[Mirinde]

Hi there,

Couple questions: at no point has he spiked a fever? have you been advised to regularly take his temperature? is he up to date on his distemper vaccine? any sign of seizure activity prior to the focal seizures after tooth extraction? seizures can be very, very strange in presentation so think about bouts of unusual behavior as well.

I would take the following course of action:

1. Call your neurologist back and confirm what they would be looking for RE: a repeated MRI. If they have specific things in mind, consider the course of treatment and whether or not you'd be willing to pursue that at his age. Also ask if a spinal tap is warranted in his situation -- causes of encephalitis are regularly treatable. Make the call based on that. We've done repeated MRIs/taps here ourselves. It's a difficult decision to weigh. I'm of two minds -- on one hand, he has not had an MRI since these events have started and things certainly could have changed. On the other, his focal seizures may indeed indicate an underlying low seizure threshold that simply needs management and I'm very reserved in what treatment I would pursue for a nine year old large breed dog if it was something more sinister but you know your dog and his limits best.

2. I think there needs to be some sort of happy medium here between the Keppra and waiting for further information from the levothyroxine, given that your dog is becoming progressively more unhappy and it is not medically advisable to continue allowing these events if they are epileptic in nature. Brain degeneration is a real risk, especially at this age. Epileptic events are not benign to the brain.

Ask your neurologist if clorazapate or clonazepam could be used to get you through the next few weeks until you hit the 6 week mark on levo. There is support for clonazepam specifically here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5508344/ and Mayo Clinic supports it's use as a stand-alone medication for myoclonic issues. These are benzodiazepine that will act fast with a relatively short wean-off period so you won't be stuck on them once his thyroid levels stabilize and you want to isolate that variable again. They may also take the edge off some of the stress he is experiencing.


I hope that is of some help. We haven't dealt with myoclonic episodes but we have one weirdly wired kiddo here and we've been down some strange paths with our vet and neurologist. It's a lot to juggle, and the diagnostics are astronomically expensive. There's rarely a right or wrong decision as long as quality of life is being attended to.

 

[Our3dogs]

I am sorry to hear about what your guy is going through. From my own experience with our 9.5 year old Golden - he started out with the infrequent twitches. He would be sitting there and all of a sudden get the jolt. Maybe not as severe as the ones you are seeing. Just about the time I thought I should bring him in to discuss this with our Vet, he had a major seizure. Even after the seizures, his blood work always looked good. So unfortunately, not always does the blood work tell you anything. We ultimately had to start on phenobarbital to control his seizures. When I discussed all of this with a good friend, who is also a Vet, I asked about doing the MRI. Knowing they are very expensive. She said to me - other than knowing what it is, if it even shows anything, will you be doing brain surgery-no, and the treatment will still be the same (at least in our situation). We opted not to do the MRI. Good luck in what treatment plans you will pursue. I know it kills us to see our fur-kids in these kinds of situations.

 

[PeytonsMommy]

Hi there,

Couple questions: at no point has he spiked a fever? have you been advised to regularly take his temperature? is he up to date on his distemper vaccine? any sign of seizure activity prior to the focal seizures after tooth extraction? seizures can be very, very strange in presentation so think about bouts of unusual behavior as well.

I haven't taken his temp myself, but every time we've been to the vet (both regular and neuro) it has been normal. He is up to date on all his vaccinations. But yes I see where your train of thought is headed and distemper/old dog encephalitis is one of the possibilities that is currently concerning me, if only because that's one of the causes of myoclonus repeatedly listed in my searches. Honestly, the focal seizures following the tooth extraction were really not that bad, but he also had strabismus following the surgery, and we suspect perhaps suffered a small stroke under anesthesia, which is what prompted me to go to the neurologist and confirm everything was ok. His current symptoms are much more consistent and concerning to me.

1. Call your neurologist back and confirm what they would be looking for RE: a repeated MRI. If they have specific things in mind, consider the course of treatment and whether or not you'd be willing to pursue that at his age. Also ask if a spinal tap is warranted in his situation -- causes of encephalitis are regularly treatable. Make the call based on that. We've done repeated MRIs/taps here ourselves. It's a difficult decision to weigh. I'm of two minds -- on one hand, he has not had an MRI since these events have started and things certainly could have changed. On the other, his focal seizures may indeed indicate an underlying low seizure threshold that simply needs management and I'm very reserved in what treatment I would pursue for a nine year old large breed dog if it was something more sinister but you know your dog and his limits best.

I had already asked about the spinal tap, and they said that yes they would probably do it. The unfortunate thing is, I was talking to a receptionist who wasn't really well informed (she had to ask someone else about the spinal tap), when I really wanted to talk to the neurologist (who was unavailable). This is a local specialist who is the only neurologist at the practice and I think perhaps stretched a little thin. I asked if she'd want to see him again prior to scheduling the MRI and they basically told me no, but I would REALLY like to discuss this with her. The neurologist we saw last year for the MRI was at University of Penn. I really liked him, but opted to go locally for this most recent neuro exam because the trip into the city and long car ride stresses Peyotn. Nevertheless, I called Penn this morning after deciding to schedule an appointment with him for a second opinion, but as my luck goes he doesn't work there anymore! So now I really don't know what to do.

2. I think there needs to be some sort of happy medium here between the Keppra and waiting for further information from the levothyroxine, given that your dog is becoming progressively more unhappy and it is not medically advisable to continue allowing these events if they are epileptic in nature. Brain degeneration is a real risk, especially at this age. Epileptic events are not benign to the brain.

Ask your neurologist if clorazapate or clonazepam could be used to get you through the next few weeks until you hit the 6 week mark on levo. There is support for clonazepam specifically here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5508344/ and Mayo Clinic supports it's use as a stand-alone medication for myoclonic issues. These are benzodiazepine that will act fast with a relatively short wean-off period so you won't be stuck on them once his thyroid levels stabilize and you want to isolate that variable again. They may also take the edge off some of the stress he is experiencing.

I actually found that article myself too! But I did not see the part about clorazapate/clonazepam so that is very interesting. We have an appt scheduled at our regular vet Friday to run a blood panel (because I am getting impatient and feel like I need to be doing something to get to the bottom of this) so I will ask her about her thoughts on that as well.

Thank you, you have given me lots of good information! I appreciate it!

 

[PeytonsMommy]

I am sorry to hear about what your guy is going through. From my own experience with our 9.5 year old Golden - he started out with the infrequent twitches. He would be sitting there and all of a sudden get the jolt. Maybe not as severe as the ones you are seeing. Just about the time I thought I should bring him in to discuss this with our Vet, he had a major seizure. Even after the seizures, his blood work always looked good. So unfortunately, not always does the blood work tell you anything. We ultimately had to start on phenobarbital to control his seizures. When I discussed all of this with a good friend, who is also a Vet, I asked about doing the MRI. Knowing they are very expensive. She said to me - other than knowing what it is, if it even shows anything, will you be doing brain surgery-no, and the treatment will still be the same (at least in our situation). We opted not to do the MRI. Good luck in what treatment plans you will pursue. I know it kills us to see our fur-kids in these kinds of situations.

Wow, so was your golden 9 1/2 when he started getting the seizures or is he 9 1/2 now? I'm assuming the seizure medication helped with the generalized seizures, but did it also improve the jerks? I am having such a hard time wrapping my head around the idea that one day he was normal and the next these jerks appeared seemingly out of nowhere. It feels like we're missing a piece of the puzzle...the onset seems so sudden, I keep thinking to myself that there must be a reason. Thank you so much for the information, although I'm sorry you are also experiencing this it's nice to know I'm not alone!

 

[Mirinde]

I haven't taken his temp myself, but every time we've been to the vet (both regular and neuro) it has been normal. He is up to date on all his vaccinations. But yes I see where your train of thought is headed and distemper/old dog encephalitis is one of the possibilities that is currently concerning me, if only because that's one of the causes of myoclonus repeatedly listed in my searches. Honestly, the focal seizures following the tooth extraction were really not that bad, but he also had strabismus following the surgery, and we suspect perhaps suffered a small stroke under anesthesia, which is what prompted me to go to the neurologist and confirm everything was ok. His current symptoms are much more consistent and concerning to me.

For what it's worth, my dog is being treated as though he sustained a brain injury of some kind (whether through the progression of a congenital issue, a life of seizure events, a vascular event, who knows) despite a clean MRI (clean spinal tap as well, though that's irrelevant).

The second comment here is helpful for understanding why some conditions may not show up on an MRI https://www.reddit.com/r/askscience/comments/6s59in/does_brain_damage_from_an_accident_or_stroke/

I can see now why you are so hesitant to put him under for a repeat MRI and that additional information would definitely change my strategy, personally -- especially given the treatment protocols (or lack thereof) for many of these issues. I would treat the seizures, aim to increase quality of life, and monitor at that point if I were in your shoes.

 

[Our3dogs]

Hi Payton's Mom = we were pretty much in the same boat as you are. Our guy was perfectly healthy when the twitches started out of the blue. The first few times when I happened to see them, I just figured a bug or something had bothered him. Then I started to see them on a regular basis. For us, in our particular situation, it was the precursor to a full seizure. Again, when examined by the Vet's (both e-Vet and our family Vet), he was in great shape. He was 9 1/2 when they started. He lived to almost 11 - and passed from bone cancer - not the seizures. Once on the phenobarbital he ceased having the seizures and the twitches. However, at one point a few months later, we had to increase his pheno level as the twitches had started up again. This was an indication to us/our Vet his body needed a higher dose, as we had not started off at the max amount to begin with. When it comes to the twitches/seizures there are so many different things/causes at play that no 2 dogs are alike and it can be very frustrating. Again - good luck to you in your search for answers.

 

[Mirinde]

Hi there Any update on your kiddo? Hope you guys are both hanging in there!

 

[PeytonsMommy]

Hi there Any update on your kiddo? Hope you guys are both hanging in there!

Hi Mirinde...so, unfortunately the myoclonic jerks kept getting worse and I really felt like my best option was to go ahead and put him on the Keppra. At first I was unhappy because he staggered a lot on his back legs, but he mostly adjusted to it after a few days. Although I noticed some improvement, I still saw jerks pretty frequently for about a week. They seem to be much less frequent two weeks in. Last week was the 4 week mark on thyroid medication so we were able to test that, which came back perfectly in mid-range (so, I think it's safe to say unfortunately the hypothryoidism was not the culprit of the myoclonic jerks...I was holding out hope perhaps his body wasn't responding to the medication and that could be still be the cause, but...that's not the case). I also remembered at exactly the time he started having these issues, the formula on his food (Merrick LID Duck & Sweet Potato) was changed to Duck & Chickpeas (and also added some other ingredients that weren't in it before like flaxseed). It seemed suspicious to me, so I talked to his vet and ordered a hydrolyzed protein food, which I was going to start this week, but unfortunately he had one/possibly two (not sure if it was him or my other dog) vomiting episodes, so I have to hold off for a bit on transitioning him to a different food. He also managed to give himself a hot spot on his tail, which he does at this time of year every year, so now he is coned to top it all off! :doh:

 

[PeytonsMommy]

Sorry I accidentally posted the same comment twice and it won't let me delete!

 

[Mirinde]

Hi Mirinde...so, unfortunately the myoclonic jerks kept getting worse and I really felt like my best option was to go ahead and put him on the Keppra. At first I was unhappy because he staggered a lot on his back legs, but he mostly adjusted to it after a few days. Although I noticed some improvement, I still saw jerks pretty frequently for about a week. They seem to be much less frequent two weeks in. Last week was the 4 week mark on thyroid medication so we were able to test that, which came back perfectly in mid-range (so, I think it's safe to say unfortunately the hypothryoidism was not the culprit of the myoclonic jerks...I was holding out hope perhaps his body wasn't responding to the medication and that could be still be the cause, but...that's not the case). I also remembered at exactly the time he started having these issues, the formula on his food (Merrick LID Duck & Sweet Potato) was changed to Duck & Chickpeas (and also added some other ingredients that weren't in it before like flaxseed). It seemed suspicious to me, so I talked to his vet and ordered a hydrolyzed protein food, which I was going to start this week, but unfortunately he had one/possibly two (not sure if it was him or my other dog) vomiting episodes, so I have to hold off for a bit on transitioning him to a different food. He also managed to give himself a hot spot on his tail, which he does at this time of year every year, so now he is coned to top it all off! :doh:

I'm glad the Keppra seems to be helping! I hesitated to say the ataxia improves in my previous posts because I know it doesn't for some dogs but for the vast majority, it really does become a nonissue. Hopefully as those levels continue to build, they will become less frequent. Treating epilepsy is difficult and clunky and many dogs will continue to have periodic breakthrough episodes, but we just do the best we can! Remember in all of this is that seizure brains hate change/stress/input, so move slowly and try to keep things quiet. It's a good excuse to bunker down and relax for a couple weeks

 

[Debbutler55]

Hi Peytons Mommy- how is your Golden doing? My boy Dunkin is 2.5 and our vet is referring us to a neurologist saying its Myoclonic Seizures. I've noticed louder noises cause my guy to twitch, or duck down a little bit.