STATUS EPILEPTICUS AND CLUSTER SEIZURES

PLEASE NOTE: The following are "textbook" definitions of status epilepticus and cluster seizures. Since every dog is different and every seizure can be different, we have added descriptions from various Guardian Angels so that you can get a better idea of exactly how our own dogs look and act during seizures. Those descriptions follow immediately after the formal definitions. We hope this is helpful to you.

Status Epilepticus:  A life threatening situation that is defined as a seizure lasting 5 to 10 minutes or even 20 minutes, which is an estimation of the duration necessary to cause brain damage. However, treatment needs to begin well before 20 minutes has elapsed. A more practical definition of Status is a continuous seizure lasting at least 5 minutes, or two or more discrete seizures without full recovery of consciousness between seizures lasting at least 5 minutes or more.

Treatment of Status Epilepticus:
As stated above, status epilepticus is a special case where seizures occur one after another without abatement. If these seizures are not stopped, the resultant hypoxia may result in irreparable brain damage. The goal, then, is to stop the seizures. This requires injectable medications: diazepam and phenobarbital from an emergency room or your vet. Although propofol is not an anticonvulsant, it can sedate the patient long enough for phenobarbital to work. Give diazepam (to effect) at 0.5-1.5 mg/kg IV. If the seizures continue, repeat and give both propofol and phenobarbital at 2 mg/kg IV. Remember to check the glucose level and give if low and consider calcium glucconate if the seizure don't seem to be controlled. Once the seizures are under control, the patient should be examined to determine the cause of the seizures and anticonvulsant therapy with phenobarbital and/or KBr continued while achieving the diagnosis.

Cluster Seizures:  Two or more seizures occurring over a brief period of time (minutes to hours) but with the patient regaining consciousness between the seizures.

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Seizure descriptions provided by Guardian Angels

Mary Jane and Maggie May (Beagle):

Typical Clusters:  As I have always been right next to Maggie during the initial seizure, she will come toward me or look to me and have that “glassy” look in her eyes. If she is standing or sitting upright, I will ease her down into a recumbent position. At this point she is salivating and typically loses bladder control. Maggie’s head is always bobbing at this point. Maggie will grow rigid now and be unresponsive. She has complete loss of consciousness. She proceeds to the tonic-clonic phase. After this initial seizure (3-10 minutes), Maggie will have a period where she is coherent but never attempts to get up (20 minutes – 1 hour). At this point Maggie has frequent (up to 25) tonic-clonic phases of short duration (10-20 seconds). Maggie is recumbent during this entire time (2-2 1/2 hours). Maggie vomited just prior to the tonic phase during her last two episodes.

Maggie has received Valium at the onset of each episode. I can only say what her post-ictal behavior is with the Valium. She has exhibited exhaustion, drowsiness, pacing (only once), increased hunger, and increased clinginess.

Maggie also exhibits muscle twitching (front legs) up to 2-3 days post-ictal. This could possibly be from the Valium. Maggie receives either iv or rectal Valium as well as oral Valium for 24 hours (Valium Protocol). For more information about Maggie's seizures, click here.

Nancy and Tahoe (Australian Shepherd):

Tahoe, being an Aussie, has seizures that are very hard to control. Border Collies also have seizures which are hard to control. Tahoe has always had seizures every 14 to 20 days and at least 3 seizures in a cluster within a few hours. Early on with Tahoe's epilepsy he would have a grand mal seizure that lasted anywhere from 1 to 4 minutes. During the seizure we would see an array of behaviors... from simple shaking to paddling, rigid and twisted body, mouth snapping, salivation, choking sounds, and loss of urine. Then he would lie there slowly paddling. Afterwards he would have a period of time in between where he would come out of it, get up and then usually he would go down again in another seizure. This would be repeated and then there was always a third seizure. This was prior to a vet allowing us to treat him at home with rectal and oral valium.

Once we had the rectal and oral valium we were able to stop cluster seizures from happening for 4 years. Last year Tahoe had one episode where he started clustering with 2 seizures a day, 12 hours apart for 2 weeks straight. He had been given valium but it took Clonazepam to break that particular cycle.

Cluster seizures and Status can be a life threatening situation. A prolonged seizure (Status) can cause brain damage or death. Some pups, once they start to cluster, can be hard to control and could end up in a Status situation. This is why the rectal and oral valium protocol is so important to use.

Luckily for Tahoe, he only had one Status situation before we started using the valium protocol. He spent 4 hours at the vets on a valium IV to stop the Status. I know that by treating him at home with rectal and oral valium we have avoided Status on several occasions.
 

Cathy and Zak (Lhasa Apso):

Zak's seizures started with him having just one at a time but within a few months he started having clusters. During these first months he was put on Pb. The seizures would come every ten days to two weeks and every time he would have another seizure our vet would increase the Pb. When the clusters started they were very violent and they totally wiped Zak out for days. The Pb simply wasn't working to control Zak's seizures and he was having more and more seizures with less amount of time between episodes. Our vet, that we had at the time, did not give me much encouragement for finding a way to
help Zak; he felt we would continue doing what we were doing and when it got too bad we would have to put Zak to sleep.

Eight months after Zak's seizures started he had his one and only status episode. It is without question the most terrifying experience I've ever had. I will note here that this is before we found the Guardian Angels and I had NO knowledge on how to stop this cluster. Always before Zak would have three, maybe four seizures and then they would stop. But this time they just kept coming, and coming, and coming. Our vet was not available and the only other vet in our community wasn't available either. We live in a small rural community and the closest ER was 70 miles away!! After wasting precious time trying to find someone to help we decided that if we didn't get started to the ER, Zak was going to die. In the two hours that Zak was having one seizure right after another, he must have had 60, 70, or more seizures. He had bit his tongue, he had bit me (we were both bleeding), he had urinated, he was foaming at the mouth, his eyes were rolled back in his head, he was burning up with a temperature...the hour that it took us to drive to the ER was terrifying!! Zak had seizures all the way until we got about 10 minutes from the ER and he just went limp in my arms. I thought he had died but we continued on to the ER.

The ER vet rushed to our car as we pulled in the parking lot and as I handed Zak to him, I told him I thought he was already gone, but as he was running inside he said he thought he was still alive...and he was as he started to seize again and again. The ER vet was very young and the first thing he ask me was if I had given Zak any valium. Within just a few minutes in this ER clinic talking with this very young vet, with my Zak very close to death, I started to learn how to deal with and handle cluster seizures. Zak was put on a valium drip and the seizures finally slowed down. Within the days after this episode, Zak continued to have seizures, but they were much milder and they got further and further apart. It was during this time I found Joanne on the internet and was able to learn about the valium protocol. I found a vet that was able to help me with the valium protocol and was willing to help me explore alternate treatments for Zak...through which we were eventually able to reduce Zak's Pb and we added Kbr.

It took Zak a long time to recover from this episode. I feared for weeks that Zak had brain damage. He was so weak, he was so lethargic, he simply wasn't the pup he had been before this episode, but Joanne kept telling me to not give up and she was right...slowly Zak got better and returned to his normal self.

Since this episode and learning about the valium protocol Zak has never had another cluster seizure!!