Epilepsy in dogs, specifically the idiopathic form, causes dogs to have recurrent seizures without an identifiable trigger. While seeing your dog have a seizure will probably always be scary, understanding the causes, symptoms, diagnosis, and treatment for epilepsy may make it less daunting. Integrative veterinarian Dr. Julie Buzby shares what to know.
A good friend of mine was recently telling me about her Labrador Retriever mix, Buddy, who had his first seizure about a year after he was adopted as an adult. By the time they got to the nearby veterinary ER, he seemed to have recovered completely. Bloodwork confirmed that there was nothing wrong metabolically, so the vet recommended monitoring him for any additional seizure episodes.
Over the next six months, her dog continued to be his goofy, happy self until a second seizure woke him from a nap. A third seizure three months after that was the turning point for my friend. She scheduled a visit with her vet to discuss starting an anti-seizure medication.
The tentative diagnosis, based on Buddy’s history, normal bloodwork, and normal activity between these three terrifying episodes, was idiopathic epilepsy.
What is epilepsy in dogs?
Epilepsy in dogs is a condition in which abnormal electrical activity in the brain results in two or more seizures at least 24 hours apart. It can be further classified into two types—acquired (secondary) epilepsy or primary (idiopathic) epilepsy.
Two types of epilepsy in dogs
Acquired epilepsy in dogs can develop due to structural abnormalities within the brain (intracranial causes) such as a tumor. Or it may be a result of a systemic imbalance or insult to other systems of the body (extracranial causes).
However, more commonly, when people talk about “epilepsy in dogs,” they are referring to idiopathic epilepsy. With this type of epilepsy, the dog has recurrent seizures in the absence of an identifiable intra- or extracranial cause. In other words, if a dog has primary, or idiopathic, epilepsy, it means the seizures do not occur due to infection, trauma, exposure to toxins, an underlying metabolic disease, or any other recognizable trigger.
Idiopathic epilepsy, which is the most common cause of seizures in dogs between one and five years of age, will be the focus of the rest of this article. Thus, any mention of “epilepsy” hereafter can be assumed to refer to idiopathic or primary epilepsy.
Which dogs are prone to idiopathic epilepsy?
Most dogs are diagnosed with idiopathic epilepsy between 6 months and 6 years of age, with an average age at onset of 2.5 years. Males may be overrepresented compared to females.
The cause of idiopathic epilepsy is proven or suspected to be genetic in nature in a variety of dog breeds, including those listed below. Due to the potential hereditary nature, dogs with epilepsy should not be bred.
- Australian Shepherd
- Basset Hound
- Beagle
- Belgian Tervuren
- Bernese Mountain Dog
- Border Collie
- Boxer
- Cocker Spaniel
- Dachshund
- Dalmatian
- English Springer Spaniel
- German Shepherd Dog
- Golden Retriever
- Irish Wolfhound
- Keeshond
- Labrador Retriever
- Petit Basset Griffon Vendeen
- Schnauzer
- Shetland Sheepdog
- Standard Poodle
- Vizsla
Interestingly, Labrador Retrievers and Golden Retrievers seem to experience seizure onset closer to 5 years of age. This is later than tends to be typical for other breeds.
What are the symptoms of epilepsy in dogs?
Seizures, like dogs, come in all shapes and sizes. Depending on the underlying cause and whether all or only a portion of the brain is affected, symptoms can vary widely between dogs, and even between episodes for an individual dog.
Some of the potential manifestations of epilepsy include:
Focal seizures
An episode that affects a small region on one side of the brain and causes involuntary activity of only one part of the body is called a focal seizure in dogs. The symptoms tend to be more subtle and may include:
- Staring blankly into space (stargazing): It may seem like the dog is looking at something that isn’t there.
- Snapping the jaws together repeatedly (flybiting or gum chewing): Some dogs seem to be tracking and then biting imaginary flies. Others have a repetitive jaw motion that looks like they are chewing gum.
- Experiencing excessive drooling in dogs: There may be more saliva coming out of the dog’s mouth than usual.
- Dilated pupils: The black portion of the eyes may look bigger.
- Altered mental status without completely losing consciousness: The dog may seem confused, become aggressive, or otherwise act abnormally.
Sometimes the dog will just have some of these focal signs. But other times, the focal seizure can progress into a generalized seizure, which we’ll discuss next.
Grand mal (generalized) seizures
Seizure episodes that affect the whole brain (both sides, or hemispheres) are called grand mal or generalized seizures. Grand mal seizures in dogs usually trigger the more traditional signs that we associate with epilepsy, including:
- Wide-based stance and wobbly gait (ataxia): The dog may be wobbly and off balance.
- Excessive salivation: You might find a puddle of drool where your dog had a seizure.
- Involuntary urination and/or defecation: Some dogs lose control of their bowels or bladder during a seizure.
- Full-body tremors or paddling the legs: The dog may be lying on his or her side and shaking or making a running motion with the legs.
- Stiffness affecting the neck and legs: Sometimes your dog will stiffen up, fall over, and then continue to have a rigidly extended neck and legs.
- Loss of consciousness: During the episode, your dog might become unconscious and not respond to stimuli.
Most generalized seizures are brief (less than five minutes), although they may feel a lot longer in the moment. If the dog has a seizure lasting longer than five minutes, this is an emergency called status epilepticus (more on this soon).
Behavior changes before and after the seizure
Prior to an active seizure event, dogs may experience subtle behavior changes during the pre-ictal period or aura phase. This could look like unexplained restlessness or a sudden clinginess.
After the active seizure, dogs usually enter a post-ictal period (recovery period). During this time, they may be lethargic, pant heavily, and drink or eat ravenously.
However, once a dog with idiopathic epilepsy recovers, he or she will be completely normal between episodes. And there can be days, weeks, months, or even years between seizures.
Changes in cognitive function
Interestingly, a study of epileptic dogs under four years old noted that they were harder to train, struggled more to obey basic commands or learn new ones, and had shorter attention spans compared to dogs without epilepsy. These signs of cognitive impairment were particularly likely to happen in dogs who had multiple seizures in a day or a higher frequency and severity of individual seizure episodes.
When are seizures in dogs an emergency?
Seizures can be scary in general. But there are two types of seizure activity that constitute an emergency: cluster seizures and status epilepticus.
Cluster seizures occur when a dog has two or more distinct seizure episodes within a 24-hour time period. Between the seizures, the dog is conscious and acting normally.
On the other hand, status epilepticus is defined as:
- Two or more seizure episodes occurring back-to-back in which the dog does not fully recover from one episode before moving into a new seizure OR
- Any continuous seizure activity that lasts more than five minutes. (Pre-ictal and post-ictal periods don’t count toward that time limit.)
After 30 minutes of continuous seizure activity, the dog is at high risk of brain damage and other systemic effects. Plus, cluster seizures, especially when the dog is having them frequently, may be similarly risky and/or progress to status epilepticus. Thus, cluster seizures and status epilepticus require an immediate emergency vet visit.
Head to the vet after the first seizure
If your dog has a single short-lived (less than five minutes) seizure, he or she should still see the vet. But this is usually less of an emergency than cluster seizures or status epilepticus. Depending on how your dog is acting once the seizure is over and whether you can think of any inciting causes (toxins, trauma, other signs of illness, etc.), the vet may recommend still making an emergency visit or scheduling a next-day urgent visit.
The hard thing about a first seizure is that you don’t know whether there will be a next one, and if so, whether it will be in a few minutes or hours, or not for months or years. Thus, when in doubt (or if you can’t reach your vet), it’s always best to play it safe and take your dog in for a visit immediately after the seizure.
Make a vet appointment if your dog’s seizure frequency, severity, or length changes
If your dog has already been diagnosed with idiopathic epilepsy after the initial seizure and then has more seizures, they are lasting longer, or they seem more severe, it is a good idea to check in with your vet. Your dog might need to start anticonvulsant therapy or have an adjustment to his or her current medications.
How is epilepsy diagnosed in dogs?
Idiopathic epilepsy is considered a diagnosis of exclusion. This means that the veterinarian will run a battery of diagnostic tests to first rule out other possible causes of seizures in your dog. If he or she finds no underlying cause, then your dog’s seizures are likely due to idiopathic epilepsy.
Gathering a history
During the appointment, your vet will take a thorough history. This gives him or her a better idea of any recent changes in your dog’s diet, health status, exercise protocol, or environment that could be related to the seizure activity. The vet may ask about:
- New medications, nutritional supplements, parasite preventives, etc.
- Known exposure to potential toxins
- Recent history of trauma
- Exposure to parasites like ticks (especially for dogs who are not on regular heartworm, flea, and tick prevention)
- Changes to your dog’s personality or activity level
- Newly diagnosed medical conditions
Physical and neurological exam
After the history assessment is complete, the next step is the physical and neurological examination. Your vet will perform the typical nose-to-tail assessment. Plus, he or she will pay specific attention to your dog’s behavior, mentation, gait, stance, and reflexes (including cranial nerves).
Dogs with idiopathic epilepsy should be neurologically normal between seizures. But other causes of seizures may lead to residual issues with the neurological system.
Blood and urine tests
Then, based on the physical exam findings and relevant history, your vet will likely recommend diagnostic tests, including blood tests for dogs and urine tests. These baseline tests help your vet assess your dog’s overall health status. Plus, they are a way to rule out underlying problems like liver disease in dogs, kidney disease in dogs, diabetes in dogs, hypothyroidism in dogs, or other systemic disorders.
In a dog with a normal examination, normal bloodwork, and a history and age that fit with idiopathic epilepsy, the diagnostic process might stop there. However, your vet will likely offer the option of advanced imaging in order to be extra certain there isn’t an underlying cause of the seizures.
Advanced imaging and/or CSF tap
X-rays are usually less helpful for most neurologic disease processes. Thus, your vet may recommend referral to a veterinary neurologist for CT or MRI studies. These advanced imaging techniques are very helpful in isolating structural diseases like tumors.
For dogs whose bloodwork indicates the possibility of infection or inflammation, a veterinary neurologist can also perform a CSF tap to collect spinal fluid for analysis.
What is the treatment for epilepsy in dogs?
Treatment for epilepsy in dogs often involves a combination of medications, nutritional supplements, specialized diets, and, in some cases, holistic therapies. Your veterinarian will be able to guide you on the best treatment choice for your dog’s individual needs.
Generally speaking, the foods, supplements, and natural treatments discussed below are not a replacement for anticonvulsant medications. Rather, they may be a helpful addition for dogs who do not yet need anticonvulsants or are already taking anticonvulsants but could benefit from some extra support.
Epilepsy medications (anticonvulsants)
In most cases, the vet won’t start anticonvulsant medications until the dog has had several seizures or an episode of cluster seizures or status epilepticus. However, this can vary from dog to dog. Starting anticonvulsants earlier may be beneficial for dog breeds who are prone to more difficult-to-control seizures.
Traditional anticonvulsant medications include:
- Phenobarbital
- Potassium bromide (KBroVet®)
- Levetiracetam (Keppra®)
- Zonisamide for dogs (Zonegran®)
- Gabapentin for dogs (Neurontin®)
- Pregabalin (Lyrica®)
- Topiramate (Topamax®)
- Imepitoin (Pexion®)
As with any new medication, you should monitor your dog closely for side effects like lethargy, a wobbly gait, or aggression. If you do observe unusual symptoms, speak with your veterinarian. He or she may recommend holding the course, adjusting the prescribed dose, or transitioning to a different medication.
Some of these medications also require regular lab work to monitor the dog for changes in liver function or to evaluate drug levels in the body. Your vet can guide you on the appropriate testing frequency for the medication(s) your dog is taking.
Expectation management for antiepileptic drugs
It is important to understand that the goal of anticonvulsants is to decrease the frequency, severity, and length of seizures. It doesn’t necessarily mean your dog will never have another seizure.
Around two-thirds of dogs with idiopathic epilepsy will continue to have occasional seizures while on anticonvulsants. And 20-30% of dogs will have seizures that are challenging to control.
Supplements for dogs with epilepsy
Dogs with epilepsy may also benefit from nutritional supplements such as a medium-chain triglyceride oil (MCT oil for dogs). Naturally derived from refined coconut oil, MCTs have many potential benefits for dogs with seizures.
Most excitingly, MCTs may help keep certain brain receptors from becoming overstimulated. This might make seizures less likely to occur. Additionally, MCT oil may help combat the cognitive decline that dogs with epileptic seizures seem to experience. And it provides the brain with an important alternative fuel source in the form of ketones.
A 2020 Journal of Veterinary Internal Medicine study looked at MCT supplementation in epileptic dogs whose seizures were not adequately controlled by anticonvulsants. In it, researchers discovered that the dogs experienced a decrease in the severity and frequency of seizures when eating a diet containing MCTs compared to when eating the control diet that didn’t contain MCTs. (Dogs also remained on anticonvulsants during the study.)
Do not give your dog plain coconut oil as a source of MCTs
It’s important to note that while MCTs are derived from coconut oil, simply adding a dollop of coconut oil to your dog’s food will not provide the same benefit. In fact, unrefined coconut oil is composed of roughly 50% lauric acid, which has been shown to cause digestive upset or even pancreatitis in dogs.
Do ask your vet about giving your dog an MCT oil supplement made for dogs
Instead, one MCT oil supplement option to discuss with your vet is Dr. Buzby’s Brain Boost™ organic MCT oil for dogs. This veterinary-formulated MCT oil does not contain lauric acid, making it a safer and more effective supplement option for dogs. Additionally, since you add MCT oil supplements to your dog’s food, they work with any diet. This includes prescription diets used to manage other canine health conditions.
Remember, as is the case with any new supplement, it is best to consult your vet before starting your dog on MCT oil.
Dog food for epilepsy
Commercially available veterinary prescription diets containing MCT oil and other nutrients with brain benefits, such as Purina® Pro Plan® Veterinary Diets NC NeuroCare®, are also an option for dogs who aren’t already on a special diet for a medical condition.
If your veterinarian recommends a diet transition, gradually mix the new diet in with your dog’s old diet over the first 7-10 days. Since abrupt changes in diet can sometimes cause vomiting, diarrhea, and excessive gas, this slower transition is typically the best option.
Ketogenic diets for dogs with epilepsy
Ketogenic diets (those that generate ketones) are an effective solution for some humans with epilepsy and have mixed results in dogs. The goal of these diets is to increase ketone levels in the body. This may provide fuel to the brain and/or have some anticonvulsant effects. There are two main ways to do this, and they vary in how well they work.
The traditional ketogenic diet is a low-carbohydrate, high-fat diet containing long-chain fatty acids (LCFAs). However, in a study using that type of diet, epileptic dogs didn’t have a significant drop in seizure number. Plus, the researchers ended up stopping the study because some dogs developed pancreatitis, a condition that may be linked to high-fat diets.
On the other hand, diets where some of the LCFAs are replaced with MCT oil show more promise for dogs with epilepsy. This is where diets like NeuroCare come into play. While not a ketogenic diet in the traditional sense, foods like NeuroCare do contain MCT oil, which helps promote ketone production.
If you are trying to figure out what to feed your dog or which supplements to try, the best thing you can do is consult your vet. He or she can advise you on what is right for your dog’s particular situation.
Natural or holistic therapies for epilepsy
For dog parents who are interested in non-traditional options for seizure control, ask your veterinarian for a referral to a holistic or integrative veterinarian who practices Traditional Chinese Veterinary Medicine (TCVM). Holistic veterinarians hold special certifications in various TCVM modalities, which may be beneficial for dogs with epilepsy, including acupuncture and herbal medicine.
As with the other diets and supplements discussed, TCVM approaches are usually an addition to, not a substitute for, anticonvulsants.
A word of caution: I do not recommend shopping online for herbal formulations that make treatment claims for any disease. Just because a product is natural doesn’t necessarily make it safe. Herbs can react with traditional medications and, in some cases, cause more harm than good.
What does monitoring dogs with epilepsy involve?
Once your veterinary team has developed a treatment plan for your dog, the next step is to monitor him or her closely at home. Keep an eye on your dog for potential medication, diet, or supplement side effects. And if you notice any unusual symptoms, please consult your vet.
Keeping a seizure journal
Your vet may also ask you to keep a seizure diary to record episodes that occur at home. It should include:
- Date of the episode
- Duration of each episode
- Symptoms your dog exhibited at the time of the event
- Anything out of the ordinary that happened around that time
- Medications and supplements your dog was taking, and if any of them are new
Usually, you will bring the journal to your dog’s next checkup. But if the seizures don’t seem to be responding to treatment as anticipated, it’s a good idea to contact your vet sooner.
Note: Cluster seizures or status epilepticus are medical emergencies that require immediate care rather than just documentation.
Checkups with the vet
Your vet will likely want to see your dog back for a recheck periodically to assess seizure control and medication side effects. For some anticonvulsants, he or she will also check bloodwork. This is important for making sure your dog’s medication levels are appropriate and that his or her body is tolerating it well.
What is the prognosis for dogs with epilepsy?
For many dogs with idiopathic epilepsy, the long-term prognosis is good with consistent medication protocols and regular monitoring. They may still have a seizure occasionally, but there should be fewer than before.
It’s worth noting, however, that a younger age of onset, higher frequency and severity of episodes, poor medication control, or repeated episodes of status epilepticus all increase the risk that the dog will end up needing to be euthanized due to epilepsy. Additionally, dogs who routinely experience cluster seizures are also less likely to achieve seizure control, regardless of the treatment protocol.
For dogs who don’t respond well to medication, hospice care for dogs can help keep your dog comfortable for as long as possible. And when it is time, in-home euthanasia for dogs can give your family and loved ones the opportunity to say goodbye to your beloved dog in the peace and comfort of your own home.
Partner with your veterinary team
If your beloved dog has epilepsy, your veterinary team has the tools and training to support you both throughout this journey. When something seems off, or your dog’s seizures change in frequency, don’t hesitate to reach out to the clinic. The vet can’t help solve a problem he or she doesn’t know your dog is having.
Also, take heart. So many dogs do go on to enjoy a good quality of life for many years following their initial diagnosis. And your dog can certainly be one of the many who move gracefully into his or her senior years with your loving care.
An update on my friend’s dog
After consulting with her vet and repeating bloodwork to confirm that no other underlying causes were to blame for the most recent seizure episode, my friend was able to start Buddy on Keppra. As a 5-year-old, happy and otherwise healthy dog, he now has the opportunity to enjoy many more good years as part of his third, and forever, family.
Does your dog have epilepsy?
Please share his or her story below.
