,802 because I don't understand it being a neurologist, but they had endoscopic 422 00:21:19,862 --> 00:21:23,462 biopsies and a lot of work was done on the medical side to diagnose IBD. 423 00:21:24,332 --> 00:21:29,732 But when these dogs were actually put onto a hypoallergenic diet, the episodes 424 00:21:29,732 --> 00:21:31,722 of fly catching completely disappeared. 425 00:21:31,912 --> 00:21:32,532 Wow! 426 00:21:32,777 --> 00:21:35,297 These behavioural seizures, we call 'em, whether that truly is a 427 00:21:35,297 --> 00:21:37,817 behaviour we don't know, and the jury is very much out on this, as 428 00:21:37,817 --> 00:21:39,017 to whether their behaviour or not. 429 00:21:39,467 --> 00:21:41,177 But a simple change in diet was great. 430 00:21:41,657 --> 00:21:43,757 When I see those patients, that's my management. 431 00:21:43,757 --> 00:21:46,817 But sometimes the fly catching is so incessant that owners 432 00:21:46,817 --> 00:21:47,777 really want a quick fix. 433 00:21:47,777 --> 00:21:51,467 So what I often do, I will give them phenobarbital as well. 434 00:21:52,277 --> 00:21:55,537 So the phenobarbital works quickly to control the fly catching, 435 00:21:55,987 --> 00:21:57,307 but they introduce the diet too. 436 00:21:57,307 --> 00:22:00,577 And then of course once everything's working together, we can then withdraw 437 00:22:00,577 --> 00:22:04,297 the phenobarbital slowly and carefully and then you hopefully end up with a dog that 438 00:22:04,357 --> 00:22:06,127 manages without these problems long term. 439 00:22:06,187 --> 00:22:09,787 So really fascinating link that we don't fully understand. 440 00:22:09,982 --> 00:22:14,812 That is fascinating and I think we'll talk more about things like the MCT diets 441 00:22:14,812 --> 00:22:16,462 as well in the later episode as well. 442 00:22:16,462 --> 00:22:18,472 So if it's something you're interested in, keep listening. 443 00:22:18,694 --> 00:22:21,994 Mark, is there any other kind of movement disorders out there? 444 00:22:22,219 --> 00:22:24,739 Well one of the other ones I'd mentioned would be Scotty Cramp. 445 00:22:24,769 --> 00:22:26,179 So Scottish Terriers. 446 00:22:26,519 --> 00:22:29,379 And this again is one of the early ones that was kind of recognised, 447 00:22:29,399 --> 00:22:32,429 although maybe it wasn't appreciated exactly what it was that was going on. 448 00:22:33,119 --> 00:22:35,339 But the reason I bring this one up is this is something that 449 00:22:35,339 --> 00:22:38,879 tends to be more triggered by exercise or potentially stress. 450 00:22:39,609 --> 00:22:42,309 Stress triggers off a lot of things and it's hard to avoid stress. 451 00:22:42,309 --> 00:22:44,079 But the exercise thing is important here. 452 00:22:44,079 --> 00:22:47,379 So these Scottish terriers, they'll be running along and they're develop like 453 00:22:47,379 --> 00:22:49,989 a skipping and hopping type of gate. 454 00:22:50,439 --> 00:22:53,619 They often sort of do, it's hard to describe on a podcast, but they're 455 00:22:53,619 --> 00:22:57,399 kind of crab like backend where it sort of swings round as they're running. 456 00:22:58,419 --> 00:23:03,129 They do have a bit of a skip to one or both back legs, and they can enter into 457 00:23:03,129 --> 00:23:07,419 these full movement disorders, which are typical of the paroxysmal dyskinesia 458 00:23:07,419 --> 00:23:08,889 where all four legs are affected. 459 00:23:09,519 --> 00:23:12,579 But the reason I like this particular condition is I think this is actually 460 00:23:12,639 --> 00:23:14,229 affecting a lot of other breeds too. 461 00:23:14,649 --> 00:23:17,229 And this seems to be a condition that we see a lot in 462 00:23:17,259 --> 00:23:18,729 Cockapoos, in young Cockapoos. 463 00:23:18,729 --> 00:23:21,874 So they're sort of hopping, skipping, crabbing when they're walking. 464 00:23:21,874 --> 00:23:21,934 Yeah. 465 00:23:22,151 --> 00:23:23,681 Again, it doesn't really cause any pain or anything. 466 00:23:23,731 --> 00:23:27,001 It's just something that affects movement. 467 00:23:27,131 --> 00:23:29,651 I think these dogs run and jump and do everything well, but once 468 00:23:29,651 --> 00:23:33,161 it's recognised, it just allows it to be boxed off and accepted. 469 00:23:33,161 --> 00:23:34,331 That's what that dog does. 470 00:23:34,751 --> 00:23:38,051 But it'll have a really good quality of life and will be happy to exercise freely. 471 00:23:38,441 --> 00:23:39,461 That's really interesting. 472 00:23:40,001 --> 00:23:43,301 I think I would probably all also mistake this for orthopaedic issues 473 00:23:44,021 --> 00:23:44,951 and that's what happens. 474 00:23:44,951 --> 00:23:48,641 Actually, quick plug, Movement Referrals, we get a lot of dogs 475 00:23:48,641 --> 00:23:51,881 coming into both orthopaedics and neurology with these problems. 476 00:23:52,271 --> 00:23:55,121 And I think, well, the orthopaedic problem that I suppose is the first 477 00:23:55,121 --> 00:23:58,771 one that springs to my mind as a neurologist would be patella luxation. 478 00:23:59,211 --> 00:24:02,111 When you said the hopping movement and skipping movement, that's what I thought. 479 00:24:02,161 --> 00:24:02,891 Exactly that. 480 00:24:02,911 --> 00:24:05,856 So, when I've spoken to orthopaedic surgeons about this, I've kind of said 481 00:24:05,856 --> 00:24:09,066 to them, well, is there anything we can kind of do to tell us about this? 482 00:24:09,066 --> 00:24:11,796 Because of course, the obvious answer is a clinical exam. 483 00:24:11,856 --> 00:24:16,416 But the more I learn, the less I examine dogs because I use a lot of 484 00:24:16,881 --> 00:24:18,771 information to try and guide diagnoses. 485 00:24:19,191 --> 00:24:21,051 And in doing so, it means I examine dogs less. 486 00:24:21,051 --> 00:24:23,331 And actually I become a bit scared of dogs sometimes because 487 00:24:23,331 --> 00:24:25,671 they're scared of me because I'm less confident in handling them. 488 00:24:26,181 --> 00:24:29,221 I will examine them of course, but examining for patella luxation is 489 00:24:29,241 --> 00:24:32,961 something that it can be difficult for somebody who's not doing it all the time. 490 00:24:33,411 --> 00:24:36,984 And what they say is if this dog is hopping and skipping, it's happening 491 00:24:37,014 --> 00:24:41,489 really like a switch, like, it's coming and then they're sort of impeded 492 00:24:41,489 --> 00:24:43,379 with their gait for a bit and then it goes back to normal, then that 493 00:24:43,379 --> 00:24:45,049 definitely fits patella luxation. 494 00:24:45,279 --> 00:24:45,869 Makes sense 495 00:24:46,199 --> 00:24:49,919 But these dogs with the Scotty cramp to give it a term. 496 00:24:50,039 --> 00:24:50,369 Yeah. 497 00:24:50,489 --> 00:24:54,539 They're actually walking fine and they're only actually showing these signs 498 00:24:54,539 --> 00:24:56,639 during the trotting phase of the gait. 499 00:24:57,059 --> 00:24:59,429 When you get them faster and get them beyond the trot phase. 500 00:24:59,429 --> 00:25:02,759 They actually develop a normal sort of gallop or run if you like. 501 00:25:03,089 --> 00:25:06,479 But when they're walking at a normal pace or a fast pace, you don't see it either. 502 00:25:06,479 --> 00:25:09,209 It's only in that trot phase when it's evident and that 503 00:25:09,209 --> 00:25:12,549 wouldn't fit an orthopaedic problem such as patella luxation. 504 00:25:12,569 --> 00:25:14,819 So I think that is a big key indicator. 505 00:25:14,819 --> 00:25:16,199 This might well be what we're dealing with. 506 00:25:16,829 --> 00:25:21,419 And so these aren't seizures, just to put that out there. 507 00:25:21,599 --> 00:25:25,079 They're not epilepsy, so therefore we just accept that 508 00:25:25,079 --> 00:25:26,249 this is what these dogs do? 509 00:25:26,774 --> 00:25:29,024 Well, that's a really good point because I'm talking about 510 00:25:29,024 --> 00:25:29,804 them as, yes, you're right. 511 00:25:29,804 --> 00:25:32,684 They're not seizures, they're nothing to do with seizures and they can end 512 00:25:32,684 --> 00:25:35,174 up in these episodes that are quite crippling and stopping them moving. 513 00:25:35,654 --> 00:25:39,284 But these dogs, they are benign these episodes and they don't cause any problem. 514 00:25:39,554 --> 00:25:43,394 There are medications we can try and use, but this comes back 515 00:25:43,394 --> 00:25:45,134 to managing epilepsy as well. 516 00:25:45,134 --> 00:25:48,044 If you've got a dog with epilepsy that has infrequent seizures, then 517 00:25:48,464 --> 00:25:51,584 often an owner may not tolerate a few side effects from medication because 518 00:25:51,584 --> 00:25:53,054 the seizures are so infrequent. 519 00:25:53,274 --> 00:25:55,097 And the same's true here that actually these dogs are getting 520 00:25:55,097 --> 00:25:56,267 around without too much problem. 521 00:25:57,017 --> 00:26:00,827 One drug we might consider is fluoxetine, so that could be a medication. 522 00:26:01,757 --> 00:26:05,177 It's been mentioned that, and selegiline are the two that we try for Scotty cramp. 523 00:26:05,617 --> 00:26:09,487 And we can get quite good results for some of these dogs, but often you end up with 524 00:26:09,487 --> 00:26:12,577 side effects that are more problematic than the problem in the first place. 525 00:26:12,577 --> 00:26:16,882 So I'm not dismissing it saying it's nothing in the 526 00:26:16,882 --> 00:26:18,022 sense that it isn't a problem. 527 00:26:18,022 --> 00:26:20,062 It's there, but it's not necessarily a problem that's causing any 528 00:26:20,062 --> 00:26:21,262 issues to that long term. 529 00:26:21,402 --> 00:26:21,462 Yeah. 530 00:26:21,462 --> 00:26:23,822 I think once people recognise it and understand it, there's 531 00:26:23,822 --> 00:26:26,912 a lot more acceptance then that they don't need to be concerned. 532 00:26:26,912 --> 00:26:29,492 This is going to lead something more concerning down the line. 533 00:26:29,537 --> 00:26:29,807 Yeah. 534 00:26:29,837 --> 00:26:33,197 It's not just suddenly going to go into a full seizure or anything like that 535 00:26:33,247 --> 00:26:37,177 And what about things like, I've heard of idiopathic head bobbing and I'm 536 00:26:37,177 --> 00:26:41,047 sure I've had a few cases of this and like the young Bulldogs and things. 537 00:26:41,197 --> 00:26:42,847 Is that another movement disorder? 538 00:26:43,022 --> 00:26:46,322 It's, well, it's a type of, what I'd say is a postural tremor, really. 539 00:26:46,322 --> 00:26:49,742 So it's a tremor because the bobbing is very fine. 540 00:26:49,952 --> 00:26:52,562 High frequency, I just mean a fast tremor. 541 00:26:52,812 --> 00:26:54,252 Very rhythmical really. 542 00:26:54,552 --> 00:26:57,419 And this is another one that it happens in all breeds of dog, so I 543 00:26:57,419 --> 00:27:00,059 don't want to limit it to a breed, but you are absolutely right in 544 00:27:00,059 --> 00:27:03,869 saying that bulldogs are probably the most common breed we see it in. 545 00:27:04,269 --> 00:27:08,249 So these really fine tremors of the head, which interestingly, you can actually 546 00:27:08,249 --> 00:27:12,209 interrupt these tremors and stop them, sort of distract the dog from them. 547 00:27:12,209 --> 00:27:14,819 So I've got a great video where a dog's doing this continually, 548 00:27:15,239 --> 00:27:18,659 it's then fed a little treat, it eats the treat, the tremor stops. 549 00:27:19,349 --> 00:27:23,369 But once it swallows, it goes straight back into tremoring and even taking the 550 00:27:23,369 --> 00:27:25,259 dog out for a walk and things can do it. 551 00:27:25,259 --> 00:27:30,449 And I've heard people say it might be related to sort of boredom sometimes. 552 00:27:30,449 --> 00:27:32,909 They're there and it's not a problem that their bored, you know, it's fine, 553 00:27:32,909 --> 00:27:34,139 but it, but that's when it comes on. 554 00:27:34,139 --> 00:27:37,349 So by then just giving that dog an activity, it seems to pass by 555 00:27:37,349 --> 00:27:40,499 and we'll go away because if we leave a dog to these episodes, they 556 00:27:40,499 --> 00:27:42,269 can go on for a very long time. 557 00:27:42,269 --> 00:27:44,009 I've known dogs go on for an hour or two. 558 00:27:44,759 --> 00:27:48,869 And the common one that I've seen myself would be dogs 559 00:27:48,869 --> 00:27:50,139 recovering from anaesthetics. 560 00:27:50,159 --> 00:27:53,489 So I remember a case we had many years ago now, it was a doberman that 561 00:27:53,489 --> 00:27:55,309 was recovering from a neck surgery. 562 00:27:55,309 --> 00:27:56,329 It had a ventral slot. 563 00:27:57,109 --> 00:28:01,619 And the nurses contacted me sort of about 30 minutes after we finished the surgery, 564 00:28:01,619 --> 00:28:04,579 saying they were really worried about this dog because it was tremoring its head. 565 00:28:04,999 --> 00:28:06,889 But when I went to examine the dog, that was exactly it. 566 00:28:06,889 --> 00:28:10,519 It had this idiopathic head tremor that had just come on as part of 567 00:28:10,519 --> 00:28:13,399 stress, I think related to the dog recovering from the surgery. 568 00:28:13,399 --> 00:28:14,869 Now it wasn't a concern for the dog. 569 00:28:14,869 --> 00:28:18,199 There was no problem with this having happened, but that's when it happened. 570 00:28:18,229 --> 00:28:20,929 And I suppose if you don't know what this is, you could start to think 571 00:28:20,929 --> 00:28:22,939 there's something quite serious going on. 572 00:28:22,939 --> 00:28:26,989 So another thing with idiopathic head tremors, I would simply say, I 573 00:28:26,989 --> 00:28:30,949 like to call 'em idiopathic, benign head tremors because they are benign. 574 00:28:30,949 --> 00:28:30,979 Okay. 575 00:28:31,669 --> 00:28:33,694 Once we've recognised them, we leave them alone. 576 00:28:33,694 --> 00:28:37,709 And I have seen dogs that are given anti-epileptic medication to try 577 00:28:37,709 --> 00:28:39,629 and control it, but that's useless. 578 00:28:39,629 --> 00:28:41,429 It doesn't control these episodes at all. 579 00:28:42,089 --> 00:28:45,359 And a particular English bulldog I remember is one that was actually 580 00:28:45,359 --> 00:28:49,469 loaded with phenobarbital and potassium bromide and these tremors persisted. 581 00:28:49,469 --> 00:28:52,289 So of course the vet not recognising the condition, was 582 00:28:52,289 --> 00:28:54,149 very concerned about the patient. 583 00:28:54,599 --> 00:28:56,729 But then actually the bigger problem was the sedation caused 584 00:28:56,729 --> 00:28:58,589 by the anti epileptic medication. 585 00:28:59,519 --> 00:29:02,759 I often see these in like the young patients as well. 586 00:29:02,789 --> 00:29:04,019 Is it more common in those? 587 00:29:04,019 --> 00:29:09,009 Because I think then I get the very concerned owner coming in and I'm 588 00:29:09,009 --> 00:29:11,589 always a bit, oh no, it will be fine. 589 00:29:11,589 --> 00:29:13,299 You don't need any treatment for this. 590 00:29:13,304 --> 00:29:14,164 Is that right? 591 00:29:14,384 --> 00:29:14,604 Or? 592 00:29:15,599 --> 00:29:15,939 It is. 593 00:29:16,059 --> 00:29:20,044 I mean it's definitely something that happens more commonly in young dogs. 594 00:29:20,154 --> 00:29:24,294 I can see them at any age and I just reassure an owner not to worry. 595 00:29:24,324 --> 00:29:27,324 I think the key point here is just to reassure an owner that there's 596 00:29:27,324 --> 00:29:29,124 nothing more concerning going on. 597 00:29:29,434 --> 00:29:32,589 And that's reassuring for us as well to know we're doing the right thing. 598 00:29:32,644 --> 00:29:35,894 Sometimes I guide an owner to the internet and ask them to Google a 599 00:29:35,894 --> 00:29:37,384 condition and look at videos of dogs. 600 00:29:37,384 --> 00:29:41,014 I'll show them that in the consult rooms they see, but they'll find forums of 601 00:29:41,014 --> 00:29:43,534 people who've got dogs with this and, and that really reassures 'em, it's 602 00:29:43,534 --> 00:29:44,854 nothing more to be concerned about 603 00:29:45,844 --> 00:29:50,629 If we see it more in the young patients, does it go away with age? 604 00:29:50,629 --> 00:29:51,709 Does it stay the same? 605 00:29:51,709 --> 00:29:52,879 Does it get worse with age? 606 00:29:52,879 --> 00:29:54,499 Like what are we expecting out of this? 607 00:29:54,499 --> 00:29:56,244 I would draw this back to all movement disorders. 608 00:29:56,294 --> 00:29:59,774 That, one of the key findings with these movement disorders, these 609 00:29:59,774 --> 00:30:03,074 dogs do tend to improve with age. 610 00:30:03,164 --> 00:30:07,004 So they tend to get better in terms of frequency or they may actually improve 611 00:30:07,004 --> 00:30:08,684 and get rid of the episode completely. 612 00:30:08,684 --> 00:30:11,444 So some of these paroxysmal dyskinesias, like the one I 613 00:30:11,444 --> 00:30:15,254 described in Cavaliers, very common in Labrador and Jack Russells too. 614 00:30:15,254 --> 00:30:18,944 But these dogs, when they get sort of to 8, 9 years plus, they tend 615 00:30:18,944 --> 00:30:21,434 to grow outta the condition and they no longer have the episode. 616 00:30:22,004 --> 00:30:25,964 Now that's a key difference to epilepsy because we need to remember that 617 00:30:25,964 --> 00:30:27,674 epilepsy is a progressive condition. 618 00:30:27,674 --> 00:30:31,184 So we've got two similar appearing conditions, but actually have 619 00:30:31,184 --> 00:30:34,814 quite different prognosis in the sense that one worsens with age 620 00:30:34,814 --> 00:30:36,134 and the other actually improves. 621 00:30:36,674 --> 00:30:41,024 And it's another reason why I'm fairly laid back with managing, because with 622 00:30:41,024 --> 00:30:43,844 a seizure we worry about the kindling effect that we talked about in the 623 00:30:43,844 --> 00:30:47,654 last episode where one seizure leads to another, but these episodes certainly 624 00:30:47,654 --> 00:30:51,014 don't have any triggering factor where one episode leads to another. 625 00:30:52,724 --> 00:30:56,714 And I guess with these it's videos, again, must have been a game changer 626 00:30:56,714 --> 00:31:00,074 for these episodes and maybe we're seeing them more now than we used to. 627 00:31:00,464 --> 00:31:02,984 We definitely are, and I think it's given the impression they're more 628 00:31:02,984 --> 00:31:04,544 common now than they ever were. 629 00:31:04,724 --> 00:31:07,334 But I think as you say, it's actually the advent of the 630 00:31:07,334 --> 00:31:09,104 smartphone that's brought this out. 631 00:31:09,204 --> 00:31:13,344 Because I certainly think back before smartphones, we were still having these 632 00:31:13,344 --> 00:31:16,524 consultations, we just weren't able to shed as much light on what was going on. 633 00:31:16,709 --> 00:31:21,389 I guess if I'm suspicious of a movement disorder, so for example, this dog 634 00:31:21,449 --> 00:31:26,639 doesn't lose consciousness or doesn't have postictal signs, for instance, other 635 00:31:26,639 --> 00:31:31,539 than looking at a video, is there actually a way to definitively diagnose these? 636 00:31:31,559 --> 00:31:35,579 Do we recommend referrals for advanced imaging or anything like that? 637 00:31:36,344 --> 00:31:39,794 Well, I think as we say, the video is key and I think if you can get a video, 638 00:31:39,944 --> 00:31:42,434 you can maybe look at it yourself to interpret, but there's always a 639 00:31:42,434 --> 00:31:44,414 friendly neurologist nearby or me, 640 00:31:44,629 --> 00:31:45,839 Yeah, send it off to Mark 641 00:31:46,044 --> 00:31:48,444 To have a look at it and I'd be happy to evaluate and see. 642 00:31:49,074 --> 00:31:51,774 But I've had people say, well, that's all right, you in your ivory tower are looking 643 00:31:51,774 --> 00:31:53,034 at that video and just labelling it. 644 00:31:53,034 --> 00:31:53,874 What is it you're doing? 645 00:31:54,094 --> 00:31:55,174 And I accept it is hard. 646 00:31:55,204 --> 00:31:57,244 Sometimes it can be very difficult to determine. 647 00:31:58,174 --> 00:32:01,414 There isn't a key test for the majority of these movement disorders. 648 00:32:01,444 --> 00:32:04,624 And yes, we've talked about genetic mutations. 649 00:32:04,624 --> 00:32:06,874 So the Cavies is we can test for a genetic mutation. 650 00:32:06,874 --> 00:32:11,164 The Border terriers, we can look for gluten antibodies, but actually it's 651 00:32:11,164 --> 00:32:12,694 very much like idiopathic epilepsy. 652 00:32:12,754 --> 00:32:15,934 There's no key test with idiopathic epilepsy and it's about ruling out 653 00:32:15,934 --> 00:32:17,674 other conditions that might mimic this. 654 00:32:18,064 --> 00:32:21,604 One thing I would say is very important in these patients, a big mimic of 655 00:32:21,604 --> 00:32:23,824 paroxysmal dyskinesia is hypocalcemia. 656 00:32:25,024 --> 00:32:28,594 So I would recommend checking calcium and ionised calcium to make sure 657 00:32:28,594 --> 00:32:31,864 that's not low, because sometimes low calcium can trigger sort of 658 00:32:31,864 --> 00:32:36,064 muscle twitches that can be quite serious and develop more problems. 659 00:32:36,694 --> 00:32:39,664 Particularly around pregnancy, lactation, those sorts of times, if 660 00:32:39,664 --> 00:32:42,634 you've got a dog having episodes, then be very aware that is a factor. 661 00:32:42,684 --> 00:32:46,524 But the simple answer is no, really we are investigating these dogs in the same way 662 00:32:46,614 --> 00:32:50,544 we investigate epileptic dogs, which is to rule out all the causes in the blood 663 00:32:51,264 --> 00:32:54,894 and then considering advanced imaging of the brain with spinal fluid analysis to 664 00:32:54,894 --> 00:32:56,304 make sure there's nothing else going on. 665 00:32:56,874 --> 00:32:59,334 But our expectation there, if this is a movement disorder, is 666 00:32:59,334 --> 00:33:00,534 those results would all be normal. 667 00:33:00,584 --> 00:33:04,064 I just wonder if you could sum it up for us, what would be your 668 00:33:04,064 --> 00:33:07,994 go-to advice for vets encountering these kind of funny episodes? 669 00:33:08,456 --> 00:33:11,921 First, always ask for a video, it's invaluable for identifying 670 00:33:11,921 --> 00:33:13,271 exactly what's going on. 671 00:33:13,931 --> 00:33:17,591 And second, don't rush into unnecessary diagnostic tests. 672 00:33:17,621 --> 00:33:22,381 If the animal seems normal during your exam, episodic conditions often 673 00:33:22,381 --> 00:33:24,301 won't show up on routine tests. 674 00:33:25,081 --> 00:33:28,001 And finally, client education is crucial. 675 00:33:28,271 --> 00:33:31,871 Owners need to understand what's happening and why these conditions, 676 00:33:32,261 --> 00:33:36,431 whilst distressing to watch, aren't typically life-threatening or concerning. 677 00:33:37,076 --> 00:33:39,476 I think that's great advice and, and really reassuring. 678 00:33:40,136 --> 00:33:43,406 And I think I'd probably add to this and say, don't forget to 679 00:33:43,406 --> 00:33:45,626 do a full physical exam as well. 680 00:33:45,626 --> 00:33:49,256 Even if the pet appears neurologically normal during the consult, we 681 00:33:49,256 --> 00:33:52,406 wouldn't of course want to miss anything medical underlying. 682 00:33:52,406 --> 00:33:54,936 So, that syncope we're talking about or the calcium you 683 00:33:54,936 --> 00:33:56,046 were talking about as well. 684 00:33:56,916 --> 00:33:59,226 So before we wrap up, Mark, any final thoughts? 685 00:34:00,051 --> 00:34:03,831 Just to say, recognising mimics of seizures takes a bit of experience, 686 00:34:03,831 --> 00:34:07,791 but really a good partnership with the owner, I mean, smartphones have been 687 00:34:07,791 --> 00:34:09,591 an absolute game changer in neurology. 688 00:34:09,767 --> 00:34:13,212 It's made the biggest difference in our discipline in recent years. 689 00:34:13,512 --> 00:34:16,782 So allowing us to observe and better understand these conditions really 690 00:34:16,962 --> 00:34:21,252 has become invaluable and never underestimate the power of a good video. 691 00:34:21,837 --> 00:34:25,227 Definitely we'll all be sending them to you now, your inbox is going to be full. 692 00:34:26,307 --> 00:34:29,187 Well, thank you so much Mark, for shedding light on this topic. 693 00:34:29,187 --> 00:34:31,947 And thank you again to our listeners for tuning in. 694 00:34:32,607 --> 00:34:36,537 Vets can also find many free resources on our Dômes Pharma website, 695 00:34:36,537 --> 00:34:40,407 including a seizure mimics chart that helps summarise these differences. 696 00:34:40,557 --> 00:34:44,247 So you can head to the Vet Vault on the website in the link below. 697 00:34:44,907 --> 00:34:47,547 And finally, don't forget to subscribe and we'll see you next 698 00:34:47,547 --> 00:34:50,847 time for some more fascinating discussions on veterinary neurology. 699 00:34:51,207 --> 00:34:55,377 I think next time is all about adjunctive therapy, so maybe picking up about that 700 00:34:55,407 --> 00:35:00,957 influence of diet and CBD oils, and what to do when phenobarbital on its own is not 701 00:35:00,957 --> 00:35:02,667 enough, so it's not one to miss out on. 702 00:35:02,817 --> 00:35:03,477 So see you there. 703 00:35:03,477 --> 00:35:04,317 Thanks again, Mark. 704 00:35:04,487 --> 00:35:05,322 Looking forward to it. 705 00:35:05,322 --> 00:35:06,042 Thanks very much.