# Losing control of hind legs



## Alfonso1517 (Dec 23, 2013)

Hi, I have an eight year old male Shih Tzu who has been diagnosed with epilepsy and a skin allergy. Recently, he has began to lose control of his hind legs. He is currently on a lot of medication: steroids for skin, epiphen and libromide for his seizures. Does anyone have any experience with these conditions?

However, I am concerned that it may be Cushing's disease as I have been reading that it can cause back leg weakness and affects the immune system which could have lead to his skin condition and seizures. Any advice or information would be greatly appreciated.


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## Sled dog hotel (Aug 11, 2010)

Alfonso1517 said:


> Hi, I have an eight year old male Shih Tzu who has been diagnosed with epilepsy and a skin allergy. Recently, he has began to lose control of his hind legs. He is currently on a lot of medication: steroids for skin, epiphen and libromide for his seizures. Does anyone have any experience with these conditions?
> 
> However, I am concerned that it may be Cushing's disease as I have been reading that it can cause back leg weakness and affects the immune system which could have lead to his skin condition and seizures. Any advice or information would be greatly appreciated.


Its hard to say if its side effects of the drugs or something else may be going on as there are several possibilities that could be occurring.

Phenobarbital can cause ataxia which is in-coordination or hind end weakness due to the way the drug works.

Phenobarbital inhibits seizures by decreasing the activity of neurons. Unfortunately, this effect is not specific to the neurons involved in the seizures but affects other neurons as well. Many of the potential side effects of this drug are caused by this effect on neurons. These side effects can include sedation, lethargy, excessive urination, excessive thirst and excessive hunger, hyperexcitability, ataxia (loss of coordination or hind end weakness) and restlessness. Most of these side effects diminish or disappear after the first few weeks of therapy. Excessive urination, excessive thirst and excessive hunger are the most common long-term side effects. 
Canine Epilepsy - Using Phenobarbital to control seizures in dogs

Potassium Bromide can also cause Ataxia hind end weakness and it seems it can also cause skin problems.

SIDE EFFECTS:

The most common side effects of bromide therapy are sedation, ataxia (hind end weakness and loss of coordination), increased urination and rare skin disorders. Increased urination, hunger and thirst are also common for dogs taking bromide alone or with Pb. Occasionally, abnormal behavior, such as irritability or restlessness can also require a reduction in dose. Side effects are more common in patients whose potassium bromide concentrations are greater than 2.5 mg/ml and the symptoms usually go away within a week after the dose is decreased. If the dog is too groggy and is on both Phenobarbital and bromide, it may be preferable to decrease the Phenobarbital dose, rather than the bromide. If the dose of bromide is to be decreased, we recommend monitoring of blood levels before any dose change in order to establish a target if seizures begin again.

Potassium bromide can also cause stomach upset, nausea and vomiting. If this occurs, you may wish to try giving the drug with food, or dividing the daily dosage into two or more portions; you and your vet may also wish to consider switching to sodium bromide which is just as effective but doesn't cause the same stomach symptoms. And some dogs prefer the taste of sodium bromide.

Also, Bromide should be used with caution in dogs with renal insufficiency.

Bromide toxicity is uncommon, however, it is a potential side effect of bromide use and most of the potential side effects that have been discussed on our list are from bromide toxicity. Bromide toxicity can occur in dogs with renal insufficiency or those that are on a very high dose of bromide. Signs of bromide toxicity include severe ataxia, sedation or stupor and muscle spasms. Usually, reducing the dose by 10% to 25% is sufficient to take care of these signs. 
Canine Epilepsy-Using Potassium Bromide to control seizures in dogs

Ive included the full link and there is also another helpful link on using the two together.
PotassiumBromide_Adjunct

Steriods too can cause side effects especially if given longer term. The most common one usually is prednisone or prednisolone. Steroid treatment side effects will actually give all the symptoms of cushings disease. With cushings the body produces too much steroid, the most common symptoms of Preds are the same increased thirst, increased urination, it can effect the hair and coat and cause animals to be more susceptible to infection as it lowers the immune system. You can actually get a condition called iantrogenic cushings which means veterinary induced. Another problem that can sometimes occur when on too high dose for too long is that the adrenal glands stop producing their own natural cortisol so that when the meds are withdrawn then there will be a lack of natural production. Usually steroids need to be used at the lowest possible dose, and tapered down slowly and cant be withdrawn immediately they usually reduce them to every other day instead of every day at first to try to avoid problems.

Dogs on epilepsy drugs and also steroids should be having regular blood tests to monitor levels and effects.

You don't mention whats come first the seizures or the skin condition or when they started. There are other conditions that can cause seizures as symptom too. One of which is Hypo Thyroid low thyroid hormone. More on minimum diagnostics for seizuring dogs below.

Minimum Diagnostic Assessments for an Epileptic 
History Your description of the character and timing of the episodes, relation to exercise, feeding, etc.Helps your veterinarian determine if this is indeed a seizure and what type. May provide clues to the cause. 
Physical Examination Evaluation of the heart, lungs, abdomen, gum colour, etc.Provide clues to diseases which could cause seizures or complicate treatment. 
Neurologic Examination Evaluation of behaviour, co-ordination, reflexes and nerve functions.Provide clues to disease of the nervous system which may be causing the seizures. 
Complete Blood Count
(CBC), routine serum
chemistry profile, and
urine analysis (UA) Blood and urine samples are taken and analysed.Rules out metabolic causes of seizures and provides baseline data to monitor effects of medication. 
Bile Acids Assay or
Ammonia Tolerance
Test Usually, the pet is fasted and two blood samples are taken.Rules out liver problems and provides baseline data to monitor effects of medication. 
Thyroid Function Test Blood samples analysed for T4 and TSH levels.Optional, but would rule out thyroid disease as a cause. 
Range of tests and examinations for diagnosis of epilepsy in the dog
Source: Canine Epilepsy Network

Specialist Tests for the Diagnosis of Seizures
Source: Canine Epilepsy Network 
MRI or CT brain scan Evaluate the structure of the brain; requires anaesthesiaRules out diseases such as brain tumours which would need to be treated directly 
Spinal tap Spinal fluid is collected and analysed; requires anaesthesiaLooks for infectious diseases and provides clues to other brain diseases 
Antibody titers Blood and/or spinal fluid is analysed for antibodiesIdentifies specific cause of an infection 
Toxin tests Blood or other sample is tested for the presence of a toxin.Tells if a specific toxin is present, but usually need a clue to what toxin to look for from the history or other test 
Other laboratory tests Advanced tests on blood, urine, or spinal fluid.Follows clues suggested by routine tests 
Electrocephalogram
(EEG) Recording of brain wave to look for the electrical storm.Allows definitive diagnosis, but can be non-diagnostic

Thyroid tests should be in the minimum set of diagnostics, thyroid can cause a host of symptoms and can vary from dog to dog seizures being one of them.

Clinical Signs of Canine Hypothyroidism

If your dog has seizures check the thyroid for low thyroid function or hypothyroidism

If you have never seen it the Canine epilepsy guardian angels website where some of the above information comes from is well worth exploring.

Canine Epilepsy and Dog Seizures Table of Contents - Canine Epilepsy Guardian Angels


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## Alfonso1517 (Dec 23, 2013)

Thanks for the detailed information -appreciate it!


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## Karen Guess (Apr 25, 2018)

I have good news. Read everywhere 2 weeks to improve hind end use. My 14 year old lab started having seizures. 3 in one night one the next morning. On pheno could not use back legs at all for the first week. Then little by little she started walking. It's day 10 and she is back to normal going for swims in the pond and walking all over the yard. She still needs assistance getting up the last step but not complaining.


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