QUARTERLY BEAT / JULY 2024
AURA / PRODROME / PRE-ICTAL
SEIZURE / ICTAL
POST-ICTAL
· Symptom · Apprehensive behavior · Pacing · Agitation · Seeking out the owner
· Tonic clonic · Clonic tonic · Pure tonic · Atonic · Myoclonic · Petit mal? Questionable in animals · Focal · Orofacial – especially cats · Fly biting · Focal vs GI vs sensory vs OCD
· Altered mentation – most often hours but can be days · Confused, disoriented, aggressive · Blind · Restless / Pacing · Ataxic
· Polyphagic · Polydypsic
Once you have established that you are dealing with a seizure, if it happens to be a focal, orofacial, or fly-biting event, here are a couple of key points to remember:
FOCAL SEIZURE This is caused by abnormal excessive neuronal discharges in a specific region of the brain and does NOT need to be associated with a sinister cause (i.e., brain tumor). It should be lateralized and it can occur in one of three ways: 1) Isolation 2) Focal seizure with impaired awareness 3) Focal seizure progressing to a generalized seizure OROFACIAL SEIZURE Orofacial seizures are exhibited by dominating orofacial motor signs and tend to be laterally dominant. Hypersalivation is a predominant sign. This is a common seizure type in felines, and when present, you should have Feline Limbic Encephalitis-Hippocampal Necrosis Complex on your list of rule-outs. This is an immune-mediated disease where antibodies are formed against voltage-gated potassium channels, a fact that is important to remember because these cases need anti-seizure medications and steroids to treat the underlying pathology. FLY-BITING SEIZURE/EVENTS Fly-biting seizures absolutely exist, however, it is much more common that patients exhibiting fly-biting have underlying gastrointestinal disease (esophagitis, GERD, gastritis, etc.). When a fly-biting patient is brought to you, treat for GI disease first (unless they are exhibiting other neurologic signs). Common GI treatments include an elimination diet, omeprazole, and +/- prednisone.
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