Okay, imagine the scenario: 2-year-old MC Labrador, with a history of 2 seizures in the last month. Owner is coming to see you and wants to know what is going on! What do you do first?
Hopefully your answer is a

THOROUGH NEUROLOGIC EXAMINATION!

If you focus on a few specific parts of the neurologic examination, you can get a good picture of what that pesky forebrain is up to. (The part of the brain that causes seizures.)

Okay, grab your pen (or what ever writing implement you use these days), here are the 4 things to focus on when you perform a neurologic examination on a patient with a history of seizures:

Assess mentation: Signs of obtundation or stupor can indicate a lesion in the forebrain (but also the brainstem, so don't be narrow minded if the pet is mentally inappropriate. Do a full exam!)
Menace, paired with pupillary light reflex (PLR): A unilateral reduced or absent menace, when PLR and blink reflex are normal, indicates a CONTRA lateral forebrain lesion. Poor menace with normal PLR means there is a problem in a) CN II, 2) Forebrain or 4) CN 7.
Gait assessment: Specifically, do you see circling? Unusual compulsion? If so, animals generally circle TOWARDS their lesion. Circling left, I’d worry about a left forebrain lesion.
Postural reactions: These will be CONTRA lateral to a lesion causing seizures. An animal with a left pelvic limb paw replacement deficit, you can worry about a lesion in the right forebrain. Note: the new name for CP is paw replacement deficit!

Beware! The neurologic examination may be abnormal after IV administration of anti-convulsant drugs, during the post ictal phase, or if the pet has received long-term anti-convulsant drugs.

Did you know that 80-90% of dogs with idiopathic epilepsy will have a normal inter-ictal neurologic examination??

Furthermore, dogs with an abnormal exam are 16x more likely to have structural brain disease than their normal counterparts! Seriously. The neurologic examination is one of the biggest tools used to predict a diagnosis in an epileptic dog (and I might add, cat).

Statistics never predict an individual’s condition but by focusing the neurologic examination on these areas you can gain important insight into the health of your patient’s forebrain. Please note: if you find an abnormality, the entire neurologic exam should be performed to make sure that you're not missing multifocal disease. Ultimately guiding owners, helping dogs, and improving everyone’s quality of life is what we’re after, right?

Not feeling confident on the neurologic examination? I'd love to be your go-to neurologist! The vast majority of my business is identifying IF neurologic disease is present in a given pet, and helping vets manage seizures.

Consult days are currently Monday through Saturday at variable times between 8 and 6pm. Email consults are completed after hours due to current childcare restraints.

Stay safe, healthy and keep those consults coming!