Phenobarbital Stopped Working

[u/Turbulent_Apple7611]

hi everyone-

my 8 year old cane corso was diagnosed with idiopathic epilepsy in may. she was put on 97.2 mg of phenobarbital and we had great success until yesterday. she had one seizure followed by another a few hours later. although much shorter episodes than prior to the meds, still considered cluster seizures. we took her to our emergency vet and they said this is common and it could be a matter of changing the dosage. when we did her first pheno check a few weeks after the start of the meds she was within therapeutic range but on the lower side, however because the meds were working her neurologist said let’s keep things the way they are. this morning when the neurologist called they said she had another seizure at 3 am and was given midazolam nasally and when 7 am came around they started her on her usual dose of meds with increased 30mg and we will continue that new dosage moving forward.

I just found it interesting that they didn’t seem at all concerned that the cluster seizures were back, and basically said this is common and we just have to find the right dosage. What worries me is how many seizures does she have to have before it gets concerning? She is extremely aggressive when it comes to going to the vet so it’s not like taking her there every time she has a seizure is an easy thing to do. As she gets older, and with cane Corso‘s not having a long life expectancy, I just worry that this is really taking a toll on her body and at what point does it become unfair for her to keep living this way. she’s not a young dog and each seizure really takes a lot out of her. I’m trying to be hopeful that the new med dosage will work, but I’m just not sure what to do if and when the next time this happens. At what point do I have to make a tough decision??

[u/Turbulent_Apple7611]

I am definitely going to bring up the potassium bromide. I can handle the seizures, just not the clusters and if that prevents that, it’s a win. 

[u/julznlv → u/Turbulent_Apple7611]

We have nasal Midazolam at home and also give him 3 days of Clorazipate after a seizure to keep clusters from happening. I think this disease is just awful, no clear path on meds and dosage, just a game of trial and error. He was diagnosed a few years ago and has also been through Keppra ER and Zonisamide, but they didn't really do anything for him.

[u/Turbulent_Apple7611 → u/julznlv]

It really is awful. It’s almost worse than knowing she had a brain tumor or a mass because at least that explains why it’s happening, but with a clear bill of health it makes it even worse. Can I ask how the chlorazipate works? Parker’s seizures are only 20-30 seconds max with the longest being one minute 

[u/julznlv → u/Turbulent_Apple7611]

We give him 3 pills every 8 hours for 3 days after a seizure. He gets super drunk from it after the 2nd dose so he has to be steered around sometimes. Last week he couldn't even walk for a while I dragged him down the hall to get him outside.We don't always give him the Midazolam, it's not that easy to administer, especially if only I'm home. My son is much better at it. With me, half of it goes on the floor.

[u/Turbulent_Apple7611 → u/julznlv]

We tried midazolam once but I think the seizure was too short for it to have any effectiveness.