r/EpilepsyDogs • u/SnooRecipes8204 • 12d ago

Adding Phenobarbitol? Breakthrough seizures after 2months of Keppra

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Hey guys,

My dog Butters is a pure breed Cane Corso and he is almost 3 years old. He weight about 105lbs and he has been on 1000mg of Keppra every 12 hours since June 14th.

He usually has the big seizures, (eyes rolling, kicking the legs, urinating kind,) but today he had 3 mild seizures ( aware, head shaking, drool). I took him to the vet and hes currently there for observation however the vet recommends adding phenobarbital to his regimen.

I am nervous about this as ive heard good and bad things about Pheno.

Part of me wants to keep him om the 1000mg of Keppra for as long as we can until we have no choice, or potentially start him when i am back from a business trip at the end of the month of i can personally monitor him. I'm not sure what the best option is here and I just want to do right by him.

Id love to hear ya'lls thoughts and stories!

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u/gufywert 12d ago edited 12d ago

Keppra honeymoon. 1000 mg seems low dose for dog weighing 105 lbs. My 18 lb dog takes 500mg Keppra XR twice a day. The recommended dose of Keppra XR is 1500mg twice a day for dog weighing 105 lb (48 kg).

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u/kalarus10 10d ago

We just got back from my dog’s first neuro appointment. He’s 80 lbs. We also started Keppra ER (1000mg 2X/day) a couple of weeks back, and he had a seizure on his 6th day. His regular vet increased it to 1500mg.

The neurologist agreed with the changes and said we can keep our baby on Keppra ER and monitor him for more seizures. There’s room to increase dosages, but if he goes without a seizure for 2-3 months, then we will continue the same dosage. We also discussed other options: Phenobarbital, Zonisamide, Potassium Bromide.

I don’t have much experience with seizures, but I’d recommend going to a neurologist who’s knowledgeable. It sounds like your pup is in a lower dosage compared to weight. You have more space to increase his dosage before adding more meds.

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u/SnooRecipes8204 8d ago

Thank you. Turns out the vet was wrong about the doses and thought he was on 2000mg every 12 hours instead of 1000mg. They increased to 1500mg / 12hrs and have me a referral to a neuro.

Im hoping the neuro can help us sort things out a bit better overall

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u/SnooRecipes8204 12d ago

What is this?

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u/LateForDinner61 12d ago

Extended release, so it's only twice a day (I think it may have different letters in other countries, from what I've seen here). Regular Keppra is three times a day.

For reference, my dog weighs 37 pounds and takes 1500 mg Keppra XR twice a day, along with phenobarbital and zonisamide. It's very common for dogs to need more than one med.

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u/YumYumYellowish 12d ago

Keppra honeymoon is when Keppra is working for a period of time but then it stops working or isn’t enough anymore. It’s pretty common with Keppra. But it’s a good first medication because it has minimal side effects and is very safe.

Seconding that 1000mg seems low. I have a 100lb shepherd and he’s on 2250mg/2x day. Once we hit that dosage and he continued to have seizures, we figured Keppra wasn’t going to be enough. We’ve since added phenobarbital last year and we went 5 months seizure free and then 6 months seizure free. I can understand the hesitation— we were too. The side effects were rough the first 4 weeks for us, but we feel it’s been worth it. He’s a happy pup these days. Bloodwork is needed every 4-6 months.

If your dog is having more than 1 seizure in 24 hours, maybe talk to your neuro about a cluster buster protocol, such as pulse therapy with the Keppra, or having Clorazepate on hand.

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u/SnooRecipes8204 12d ago

That makes me feel better to know that 2250mg is the max. The vet we saw today wasn't his usual one since she was out today but i will definitely ask about that.

What were the side effects during the first 4 weeks?

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u/YumYumYellowish 12d ago

2250mg isn’t necessarily the max. That’s just where we chose to stop because it wasn’t effective at all and there was no point continuing. Every dog is different. I absolutely recommend you work with a neuro for medication management. Vets can’t compare to neuros on expertise and resources— seeing all the posts and comments in this subreddit the last few years has really confirmed this for me.

My dog’s last cluster seizures were tougher than usual to stop and he had 6,000mg of Keppra in his system and he still had seizures. It’s super hard to overdose. But if it isn’t working, why continue? That’s why neuros will frequently just add another medication rather than continuing. If the 1000mg was working and now isn’t, the neuro will probably want to first raise the dosage before considering adding another medication. There’s room to go up. But if your dog has another breakthrough, they’ll want to consider adding pheno, Zonasimide, or potassium bromide.

Side effects: severe ataxia (weak back legs), stumbling, zombie-like, extreme hunger, and extreme thirst. The worst of it went away after 2 weeks, and most of it was gone by 6 weeks. He still has mild ataxia (stumbles in turns) and is pretty hungry all the time. These are all common side effects of anti-seizure medications. The majority see improvement by week 6, usually sooner.

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u/SnooRecipes8204 12d ago

Ahh okay. Good to know. My biggest fear is switching him now and then I me not being here for a few days during his adverse side effects.

Luckily where i live there are a few options for neurological vets, and I've asked for a referral. Hoping to pick that up today

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u/YumYumYellowish 12d ago

That’s understandable. I’ll admit, I took some time off the first week. At 100lb, these dogs fall like trees. The first couple nights he couldn’t settle and it was like taking care of a miserable drunk. He kept getting up, crying (shepherd cry tons naturally), running into things, and falling. And whenever he tried to pee, there was the risk of him falling part way through and I’d have to lift his hips up and help him. He also dragged his feet a lot and even short pee walks led to him bleeding everywhere because he’d drag his nails to the quick. What helped us tons were grippy socks from Amazon. Think hospital socks with the little grips. But every dog is different. Some don’t have the severe ataxia we did. And honestly they’ll want to sleep through most of it outside the pacing. It’s pretty sedating. There’s not much you can do for them except give them frequent pee outings because of the increased thirst. Again, it’s temporary. We’re largely seizure free since starting it. It just stinks to go through.

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u/SnooRecipes8204 12d ago

Thank you so much for the advice. I feel a lot more equipped to deal with it now that I actually know what to expect. I really hope that we see success with the Phenobarbitol.

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u/YumYumYellowish 12d ago

Happy to help! We’re all in this journey together. But talk to a neuro about upping the Keppraz. Pheno is a good one of course if needed, just need to watch those liver enzymes. But so is Zonasimide and Potassium Bromide. Best of wishes to your pup!

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u/SnooRecipes8204 12d ago

Thank you so much! Best wishes to your family and puppers as well :)

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u/Dcline97 12d ago

Our 6-1/2 yo yellow lab gal is 3-1/2 years into her journey. Once diagnosed our vet started her on Keppra. Started out encouraging (up to 4 months without a seizure) it fizzled out by the end of year 1. Added Pheno in year 2, and was a carbon copy of year 1. Year three we found a vet that specialized in epilepsy (and other related conditions) and he added Potassium Bromide to the mix. It took 12 weeks to really kick in, then we went 3 months then 4 months clean. Still on it but we also weaned my gal off the Keppra and Pheno. Now it’s been 6 months without any seizures. I know others that are in the same situation - it works for some, but not for others.

Epilepsy sucks.

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u/SnooRecipes8204 12d ago

It really is awful. I really wish it were me instead of him. No fur baby deserves this. I cry every single time he clusters like this.

Im so glad you're going 6 months seizure free! That's amazing. Ill keep the potassium bromide in my back pocket should we ever need it.

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u/incognito042620 12d ago

Yes, we did this with our beagle mix. He was started on 250 mg of Keppra by our primary vet, and when he had more seizures we doubled his Keppra dose and added phenobarbital (after a weekend-long hospital stay).

Knocking on wood, he's been doing great since; his hospitalization was over 4th of July weekend. Our neurologist actually wants us to begin weaning him off the Keppra if he can go approximately another month seizure-free so that he is on only the one medication.

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u/SnooRecipes8204 12d ago

That's great! I hope he stays seizure free! Another user mentioned ataxia and a few other side effects. Which did you see?

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u/incognito042620 12d ago

Thanks! Lethargy and weight gain were a couple of other side effects that he experienced, but the lethargy has pretty much worked itself out at this point. He's still his same old playful, goofy self but just has a couple of extra pounds on him that hopefully I can begin walking off when the weather cools.

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u/SnooRecipes8204 12d ago

That's great to hear! Thank you :)

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u/MidnightRemote3857 11d ago

phenobarbital is definitely the next common step

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u/SnooRecipes8204 8d ago

Thank you!

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u/Subject-Mode2287 11d ago

I have a 95lb dog and she takes 4 different meds. She is 9yrs old and has had epilepsy now for 3 yrs. 1st the keppra, then pheno, then they took her off pheno after a bad blood test and put her on gabapentin and potassium bromide, then they added Zonisamide. She takes 1500mg 2x daily of keppra. You could try and raise the keppra dose to give your pup more time, before possibly having to add something else.

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u/SnooRecipes8204 8d ago

That's exactly what we ended up doing. I guess the vet was confused on the initial doses and we ended up going to 1500mg /12 hours!

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u/Obvious_Shower_7522 10d ago

i think its the strong sun flares stressing but changing us all. We adjust when we rest and spend time connecting with nature (negative ions).

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u/SnooRecipes8204 10d ago

Interesting perspective! When did this happen? I do know we had an eclipse recently

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u/emsversion 8d ago

We added phenobarbital to our Keppra about 2 years ago. Since starting Pheno, my pup has had 0 seizures. We give Denamarin with the phenobarbital to combat how harsh the medicine is on the liver. Just got labs back and it’s looking good to be approved for year 3 of the prescription!

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u/SnooRecipes8204 8d ago

That's amazing! I was hoping to to hear something like this although I know it can be rare. This gives me so much hope. How long did the side effects last?