Seizures in Cats

What are seizures?

Seizures (convulsions or fits) are the result of a sudden and uncontrolled burst of electrical activity within the brain. They are one of the most common neurological disorders in cats, although the prevalence is much lower than that of dogs. Seizures occur in the cerebrum, which is located in the front of the skull and is responsible for sensory and neural functions as well as behaviour.

Seizures can affect cats of any age; however as many of the underlying causes occur more in older cats, seizures are more common in middle-aged to senior cats. Approximately 0.5 – 1% of cats are affected by seizures.

Seizures fall into two categories:

• Tonic-clonic seizures: Formerly known as generalised or grand mal seizures, tonic-clonic seizures are a type of seizure that affects the entire brain.
• Focal seizures (partial seizures): Focal seizures are restricted to one location in the brain and are further divided into simple focal or complex focal. Simple focal seizures are when consciousness remains; complex focal seizures are when there is a change or loss of consciousness.

Causes

Any disease which alters the way the brain functions can potentially cause seizures. Epilepsy is the most common cause of seizures in cats and is defined as recurring seizures resulting from an intracranial cause (see below). It calls into two categories:

• Inherited, acquired or idiopathic (no known cause)
• Symptomatic epilepsy

Causes of seizures may be extracranial (problems occurring outside the brain) or intracranial (problems occurring inside the brain).

Some common causes of seizures include:

Intracranial:

• Brain tumour, benign or cancerous (meningioma, glial cell tumours, and lymphoma)
• Head trauma
• Hydrocephalus (water on the brain)
• Brain infections or inflammation such as meningitis and encephalitis
• Bleeding into the brain
• Abnormal migration of heartworm

Intracranial diseases are the most common causes of seizures in cats.

Extracranial

• Heatstroke
• Hypoparathyroidism
• Portosystemic shunt
• Bacterial (tetanus) or viral infection (FIP, feline leukemia virus)
• Fungal infection (blastomycosis cryptococcosis)
• Kidney failure
• Liver disease can cause a build-up of toxins in the body, which can lead to seizures
• Certain medications (antibiotics, antihistamines)
• Poisoning – Common causes of poisoning include antifreeze, lead, insecticides, tea tree, snail bait, aspirin, marijuana, zinc, pseudoephedrine, chocolate, flea products, mycotoxins
• Hypertension (high blood pressure)
• Metabolic disorders – Hypoglycemia (low blood sugar), hyperglycemia (high blood sugar), uremia, hypercalcemia (high blood calcium), hypocalcemia (low blood calcium), hypothyroidism
• Feline ischemic encephalopathy – A neurological disorder caused by parasitic infection of the Cuterebra larvae which are located in North America, South America, and Canada.
• Lysosomal storage disease
• Thiamine deficiency
• Systemic lupus erythematosus

Symptoms

Symptoms can vary depending on the severity of the seizures as well as the underlying cause. Nonspecific signs may include unusual behavior, lethargy, anorexia. There may be accompanying symptoms if there is an underlying cause.

Focal seizures affect only part of the body (for example the face), whereas clonic-tonic seizures affect the entire body. Most seizures last between 5 – 60 seconds but can be longer. Read our article: What seizures look like in cats to view pictures and videos.

Seizures come in three phases known as preictal phase (also known as aura), ictal phase and postictal phase.

• Involuntary vocalisation/calling out
• Ear, eyelid and whisker fluttering or twitching
• Rigid extension of the legs
• Loss of consciousness
• Involuntary urination and/or defecation
• Loss of breathing
• Salivation/foaming at the mouth
• Champing or chewing
• Tongue biting

There may be subtle signs in your cat before him having a seizure such as mild changes in behaviour, pacing, crying, clinginess, and attention-seeking. To learn more & view pictures of videos, read: What seizures look like in cats.

Emergency care

Please be aware that while (and often after) a seizure has occurred, your cat may not be aware of his surroundings and it is common for him to not respond to, or recognise you. His actions are involuntary, and it is important you keep a safe distance from him as it is possible you may get injured.

• If you suspect your cat is having a seizure, stand aside until the seizure abates.
• Remove objects which may harm your cat such as furniture.
• If there is a risk of falling (such as being close to stairs or near water), carefully move the cat out of danger.
• Do not try to force your fingers or objects into the cat’s mouth to prevent choking on the tongue. It is not possible for this to occur.
• Make a note of how long the seizure lasts, symptoms and behaviour before, during and after the seizure. This will be very helpful to your vet.
• It is normal for a cat to be confused and disoriented after a seizure.

As soon as the seizure is over, take your cat to a veterinarian. Seizures lasting longer than five minutes are an immediate danger, seek veterinary attention immediately.

Diagnosis

The veterinarian will perform a complete physical and neurological examination of your cat. He will obtain a medical history from you including the onset of symptoms, how many seizures your cat has had, any medications or poisons your cat could have ingested (accidentally or given by the owner), any recent accidents or illnesses when your cat was last vaccinated. Diagnosis is difficult unless your veterinarian sees your cat having an actual seizure at his practice. There is no test to diagnose seizures in cats.

Diagnostic workup:

• Biochemical profile, complete blood count, and urinalysis to evaluate the overall health of your cat and evaluate how the liver and kidneys are functioning.
• Imaging of the brain such as CT or MRI scan.
• Antigen testing for certain infections.
• Ultrasound to check for a portosystemic shunt.
• Fecal examination to look for the presence of parasites.
• Bile acid test to measure the performance of the liver.
• Metabolic screen to look for abnormal metabolites in the cat’s urine. This may indicate lysosomal storage disease.
• Cerebral spine fluid (CSF) analysis to check for encephalitis (inflammation of the brain).

In some cases, a cause can not be determined, in which case your cat will be diagnosed with primary or idiopathic seizure disorder.

Treatment

The goal of treatment is to find the underlying cause and treat it as well as control the seizures.

Emergency care:

• If the cat presents to the veterinary clinic seizuring, the veterinarian will administer injectable diazepam or phenobarbital.

Supportive therapy:

• Oxygen therapy.
• Intravenous fluids to prevent dehydration and correct electrolytes.
• Thermoregulatory support (control temperature).

Once the cat is eating and drinking and able to stand, he can go home.

Address the underlying cause:

Some conditions are entirely reversible (lead poisoning, low blood sugar, certain infections for example), and once this has occurred then the seizures should stop.

For cats who have repeated seizures (more than once a month), cluster seizures (seizures which start and stop in groups right after one another), or in the event of a permanent head injury) the veterinarian will prescribe long-term anticonvulsant medications, which may include:

• Phenobarbital
• Diazepam
• Clonazepam
• Gabapentin
• Levetiracetam
• Zonisamide

Regular follow-ups will be necessary to ensure the medication is working and it is not causing any side effects.

Aftercare

• It is quite common for a cat who has had one seizure to have repeat seizures at a later date, therefore it is recommended he be kept indoors.
• Administer medication as instructed.