I have been a small-animal veterinarian for the past 15 years mainly dealing with nervous system disorders of dogs, such as anxiety or panic disorders and epilepsy syndromes.
During my work I experience more and more frequently an extraordinarily diverse and many-coloured symptomatology of panic disorders. Through my experience collected over more than a decade by monitoring for several weeks or months each of my little patients and by noting the daily reports of the owners, I can distinguish between psychiatric symptoms, pain syndromes, non-convulsive forms of epilepsy and so called pseudo-attacks.
These neurological symptoms are coloured by occasional pseudo-fit attacks which may be followed either immediately, or later by genuine epilepsy attacks with convulsive symptoms frightening the owners.
It is clear that a veterinarian must keep in mind during his/her daily work that, a dog suffers from depression, panic bouts, phobias, and numerous psychiatric diseases to the same extent as humans. Since an animal can only communicate with its body language, personality changes, modified behaviour, loss of house training, unexpected and aggressive expressions, strange habits and unusual bodily positions, it has to be interpreted what the animal s trying to convey with these manifestations. This is the beauty of our challenging work.
There is a period of the year between the 20th of December and the 4th of January when the highest number of dog patients showing one or a combination of the neurological symptoms listed above enter my consultation-room. During the period between Christmas and New Year’s Eve I have to answer numerous calls, not only from Budapest but also from other regions of Hungary. Owners ask for my advice as to how they can prepare their dogs with medication for the period of fireworks and other pyrotechnical amusements.
There are owners of dogs suffering from real epilepsy cared for by me for years, who fear for a possible increase in the frequency of epileptic bouts of their dogs, during this critical period. There are also those consulting me who have large watch dogs with a healthy nervous system living in the garden, and reluctant to enter the living quarters even for this critical period.
The solution is relatively simple for the latter case. A large dose of tranquilliser (available as tablets or gels to be smeared on the mucous membrane of the dog’s mouth) given daily, (or at least on New Years Eve to less excitable dogs), can reduce the sense of fear often intensifying in large dogs as a result of fireworks explosions.
The situation is much more serious if there is genuine epilepsy. In this case the dog’s panic symptoms are increased with every firework explosion (panting, restlessness, tremors, dribbling, loss of appetite, panic attacks and possible aggressive manifestations).
Clinical symptoms listed above may apply to dogs living in flats as well as to those living in gardens. During these periods those living in gardens have only one objective: either to get inside the safe flat or to escape from the frightening noises. One of these could induce an epileptic fit, which could be followed by several others or even a large number of them (30 – 50 bouts can occur within 2 hours). Consequently, the whole family is preoccupied during this period with calming their dog, especially on New Years Eve, as successive explosions not only cause panic attacks but also may provoke epileptic fits. Most families would not consider leaving home, and putting their dog into kennels, or into the care of a friend during this time.
In many cases the first epileptic bout appears during this critical period. These cases pose a particular professional challenge for me as convulsive symptoms can be caused by genuine epilepsy, by occasional fits or by s-called pseudo-fits. Only an electro-encephalographic examination could identify one of these three manifestations. This could be impractical during a holiday season, with the need for a prompt medicinal intervention as a priority. Yet, in case of a pseudo-fit bout (psychogen fits) giving anti-epilepticum could increase the number of bouts and only an injectable tranquilliser is indicated. However in case of genuine epileptic fits and occasional fits the injection of a large dose of anti-epilepticum is advised until a convulsion-free status is achieved.
Often occasional stress induced bouts of fits become fixed in animals exposed to multiple stress situations during this period and the animal remains epileptic till the end of its life. In other cases, when the first epileptic bout appears only as a result of such intensive stimulus but the dog does not encounter such stimuli again, epilepsy does not develop at all.
Treatment of a permanently sick dog poses a huge financial burden on the family, because anti-epileptic and sedative drugs are expensive in Hungary. There are cases when after the critical season the family opt for the euthanasia of the hitherto healthy dog, as the treatment would overload the family budget.
Traumatic injuries are very frequent at New Year’s Eve. Dogs may get caught on fences as a result of panic, triggered by firework explosions and even its owner can not get near the panic- stricken dog. There was a case in my practice when the animal attempted to climb over a fence and perished from torsion of the stomach caused by several hours’ struggling. In another case the dog broke the kitchen window in panic with its head in order to find shelter in the flat. Many animals escape during walks looking for a shelter from the noisy explosions, disorientated from fear and never find the way home again, or run under the wheels of vehicles right in front of the owner’s eyes.
I have never had so many notices on the wall of my waiting room wall with the plea: “My dog is lost, please help!” except in the New Year’s Eve period. (There are cases when the dog is hit by a firework accidentally or even deliberately, resulting in serious injuries.) I have never received so many lost dogs in my consultation room as I do in December and January of every year, with the finders asking for advice and help.
As I wrote these lines at the beginning of February, someone rang my door bell with an emaciated but beautiful, large, obviously long-lost stray dog. It may have been chased away by fireworks. I housed it because I have facilities for this and I could not resist its pleading eyes. My children named it Teddy-Bear, and it will spend the rest of its life with us as a watch-dog. I believe it belongs to the luckier victims.
For many people loving their dogs as a family member or the only companion in their lonely life, this holiday season can become the most tragic days of their lives, when they loose their dog. And all this can be attributed to the senseless pyrotechnic ravings at Christmas and New Year’s Eve, controlled with decreasing, instead of increasing vigour by legislation.
I have lengthy conversations with dog owners during the fireworks season to advise them and to answer questions in preventing and reducing the stress of their pet. A usual topic of conversation is where people spend New Year’s Eve. According to my experience members of older generations having survived a World War or the 1956 Revolution as a child or adult explicitly state, that firework explosions reopen the wounds already healed since. They are frightened to go outdoors to visit their children, or grandchildren even if they live in the neighbourhood and are invited. These people seek refuge on New Year’s Eve like their beloved dogs, because of the emerging bad memories.
Budapest, the 3rd of February 2005
Dr. Gabriella Kiss
1. The operative principle of the apparatus and the methodology of its use:
The EEG examination senses, strengthens and registers the small bio-currents arising during the functionning of the brain The apparatus consists of two parts:
1. Patient circuit (the connection between the recording device and the patient)
2.The internal circuitary of the recording device.
For the EEG recording the changes of the current are sensed between two electrodes inserted into the hairy sculp. Using EEG with the electrodes in the scalp, a „window” opens to the electric currents of brain function.
Ictus = fit; interictális = between two fits; postictus = after the fitting attack stage.
In veterinary practice, only the so-called. interictális EEG recording is practicable while in human practice ictális recording is also possible with the use of special electrodes attached to the skin by adhaesives.
It is often being asked from the veterinary clinician: What information do we get from EEG? Answer:
1. The determination of normality or abnormality of the basic brain function.
2. The epileptiform pattern (abnormal electrical brain signals, anxiety curves).
3. Excitement levels, diagnosis of organic brain damage, electrical recording of subclinical seizures.
4. Localisation of severe brain damage.
5. The possible diagnosis of the background of the seizures. (Idiopathic, congenital, or symptomatic).
6 To determine the need for further imaging (MRI, MRA, PET).
The areas of indication for routine EEG test:
The definition of the electroclinical category of the seizures: (occasional seizures, true epilepsy, psychogenic seizures, symptomatic epilepsy):
1. Confirmation or rejection of the clinical diagnosis.
2. The determination of the existence of genuine epilepsy as against possible „pseudo” fits.
3. The localisation of the focus of the fits in the cerebral lobes and the estimation of the strength of the abnormal electrical activity (electrical status).
4. The likelihood of organic origine of the epileptic dysfunction.
5. The distinguishing of panic seizures from subclinical epilepsy of temporal lobe origin.
6. Detecting the changes in the level of consciousness in the brain, how they affect the abnormal brain electrical activity during electrical provoking of an attack or localisation of epileptic foci.
7. Determining the timing of the conclusion of recommended medication in case of apparent remission.
The available provocation methods in veterinary medicine under EEG recording:
• awakening from unconsciousness or sleep and recording the effect of the change in consciousness levels on the abnormal electrical brain activity
Further EEG testing options for human patients:
• 24-hour EEG recording
• 24-72 hours simultaneous split-screen, video-EEG monitoring
• EEG study during sleep following sleep deprivation.
• Deep-electrode EEG studies
• EEG recording during anaesthesia
The choice of the appropriate antiepileptic treatment regime appropriate to the type of seizures is based on the historical data, the typing of seizures and the EEG-curve analyses. All owners need to be taught the principles of strict long-term antiepileptic therapy, so that in case of an attack they can help most promptly and effectively their loved one, to minimise the discomfort, pain and anxiety associated with it. For my EEG examinations I do not anaesthetise the patients, only tranquillise them into an euphoric state in order to minimise their movements and yet to maintain the lines of communication with the patient as well as with its owner.
Antiepileptic care of the patient is usually meant to be for a lifetime. Constant, often daily contact with the owner in person, by phone, fax, or e-mail is essential for the effective treatment or possibly the cure of the animal. I need to know of every epileptic incident of the patient in order to be able to adjust, raise of replace its medication according to its symptoms.
Dr. Gabriella Kiss Kutyaapró, Vol 12, 2007. Debrecen, CACIB, 25-26 August 207.
A little history of epilepsy
Perhaps I may increase the general knowledge on the history of medicine with some new facts. For thousands of years in various cultures people with epilepsy were branded as outcasts or „possessed”. This stigmatization embittered the life of people with epilepsy. Only a few examples: in England until 1970, the marriage of people with epilepsy was forbidden. In the United States the same law was only abolished in 1980 in the last state to do so. Unemployment, under-employment are still phenomena affecting the epileptic population. Epileptic children in many cases are still excluded from schools attended by healthy children, defying the opinions of professional epileptologist carers.
People with epilepsy are often regarded as insane or mentally subnormal because of the confusion and other psychological symptoms often displayed before or after the attacks. There exist no doubt cerebral lesions resulting in mental abnormalities as well as in epileptic seizures but certain types of epilepsy (and this is more often) may be associated with exceptionally high intelligence and unique genius qualities. The few examples in history: Alexander the Great, Peter the Great, Julius Caesar, Charles Vth, Richelieu, Jeanne d’Arc, Shostakovich, Handel, Berlioz, Flaubert, Petrarch, Byron, Gershwin, Van Gogh, Dostojevskij.
The historical review of epilepsy
Signs of operations involving the skull can be seen in finds at archeological digs in mummies and bones in Egyiptian, Inca and Celtic sites. The results of archeological research indicate that small holes were made in the skull by the physicians, presumably to save the lives of the patients. The modern neurosurgery still carries out this type of operation, in order to relieve the increased intracranial pressure due to tumours or other causes of illness. It must have been based on hundreds of years of experience thousands of years ago as a life-saving intervention. On many of the skulls, the bony edges of the bored holes were showing signs of repair, indicating that the patients not only survived with an opened skull but may have lived without pain and further seizures.
In Mesopotamia, the seizures were attributed to the „Hands of Sin”
In.1780 a.d. the Legal Codes of Hammurrabi dealt in detail with the Code of Rights of the epileptic patients. For people with epilepsy marriage was illegal, and were not allowed to act as witnesses in a Court of Law. The slave trade was vigorous at this time. If within three months after the sale the slave had epileptic fits, if was a default under guarantee with an obligation to refund the sale price.. Probably the contemporary healers have encountered this condition often and have noticed that between seizures weeks or even months could elapse.
In 2500 a.d. Hippocrates strongly condemns those who consider this disease sacred. It also notes that it is an inherited disease, the cause of which is brain defect and drug use.
In the New Testament, in the Gospel of Mark, „On the road to Jerusalem”, chapter 9 verse 14 describes the recovery of a „possessed” youth. An authentic case history of an unfortunate young man suffering from childhood epilepsy unfolds, told as seen by an exasperated father, accurately describing a Grand Mal with its pre-and post-seizure symptoms. The father begs Jesus to heal his son because he fears the loss of his son from the pain of these seizures. Jesus heals the boy by the expulsion of the „evil spirit”.
Then centuries later we are moving towards the Dark Ages, when the church dogmatically stated that epilepsy was a contagious disease. The “possessed” were driven out of churches, because they contaminated the holy objects and the faithful worshippers. The „treatment” of these unfortunate people matched these concepts: chained to the rods iron of bedsteads in the darkness of asylums they were deprived of all remnants of human dignity throughout their lives, until about the nineteenth century.
In the 1890s Hughlins Jackson clarified the mechanisms going on in the epileptic brain. It was about this time that bromides were introduced into the treatment schedules of patients. The scientists discovered that in the brain bioelectric processes are taking place and began to explore ways of making them visible to the human eye. The first EEG examination was carried out by a psychiatrist, Hans Berger in Jena on a patient with a brain tumour in 1924. It was done with an incredibly primitive technique compared to the modern EEG devices, but the results were interpretable.
Since then epilepsy research has progressed at an amazing speed, using the assistance of modern imaging procedures. Epilepsy Centers are established worldwide in all developed countries ensuring effective patient care and cure. After the war the International League Against Epilepsy was established, which among other things brought together the world’s professional neurologists to stanardise the symptomatology, diagnosis, and treatment of neuro-surgery interventions. In the veterinary field eplilepsy research has a 30 year record of research in the symptomatology, aetiology, EEG diagnosis and treatment. Outstanding results have been achieved in these areas by the veterinarians in the neurology departments of Vienna, Bern, Hannover and Ontario colleges.
I have been dealing with epileptic dogs and cats for some 20 years. using EEG recordings for diagnosis for the past 15. This unfortunately (due to the absence of expertise) is only used by a few veterinarians as a diagnostic method for epileptic dogs not only in Hungary but also in the rest of Europe. This is perhaps understandable, since the preparation and evaluation of EEG recordings is an extremely complex task and requires immense practice. However, in the absence of this test method it is very difficult to identify the cerebral lobe where the process originates ant to gauge the intensity of the abnormal electrical activity and the size of the total area damaged in the brain
Unfortunately the advanced diagnostic and imaging studies of epilepsy used in people for years or even decades in the medical field (for example EEG and MRI recordings made during fits, 24-hour video-EEG monitoring, etc.) are difficult to apply in small animal practices for a variety of reasons.
First, because of the incredible costs, and because certain tests cannot be made without verbal communication. But even if full diagnosis is made necessitating brain surgery instead of medication, most veterinary surgeries have no capacity to carry it out.
I believe that within 20 years this is not likely to change, so we have to remain with the pills, injections or the final farewell for dogs affected with epilepsy. Had they been born human, they could be cured and could have a chance to forget this terrible, but at the same time mysterious disease.
Kutyaapró. 2008, No 13. Miskolc, CACIB
Dr. Gabriella Kiss