Are the episodes definitely seizures?

Are the episodes definitely seizures?

1. Questions to ask?

   • 1) Is there abnormal mentation during an episode? 2) Are there autonomic signs (salivation, urination) 3) Are the episodes short in duration <5 min? 4) Are there postictal signs?
   • No
     • Ask for the owners to film an episode
       • Consider conditions that mimic seizures
         • DDX
           • - Myokymia - Movement disorders - Cataplexy/Narcolepsy - Postural myoclonus - Atypical seizures - Focus of pain - Syncope
   • Yes
     • Are seizures recurrent?
       • Yes
         • Investigate extra-cranial causes for seizures
           • - H&B - UA - Fasting glucose - Pre/post prandial bile acid concentrations - Fasted triglycerides/cholesterol - Blood pressure measurement - ECG
           • Hypoglycemia
             • If <5 mmol/l repeat every 2 hours for 6 hours in total
               • DDX
             • If <3.5 mmol/l, take concurrent serum insulin concentration
               • DDX
                 • - Insulinoma - Addisons - Hepatic disease - Other neoplasia - Toy breed/juvenile hypoglycemia - Sepsis - Toxic - Glycogen storage disease - Polycythemia - Insulin overdose - Lab/sampling error
           • Normal
             • Investigate intra-cranial causes for seizures
               • Neuro check
                 • Abnormal mentation? Loss of learned behaviour? Pacing round the house/unsettled Abnormal menace response Postural reaction or hping deficits?
                 • Repeat neurological examination in 24 hours
                   • Yes
                 • Yes
                   • Had a seizure in the last 24 hours?
                     • Yes
                     • No
                       • Consider MRI/CT/+/- CSF
                         • Juvenile dog <6 months old
                           • DDX
                             • Meningoencephalitis (GEME) Neoplasia Congenital malformation Infectious encephalitis (distemper, bacterial, FIP)
                         • Adult dog 6 months to 6 years old
                           • DDX
                             • Meningoencephalitis (GEME) Neoplasia Congenital malformation Infectious encephalitis (Neospora, bacterial) Cerebrovascular accident (stroke)
                         • Older dog >6 years old
                           • DDX
                             • Neoplasia Infectious encephalitis (disptemper, Neospora, bacterial, FIP) Cerebrovascular accident "stroke"
                 • No
                   • Aged b/w 6 months and 6 years when had first seizure?
                     • Yes
                       • Consider idiopathic epilepsy the most likely cause
                         • Consider MRI/CT/+/- CSF
                     • No
           • Hypertension
             • Systolic blood pressure > 180 mmHg
               • DDX
             • Fundic examination
               • DDX
                 • Renal disease Cushings Phaeochromocytoma Primary idiopathic hypertension
           • Increased pre/post prandial bile acid concentrations
             • Abdominal US
               • DDX
                 • Hepatic insufficiency (PSS)
             • +/- Ammonia
               • DDX
           • Fasting hyperlipidaemia
             • Measure T4 and TSH
               • Hypothyroidism Idiopathic familial hyperlipidaemia Cushings DM Pancreatitis Hepatic disease
       • No
         • Consider toxin exposure