Neurologic emergencies: status epilepticus, seizures and spinal cases

Huck, a two-year-old neutered male Australian Shepherd, had a seizure last night. [1] He had been playing in the yard, and an hour later he was resting in the house when he had the seizure. [1] The seizure lasted about two minutes, and he seemed dazed and clumsy for about an hour afterward. [1] His neurologic examination was normal. [1] The recommendation was for the owner to watch for additional seizures, because he may never have another one. [1]

When does a seizure become status epilepticus?

Status epilepticus means a seizure lasting longer than five minutes, or two seizures back to back without the animal regaining consciousness or recovering between them. [1] It is an emergency, and the seizure must be stopped. [1]

Cluster seizures are at least two seizures within a 24-hour period. [1]

What does the neurologic examination contribute?

Seizures originate in the forebrain, specifically the cerebrum and thalamus. [1] Perform a full neurologic examination on every patient presenting with seizures, even one that appears normal, to help prioritize differential diagnoses. [1]

The lecture groups seizure differentials into idiopathic epilepsy, intracranial causes and extracranial causes. [1] With extracranial causes, the problem originates outside the brain, and the brain is a bystander. [1]

The classic idiopathic epilepsy patient has seizures beginning between six months and six years of age, although juvenile epilepsy and epilepsy of advanced age also occur. [1] Seizures are often the first clinical sign of a brain tumor in dogs, and these dogs can be neurologically normal. [1] Toxins, metabolic diseases and nutritional diseases fall within the extracranial category. [1]

When should maintenance treatment begin?

Two weeks later, Huck had another seizure and then a third the following day. [1] He remained normal between seizures, but the recommendation was now to start treatment. [1]

• Start an anticonvulsant after two or more seizures within a six-month period. [1]
• A single seizure with a prolonged, severe or unusual postictal period may also warrant an anticonvulsant. [1]
• Start an anticonvulsant even after a single seizure if the patient has an identifiable structural lesion or a prior history of brain disease or injury. [1]
• Multiple seizures before presentation or presentation in status epilepticus also warrant an anticonvulsant. [1]

The lecture describes a trade-off: more effective anticonvulsants come with more side effects, while drugs with fewer side effects are less effective. [1] For drugs with an established monitoring protocol, the recommendation is to follow that protocol. [1]

Which spinal cases need immediate referral?

Treat patients with rapid deterioration or absent limb sensation as surgical emergencies, and refer them immediately. [1]

Do not keep these patients hospitalized overnight or wait until morning to transfer them. [1] Let the attending neurologist or surgeon decide whether to operate. [1]

Related lectures

On-demand lecture

Neurology in a Nutshell

References

• Dr. Susan Arnold: Neurology in a Nutshell (lecture recording, Aug 22 2026) Vet On It lecture transcriptLecture source retained by Vet On It.