Expert: Ali - 6/21/2009

Question
QUESTION:   Monday the 15th my sister found a stray kitten in the middle of the road about to get hit by a car. So she jumped out scooped him up and brought him to me. Upon receiving him I immediately removed the flea collar from his neck. Also began feeding ( he eats like a champ)every few hours. . He was filthy and had a wound to his left shoulder.
         There is a problem though. I had to rush him to the emergency vet Monday evening because after giving him a bath I noticed drooling which I recognized as abnormal. He had a Corneal stain, a fecal flotation and a FeLV/FIV test which all came back negative though the vet said she suspected worms and explained how sometimes the test comes back negative because the worms were not shedding eggs at the time so he was also wormed. He had an upper respiratory infection and eye infection which I received anti-biotics for. They also cleaned and shaved the wound to his shoulder which is healing great.
         The last few days the poor little baby has had roughly 6 seizures (that I've witnessed anyway not including the first episode of drooling in which I took him to the emergency vet)and upon visiting my vet yesterday they did a blood sugar test which came back normal at 83. The vet informed me that it could be a liver shunt and to monitor him for the next few days after meals,even though a shunt is not definite. I was also told that even a no kill shelter would probably put him down because of the seizures which seem to last 30-45 seconds.
         Then the same day (yesterday) it had another seizure approx. 6 hours later and back to the vet I went for some antibiotics he said we could try to rule out Toxoplasmosis. He said we would know if it helps in 3 or 4 days. Then two more seizures today. I spoke with another vet and she informed me she did not think it was liver shunts because it acts normal after meals.I just don't know what it could be.          
         This saddens me beyond belief. I have become quite attached to him over the last 4 days and am incredibly saddened that a normal shelter would either not accept him or put him down. He is a wonderful kitten, very friendly and gentle and other than the seizures seems completely normal. I don't have the heart to let him suffer (or die unnecessarily) and would love to find someone who isn't ready to give up on this poor stray kitty. Though having just lost and FIV cat a month and a half ago I feel emotionally unready to care for him since I have been very depressed about my cat and am not sure how to deal with this situation without just bursting into tears, thinking about the rollercoaster ride I went through trying to keep my cat alive his last couple of months.  Not to mention the financial strain it put on me but I had to try everything I could for him. I live in Southern Michigan and am unable to find a willing rescue to take this baby. I will try again tomorrow. Other than the seizures he is a completely normal loving kitten.
         My question is does anyone know any organization that could help foster/take care or help with medical treatments for this sweet baby? Or does anyone have any suggestions as to medical treatment or test that wouldn't cost too much to help him. I want to save this kitty, and the best possible outcome I feel is if someone took him that had experience taking care of kittens with medical issues? I would hate to give him up because of my attachment to him and I want so much to try to help but know it would be best for him to have someone who can help him better than me.
Someone please help me help this little guy!!!!!!!!!!I just don't know what to do next for him. I refuse to put him down, I really think he has a chance and have found out this is not as rare as I first thought in cats. HELP HELP HELP!!!!!!!!!!!

ANSWER: Sonia,

This is a tough situation, and I'm not sure what your finances are like. I'd suggest that you consider seeking the advice of a holistic veterinarian because sometimes alternative medicine can be used to alleviate symptoms that might not be treatable with conventional medicine. You may want to consider checking the Ask the Vet portion of this site and sending a question Dr. Chambreau's way, she's a holistic vet and she offers consults over the phone for a fee. There are a number of things that can cause seizures in kittens and although I'm not a vet and can't provide a diagnosis my guesses would be distemper neuropathy which can't be cured, but I believe the seizures can be managed. Head trauma or epilepsy also rank high on my list of suspects and both of these can be treated, head trauma will heal over time, epilepsy is a chronic condition that will require lifelong medications to manage. If the seizures can be brought under control and a cause can be found then those are important first steps.

As for a sanctuary that might be willing to take this kitten on I'd recommend North Shore Animal League or Best Friends Animal Society. I've included the information for Best Friends below:

Best Friends Animal Society
5001 Angel Canyon Road
Kanab, Utah 84741-5000
Main phone: (435) 644-2001
Placing an animal with Best Friends: nmhp@bestfriends.org

Best Friends Animal Society is different from other shelters and sanctuaries because they aren't limited by cost when it comes to testing and treating any medical issues a cat, dog or other animal is having. They may be willing to take this kitten in and from the information I have they're absolutely wonderful and they'd be willing to do whatever it takes for this baby to live as long and healthy a life as possible. If a forever family willing to accept whatever diagnosis this kitten comes from comes along the sanctuary checks them out very thoroughly and then if it's a good match for pet and human family they complete the adoption. I'd say these folks would be your best bet at the moment if your finances are limited to the point where you wouldn't be able to seek out the opinions of veterinary specialists even if it happens to take 2-3 different vets practicing general medicine before you finally get someone willing to make the referrals. I can also send some resources your way that might be willing to help with the cost of treatment - I can't guarantee anything, but it's worth a shot...

---------- FOLLOW-UP ----------

QUESTION:         I wish I could try the Best Friends animal society, but I live in Michigan and there's just no way to get the kitten to Utah, though the way you speak of them they are exactly the kind of people I am looking for to help. Someone to give this baby a chance.
         I'm not sure what kind of resources you could find to help but if you are willing I would love to have some help with the bills if you could find some resources, organizations to help and such. Since I've spent a lot on my FIV cat and a few bills from my dogs recently, I'm just not sure how much more I can afford right now. Of course I tend to spend money at the Vet with my heart and not my head, it's very easy for me to forget the more I spend on unnecessary tests the less I have to spend on treatment that could actually help. I will talk this over with my husband, maybe I could help get some of the test done if I could find someone to sponsor some of this kitty's treatment. I'm hoping the fact that I've already done some test to rule out certain things, someone would be more willing to help since we don't have to start at square one. I am going to get him vaccinated on Monday hopefully, I don't know how much it is for a cat at my vet but I figure he needs to be vaccinated because if he picks up FIV or FeLV I will never find a good home for this sweet stray kitty, not to mention I hate to see another FIV cat,it's a horrible disease.
         I'm not exactly poor, but just know that if it is something serious there's no way I can afford a surgery that will cost a thousand dollars or more. The way I see it I would probably go into bankruptcy to help this little guy, but I know this will not help me continue to help all the strays in the area, since I'm looking into low cost spaying/neutering for them ( problem is there is at least 12 cats that frequent my porch and would love to make sure there won't be any further breeding of homeless cats). I'm just looking for a way that I can help everyone but especially right now I want to help this kitten and give him a chance to be placed in a loving home. Any help would be appreciated. Thank so much for the first response, I'll be looking for the next! Thank You again!

ANSWER: Sonia,

I've spent a fair amount of time considering what little I know about seizures in cats (I've only seen a kitty have a seizure twice in my lifetime and that was so long ago). I did some extensive research about seizures in kittens, the possible causes, the diagnostic tests that should be considered and the longer term treatment options specific to each condition. As I stated in my original answer I'm not a qualified veterinarian so I'm not trained to provide you with a specific diagnosis, treatmen options or a longer term prognosis, but when any of my cats has received a medical diagnosis that's likely to cause permanent or long term problems I believe in doing the research so that I have as much information as possible. Having done the research and obtained the information about a specific diagnosis allows me to ask my vet more detailed questions, better understand her answers and ultimately make appropriate decisions about medical treatments and procedures based on the complete picture.

It really doesn't sound to me like very much has been done in terms of tests to investigate many different causes for seizures in this kitten and I'm not sure whether that's specifically related to limits imposed by finances or the vet watching and waiting before making decisions about what tests should be performed. Regardless of the specific reasons that more thorough testing hasn't been done I'm glad that you contacted me again, I've taken the last 24 hours or so to do some fairly thorough research about potential causes of seizures in young kittens and I've found some interesting things out that may or may not have been considered by you and the treating veterinarian at this point.

According to most of the literature I've read there are a number of reasons young kittens can have seizures that could include congenital defects to trauma, exposure to certain chemicals or underlying illnesses, infections or syndromes. Occasionally there isn't a discernable cause for a kitten's seizures, this is referred to as idiopathic (unknown origin) seizures. Overall seizures and some of the disorders that cause them are usually more common in dogs than cats, but I can clearly see that you want to do everything in your power to help this kitten live a good quality life for as long as possible so I've included every bit of information I could find, maybe there will be tests that haven't been performed yet or possible causes for this kitten's seizures that haven't been considered. Ultimately in order to know with any degree of certainty what's causing this kitten's seizures there are a number of things that have to be considered including the approximate age of the kitten, physical findings, results of any diagnostic tests and outside influences such as any exposure to chemicals. I don't know if you mentioned that the kitten was wearing a flea collar to the treating veterinarian, but it's possible that the chemicals contained in a flea collar could cause serious health problems including seizures depending on his age and the specific product used.

Based on the information you provided the first time you contacted me it seems as though the treating veterinarian has tried to rule out some common causes of seizures in young kittens inlcuding FIV, feline leukemia, round worms and toxoplasmosis. I'm not sure if your vet also tested for FIP (Feline Infectious Peritonitis) at the same time she tested for feline leukemia and FIV, but this infection could cause seizures in a young kitten. Environmental toxins are difficult to rule out since this kitten was found wandering the streets, but as I said, depending on how old this kitten is the fact that he was wearing a flea collar when he was found could offer a possible explanation for his seizures since young kittens under 8+ weeks of age shouldn't be exposed to certain products often used to treat fleas. The information that I've provided about specific tests and causes of these seizures isn't an indicator of how well your kitten is expected to do in the longer term. My goal at this point is to try and provide you with as much information as I can so that you can raise specific issues with the vet, inquire about treatments or diagnostic tests which might be helpful in this situation, in no way am I trying to provide you with a diagnosis or give you a prognosis, I'm not trained to do that.

I've attempted to find you as much information as I could about the potential causes of seizures in kittens, there is no guarantee that this kitty's seizure problems are specifically related to anything I've come across because just like in human beings there are some rare genetic disorders and syndromes that can show up in our pets and the rarer issues often require a specialist to perform extensive testing to confirm a specific diagnosis. At this point the first thing that must be figured out is whether this kitten's seizures are being caused by his brain or if there is a problem somewhere else in his system. Seizures caused by a problem within the brain could be the result of a brain tumor or congenital abnormality - these are issues which may mean that expensive tests need to be done in order to provide your veterinarian or specialist with a complete picture of your kitten's brain.

One possible cause of seizures caused by the brain would be epilepsy, this wouldn't necessarily show any abnormal results on a CAT scan or MRI and epilepsy is usually only diagnosed once all other causes have been ruled out. Overall from what I understand by reading through veterinary medical articles is that epilepsy is far more common in dogs than it is in cats, but just because it happens rarely doesn't mean that's not what's happening here. An epileptic cat shouldn't have any other neurological symptoms beside seizures and his physical exam including blood work, ultrasounds, x-rays and urine tests should be completely normal in every way - it's essentially a diagnosis made by eliminating all other possibilities.

Sometimes seizures can be caused by problems related to other major organs, these seizures are often referred to as reactive seizures which essentially means that the brain is reacting to some condition or imbalance outside of the brain. Some examples of reactive seizures would include toxic insults to the kitten's system or physical truama. Just like people some cats are born with metabolic disorders or genetic conditions and in some cases it's quite expensive to diagnose these conditions because many are quite rare. There is a condition called a porto-systemic shunt (PSS) which can cause seizures as well as several other symptoms in cats, in fact it's one of the more common causes of reactive seizures in young kittens.

PSS refers to one or more abnormal blood vessels on the inside or outside of the liver that cause blood to bypass the liver entirely. The liver is an organ meant to filter toxins like ammonia from the blood and send the newly filtered blood back into the cat's system. In some cases PSS can cause seizures, depression, blindness, lethargy, coma, anorexia, behavior changes, personality changes, vomiting, diarrea, excessive salivation, stunted growth and fever. Pets with a shunt may show significant changes in their behavior or personality after eating. Some symptoms that are often seen in pets with PSS are more general which may delay diagnosis, it's not uncommon for pets with PSS to have vomiting and diarrea that just doesn't completely go away in spite of dietary changes or medications.

Some pets experience more serious symptoms like coma or seizures these symptoms can also become noticeably worse shortly after the kitten has eaten. Young pets with PSS often don't gain weight and grow as they're normally supposed to do because their bodies just aren't able to get all of the nutrition from their food. For many pets the symptoms often associated with a PSS are so subtle that the diagnosis won't be made until they're spayed or neutered - pets with PSS often have a more difficult time recovering from anesthesia because their system can't get rid of it as quickly or efficiently since the liver isn't doing its job by filtering toxins from the blood. It's not uncommon for kitties with PSS to drool and have foul breath, sometimes these kittens can become quite confused and seem somewhat out of it. Unfortunately the symptoms associated with PSS may not be consistent so it can be difficult for the vet to know what's causing the problems.

It's extremely important for the vet to perform extensive tests if s/he suspects that your kitten has a PSS because there are many other health problems that can look like a shunt. An infection of the liver, cancer in the liver or liver toxins can show similar symptoms to PSS. The liver is a very important organ within the body, it performs a number of functions and it's important to avoid causing damage to the liver by treating the wrong condition so every effort should be made to have a definite diagnosis before putting a treatment plan in place. When a vet performs a thorough physical exam s/he may be able to feel the liver, if the vet suspects that the kitten's liver is smaller than normal further tests should be done in order to make a definite diagnosis so that a treatment plan can be made and you'll have a good idea what the kitten's chances are of living a normal life. Cats are normally very clean animals who take great pride in their coats, sometimes kitties with PSS have a dirty, greasy coat and look somewhat unkempt, however this is an issue that your treating vet wouldn't likely notice since you've recently bathed this little guy. During a physical exam the veterinarian may find that the kitten has excess fluid built up in his abdomen, this is referred to as ascites and is often an indicator that something's wrong with the liver.

There are a number of tests that can be performed to help determine if problems with this kitten's liver are causing his seizures. Having your vet perform a complete pre-anesthetic blood profile will provide him/her with an accurate picture of what's happening with this little guy's major organs including his liver. In cats with PSS it's not uncommon for their blood results to come back with high levels of ALT and Alk Phos and bilirubin to be high. In some cats bilirubin will be present in large quantities in their urine so a urine test may provide useful information. Your vet can perform a bile acids test, if your kitty has PSS this test result will likely come back elevated and the levels of ammonia inthe blood may also be high. It's quite possible that a kitty with liver problems will be anemic, have a low BUN, low potassium, high cholesterol, low albumin and high glucose. The build up of ammonia in a cat's bloodstream is believed to cause many of the symptoms associated with PSS. Having a sample of your kitten's urine tested could offer some clues about what's happening, in some cases kitties with liver problems have abnormal crystals in their urine often made up of ammonium biurate.

Some fairly high tech tests are possible if you're financially able to provide that advanced care and testing for your kitten. Positive Contrast Portography is considered to be the best test to determine whether a kitty has PSS or not. A dye that shows up on x-ray is injected into a vein in the kitten's small intestine while they're under anesthesia and x-rays are taken. If the kitten has PSS it will show up onthe x-ray. Scintigraphy is a nuclear medicine scan that will provide your vet with a definite diagnosis if your kitten has PSS. For this scan your kitten will be injected with a small amount of radioactive dye and he'll be scanned as the dye travels through his system. If your kitten has PSS the radioactive dye will show up in the heart before the liver. In a normal scan the dye will end up in the liver before it makes its way through the system and into the heart. An advantage for kitties with PSS is that this test doesn't require anesthesia so it's less risky than some of the other diagnostic tests available.

X-rays can be taken and in some cases if the liver is significantly smaller or larger than it would normally be expected to be the vet will know after looking at the films. An x-ray is a fairly inexpensive test that can help your vet get an idea what is happening and you can make decisions about further testing based on the results. Your vet can perform an ultrasound which can be a great tool to diagnose liver defects or diseases - if the kitten's liver values are abnormally high or his bile acid test is abnormal an ultrasound is a good test to consider because it offers more information than a standard x-ray. In the event that the ultrasound of your kitten's liver is abnormal the veterinarian can perform a biopsy during the ultrasound. A small sample of your kitten's liver can be sent to a pathologist for examination under a microscope and any abnormal findings can be passed along to your veterinarian.

If the vet suspects that this kitten has liver disease or PSS it's probably a good idea for the vet to perform a blood test to determine how well your kitten's blood is clotting because problems with the liver can cause serious problems with bleeding. If the vet has good reason to suspect that your kitten has liver problems based on the test results then s/he can perform exploratory surgery to look at the health of his liver, confirm the diagnosis and if necessary take another biopsy for analysis. Obviously surgery isn't without risk, especially when a kitten is already dealing with health problems but if your little guy does have PSS and you opt to correct the defect he'll need surgery anyway. According to the information I've read kitties with PSS can sometimes take significantly longer to recover from general anesthetic than healthy kittens so it's probably best for the vet to be fairly sure of what's going on so that your kitten can be neutered, have his PSS corrected and any biopsies or other tests to be performed under anesthesia at the same time to avoid repeated exposure to general anesthetic.

Contrary to popular belief the diagnosis of PSS or another liver problem isn't necessarily a death sentence, there are treatments available, but again this comes down to what you're reasonably able to afford financially. Giving IV fluids to a kitten with liver issues helps to rehydrate them and provide their bodies with the sodium, potassium and choride he needs. If your kitten has PSS and is seriously ill he shouldn't get anything by mouth at first so that his system has a chance to reduce the toxins in his body. Your vet may prescribe enemas if s/he feels they'll be helpful in terms of reducing the bacteria in the intestinal tract which helps reduce the ammonia absorbed into the kitten's system. Antibiotics and other medications may be prescribed to allow your kitten to have less harmful substances in his system. In many cases pets with PSS need to eat a reduced protein diet, this is meant to help minimize the toxins that build up in the bloodstream which will hopefully reduce some of the symptoms associated with PSS.

In many cases it's possible to correct PSS surgically by identifying the abnormal blood vessel that's directing blood around the liver instead of through it. The veterinarian performing the surgery will close off the abnormal blood vessel which will allow the kitten's blood to pass through his liver instead of around it. This surgery is extremely expensive and it's not without risk. Pets undergoing surgery to close off a porto-systemic shunt must be carefully watched after surgery because there's a chance that the pressure in their liver will become dangerously high because of the increased blood flow since the liver isn't accustomed to handling the normal blood flow. Sometimes it's necessary for surgeons to go back into the operating room to either reduce or remove the stitch closing off the abnormal blood vessel. It's not uncommon for pets with PSS who have successful corrective surgery to begin having seizures which must be stopped promptly to prevent permanent brain damage. This surgery carries a risk of death with it and I would strongly urge you to carefully consider the benefits of the surgery as well as the very real risks associated with this procedure in the event that your kitten does have PSS. In some situations the quality of life becomes more important than the quantity and in my opinion this is one such case. Not all cases of PSS can be successfully repaired surgically and ultimately the final result depends on where the abnormal vessel was, how the cat tolerated the anesthesia and surgery, how old the pet is and how long the defect has been there.

Another possible cause of your kitten's seizures is thiamine deficiency. Thiamine allows your kitten to break down carbohydrates and amino acids so that he can use them properly within his body. Uf your kitten hasn't been eating or has been fed a diet made up entirely of fresh fish or other foods where thiamine is destroyed that could be the cause of his seizures. Depending on your kitten's age it's possible that his seizures are related to hypoglycemia or low blood sugar. Kittens younger than 8-10 weeks of age can experience serious drops in blood sugar if they don't have frequent enough access to appropriate food. Sometimes hypoglycemia can be related to a severe infection or problems with the liver. You mentioned that you removed a flea collar from this kitten when he came to you, if he`s younger than 9-10 weeks he may be having seizures caused by the chemicals on the flea collar. Since this kitten was outside it`s also possible that he came into contact with any number of other toxic substances including lead, antifreeze, slug bait or rat poison. I highly doubt that these more toxic chemicals are causing this kitten`s seizures because I suspect he would have passed away by this point if these types of poisons were responsible for his seizures. Deficiencies of calcium and other nutrients could be responsible for this kitten`s seizures if he wasn`t given a species appropriate diet before he came into your care.

Epilepsy is another common cause of seizures. Sometimes epileptic seizures in cats can be caused by brain tumours, in other cases auto-immune conditions or infections known to suppress the immune system can cause seizures, but it`s not very common in cats. Cryptococcus is another possible culprit when it comes to causing seizures. Since this kitten was rescued as a stray there`s a chance that he had already survived a glancing blow to his head after being hit by a passing car, he could have fallen from a significant height and hit his head or he may have been the victim of an act of human cruelty so head trauma is another possible explanation for this kitten`s seizures. There are congenital defects that cause seizures as well, such as a condition called hydrocephalus which is simply excess fluid inside the skull that`s applying pressure to the kitten`s brain. Ultimately there are a number of potential causes for your kitten`s seizures and I`ve provided a list below:

- Degenerative (storage diseases)

- Developmental (hydrocephalous, porto-systemic shunts)

- Toxic (lead, organophosphates)

- Infectious (distemper or other viral, bacterial and fungal encephalitides)

- Metabolic (transient hypoglycemia, enzyme deficiency)

- Nutritional (common with parasitism)

- Traumatic (acute head injury)

I'm not sure if you have listed all tests that have been performed on this baby so I've gone ahead and made a list of the most commonly recommended tests to help determine causes of a kitten's seizures.

- A complete blood count (CBC or hemogram), this helps the vet determine whether or not there's some sort of infection or other process going on that would potentially show up when the numbers of white blood cells (they fight off infection and serve other purposes within the immune system) or red blood cells (they carry oxygen throughout the system) are analyzed.The CBC might show a decrease in the number of red blood cells (RBC's). This decrease in RBC's is called anemia. The white blood cell count (WBC) might be elevated (leukocytosis), normal, or decreased (leukopenia), mostly depending on the cause of the liver problem and how long it has been present.

- A serum biochemical profile to evaluate for low blood sugar/low blood calcium/abnormalities of liver function. This test is pretty much self explanatory, abnormal results can mean that different things are happening so your vet will have to provide you with the results and interpret them for you.

- Bile acid determinations to evaluate liver function, this test allows the vet to see how the kitten's liver is working, abnormal results could suggest liver failure or a portosystemic shunt. If you`re interested in reading more about PSS please feel free to check out http://www.lbah.com/liversummary.htm this site offers photos of normal liver, ultrasound of normal liver and photos of shunt along with extensive information about a portosystemic shunt.

- Urinalysis

- Fecal examination

- X-rays of the abdomen to evaluate liver size

- Ultrasound examination of the abdomen to evaluate liver size, assess other internal organs and identify tumors that may be present

- Electroencephalography (EEG) to record electrical activity of the brain

- X-rays of the skull

- Blood lead determination if lead poisoning is suspected

- Cerebrospinal fluid analysis

Obviously at this point the important thing that needs to happen is finding out why this kitten is having seizures so that he can receive appropriate treatment to control them or treat the underlying condition. Ultimately if the vet can`t find a cause for your kitten`s seizures he may have to take seizure medication regularly for the rest of his life, the right drug will usually control the seizures but it isn`t a cure. I`m not sure if anything is currently being done to help treat these seizures until a diagnosis is made, but I would expect some form of treatment to minimize the chances that your kitten will have a severe seizure with fatal results. Drugs commonly used to treat pets with seizures include Phenobarbital, Potassium Bromide or Diazepam. Phenobarbitol is usually used to treat epilepsy in cats, if the seizures aren`t adequately controlled on this medication alone then Potassium Bromide may be added. Diazepam is normally used to treat seizures in an emergency situation.

Pets that experience a number of seizures over a relatively short period of time may require hospitalization and careful monitoring while tests are performed. Pets that have more than two seizures in 24 hours, are often hospitalized until they have had no seizures for 24 hours. Intravenous drugs such as diazepam may be used to control seizures initially. While a pet is hospitalized s/he may receive supportive care including IV fluids, soft bedding and taking his/her temperature regularly. Be sure to follow all treatment instructions and administer medications as prescribed by your veterinarian.

In this case it might be a good idea to start writing down when your kitten has seizures, how long they last and what happens up until your little guy is behaving normally again. It might be helpful for your vet if you can video tape one or more seizures as they`re happening so it might be worth keeping your camera or cellular phone nearby. Along with keeping track of seizures it`s a good idea to keep a record of any hospitalizations, any prescription drugs your kitten receives, when he receives these medications and the dates and results of any blood work performed. I`ve included an article about seizures in cats below, hopefully you`ll find the information helpful.

Seizure Investigation and Management in the Cat
Jacques Penderis, BVSc, MVM, PhD, CVR, DECVN, MRCVS
Institute of Comparative Medicine, Faculty of Veterinary Medicine, University of Glasgow
Glasgow, UK
 
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18293640Feline seizures differ from canine seizures in a number of ways. The manifestation of the seizures is different with most cats presenting with atypical seizures (often representing focal seizure episodes, with a high incidence of vocalisation, aggression and salivation). At the onset the seizure frequency may be high, often with multiple short seizure episodes per day. This high frequency of onset does not necessarily equate to difficulty in controlling the seizures or a poor prognosis. Although idiopathic epilepsy in cats is an important cause of seizures, other systemic and/or neurological findings are common--it is therefore important to assess for the presence of underlying causes in cats.



Investigation of Seizure Disorders

When deciding on appropriate tests to investigate the causes of seizures, consideration should be taken of the animal's age, the suspected anatomical localisation of the underlying cause and presence or absence of inter-ictal neurological deficits in formulating the diagnostic plan. Routine haematology and biochemistry (including a glucose determination) should be performed in all cases. In cats less than a year of age a pre- and post-prandial bile acid assay should also be performed.

If finances are limited then at this stage it would not be unreasonable to make a diagnosis of idiopathic epilepsy if:

There is a normal haematological and biochemical evaluation.

There are no abnormalities in the inter-ictal period.

If these cases later developed further clinical signs to suggest an alternative diagnosis, or if the seizure control was poor, then further investigation would be indicated. However, because underlying causes for seizures are so common in cats a full investigation should be performed wherever possible:

First Investigate for Possible Extra-cranial Causes

Complete haematology

Comprehensive biochemistry including pre- and post-prandial bile  acid assay

Urinalysis

Total T4 in adult cat suspected of hyperthyroidism

FeLV, FIV and FIP tests

Toxoplasma serology

Then Consider Investigation of Intra-cranial Causes

Thoracic radiographs

MRI or CT of the brain

CSF analysis (protein quantification, complete and differential cell count)

CSF PCR for coronavirus, toxoplasmosis, FeLV, FIV and Borna virus

Maintenance Therapy for Feline Seizures

The aim of any anti-epileptic treatment is to 'control' the seizures by reducing their frequency, intensity and severity with minimum side effects--treatment is unlikely to totally abolish the seizures. Where possible the underlying cause of the seizures should be treated. In some metabolic and toxic disorders (in particular porto-systemic shunts, hypoglycaemia and some intoxications) standard treatment regimes would be contraindicated.

Aims of Treatment

Reduce the frequency and severity of seizures.

It is important to explain to the owner that it is very likely that the animal will still seizure despite the therapy.

Minimise potential side effects.

Minimise the demands made on the owner.

Initial Anticonvulsant Therapy

Treatment of seizures in cats relies on phenobarbitone or diazepam as maintenance drugs of choice. Phenobarbitone does not usually result in clinically significant enzyme induction in cats and the elimination half-life therefore remains stable. Potassium bromide is not appropriate as a maintenance therapy in most cats due to unacceptable side effects.

Phenobarbitone

The half life of phenobarbitone in cats is 34 to 43 hours, but auto-enzyme induction is negligible and therefore drug concentrations of phenobarbitone are not expected to decrease in cats receiving long-term phenobarbitone therapy. Frequent monitoring of blood levels is therefore less important in cats. The time to reach steady state is approximately five times the elimination half-life (10 to 12 days in cats).

The drug acts by facilitating GABA-mediated synaptic inhibition by binding to barbiturate receptors on the chloride channel complex. Phenobarbitone binding results in higher intracellular concentrations of chloride and hyper-polarization of the resting membrane potential.

The initial dose is 2 to 3 mg/kg BID (i.e., total daily dose of 4 to 6 mg/kg).

Individual dosages are determined by the serum concentration (once the serum concentration has stabilised), not the actual oral dose.

Diazepam

Diazepam is also effective as a maintenance treatment in cats. In dogs it is not effective as a maintenance therapy due to its short half-life. Functional tolerance does not appear to develop in cats on diazepam. The starting dose is 2 to 5 mg/kg BID or TID. The effective serum concentration is 500 to 700 nmol/l. There are minimal side effects in cats on diazepam, although acute hepatic necrosis as an idiosyncratic reaction has been reported.

Potassium Bromide

The use of potassium bromide is contraindicated in most cats due to the development of severe respiratory signs, secondary to eosinophilic bronchoalveolitis. In those cases where use in unavoidable: potassium bromide has a long half life in cats of around 10 days and the starting dose is 1.5 mg/kg SID.

Treatment of Refractory Epilepsy in Cats (Adjunctive Therapy)

Refractory epilepsy is where the animal's quality of life is compromised by frequent or severe seizures episodes, despite appropriate therapy with phenobarbitone and/or diazepam.

Because the clinical effect of phenobarbitone is related to the serum concentration the first step in any cat apparently refractory to phenobarbitone therapy is to assess the serum levels. It is also important to exclude other factors that may be contributing to poor seizure control:

Poor owner compliance (dosages missed)

Dosage too low (determine serum concentration of phenobarbitone)

Incorrect diagnosis (repeat investigation)

Interference with absorption (malabsorption)

Drug interaction affecting phenobarbitone metabolism

Another new disease causing seizures

Poor owner compliance can be difficult to prove but can be a particular problem in cats. If you are strongly suspicious then hospitalise the animal to ensure they receive all the doses for a few days, before repeating the blood level determination. If the low blood levels were due to poor owner compliance then increased blood levels should already be evident after only a few days.

It is also important to recognise that any treatment is unlikely to totally resolve the seizures and to ensure that the owners are being realistic about what they term 'adequately controlled'.

Combination treatment with phenobarbitone and diazepam is the first management choice in refractory feline epilepsy. If this combination therapy is not effective and there are adequate serum concentrations then treatment with Keppra (levetiracetam) can be assessed as an add-on maintenance treatment or on its own. Levetiracetam is not veterinary licensed and the owners need to be made aware of this.

Levetiracetam (Keppra®)

Levetiracetam is associated with few side effects and has minimal hepatic toxicity. Although it is of benefit in some cases, it has an extremely short elimination half-life in the cat which would normal preclude its use as a routine maintenance anticonvulsant therapy. Recommended dosages in cats are 5 to 30 mg/kg BID to TID.

Speaker Information
(click the speaker's name to view other papers and abstracts submitted by this speaker)
Jacques Penderis, BVSc, MVM, PhD, CVR, DECVN, MRCVS
Institute of Comparative Medicine, Faculty of Veterinary Medicine
University of Glasgow
Glasgow, United Kingdom

The great thing about the Best Friends Animal Society is that they rescue all kinds of animals worldwide, from places including the Middle East, USA, Canada and beyond. They are a sanctuary that doesn`t euthanize unless it becomes necessary in order to alleviate an animal`s suffering. In the event that this kitten is too unstable to leave Best Friends he would either be fostered by a loving caregiver until his time came to go over to the Rainbow Bridge or he`d be adopted via a special needs placement so that his new family would understand his medical condition and the emotional and financial commitment involved in caring for a kitty with chronic health problems. If this sanctuarly agrees to take this kitten on they will either send a volunteer to Michigan to come and get hime and pay for his transportation to Utah or they have their own small plane available to rescue animals worldwide. That having been said I'd suggest that you consider contacting them, explaining the whole situation including what the vet has already said, the fact that the local shelters/rescues have said they'd euthanize if he is placed with them, the financial issues involved in providing this little guy with the tests, possible surgeries and ongoing medical care that he apparently needs at this point and your wish to help him to have as healthy, long and normal a life as possible. If you intend to keep this kitten and go through all of the expensive tests, any necessary surgeries, medications and treatments he may need then you may want to consider checking into CareCredit which is an organization that finances veterinary care.

Charitable organizations that might help cover some or all of the cost of this kitten`s medical care include:

- IMOM Inc, www.imom.org
- Help-A-Pet, www.help-a-pet.org
- The Pet Fund, www.thepetfund.com
- Angels For Animals, www.angels4animals.org
- Feline Veterinary Emergency Assistance Program, www.fveap.org
- Feline Outreach, www.felineoutreach.org
- Cats in Crisis, www.catsincrisis.org
- MHS Detroit Center for Animal Care
Veterinary Center:
7401 Chrysler Drive
Detroit, Michigan 48211
(313)872-0004
- Rochester Hills (MHS)
3600W. Auburn Rd.
Rochester Hills, MI 48309
(248)852-7424
- Westland (MHS)
900N. Newburgh Rd
Westland, MI 48185
(734)7214195

---------- FOLLOW-UP ----------

QUESTION:       Thank You so much for actually giving me some info! It's hard to get explanations or a possible diagnosis from some vets. I'm the one one that actually had to bring up toxoplasmosis to my vet, that's when he said it wouldn't hurt to rule it out. Well why did I have to bring it up? I would never have known if I hadn't been looking on the computer for pretty much this whole week. My vet has helped my dogs in the past and I am thankful, but sometimes it's like they don't have time for you. Not to bash on Vets, I think it's one of the most admirable professions, but SOME Vets just need to have more compassion when you're freaking out about what it could be.
     Not about some of the things that have happened at my vet. The first night I took him to the emergency vet, the did an examination of his wound because they were worried that maybe he did get hit by a car before getting picked up from the road. They stated that most likely this was not the case. She said the kitten weighing 1.80 pounds would probably have more extensive injuries being only 8 weeks old (approx.) i.e. a broken leg or bruising. The wound looks more like a gash (not too deep) which she said could be the result of an animal attack or human cruelty. Of course it could still be some sort of head trauma (as per the vet I spoke with over the phone, not my vet but a vet referred to me by an animal rescue group that didn't have room for him). Though it was not showing any symptoms except for seizures, that I've witnessed, it could not be ruled out unless tests are performed. Now back to monday night at the emergency vet. They did the fecal test, the FIV/FeLV and a corneal stain which all came back negative. It was wormed anyway. They gave me antibiotics for his eye infection which I'd say was mild, and some for the upper respiratory infection which has since cleared up mostly. Then they pretty much sent me on my way and told me to follow up with my normal vet in 7 days for vaccinations.
     Now back to my normal vet which I've seen 2 times this week and one 15 minute phone call in which I ask about every possible problem I knew of to date it could be. A blood sugar test was done and came back "perfect at 83". I then after witnessing another seizure brought up the toxoplasmosis over the phone in which he said come on back and get some antibiotics for this. I'll have to add his temperature has been normal every vet visit. So I have stopped the upper respiratory antibiotic, and started him on the toxoplasmosis one, which has been since Thursday. I was told if this is the case I would see a difference in the seizures in about 4 days. After asking where I go from there he said I would need to get a stomach bile test to rule out liver shunts but they did not perform it. I would have to drive and hour a way to the Michigan State University Animal Hospital, which is no problem except he stated the cat is too young and small for this test. He also said something about some blood test I could have done, but again, he's to small. I have no problem driving to the hospital, but once I that test done I'm not sure how I could possibly pay for surgery if it is a shunt, not to mention I'd have to wait a few months for him to grow just to test him.
   Now the vet I spoke with on the phone seemed more knowledgeable on seizures than my vet(or maybe she just had more time). She practices about 45 minutes away. After I stated exactly how the seizures happen/last, she gave me some info. Since the seizures seem to last 30-45 seconds every time it happens, and it seems to become aware like a light switch about a minute after the seizure ends, she stated it sounds like petit mal seizures. She asked if it acted drunk or goofy after eating, and it doesn't. She said it does not sound like a shunt but of course it could not be ruled out unless the test are done. Also she said she had a cat in the office they keep which used to have about a 100 seizures a day (hard to imagine, I'd be freaking out) and after being on seizure meds it's down to 10 or 12 a day. She said she had every test under the sun done for it and finally had to diagnose epilepsy, since they could find anything.
     I'm going to go back to my vet monday but I've been told the cat should not be vaccinated if it is not well, per the advice of the head of a rescue I spoke with(who of course didn't have room for him). I'd hate not to vaccinate but also don't want to make it worse. I've heard the same with dogs, so I've never vaccinated my dogs when they were sick, even with a cold. I've always opted to wait until healthy. I will talk it over with my vet I guess. I will also ask the age I can exactly perform any tests and if they don't know maybe seek a second opinion. Like I said I'm not sure how far I can stretch my finances but I might look into finding a neurologist if I can. I can keep watching it have seizures, it kills me. I keep wondering why my vet gives me no direction unless I BRING IT UP. Thats why I have to thank you for all the info. It helps me know what I'm going to have to ask about.
     By the way I was told by the emergency vet( just someone who answered the phone) that they do not have a test for FIP, though I'm thinking they must be mistaken because I swear I've heard of test for this. I will ask my regular vet.
     Also, I have been keeping detailed records of every seizure I've witnessed since he came home to me, Which has been about 8-9 since Monday. I have also been noting every time he eats, which is tons ( at least we have something going for us), and been feeding him organic food (wet) and am going to the store tomorrow to find no preservative and no dye kitten food. I have been told they could cause seizures and the organics does not list if it has either  ( so I'm guessing it does). I just learned that today. I love the organic stuff but probably won't be able to find organic with no preservative or dye. So I'll go with no preservative or dye. Good thing he's gaining some weight though, the vet said usually liver shunts kitties have trouble gain any weight and he's just over 1.90 as far as Thursday(1.80 at the emergency vet Monday). I've also written every time he has antibiotics. I've pretty much written every detail of everything so far. I hope this can aid whoever I see next about the seizures, or if I find a rescue for him.
     Just to tell you a little about the kitty. He's black and white. He loves to sleep in your lap and receive affection. His favorites are neck rubs and belly scratches. He's seems a little on the quiet side with meowing but still gives one when he's curious about something. He's playful but very gentle. And apparently car rides makes him very sleepy. He's such a sweet kitty, it's hard to think about giving him up but I know it would be better for him if he could find someone who could get him all the tests he needs and hopefully has some experience with seizure kitties. Its sometimes hard to remember you have to do whats best for him and not your heart. I want him to have the best chance possible, he's such a wonderful loving little guy. I love him already and the thought of him leaving makes me cry.
     Thank You for all the advice. It's really gonna help me help him. One last thing, if you would like to give me your thoughts about the vaccinations, seeing as I'd like to get as many opinions as possible. I'm only worried because I feed several ferral cats on my porch ( which I'm also trying looking into someone who can spay/neuter low cost) and would hate for him to pick something up. Even though I'm told it is unlikely I'd really like to know how unlikely.
     I will try to attach a picture of him from 8 pictures I took for a rescue group who is trying to find some kind of opening. I hope it works. The one I'm sending you can see his wound but I hope that won't make him any less precious.
     I can't thank you enough-Sonia

p.s. I will call The Best Friends rescue, I didn't know maybe they could arrange pick up. They sound like something I was looking for exactly.And Thank you for all the list of charitable organizations. Who knows if he's stuck with me I might have to call one ( no way I'm giving him to the pound to get put down just because there is no room at the rescue-since he seems to be healthy between seizures as far as now, cross your fingers and hopefully he'll keep that up :) ). He'd definitely be getting lots of love though if he is.

Answer
Sonia,

I'm so glad that you appreciate the research I've done and the information I've provided. Hopefully this little guy's seizures will either stop on their own or a cause will be found soon. Since your baby is gaining weight fairly quickly I'm less inclined to think that a shunt is the reason for the seizures since pets with shunts often don't grow normally or put on weight very well. It sounds like this little fighter has a dedicated person looking out for his best interests, it's obvious to me that you want to make sure that this baby gets the very best care possible even if that means breaking your heart and asking a sanctuary like Best Friends to take him. I'm certainly willing to listen and offer support regardless of what your decision ultimately turns out to be, I know just how difficult and scary it can be to know that a much loved pet is sick and not have any concrete answers to explain what's happening. You and this kitten have been and will continue to be in our thoughts and prayers - I wish you both the very best of luck.

As for foods I'd recommend that you check out catinfo.org if you want to make this kitten's food yourself (that way you know exactly what he's getting and you won't have to worry about recalls), you can purchase foods like Feline Pride, they're raw foods made from high quality ingredients and they cost roughly the same as feeding a decent diet or you can try foods like Wellness and Spot's Stew by Halo - this kitten doesn't need anymore strikes against him, he's already got enough problems so these are the only two traditional type pet foods I feel comfortable recommending to pet parents since I've done extensive research about the pet food industry, these foods have never been recalled for any reason to my knowledge and that's important to me since my eldest cat almost lost her life to renal failure as a result of eating food tainted with melamine during the Menu Foods recall of 2007. I really felt betrayed by what happened there because I was paying a substantial price for what I thought to be a high quality food and to have it end up being a part of the Menu Foods recall just shocked me to the very core.

If there's anything else I can do to help you, please feel free to let me know.