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.
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.