"Alternative" therapies

People have sought to help their pets with their ailments since ancient times, but we have learned much since those times.

Epilepsy can be a frustrating disease since in a few cases available therapies don't work well or have adverse side effects. This can lead owners to search for alternatives which might better help their pet. These may include treatments such as acupuncture, herbal remedies, homeopathic preparations or magnets. In the words of one philosopher, "there are only two types of therapies: those that work and those that don't." Labeling a therapy as "alternative" or "conventional", "homeopathic" or "allopathic" only sidesteps the real question: Does it work?

Epilepsy can be a highly variable disease. We routinely see epileptics who appear well controlled suddenly have a terrible month and conversely see epileptics who have been chronic problems suddenly smooth out and do well for a while. Such variability makes it easy to be fooled into thinking that a treatment is working or not working if we take too narrow or short term look at a therapy.

As a case in point, we recently evaluated a new treatment for epilepsy that theory and experimental studies suggested might be a good treatment. One of the first dogs we tried it on was a Labrador Retriever who was having severe seizures in spite of everything we'd tried before. The dog went 6 months without a seizure and we thought we were on to something. So we tried the treatment on more dogs. It failed miserably from then on out, including the first dog who did so well initially. We can't say why it seemed to work initially, but it was clear by looking at a number of dogs over a period of time, that it wasn't a therapy that worked. Thus the only way to say if a therapy is truly effective or not is to conduct a clinical trial and objectively see how it performs.

Most promotions for alternative therapies rely on testimonials; a few people's stories of how the therapy worked for them. This sort of approach leaves important questions unanswered.

• How was the initial diagnosis established? We've had people bring in everything from cats in heat to dogs with ear infections and say their pet was having seizures when really something else was going on.
• What criteria was used for "success"? If the dog only went a month or two seizure free, that may just be the natural variation of the disease and not an effect of the treatment.
• How many animals were treated and didn't respond? This critical piece of information is always conveniently overlooked in testimonial promotions. They quote the owners of that Labrador when he was doing well and forget the other 12 cases that did not succeed.
• How was the "placebo effect" controlled? People want to believe that the new therapy will be the answer for their pet. Thus even if the treatment is a placebo (a sugar pill or some other treatment that has no real effect), you typically see up to 30% of the animals improve. This is simply because we want to believe in the new treatment, and that colors how we look at the results. This is especially true if there is no firm measure of success established, and we rely on a subjective impression of whether the seizures are getting better or not.

"There must be something to this ancient wisdom"

The herbalist lore began with people's attempts to treat disease with the tools available. Much of our modern knowledge of therapy evolved from these treatments. It was clear that willow bark (aspirin) relieved pain, that foxglove (digitalis) helped heart disease, or that ma huang (ephedrine) relieved congestion. People attempted to explain these observations based on the knowledge of the time and developed theories that the shape of the plant somehow determined what effect it would have or that the treatment altered the flow of some unseen energy or "humor".

Much of this ancient wisdom was, however, founded on ideas that had little basis in fact. Keep in mind that the same ancient wisdom that discovered ephedrine also maintains that rhinoceros horn cures impotence, pushing that species ever closer to extinction. The same ancient wisdom that discovered digitalis also maintained that blood letting was good for just about anything. After a while, people began to realize that blood letting was usually doing more harm than good, and to question why aspirin helped pain and why digitalis helped heart failure. The result was modern medicine where therapy is based on understanding as best we can what is really happening to the body in a disease and doing what we can to maintain health.

That understanding doesn't come easy. It is simpler to fall victim to wishful thinking that there is something mystical to these herbs and treatments that we don't need to understand. Still, we can use what was truly wise from these ancient treatments without turning our backs on the more recent wisdom.

An open-minded clinician doesn't reject a new approach to a problem just because it is different, but a wise clinician does not accept a new approach just because it is different. Some unconventional approaches (e.g. the ketogenic diet) are based on sound reasoning and show promise. There is ongoing research into herbal remedies to see if there are truly active compounds in the plants which could help. In general, whenever someone claims to have a new therapy of any kind for epilepsy, be it conventional or not, we take the Missouri philosophy - "Show me!"

"If it's natural, it must be safe"

Sassafras makes a delicious tea and was recommended as a tonic for a number of ailments. Trouble is, one of the major ingredients in sassafras causes liver cancer in rats. We tend to think of toxins as industrial chemicals, but plants were the original toxin factories. They produce a wide array of toxins either to protect themselves from being eaten, or simply as a byproduct of their everyday living. There is no way to know that this danger exists from looking at the plant, or tasting it, or even seeing what happens to someone who's just drunk sassafras tea. Only by scientific studies was it shown that this danger lurks beneath the sweet taste of sassafras. Granted, people aren't rats, but would you want to bet your liver that we're that much different?

Digitalis was long the mainstay of treating heart conditions, but it wasn't easy. There was a fine line between enough digitalis to help the heart and too much which could kill the patient. Many things can influence how much digitalis is in a foxglove extract. The potency was influenced by everything from the stage of growth when harvested, the weather conditions during growing, and the amount of insect damage the plant suffered; to the way the extract was prepared, and how long it has been stored. Thus extreme care had to be taken to ensure that the amount of digitalis that was given was indeed what we wanted. By looking at how digitalis both helped and hurt, we've been able to develop new drugs which can improve heart disease without some of the risks inherent to digitalis.

While some herbal preparations may be completely harmless, if they truly have effects on the body, there may also be harmful side effects. Drugs are only approved by the Food and Drug Administration after safety studies have established what side effects might be expected from the drug. Such studies are not done for "alternative" therapies and there is no guarantee that they will be safe. We recently saw an epileptic dog who was being treated with an herbal preparation which contained bella donna extract. The active drug in bella donna is scopalamine which has been evaluated by the FDA and shown to cause seizures! Not exactly a wise treatment for an epileptic.

Some alternative therapies, such as acupuncture, massage or magnets, have little potential to do harm in and of themselves. The danger lies in being lulled into rejecting a more rational approach to treating the problem. We tend to take modern medicine for granted and when the seizures finally abate, assume it was the acupuncture rather than the phenobarbital that was also used.

So be skeptical of claims for success with epilepsy treatments. Any treatments we recommend for our patients are backed by studies proving their effectiveness and carefully assessing their side effects. Don't settle for anything less.

Living with an epileptic pet

Most importantly, LIVE

Epileptic pets can lead happy, fulfilling lives.

Do what's enjoyable; all the things that make anyone keep a pet. You may need to make some adjustments to avoid dangerous situations, but go have fun with your companion! Concentrate on the time your pet is happy and doing well, rather than dwelling on the small percentage of time when there are problems.

Most epileptics pets can live relatively normal lives. We can successfully control epilepsy in over 2/3 of the cases. These dogs may require daily medication, but they can still run and play and love. Even the best controlled epileptic will still have some seizures, but usually we can keep their occurrence down to a tolerable level. The number of dogs who have serious side effects from the medications is very small. Some may experience sedation, but this does not prevent them from being loving companions. They don't need to stay awake in class or behind the wheel, so if they need an extra nap in the afternoon, who cares!

Unless the seizures are due to low blood sugar or heart disease, there is no reason to restrict exercise in your pet with epilepsy. While swimming carries some risk of drowning should the dog have a seizure while in the water, most seizures occur when the pet is relaxed and quiet or sleeping. Thus the odds of having a seizure while swimming are pretty remote. Canine life vests are also an option.

An epileptic needs a high quality, balanced diet. Any top quality commercial dog food will supply the needs of your pet. Diets based largely on table food or less expensive commercial foods may require supplementation to maintain optimum health in your pet. Consult your veterinarian for specific recommendations.

Keep records of seizures

Accurate records will help your veterinarian judge the effectiveness of the therapy.

Keep a notebook or a calendar where your family can record when your pet has seizures. The goal of therapy is to reduce the number and severity of the seizures. The only way we can judge whether we are reaching those goals is if we know how frequent and how bad the seizures have been. Relying on memory isn't sufficient since it might be six months from now when we're deciding how to alter the medication. Write things down as they occur.

Be conscientious about treating

Treating epilepsy isn't like treating many other conditions. Missing a dose or two of the medication could have dire consequences. Be sure you have a routine for giving the medication and know who's responsible for giving it. If more than one person in the family may be giving the medication, use a "weekly pill box". These are plastic boxes available at your pharmacy which contain a compartment for each day of the week. Simply load the week's medication in the compartments and then you will know if the medication has been given or not. When you go out of town, be sure the boarding kennel or pet-sitter knows how to give the medication properly. Plan ahead so that you never run out of medication. You don't want to be down to one pill on a Saturday night and be frantically trying to get the prescription refilled on Sunday morning.

Occassionally your pet may vomit right after receiving the medication. We generally recommend waiting a while so that they don't just vomit again, and then giving the medication again. Usually we are more concerned about them missing a dose than we are about giving a double dose. If in doubt about whether to repeat the medication or not, consult your veterinarian. Vomiting can also be a side effect of the medication, so consult your veterinarian if the vomiting continues. If your pet is unable to keep things down, they may need to get injections of their antiepileptic drugs to keep from having seizures.

When you come for a recheck

Recheck visits are required to monitor the pet's progress.

Regular rechecks are essential to succesfully treat epilepsy. At the very minimum, your veterinarian will need to evaluate your pet once a year. More commonly, two or more rechecks a year are needed. We can do our best for your pet if you prepare for your appointment. Here are some things you can do to help.

• Hold them off food that morning. If blood tests are performed, they will be more meaningful if the pet has been fasted. If your pet is a toy breed with low blood sugar problems, a diabetic, or has other problems which might make fasting dangerous, consult your veterinarian first.
• Schedule the appointment so we can measure trough blood levels. Sometimes we will see them first thing in the morning and give their medication immediately after the blood is taken. Other times we will schedule them late in the day and get the blood before the evening dose.
• Bring your records. Your veterinarian will need to know how the pet has been doing to decide whether adjustments in medication are necessary.
• People often worry about how their pet will live with the disease and how bad the side effects of medication may be. Share with us your story ... Tell us about your life with a successfully controlled epileptic pet in the CEN Discussion Forum.

What do you do if your pet has a seizure?

DON'T PANIC!

Most seizures will be very brief. They may seem to go on forever, but the average seizure lasts less than 2 minutes. Looking at a clock and timing approximately how long the seizure lasts will be helpful. By observing exactly what your pet does during the seizure, you may be able to provide your veterinarian or the neurologist with important clues to what is going on, so watch carefully. Make certain the dog is safe, that they won't fall down stairs, bang into a sharp edge on the furniture, get tangled in an electric cord, or otherwise injure themselves. They will NOT SWALLOW THEIR TONGUE. They will frequently chomp their jaws so if you try to pull the tongue out either you or their tongue is likely to be bitten. KEEP YOUR HANDS AWAY FROM THEIR MOUTH.

Your veterinarian may recommend giving diazepam (either rectally or orally) or extra oral phenobarbital if the dog seizes. If giving oral medication, first be sure the dog is awake enough to swallow and aware enough to not bite. Often they will be hungry immediately after a seizure and adding the medicine to a ball of food can be an effective way to give it. If lower blood sugar is suspected as a cause of the seizure, your veterinarian may recommend giving some honey or corn syrup to bring the blood sugar up quickly.

The altered behavior following a seizure (post-ictal behavior) can often be as disturbing as the seizure itself. Most dogs will appear disoriented and blind for a period up to several hours after the seizure. Usually just leaving the pet alone and ensuring that they won't injure themselves until they get back to reality is the best approach. Sometimes reassuring words and petting can calm them; other times they are oblivious to our attempts to help. Rarely dogs can become irritable during the post-ictal phase. If your dog is very agitated or irritable, be careful, especially if children are involved, since the dog may snap even if they normally wouldn't do such a thing. Don't attempt to hug or hold them still if they are behaving this way.

When do you seek immediate care?

If your pet has a seizure that has lasted more than 5-10 minutes without stop, they need to be seen by a veterinarian immediately. Within 30 minutes of continuous seizing, the risk of brain damage skyrockets, and it will take time to get to your veterinarian or the emergency clinic. Don't confuse the post-ictal behavior (blindness, pacing, agitation, etc.) with the seizure itself. The post-ictal behavior can frequently continue for hours. If the post-ictal behavior is prolonged or severe (for example the animal is at risk for hurting themselves or behaving aggressively), it may be worth a trip to the veterinarian even though they aren't actively seizing.

Repeated seizures can also be dangerous. Clusters of seizures have a tendency to progress to continuous seizures (status epilepticus). If you pet has 3 or more seizures in a day, they also need to be seen immediately.

Plan ahead

If your dog begins to seize, know what you need to do so that both of you are safe.

• Will you need to close a door to a stairway or room that could be hazardous? Move furniture, unplug lamps, or remove items that could fall over?
• Will other pets need to be restrained or shut out of the area? Sometimes other pets will be confused and can act aggressively toward the seizing pet, so it may be best to remove them when a seizure starts.
• If your veterinarian has prescribed rectal diazepam or other emergency-use drugs, do you know where they are and how to administer them even under the stress of a seizure?
• Where is the phone number for your veterinarian and/or the nearest emergency clinic? What is the best route to get there and how long will it take? Don't speed or otherwise violate traffic laws; you won't be able to help your companion if you are in the hospital from an automobile accident.
• If you need to transport a seizing or unconscious dog, how will you do it safely? For large breeds, how will you carry them from the house or yard and load them into the vehicle? Since your pet may seize again or be in the post-ictal disorientation while you're transporting them, both you and your pet will be safest if the pet is in an airline crate.
• It may be a good idea to have a "seizure drill" while everything is calm to be sure things are manageable if a seizure begins. You will be calmer, more confident, and better able to help your pet if you know what to do and where things are.

More questions?

Talk to your veterinarian. They should be able to answer other questions you may have or point you toward addition sources of information.

Last updated: 4/19/02