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Seizures In The ER
Written by: Natasha D. • 2017 Scholar
HISTORY
Emma is a 16-year-old spayed female mini poodle. Emma has a history of Evan’s Syndrome and cardiac disease. She has experienced 2-3 episodes of twitching over the last 2-3 months. She appeared ataxic and wobbly afterwards but always recovered. She experienced a similar episode in the morning before her evaluation at the doctor occurred.
REASON FOR IVS VISIT
Emma was actively seizing when she came to IVS. She was quickly moved to the back of the hospital for treatment to stop the seizure activity.
PHYSICAL EXAM FINDINGS
Grade 3 left-sided systolic heart murmur.
- Identified when the heart was listened to with a stethoscope. Presents as a whooshing noise and is caused by irregular blood flow. Systolic murmur means the turbulent blood flow is heard when the heart is actively pumping blood out to the body.
Neurologic deficits
- Mentally not all there. Appears as a glazed over look, slow reaction timing, and ataxic. Ataxic is loss of muscle coordination. In Emma’s case, her back legs weren’t holding weight after the seizure episode ended.
DIAGNOSTICS
CBC
- CBC stands for complete blood count. This diagnostic test determines the number of red blood cells (RBC), white blood cells (WBC), and the different types of white blood cells. There are five types of white blood cells: neutrophils, bands, lymphocytes, monocytes, and eosinophils. Emma’s CBC came back in normal ranges.
Chemistry Panel
- This test looks at different organ function based on substances found in the blood. Emma’s BUN, blood urea nitrogen, came back slightly elevated. This shows slight decrease in kidney function. This typically occurs with cardiac failure due to the kidney experiencing a decrease in blood perfusion. This causes the kidney to work at a less efficient rate.
Radiographs
- X rays evaluate organ size, shape, and appearance. This diagnostic test helps rule out a physical abnormality or metabolic source for the seizures. Emma’s right view shows a normal heart shape but her left shows a dilated enlargement. This is the source of her grade 3 left-sided heart murmur.
TREATMENT PLAN
Short-Term Plan
- Diazepam was administered immediately upon Emma’s presentation of active seizing. This drug is short acting and sedates the patient, relaxes their muscles, and has anti-convulsant properties. Although its effect is immediate, diazepam, also called Valium, isn’t a long-term medication due to the animal building up a tolerance to its effects.
- Seizure watch for 24 hours to help determine a source for Emma’s condition. The potential causes include, but aren’t limited to: toxins, infectious agent, inflammatory response, metabolic disease, organ failure, or cancer.
Long-Term Plan
- MRI, or magnetic resonance imaging, can shorten the list of differentials. This diagnostic test can provide more insight into specialized treatment for Emma. If a mass is found, the treatment plan would consists of removing the affected tissue or chemotherapy. This would be different from a metabolic disease, which would result in a different treatment plan.
- Levetiracetam, also known as Keppra, is another drug option. It provides treatment for long term, recurrent seizing patients. The safety of the drug is very good and has little adverse effect. It can work in conjunction with phenobarbital
- Phenobarbital is also a long-term anti-seizure drug. Efficacy, safety, low cost, and dosing frequency makes this barbiturate the first choice for prevention of seizures. Blood tests are required to check the level of phenobarbital in the blood and the function of the liver while on the mediation though.
OUTCOME
Emma went home after being seizure free for 24 hours. She returned with a prescription for phenobarbital and levetiracetam to prevent future seizures from occurring. The cause of her seizures is still unknown though hospitalization and other testing she underwent took a few options off the list of differentials for her. Emma has regained muscle coordination of her back legs and is doing well again!
Sources
Plumb, D. C. (2005). Plumb’s Veterinary Drug Handbook (8th ed.). Wiley-Blackwell.
- Radiographs of left and right lateral abdominal views. [Digital image]. (2017). Retrieved
- July 24, 2017 from IVS Emergency Hospital.
