Are the episodes definitely seizures?

Annotations:

• 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?

1. No
   1. Ask for the owners to film an episode
      1. Consider conditions that mimic seizures
         1. DDX

            Annotations:

            • - Myokymia - Movement disorders - Cataplexy/Narcolepsy - Postural myoclonus - Atypical seizures - Focus of pain - Syncope
2. Yes
   1. Are seizures recurrent?
      1. Yes
         1. Investigate extra-cranial causes for seizures

            Annotations:

            • - H&B - UA - Fasting glucose - Pre/post prandial bile acid concentrations - Fasted triglycerides/cholesterol - Blood pressure measurement - ECG
            1. Hypoglycemia
               1. If <5 mmol/l repeat every 2 hours for 6 hours in total
                  1. DDX
               2. If <3.5 mmol/l, take concurrent serum insulin concentration
                  1. DDX

                     Annotations:

                     • - Insulinoma - Addisons - Hepatic disease - Other neoplasia - Toy breed/juvenile hypoglycemia - Sepsis - Toxic - Glycogen storage disease - Polycythemia - Insulin overdose - Lab/sampling error
            2. Normal
               1. Investigate intra-cranial causes for seizures
                  1. Neuro check

                     Annotations:

                     • Abnormal mentation? Loss of learned behaviour? Pacing round the house/unsettled Abnormal menace response Postural reaction or hping deficits?
                     1. Repeat neurological examination in 24 hours
                        1. Yes
                     2. Yes
                        1. Had a seizure in the last 24 hours?
                           1. Yes
                           2. No
                              1. Consider MRI/CT/+/- CSF
                                 1. Juvenile dog <6 months old
                                    1. DDX

                                       Annotations:

                                       • Meningoencephalitis (GEME) Neoplasia Congenital malformation Infectious encephalitis (distemper, bacterial, FIP)
                                 2. Adult dog 6 months to 6 years old
                                    1. DDX

                                       Annotations:

                                       • Meningoencephalitis (GEME) Neoplasia Congenital malformation Infectious encephalitis (Neospora, bacterial) Cerebrovascular accident (stroke)
                                 3. Older dog >6 years old
                                    1. DDX

                                       Annotations:

                                       • Neoplasia Infectious encephalitis (disptemper, Neospora, bacterial, FIP) Cerebrovascular accident "stroke"
                     3. No
                        1. Aged b/w 6 months and 6 years when had first seizure?
                           1. Yes
                              1. Consider idiopathic epilepsy the most likely cause
                                 1. Consider MRI/CT/+/- CSF
                           2. No
            3. Hypertension
               1. Systolic blood pressure > 180 mmHg
                  1. DDX
               2. Fundic examination
                  1. DDX

                     Annotations:

                     • Renal disease Cushings Phaeochromocytoma Primary idiopathic hypertension
            4. Increased pre/post prandial bile acid concentrations
               1. Abdominal US
                  1. DDX

                     Annotations:

                     • Hepatic insufficiency (PSS)
               2. +/- Ammonia
                  1. DDX
            5. Fasting hyperlipidaemia
               1. Measure T4 and TSH

                  Annotations:

                  • Hypothyroidism Idiopathic familial hyperlipidaemia Cushings DM Pancreatitis Hepatic disease
      2. No
         1. Consider toxin exposure