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EVERYTHING A GENERAL PRACTITIONER NEEDS
TO KNOW ABOUT CANINE EPILEPSY
L. Garosi
IPER/United Kingdom
Qualifications:
Laurent Garosi
DVM, Dip ECVN, FRCVS
RCVS & EBVS specialist in veterinary neurology
laurent.garosi@vetoracle.com
INTRODUCTION
Idiopathic epilepsy is a term that is reserved for patients with chronic,
recurring seizures but no detectable underlying cause; these seizures are
presumed to be genetic in origin. Canine idiopathic epilepsy most commonly starts between the ages of 6 months and 6 years. If seizures start
outside this age range, then it is important to consider the likely possibility
of other causes.
One of the key features of idiopathic epilepsy is the absence of neurological deficits in the inter-ictal period. Therefore, when abnormalities
are present in the inter-ictal period this would usually exclude idiopathic
epilepsy from the differential diagnosis list. However, there are two exceptions to this rule:
Depression of forebrain activity occurs during the period immediately
following an epileptic seizure (so-called post-ictal depression). During this
period subtle neurological deficits, including conscious proprioceptive
deficits, may be evident. Post-ictal depression can last a variable amount
of time, but most cases return to normal a few hours (up to a day) following the seizure episode.
Neurological deficits may also result secondary to severe or prolonged
seizures due to hypoxic injury or the so-called excitotoxicity phenomenon.
Sequential neurological examinations at 2 to 3 day intervals following the
seizure are recommended if in doubt about the origin of the neurological
deficits (i.e. whether they are post-ictal versus relating to a potential
underlying structural intracranial or extracranial cause).
A diagnosis of idiopathic epilepsy therefore requires normal results of
physical and neurological examinations and is essentially a diagnosis of
exclusion.
WHAT MINIMUM DATABASE TO PERFORM?
An extra-cranial work-up is indicated ideally in every seizuring patient.
Baseline blood work should include a complete blood count and fasted
chemistry profile (ensuring blood glucose, resting bile acids, Na+, K+,
Cl-, and Ca2+ are performed) to rule-out systemic/metabolic causes of
seizures. Liver function should be crudely assessed by evaluating glucose,
albumin, urea and cholesterol concentrations. Further liver function tests
such as dynamic bile acids are indicated when there is clinical and clinicopathological evidence of liver disease. Urinalysis is also a key part of this
process with particular emphasis placed on specific gravity, proteinuria
and glucosuria.
WHEN TO CONSIDER FUTHER INVESTIGATIONS?
If any of the following criteria are met in the presence of a normal extra-cranial work-up then intracranial investigation (MRI +/- CSF analysis) is
indicated:
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