Database Updated (29th November 2019)
EMERGENCY CLUSTER MEDS - By Lindsay Sarmadi-Fard (27th November 2019)
EMERGENCY CLUSTER MEDS - By Lindsay Sarmadi-Fard (27th November 2019)
A "cluster" is defined as more than one seizure in a 24 hour period. Clusters can continue beyond 24 hours though, for 3-5 days in severe cases. Clusters most often involve generalized (grand mal) seizures, but can occur with partial (focal) seizures as well, and focal seizures may progress into grand mals. Emergency cluster meds are designed to be given after the first seizure, to prevent further seizures from occurring. You also want to administer these meds for any seizure lasting longer than 5 minutes.
Clustering is a concern in epilepsy, for both dogs and humans, due to what is termed the "kindling effect." The more seizures a dog has, the more likely that dog is going to have further seizures. Basically each time the brain has a seizure it "learns better" how to have the next seizure. This phenomenon is not entirely understood but involves changes in the electrical behavior of brain cells and changes in their chemical receptors. Clustering is a big concern because a cluster can progress into one continual seizure, called "status epilepticus," that can be fatal.
Every owner of a dog with epilepsy needs to have cluster medication on hand at home for emergencies. Even if your dog has never clustered before, chances are they will in the future, and time is of the essence. Driving to the nearest emergency clinic is not only time-consuming, it can be extremely expensive for most owners, especially for dogs that cluster routinely.
The best cluster protocol involves both a fast-acting medication and a slower-acting medication. These medications are given for a few days, in addition to the daily anti-epileptic medications the dog may be taking.
For fast-acting meds, rectal Diazepam (Valium) or nasal Midazolam are the most effective according to the published literature. These fast-acting meds should be given after the first seizure, or during any seizure lasting longer than 5 minutes to bring the dog out of the seizure.
Nasal Midazolam had better results than rectal Diazepam when studied, but may be more expensive and not available in all areas. Using a mist attachment can be helpful for nasal administration of the liquid. Recent studies suggest that the gel form of Midazolam has the best absorption rate when administered nasally, but availability depends on the compounding pharmacies in the area. For owners comfortable giving injections, Midazolam is also very effective when given as an IM injection. Suggested intranasal dosage of Midazolam is 0.2 mg/kg.
Rectal Diazepam takes a few minutes to work, up to 10 minutes, but absorption is fairly rapid. Rectal diazepam can be repeated up to 3 times in a 24 hour period. Diazepam should be protected from light and stored in glass, not plastic (Diazepam binds to plastic, so do not leave it stored in plastic syringes). Glass syringes can be specially ordered through your veterinarian if you wish to have syringes pre-loaded and ready to use. The usual dose is 1.0 mg/kg, but dogs on Phenobarbital need DOUBLE the dose (2.0 mg/kg). Many vets are not aware of this double dosing needed for dogs on Phenobarbital so please check your medication and see how many mg you are giving per dose.
Rectal Diazepam suppositories have shown poor absorption rates in dog studies and are not recommended. A rectal gel formulated for humans (Diastat) has not been studied in dogs, but human studies have shown promising results.
These fast-acting meds wear off within 1-3 hours, so in order to provide protection for the next 24+ hours you need a slower-acting oral cluster med as well.
SLOWER-ACTING (ORAL) MEDICATIONS
For oral cluster busters, Keppra (Levetiracetam) and Clorazepate are the best choices according to the most recent studies. They do take 1-3 hours to reach therapeutic levels in the bloodstream, which is why they are considered slower-acting cluster meds. They complement the fast-acting cluster meds that wear off within 1-3 hours.
Some owners give Keppra daily for seizure control, and during a cluster they can give extra Keppra to raise the seizure threshold. Dogs not on Keppra daily may use it only for clusters, for a few days (called "pulse therapy"). Clorazepate is in the same family of drugs (the benzodiazepines) as Diazepam. Other benzos like Clonazepam or Lorazepam may also work well to stop a cluster, it depends on the dog.
Keppra and Clorazepate are typically dosed every 8 hours. Suggested dosage for Keppra in pulse therapy is 20-30 mg/kg. Dogs with tough clusters may need dosing every 6 hours, and the higher dosage range may be needed for dogs also taking Phenobarbital. The suggested dosage range for Clorazepate is 0.5-2.0 mg/kg, but as with Diazepam dogs taking Phenobarbital need a higher dose of Clorazepate. (Phenobarbital usage speeds the clearance of Benzodiazepines through liver metabolism).
Give the first dose after the first seizure (as soon as the dog is comfortably able to swallow) and continue dosing every 8 hours until you have gone at least 24 hours seizure-free. Some owners may continue dosing for 3-5 days, depending on their dog's typical cluster pattern. Clorazepate is similar to Phenobarbital in that dogs may develop a tolerance over time, and show withdrawal symptoms if the medication is used longer term and stopped suddenly, so discuss this with your veterinarian. They may suggest a tapering down of the Clorazepate.
Some veterinarians dispense oral Valium/Diazepam for cluster seizures, but published literature suggests this is not very effective. Oral Diazepam wears off far too quickly because the dog's liver metabolizes it (studies have shown you need to dose every 1-2 hours to maintain steady serum levels). Rectal Diazepam bypasses the liver initially which is why it works so quickly and stays in the dog's system a little longer. Continued oral Diazepam use may also cause the dog to build a tolerance, which can affect the effectiveness of emergency rectal Diazepam administration.Oral Phenobarbital is sometimes suggested as a cluster buster, and it does last longer than oral Diazepam, but it also takes too long to get into the dog's system for most clusters (peak levels occur 4-8 hours after dosing). When Phenobarbital is used at the veterinary hospital to break a cluster it is given IV. Phenobarbital is also much harder on the liver than cluster busters like Keppra or Clorazepate, and liver function is a concern for most owners.
Database updated (29th October 2019)
Changes to Submission Criteria (17th October 2019)
Database updated (29th September 2019)
The Animal Health Trust (AHT) Epilepsy Research Information (25th September 2019)
Sunday 25th August
Information regarding the 'epilepsy app' from the RVC (23rd July 2019)
Another interesting piece of information regarding epilepsy in ISDS Border Collies can be found HERE
DATABASE IS LIVE (21st July 2019)
INTRODUCING THE BORDER COLLIE & WORKING SHEEPDOG FITTING DATABASE UK
We took on the huge task of creating a totally new fitting database and website from scratch. It would be fair to say it’s taken over our lives for the past 3 months, lots of hard work from everyone in our small team has gone in to develop what we have come up with. Not only for the database but all the GDPR policies and documents behind the scenes to ensure we have everything covered legally and compliantly. To say we have been frustrated at times with the technology is an understatement but we now have, what we consider to be, a database to be proud of. It has been a huge learning curve for us all, our brains are frazzled and we're relieved we are now at the stage where we can launch it for you all to see, and on the day we had set which is fantastic.
We have checked and checked the entries and tested and tested the
options within the database on different devices and on different
We have taken this into consideration and have 3 different options for everyone to view so you can find the one that suits your device.
Everyone should be able to view one of the options:
1/ Excel version
2/ Online version
3/ PDF version
However, we are still expecting some teething issues. So please be kind to us and respect there may be 'difficulties' until you get used to what you’re looking at. We will deal with any queries that crop up as soon as we can, we all have lives outside of the database so may not be able to respond immediately. There is guidance on the database page, please have a read of this plus 'Frequently Asked Questions' will be developed and put on our website as we collate the queries.
This first launch has 39 entries, all from owners who have taken their time to submit their details direct to us for which we are very grateful. There are many more entries that will be added over the coming weeks. We are aiming to add new submissions and/or update existing entries on a monthly basis. A post will go out on our Facebook group to let you all know when an update is ready to view.
We'd like to extend a warm welcome to Lyn Norton who has recently joined our team and thank her for all the hard work creating the first BC&WSD Fitting Database way back in 2012.
Thank you for all your support and kind words so far, we're excited to say the database is now 'LIVE' and ready for everyone to view 🎉🐾🎉
Announcement (2nd July 2019)
We are delighted to be able to announce that after having received legal advice, we are able to use the data of dogs (not personal details) that were submitted to the original fitting database; which started in 2012. This database ran prior to the data being passed over to the PBHF in 2015. The ICO have also confirmed that there are no GDPR compliance issues.
save around 140 fitting dogs from having to have their full details resubmitted
to us. However, we would like to ask
those owners/breeders that originally submitted details of fitting dogs to use
our website submission form to provide any updated information relevant to
their dog, especially if the dog has now sadly passed away. (As this is ‘pre-existing’ data we are willing
to accept information from whoever submitted to the original database, as
stated on the home page). The form can be found HERE
For those owners that submitted their dog’s fitting details direct to the PBHF and who may have received a letter saying that the dog’s data was being transferred to us (Border Collie & Working Sheepdog Fitting Database UK), this is no longer the case and no transfer will be taking place. We would therefore be very grateful if you would complete the full submission form on our website, mentioned above. This will enable the BC & WSD FDUK to include your dog’s fitting details on our new database.
Please use the ‘contact us’ form on the website if you should need any assistance with a submission. We will do our very best to help and make it as easy as possible.
With kind regards
BC & WSD FDUK
Formal Statement Regarding Fitting Database (19th June 2019)
We (Suzanne Taylor and Debbie Back) formally proposed to take over the upkeep of the entire fitting database from the pbhf. We complied with all of the requests made and with the help of a few others were excited at the prospect of the entire database being transferred to the newly formed Border Collie & Working Sheepdog Fitting Database UK.
· Debbie designed the website, and organised the domain, custom emails and submission forms
· Suzanne worked as a Data Officer, so was familiar with the DPA rules and application. She has been in constant contact with the ICO to ensure our privacy notice complies with the GDPR 2018.
· Margaret Roberts very kindly donated the funds for the website upkeep/domain etc for the first two years
· Frances Wright joined the group and brings with her a vast expertise and knowledge of epilepsy and has a wealth of information that she shares with owners of fitting dogs. (For those that don’t know, Frances was instrumental in getting Rowena Packer and the RVC to attend health seminars and has also worked with the RVC on their research projects. Frances’ dog Casey was the poster dog for the launch of their epilepsy app and is also the dog in our website header)
Sadly, on the 18th of June, we were notified by the chair that the
committee of the pbhf were withdrawing from negotiations and that no
data would be transferred.
To this end, may we ask that if you are one of the 199 people that had dogs previously added to the pbhf database or if you had submitted the often painful details to the pbhf but had not had your submission uploaded, that you go to our submission page and kindly resubmit to us.
We will also now be taking new submissions from owners of fitting collies.
We can reassure you that the BC & WSD FDUK is definitely still going ahead and all dog's details will be uploaded without bias, with regular updates being posted. We should have our first update within the next four weeks
Debz, Suzanne, Margaret and Frances