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Epilepsy Seizures In A Dog

by sara.baldey - April 18, 2018 View Case Report

Hi,

Snowball is a 15 year old, female, speyed, Maltese X. Snowball started having seizures a year ago and was started on phenobarbitone for canine idiopathic epilepsy. This was following routine blood work and urinalysis. She also has a bilateral systolic heart murmur, grade 4/5, consistent with AV valve insufficiency. Examination by a veterinary Cardiologist confirmed that the seizures appeared to be neurological and not due to an underlying problem with the heart.

This month Snowball has had 3 seizures. Normally she will have only one, sometimes two. The seizures occur around 6.30-7.30am (horary time LI/ST, lowest energy for KID/PC).

The phenobarbitone dose was recently increased as the trough serum level was found to be sub-therapeutic. She is the regular patient of a Vet colleague at the practice I am working in, and he suggested that maybe I could offer some help from a TCM approach.

I examined Snowball on 13/4/18. Her tongue was pale/lavendar,with no coat, and not moist. Her pulses were weak, with the L pulse almost absent, and R pulse weak, think, and fast. She was a little "flinchy" over ribs, but did not seem painful and this was not consistent. Back shu points were normal, Alarm points were normal. I palpated GB34, GB30 and GB25 (at the angle of the ribs and T-L junction) and these seemed ok.

I think the cause of her seizures is an underlying KID and LIV Yin deficiency. I was thinking to recommend placing her on Tian Ma Gou Teng Yin for the seizures and Zhi Bai Di Huang Wan or Liu Wei Di Huang Wan for the underlying Yin deficiency. Does this sound appropriate for her? (I am still new to using herbs alongside acupuncture and am still developing confidence in doing this). If this plan sounds good, which formula should I give in the morning and which at night? I would really appreciate your advice.

Many thanks in advance,
Sara.

by naturevet

April 25, 2018

Hi Sara,

I agree with your assessment of starting with Tian Ma Gou Teng Yin. A (Blood and Yin) deficiency aspect to the seizures is suggested by the advancing age, weak pulses, pale tongue, and small stature. Note that at the time the seizures are occurring, Tai Yin is in excess, and thus Jue Yin is in deficiency. Thus, a Liver Blood deficiency could be aggravated at that time. The seizures are also worse in your autumn, when Yang should be internalizing. Ordinarily, this would make you think of a Shao Yang issue, such that Yang is left lingering in the head and on the body surface. It is also consistent with a Yin deficiency, though, such that there is too little residual Yin on the body surface at that time to balance Yang, resulting in Yang rising (internal wind) symptoms.

I would start with TMGTY, and the follow up with a Yin tonic once the improvements are seen. If there is time to back down on the PB, I'd suggest it, if you don't think the dog will cluster. That way, if the pattern breaks, you'll know it's TMGTY doing the job. Otherwise, just track the pulse and tongue as indications that the dog is improving under its influence.

Let us know how it goes!

Steve

Tian Ma Gou Teng Yin

by sara.baldey

April 26, 2018

Thank you very much, Steve. I'm so grateful for your advice. I will be sure to let you know how it goes!
Kind regards,
Sara.

by sara.baldey

June 26, 2018

Hi Steve,

Since my last post, Snowball has been on TMGTY (am) and LWDHW (pm). She is tolerating these herbs well, with no adverse effects. I have been seeing her for acupuncture every 2-3 weeks. She is still having approximately 2 seizures per week, and feel like I have made little progress in the last month. Over previous weeks, she has appeared very Yin deficient (mostly based on tongue and pulses) and her pulses definitely improve with the acupuncture treatments I give her. The colour of her tongue has improved from originally pale to now pink, but her pulses are still incredibly weak. (And, of course, no improvement in seizure frequency). Her phenobarbitone dose has been increased, and it is now just within therapeutic serum levels. However, this has caused a noticeable increase in her hepatic enzymes. She is still on KBr. We are planning to change the phenobarbitone to levetiracetam ("Keppra"). Good news is that Snowball is still well in herself, and appears otherwise normal.

When I recently saw her, Snowball's tongue was pink, with a hint of lavender. Both her pulses were very weak, her Yin pulse was weaker than her Yang pulse. There was no response to back shu or alarm points, however BL23 felt pronounced/damp/excess. Previously, Snowball has sometimes reacted to palpation of BL17 too.

I am stumped. Should I be increasing the dose of TMGTY and LWDHW, or should I be considering a blood tonic as well? Or, should I be approaching from a different angle? Your input would be greatly appreciated.

Many thanks, as always.
Kind regards,
Sara.

by sara.baldey

June 30, 2018

Hi,

I forgot to mention that the pulses are not only very weak, but also thin and not toned.

Thanks again,
Sara.

by naturevet

July 5, 2018

Hi Sara,

There are two other options here for epilepsy with weak pulses:
1) Ban Xia Bai Zhu Tian Ma Tang. I'd use this twice a day if there is now a suggestion of Dampness in the symptoms
2) Chai Hu Gui Zhi Gan Jiang Tang - this is a new formula (for me) that I'm trying out, but so far (knock on wood), it has worked. Despite the weak pulse, if you tonified GB points and the pulse got more moderate, then I would use it. It also fits the elevated liver enzymes, which Chinese medicine would not assume was a drug side effect, but somehow linked to the pathology

The final thing we try in winter solstice epilepsy is a combination of Wu Mei Wan and Qing Ying Tang. We perhaps 15g of Tian Ma to the WMW. I would expect more of a wiry deep pulse, however, or else a floating buoyant one, but keep it in mind.

You may have trouble finding the CHGZGJT in a commercial form, and may have to mix it up yourself, but you should be able to find the recipe in a standard reference text. If you can't (or don't have such a text) I can dig up a recipe

Hope that helps you out!

Steve

by sara.baldey

July 12, 2018

Hi Steve,

Many thanks for your advice! I appreciate having a few options to consider, also in light of the season. Its a rubbish winter we are having here in Melbourne, very cold and wet and windy ("bleh!").

I am waiting to hear when I will see Snowball next, as I will be going away for a short break soon.

Just wondering..., with the herbs you have mentioned, should I use these alongside the TMGTY and LWDHW, or should I use these instead of TMGTY and LWDHW? I think I have found a supplier for CHGZGJT, should I need to reach for it.

Thanks again!
Kind regards,
Sara.

by sara.baldey

July 12, 2018

Hi Steve,

Many thanks for your advice! I appreciate having a few options to consider, also in light of the season. Its a rubbish winter we are having here in Melbourne, very cold and wet and windy ("bleh!").

I am waiting to hear when I will see Snowball next, as I will be going away for a short break soon.

Just wondering..., with the herbs you have mentioned, should I use these alongside the TMGTY and LWDHW, or should I use these instead of TMGTY and LWDHW? I think I have found a supplier for CHGZGJT, should I need to reach for it.

Thanks again!
Kind regards,
Sara.

by naturevet

July 13, 2018

Hi Sara,

If you honestly have not seen a benefit of TMGTY and LWDHW, then you could stop them and switch to CHGZGJT.

However, the CHGZGJT can be drying, so if we are wrong, and Snowball is Yin deficient (and maybe just needed BID dosing of the previous formulas), then she won't improve.

You can try continuing the LWDHW to cover that possibility, but the two formulas don't really treat the same condition, so it would be best to use just the CHGZGJT, and to positively rule out Yin deficiency beforehand, so that the only thing going into the dog is (hopefully!) exactly what the dog needs. That way, it doesn't have to waste any energy processing something else that isn't so appropriate.

To absolutely rule out Yin deficiency, give the TMGTY twice daily, the LWDHW once daily, and make sure the non-response thus far is not just an issue with dose. If there is still absolutely no response, then you're more clear to try the CHGZGJT

CHGZGJT is more compatible with BXBZTMT, in case you need a little more anti-convulsant effect, but since there are already drugs on board, I don't think you need to go that route

Steve

by sara.baldey

September 11, 2018

Hi Steve,

Sorry it has taken so long to provide an update on Snowball.

Since your last post I advised to trial Snowball on TMGTY bid and LWDHW sid (pm). The owner had surgery for plantar fasciitis and was at home to monitor Snowball during the day. The owner reported that Snowball's seizures initially reduced to one per week (compared to two per week), and then no further seizures were observed from 30/7/18. However, the owner attributes this improvement in frequency of seizures to her being at home, and the morning ritual being less stressful for Snowball. (In the past Snowball's seizures have occurred around 7.30am during the height of activity at the start of the day, before the owner goes to work). There is a big part of me that wonders if the owner is right about this, despite the improvement in seizure frequency.

I last saw Snowball on 17/8/18. Still no further seizures, and still on TMGTY bid and LWDHW sid. Also on phenobarbitone and KBr, as before. The findings from her examination are listed below:

T: dark pink and lavender, little bit of sticky saliva at back of throat (not much), no coat
P: both deep, weak, R weaker than L today (Qi/Yang)
Back Shu: BL20 (deficient), BL23 (response + deficient), BL24 (deficient)

When needled with GB points (reinforcing method) : GB30, GB25 (lumbar-costal angle), GB34 and this made the pulse more moderate
Also needled BL19, GV20, ST40 (note ST40 weakened the pulse)

Given the above results I decided it was worth trialing Chai Hu Gui Zhi Gan Jiang Tang. The owner still had some TMGTY, so the plan was to continue this until finished. Snowball is no longer on LWDHW.

I also repeated a small biochemistry panel on Snowball and there was no appreciable change in ALP and ALT over the last 6 weeks.

I spoke to the owner on 6/9/18, and apparently Snowball has been doing fine on the CHGZGJT and is due to finish TMGTY soon - in a few days. So, I am a bit divided as to whether the TMGTY and LWDHW was actually working (once the dose was corrected), or whether CHCZGJT is the most appropriate formula given the findings on examination and treating GB points.

I guess I will have to wait and see. Do you think there is any risk of rebound seizures once the TMGTY stops? (Or am I just being a "scaredy cat"?). I will continue to keep you posted.

Kind regards,
Sara.

by naturevet

September 12, 2018

Hi Sara,

Thank you for your update

We've been adding Tian Ma to the CHGZGJT. If you don't have it on your shelf to add to the formula (15 to 20g per 100g), then continue TMGTY instead.

Hopefully you'll see continued success!

Steve

by sara.baldey

November 13, 2018

Hi Steve,

Just wanted to give you an update on Snowball.

Snowball was doing really well after I last contacted you. However, over the last few weeks, her seizure frequency has increased to one seizure per week. The majority of these seizures occur in the morning, around 7am.

Snowball is on CHGZGJT and TMGTY (both bid), as well as phenobarbitone and KBr. I recently saw Snowball on 9/11/18. Her pulses were deep, weak, and not very toned. Her tongue was dark pink with a touch of lavender, not coat and moist. I got a response over BL19 when assessing the back shu points. The alarm points felt ok. I performed a small in-house haematology and biochemistry panel, which showed hepatic enzyme elevation consistent with phenobarbitone therapy. This is essentially the same result as when the bloods were performed 3 months ago.

I am a bit stumped. Are there any insights you may be able to offer, please? Should I be changing her herbs again? Right now we are in the midst of Spring, which seemed to arrive on time this year (September-ish). Snowball was doing very well and had good seizure control, until the recent weeks. She is otherwise fine in herself. Snowball is 15y 9m and first developed seizures last year in August (late Winter). My plan is to re-check her again soon and do a neuro exam to try to search for any hint of an intra-cranial lesion - though I will be the first to admit that I'm not the best at this!

I always appreciate your advice. Many thanks in advance!
Kind regards,
Sara.

by naturevet

November 14, 2018

Hi Sara,

Given the time of year and time of day when the seizures are worsening, it implies Dampness is the current cause. Treatment options include Si Miao San, Long Dan Xie Gan Tang, and Ban Xia Bai Zhu Tian Ma Tang. We mentioned the latter as an option for Snowball back at the beginning of our discussion. I think it's worth trying now, particularly if the owner feels stress is a trigger. Unlike the other formulas, it contains Ginseng, which has an adaptogenic effect that can increase tolerance to stress

I think you can discontinue the other formulas for now. The Tian Ma Gou Teng Yin is quite non-dampening and is safe to continue if you are nervous about that. The CHGZGJT is internally warming though, so should probably be stopped as you head into your warm months, if the formula has not shown a consistent benefit, and now has a reddish tongue

Steve

Ban Xia Bai Zhu Tian Ma Tang

by sara.baldey

November 15, 2018

Hi STeve,

Thank you very much for your advice! I am really grateful! I will let you know how she goes.

Kind regards,
Sara.

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