3. Eplilepsy in an older dog

Epilepsy - 7-year-old Miniature Bull Terrier
Baxter's History

May 14, 08. One fit. I asked the owner to consult the competition. He said that there was nothing abnormal in Baxter's blood test and examination. The vet prescribed phenobarb 30 mg and advised 2.5 tablets 2 times per day for 2 weeks. The owner was told that Baxter would need the drug for life. Baxter did not complete the 2 week of medication. As to the cause of this fit, it was not possible to pin point. The owner had antibiotics given. I advised dental examination under general anaesthesia some months before and even after the first fit to remove bacteria multiplying in Baxter's mouth. Baxter had objected to any mouth touch and always looked lethargic with his head down whenever I visited his owner at the office.

As there was the possibility of deaths under general anaesthesia, the owner was not keen on my recommendation. More than one year ago, I had extracted 9 decayed teeth from Baxter under general anaesthesia but the bad breath had returned in 2008. Baxter is fed mainly home-cooked food. His coat condition is normal. His weight is normal and he exercised with his owner by jogging every morning around Mount Sophia area. Therefore hypothyroidism as a cause of his lethargy was ruled out.

Aug 9 08. National Day, Singapore
Baxter At home
2.30 pm lst fit (Stesolid rectal tube with 5 mg diazepam gel given by owner) > 45 sec
10.30 pm 2nd fit (Stesolid rectal tube with 5 mg diazepam gel given by owner) > 45 sec

Aug 10 08. Sunday
Baxter At home
7am 3rd fit (toilet roll into mouth to prevent tongue biting). 8 am 4th fit
8.30 am 5th fit
10 am 6th fit
Shorter 15 sec. Massage his shoulder and talk to him
Sutffed thick towel into mouth to prevent tongue biting.
Owner wanted to observe duration of fits. Noted shorter duration of fits when he massaged the dog.

Aug 10, 08.
Baxter at Toa Payoh Vets at 2 pm
2.10 pm IV catheter inserted. Took blood samples. Took urine sample via catheter.
2.15 pm IV 5% dextrose saline 200 ml
3-4 pm General anaesthesia gas. Extracted 20 loose teeth.
6 pm 7th fit of <20 seconds

Aug 11, 08.
4 am 8th fit (rectal diazepam)
7 am 9th fit of <20 seconds
10 am 10th fit of <20 seconds
2 pm 11th fit (diazepam 15 mg IM).

Aug 12, 08.
No fits
3 pm Jaws chattering (diazepam 15 mg slow IV drip).

Aug 13, 08.
No fits
8 pm Goes home.

Thur Aug 14, 2008
9 am Phoned owner. No fits overnight.
1.30 pm Visited Baxter at owner's office in downtown
Baxter quiet under the table
Had phenobarb 30 mg x 1, KBr 200 mg tablet x1 at 3pm, 9.30 pm on Aug 13, and at 9.30 am on Aug 14.
No fits since discharge from surgery on Wed Aug 13, 2008 at 8 pm. Drowsy.

Polyphagia. Owner said: "Dog is very hungry. Tried to topple the food container last night. Followed me everywhere." "Hunger is a side effect of medication," I advised.

Less lethargic. Owner said: "I notice that Baxter looks more alert and not so sleepy after extraction of his 20 loose teeth." This was despite phenobarb medication which causes drowsiness. I had noticed Baxter being very tired looking for past months and had a foul breath and did not permit anyone to touch his mouth.

Cause of epilepsy. Owner wants to know what is the cause of Baxter's epilepsy.
"Many causes of epilepsy in dogs are unknown and the epilepsy is termed idiopathic epilepsy," I said.
"Various causes of epilepsy include hereditary causes in dogs less than 5 years old but Baxter is 7 years old, damage to the brain by injury, toxins and diseases. In Baxter's case, total white cell count from blood sample revealed higher than normal. I believe it would be that Baxter's brain was infected. Encephalitis caused by bacteria leading to high fever and convulsions on National Day. The most obvious location of bacteria would be from the mouth. 20 loose teeth with exposed roots were infected and extracted. Also, the extreme pain in his mouth may finally aggravate his fits."

One of the tips of Baxter suffering from severe mouth pain when the owner said: "Baxter cries every day when he opens his mouth." Ms Tan, the 2nd year Victoria College student did mention it in her report which I asked her to write.


Advised him to reduce dosage by half the amount from 9.30 pm on Aug 14, 2008 and wait and see if there are fits. Best is to give the least dosage that is effective as dog gets hungry and sedated with phenobarb.

AN INTERESTING REPORT ON BAXTER WRITTEN BY MS TAN XINRU,
A 2ND YEAR VICTORIA JUNIOR COLLEGE STUDENT
SEEING PRACTICE AT TOA PAYOH VETS

Sunday August 10, 2008

A bull terrier was brought in later in the afternoon for a blood test. His stomach hurt when touched and could only be carried at the shoulders and hind legs. It had suffered from fits in May and had a relapse yesterday. The previous blood test at Mount Pleasant showed no anomalies. The fits last around 30-45 seconds and subsided when some medicine was inserted through the anus. It lasts 8 hours before the fits return again. His spine was prodded and the dog whined when the middle back was pressed, indicating pain, as when the stomach was pressed. Blood samples were taken (3 tubes) and sent to the lab. Two samples were taken to verify the consistency of the results. The dog yelps in pain when it yawns, not surprising when you look at the state of its teeth. Most were rotting away. The teeth were extracted as quickly as possible, gassing the dog at intervals to minimise the pain. The pain from the decaying teeth could be cause of the fits. A urine sample was also taken, which hinted at a problem in the kidneys. After the majority of his teeth were removed, the remaining were scaled. The dog was then put on a drip and left to rest. However, he had a fit about an hour later.