Seize Her Seizure, Caesar


Hello Bored Surfer! Thank you for joining me for another informative and amusing edition of BLOG blog!

July is here, which means a hot, noisy summer month in North America (and the cold season for those of you in the Southern Hemisphere). If you had exciting plans for this year, they have probably been postponed. So, while you are at home, relishing the magnificent invention of Willis Carrier (or the portable version created by Frederick McKinley Jones), I would like to offer a few occasions to consider celebrating. From the noble cause of July 11th (National Cheer Up the Lonely Day), it is only one small step to National Moon Day on the 20th. The 5th is listed as Workaholics Day, but that doesn’t sound like a fun way to spend a Sunday. July 10 is Clerihew day, named after a poet who created a style of amusing poetry that consists of 2 rhyming couplets. Here is one example, penned by Kim Merryman:

Julius Caesar
Had a few seizures
Great Leader of the Roman Empire,
On the Ides of March, he expired

You undoubtedly have at least a passing familiarity with Julius Caesar. As the dictator of Rome (before it became the Roman Empire), he was rather famous in his own time (years 100- 44 BCE), and his name persists to this day. This month was named for him, even if the orange drink was not. ‘Caesar’ started as his name and became a job title for his successors. Nowadays it adorns various things, including a medical procedure (that his mother did not have), a salad, a pizza-pizza chain and a casino as well as providing the basis for words like Czar and Kaiser.

Seizure can refer to taking something by force or a sudden attack of illness. Julius Caesar provides an example of both. His military conquests (his personal conquests are well beyond the scope of this blog) are well documented. There were also four occasions where he had attacks of “the falling sickness”, or so we are told. While these episodes have long been attributed to epilepsy, in 2015 a theory was posited that his symptoms may have been caused by multiple Trans

Ischemic Attacks (aka TIAs or mini-strokes). There is some overlap between symptoms, even though they have different origins: seizures are due to increased electrical activity and TIAs are due to cardiovascular dysfunction.

Seizures caused by a sudden uncontrolled electrical disturbance in the brain may not be subject to the 4th Amendment, but they are the subject of this month’s composition. Other names for a seizure include fit, spell, convulsion, spasm, paroxysm, raptus and ictus. Also, please note that the present participle verb form is ‘seizing’.

“No one is so brave that he is not disturbed by the unexpected.” This quote from Julius Caesar is here to remind you that seizures are alarming - especially the first one. I shall now attempt to demystify them and prepare you for a potential encounter.

In humans, 4 stages of a seizure have been described. Hours (or even days) before the seizure event, some people enter a Prodromal stage and experience mood and behavior changes. The Aura is actually an early stage of the seizure and can feature unusual sensations of sight, sound, smell, or taste as well as numbness, tingling, pain or twitching of the limbs. It can also include hallucinations, déjà vu (the feeling that something is familiar, even though you have not experienced it before) or jamais vu (the feeling that something is not familiar, even though you have experienced it before). Although they cannot report these sensations, animals (and non-verbal humans) occasionally exhibit some behaviour changes prior to a seizure, and likely experience at least some of these phenomena.

The Ictal stage is the seizure itself which can manifest in a variety of ways. If only one cerebral hemisphere is involved, it is considered a focal (aka petit mal) seizure. In this situation, the patient usually remains conscious. They can exhibit signs ranging from seeming dazed to making chewing motions to episodes of abnormal (often aggressive) behavior. More well-known, as well as more obvious to the casual observer, is a generalized (aka grand mal) seizure. This type involves both cerebral hemispheres and is characterized by a loss of consciousness and violent muscle contractions. They may also be described as tonic-clonic seizures, which describes the stiffening of muscles (not a carbonated beverage in New England) and the twitching movements (not a reference to a genetic copy).

The Postictal stage may last from minutes to hours after the seizure episode and commonly features drowsiness, confusion, memory loss, headache, body soreness, nausea, thirst and general malaise.

Seizures are a symptom, not a disease, and can be caused by a variety of factors. While the seizure itself is an electrical disturbance within the brain, the inciting cause can originate inside or outside the brain. While many of these causes can affect multiple species, I will focus primarily on the raptus conditions of dogs and cats.

In some cases, the brain itself is normal, but other factors lead to a disturbance in the electrical signals. Toxins can be one such factor. Strychnine is obviously poisonous. Medications, especially if given at the wrong dose or to the wrong species can also have adverse effects. One all-too-common example of this is when cats are exposed to certain flea/tick preparations that are meant for dogs. There are also toxic plants like mushrooms and blue-green algae. Foodstuffs containing xylitol or high levels of dark chocolate can also be problematic. And should you happen to have any mind-altering substances in your possession, please secure your stash. Ironically, there is a cannabidiol drug approved to treat certain forms of seizures in humans, but seizures can be a symptom of marijuana poisoning in pets.

Changes in metabolism is another subset of causes. This includes disruptions to the body’s maintenance of glucose, calcium or sodium levels. Severe liver disease can cause waste products to build up in the bloodstream, which can lead to neurologic signs.

Infectious agents can also infiltrate the nervous system and wreak havoc. They cause conditions like Toxoplasmosis (caused by the protozoa Toxoplasma gondii, no relation to Gandhi) and Cryptococcosis (caused by the fungus Cryptococcus neoformans, no relation to the Cryptkeeper, although may have been a fun guy). There are also viral diseases like distemper in dogs and Feline Infectious Peritonitis in cats that can cause paroxysms. Of course, no list of infectious animal diseases that affect the nervous system would be considered complete without a mention of rabies. Puppies that are “just weaned” may have had one set of vaccinations, but will need boosters. Also very important to know is that the first rabies vaccination is not given until they are a minimum of 12 weeks of age.

An electric shock (from a run-in with a light socket or power line or electroconvulsive therapy) can alter the brain of any species. Photosensitive seizures, caused by repetitive visual effects, occur in humans and baboons but are not prevalent in dogs and cats. To be on the safe side, however, you probably should limit their exposure to Pokémon marathons on TV.

There can also be structural problems within the brain. This can be due to congenital malformations (like hydrocephalus or an incompletely absorbed fetal twin), traumatic brain injury or a tumor.

There are many instances where a probable cause is not determined. This is not justification for Stop-and-Frisk (there is none). Rather, it is a condition called Idiopathic Epilepsy, which I shall hereafter refer to simply as Epilepsy. In case you are wondering, yes, idiopathic does share an etymological bond with the word idiot. The Greek word idios means “of one’s own”. Combining it with pathos(disease) creates a term for an illness that is not connected to a particular cause. Using it to describe a person (idiotes) originally meant the subject was a private person who did not take part in political affairs. The derogatory connotation came later.

Epilepsy is “a common brain disorder that causes repeated seizures” per the Centers for Disease Control. (We interrupt this BLOG blog to take a moment to express appreciation for the CDC and the plethora of other public health agencies whose best work often goes unnoticed. Now, back to the regularly scheduled ramblings...) While the exact cause is unknown, there does seem to be a hereditary component to epilepsy. Purebred dogs in general, and some breeds in particular (including the Australian Shepherd, German Shepherd, Border Collie, Belgian Tervuren, Vizsla, Shetland Sheepdog, Beagle, Labrador and Golden Retrievers) are predisposed to the condition. Please note that the wolf-Malamute hybrid at the research outpost in Antartica may have started shaking dramatically before it sprouted flagella and crab legs, but the condition in question was decidedly not epilepsy.

As you have probably deduced, discerning the precise cause of a seizure can be difficult. The first step is discussing the symptoms and medical history.

Next is an examination of the patient to observe any visible neurological deficits. Then come blood tests to look for signs of infection or metabolic abnormality and to assess organ function. At this point, the physician treating a human patient would probably order further testing such as an EEG, CT and/or MRI. Depending on the cost and availability of such testing, veterinarians may (and often do) forgo these procedures and progress directly to the discussion of treatment.

Ideally, an underlying cause is found and addressed. Realistically, this is not the most common scenario. Frequently, we rule out as many potential causes as possible and then proceed to treating the epileptic symptoms.

The treatment for epilepsy is primarily pharmaceutical. Anti-seizure medication is given orally, often multiple times a day. Depending on the medications used, bloodwork may be required to assist in assessing the appropriateness of the dose.

Depending on the particular condition of your pet, medical treatment may not be immediately necessary. If the seizures are short in duration (1 minute or less) and infrequent (more than 1 month between occurrences), the benefits of treatment may not outweigh the cost of twice-daily pills and possible liver damage. This is an important discussion to have with your vet.

You provide an invaluable contribution to your epileptic pet’s care by monitoring their actions and administering medications as directed. Please record any and all seizure activity you witness. Try to document the length of the convulsing and any after-effects as well as the date, time, location of the incident and any possible precipitating factors/triggers. If you notice a pattern of increasing frequency or severity, please notify your vet.

Hopefully you now have a better understanding of seizure disorders in general. Now it is time for the practical steps you can take if your pet should have a fit.

You may notice some behaviour changes, such as increased clinginess, beforehand, you may recognize them in retrospect, or there may not be any warning.

Your pet may suddenly fall over and start shaking violently and flailing its limbs. Seizures can also occur when your pet is resting comfortably or sleeping. It may seem to be one of those ‘chasing rabbits’ dreams with little foot twitches and small noises, but on a much larger scale. They may vocalize loudly (and usually rhythmically). Drooling is not uncommon, and does not mean they are rabid. They may also temporarily lose control of their bladder and/or bowels.

This can be very disturbing to witness, especially if you have never seen it before. Do your best to remain calm. Keep in mind that your pet is unconscious and not in pain, no matter how horrible it may sound.

Safety is important for all parties involved. If your pet has a spasm at the top of the stairs or in the middle of the street or some other potentially hazardous site, try to move them to a safe area to prevent further injury. Be very careful during this process to avoid being unintentionally bitten.

Provide what comfort you can. Cushion their head (while avoiding the mouth) and gently hold them until they regain consciousness.

If you have the wherewithal (or another person present) to monitor the time and record the incident, please do so. It may only last a minute or so, but it seems like an eternity when your beloved pet is in the throes of ictus.

Be aware that while an occasional seizure is disconcerting, some circumstances are true emergencies and require immediate medical attention. These particularly worrisome conditions include: a known traumatic cause (head injury, electric shock, recent exposure to a toxin etc.); any seizure that lasts for 5 minutes (or longer); or more than one seizure within a 24-hour period (aka a cluster). Any of these cases require a trip to the vet (or vet emergency clinic) as soon as possible.

Hopefully you will not encounter this situation, but if it should happen, at least you will be equipped with some knowledge. On any subsequent occurrences, you will definitely be prepared because, according to Caesar, “Experience is the teacher of all things”.

This concludes this month’s edition of BLOG blog. I hope you found it delightful and insightful and will join me again next month.

Stay cool, Bored Surfer!
Dr. Debbie Appleby