Pearls and important clues from the Neurological Exam

• Goals for lecture–Emphasize 3 components of the

neurological exam that YOU canhelp your doctor

AT HOME TREATMENT OF STATUS EPILEPTICUS

Jay McDonnell, DVM, MS, DACVIM-N

RATIONALE

� The most common neurological complaint in canine patients is seizures

� In cats, this is in the top 3 complaints

� The number one cause of death in dogs with seizures?

�Seizures are frightening anddisturbing to owners

�Seizures should be treated onemergency basis if prolonged orrecurrent

�Treatment at emergency clinics can be costly

RATIONALE

SYSTEMIC EFFECTSThe brain is a desert

OxygenEnergy

Waste management is not its strong suit

Neuro logy-Neurosurgery

Mirror Focus - Kindling

SEIZURES AND STATUS EPILEPTICUS

Seizures kill

Seizures make new seizures

Stop the seizures

Support the patient

EMERGENCY VET CARE IS EXPENSIVE

RATIONALE

� Dangerous and Expensive

STATUS EPILEPTICUS

�Importance�Loss of consciousness and

autonomic control

�Increased muscular activity

�Increased cortical activity

�Indications� cluster seizures/status

epilepticus

�PR parental diazepam gives effective bloodlevels within 30-90 sof administration

AT HOME TREATMENT OF STATUS EPILEPTICUS USING RECTAL VALIUM

AT HOME TREATMENT OF STATUS EPILEPTICUS USING RECTAL VALIUM

�Adequate dose� 1-2 mg/kg

�Adequate training

�Proper preparation

Status Epilepticus-Cluster seizures

Rectal or nasal diazepam 1-2 mg/kg

When seizures stop, give additional dose

of current anticonvulsants

Seizures controlled è return to normal dosing of anticonvulsants

ER

BUT WAIT - -- -THERE’S MORE!

�Midazolam� Benzodiazepine

� Water soluble

� Rapid onset of action

BUT WAIT - -- -THERE’S MORE!

�Midazolam has been shown to be more quickly absorbedsystemically when given intranasal by an atomizer

�Adequate dose� 1-2 mg/kg

�Adequate training

�Proper preparation

MIDAZOLAM

�Midazolam given by MucosalAtomizer Device (MAD)

STATUS EPILEPTICUS

Seizures kill

Seizures make new seizures

Stop the seizures

Evaluate the patient

Support the patient