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PROTOCOL FOR THE EMERGENCY MANAGEMENT OF CLUSTER SEIZURES IN DOGS

This protocol combines 2 approaches for the emergency management of cluster seizures in dogs at home and has proven to be very effective. Valium and its generic name diazepam are used interchangeably throughout. As always, consult with your veterinarian before trying anything different.

Something which has been highly effective is to add oral valium to the liquid valium to maintain the level until you feel that the cluster period is past for a safe period.
The other approach is to administer an extra dose of whatever antiepileptic drugs (AED) the dog is on after the 1st seizure and after each successive seizure in the cluster.

Some key points:

  • You must hit the cluster as early as possible with administration of the liquid valium administered rectally to be most effective. Liquid valium should be administered rectally immediately after the 1st seizure or definitely after the 2nd seizure within a relatively short period of time, say 30 minutes or less. The more seizures that they have in a cluster before starting treatment, the harder it is to break the cluster. Dr. Podell's article has guidelines of a low dose of 0.5mg/kg to a high dose of 2.0mg/kg. It is important to use valium or the generic equivalent diazepam. There are other varieties, i.e. oxazepam that have different half lives and periods of efficacy and do not apparently work as well.
  • ABSOLUTELY necessary to be effective is to hit the cluster hard with enough liquid and oral valium. You are not going to kill them by giving them too much valium unless you gave them massive doses. There are guidelines in Dr. Podell's article on his research on the use of rectal valium on how much to use per kg of the dog's weight.
    These guidelines are a low dose of 0.5mg valium per kg of dog's weight to a high dose of 2.0mg valium per kg of dog's weight.
  • Maintain valium administration with oral doses once the dog comes around and can swallow the tablets until you feel they have gone a "safe" period seizure free. This "safe" period would normally be at least 12 hours, perhaps as long as 24 hours depending on the individual case. For a 100lb dog (±45kg), this maintenance dosage would be about 30mg of valium every 3 hours, again needing to be adjusted for the individual case.
    NOTE: The only difference with the use of the rectal and the oral valium is how quickly it gets into the bloodsteam and is effective. The liquid valium administered rectally is absorbed quickly and begins being effective within 10 minutes, whereas the oral valium could take 30 minutes or longer. Also, the liquid valium can be administered rectally even while the dog is having a seizure, which would not be possible with the oral valium. Therefore, liquid valium is used rectally for the 1st dose to start having an effect to break the cluster as quickly as possible. After the 1st dose of rectal valium, you can use the oral valium to maintain the level.
  • Valium has a short life, therefore you need to give additional oral valium every 3 to 4 hours to keep the level up.
  • After the 1st seizure and again after the 2nd seizure, (if the 2nd follows within 4 hours of the 1st,) an additional dose of the AED drugs is administered (in this case, Pb and Kbr).

In summary:

a) during the 1st seizure, administer liquid valium per rectum in a dosage at least equal to the recommended low dose. After your dog has started to come out of the seizure and you feel they can once again swallow safely, administer additional oral valium tablets to bring the total dosage of combined rectal liquid valium and oral valium tablets into at least the mid-range of recommended dosages. At the same time, administer an extra dose of the antiepileptic drugs that they are normally on.

b) if a 2nd seizure occurs within a fairly short period of time, say within 4 hours, repeat step a).

c) if there is not a 2nd seizure within 3 hours after the 1st, administer additional oral valium to maintain the level. Continue every 3 hours until you feel the emergency has passed, usually for the period of the next 12 to 24 hours

NOTE: Once again, you should always consult with your veterinarian. The dosages and timing of administration would need to be adjusted to your individual case. The key point is use of the rectal valium early in sufficient dosage to be effective, followed by oral valium to maintain the level, and additional dosages of the AED that your particular dog is on.

 

The main approach this protocol is based on is described in Dr. Podell's article:

Podell, M. The use of diazepam per rectum at home for the acute management of cluster seizures in dogs. J Vet Int Med (1995) 9:68-74.

The address for reprint requests is:

Michael Podell, DVM
Department of Veterinary Clinical Sciences
601 Tharp Street
College of Veterinary Medicine
Columbus, OH 43210

 

 

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