The experience of your pet having their first seizure is already scary, but having your pet examined and then leaving your veterinarian’s office without any treatment for seizures can be confusing for many owners. Let’s take some time and explore some of the reasons why veterinarians rarely prescribe anti-epileptic (anti-seizure) medications after the first single seizure episode!

Diagnosing the Underlying Cause:

Seizures can be caused by various factors, including genetic-based epilepsy, brain tumors, liver disease, or even toxins. The first seizure is a symptom, not a disease itself. Vets usually want to identify the underlying cause before starting any treatment. Prescribing medication without a thorough diagnosis can mask symptoms, making it harder to identify the real issue. In some cases, masking the signs means that the true underlying cause can worsen without us knowing about it!

Now, let’s take a second and recognize that seizures can (and should) be treated even if you can’t afford or aren’t interested in an MRI (At Pet Parent Educators, we want to normalize the idea that not every pet can get an MRI and take away any stigma that you are a bad pet parent if you cannot or do not want to pursue an MRI – IT ISN’T TRUE!). While considered one of the best diagnostics for seizures, an MRI is not the only diagnostic in our toolbox. Bloodwork, liver function tests, and a great neurological exam can be extremely valuable, and all be done right with your trusted primary care veterinarian! Don’t think that just because blood work comes back normal, it isn’t a valuable test because that can show us that we aren’t dealing with some very serious conditions!

Sometimes, we want to ensure that this wasn’t a toxin, environmental cause, or some other issue that looked like a seizure but wasn’t. Is it strange that animals have only one seizure and we never see it again. . . yes. Does it happen. . . yes.

Frequency and Severity of Seizures:

As noted above, not all seizures are indicative of a chronic condition. Sometimes, seizures are isolated incidents or may have a frequency of years between seizure episodes, and medications won’t improve that. We want to ensure that the seizures are occurring frequently enough that the medications can be of benefit.

Vets generally look for a pattern or frequency in seizures before prescribing medication. Chronic medication is usually considered if seizures occur more frequently (typically more than one seizure every 1-2 months, but thresholds may slightly vary from vet to vet!).

Sometimes, a seizure can be severe (greater than 3-5 minutes). In that scenario, our neurologist often considers the use of an anti-seizure medication unless a known cause is identified for the prolonged seizure episode.

Side Effects/Management of Medication:

Seizure medications can have significant side effects (but not always!) and often require lifelong administration. For instance, phenobarbital, a common seizure medication, can cause increased appetite, thirst, and urination, as well as potential liver damage over long-term use. Veterinarians weigh these potential side effects against the benefits of controlling seizures. Ensuring that we will get benefits out of the medication before starting a lifelong medication is something veterinarians are always considering!

Seizure medications often require regular blood tests to monitor their levels and effects on liver and kidney function. Starting a pet on these medications is a commitment to ongoing monitoring and potential dosage adjustments.

It's important to understand that seizure medications do not cure the underlying condition; they only manage the symptoms. If a pet has a non-epileptic cause for seizures, treatment with anticonvulsants might not be beneficial. It could lead to unnecessary medication or, as noted above, hide the progression of the disease.

Risk-Benefit Analysis:

The decision to start seizure medication after a pet's first seizure involves a comprehensive evaluation of the pet's overall health, the nature of the seizures, and the potential impacts of long-term medication. There are many aspects a veterinarian considers when making this decision, and I can assure you that it’s made with the pet's best interests in mind!

If your pet experiences a seizure, it's crucial to consult with a veterinarian to determine the best course of action tailored to your pet's specific needs and health status. Each pet is an individual, and there is as much art in seizure therapy as there is in science. Engage your veterinarian in conversation and discuss the pros and cons of starting anti-seizure medications. Do not worry if your pet is not started on medications after a single seizure episode – that is completely normal and means your veterinarian is considering the whole situation!