There are anecdotal reports of the successful use of proligestone and delmadinone injection to control mild canine epilepsy in both sexes. The usual reports of usage of these drugs are for dogs that have had several brief seizures over a couple of years, but perhaps not of sufficient frequency to justify daily phenobarbital administration. In these reports the datasheet recommended dose has been given every 6 months. However, it is obviously difficult to monitor the benefit of treatment in any animal where seizures are only occurring a few times a year. Proligesterone is a synthetic progestagen (the only natural progestagen being progesterone). All progestagens have antioestrogenic and antigonadotropic properties. Delmadinone is an antiandrogen with a greater antigonatropic effect than progesterone. So is there any rationale for these treatments?

The effect of sex hormones on epilepsy has been well-documented in man and experimental animals. In animal models oestrogen has been shown to have proconvulsant effects whilst progesterone has anticonvulsant properties. Infusion of oestrogen can lower the seizure threshold – with increased effect in animals with an existing cortical lesion.

Some anticonvulsant drugs may suppress seizures by enhancing activity of GABAergic systems. Enhancement of the effects of GABA should increase seizure threshold. Progesterone's anticonvulsant and neuroprotective effects may be due to the steroid's actions on GABAA-benzodiazepine receptor complexes (GBRs) rather than intracellular progestin receptors, as many progesterone metabolites have a greater effect in vitro on benzodiazepine binding and chloride flux than progesterone, but poor affinity for progestin receptors (Frye CA 1995). Progesterone may have further effects through another action in inhibition of glutamergic activity. Of course in the real world where patients may be exposed to multipharmacy we should also consider that some of the responses reports may be related to the effect of sex hormones on concentrations of anticonvulsant drugs.

Catamenial epilepsy (associated with the menstrual cycle) is recognised to affect one in three epileptic women (Foldvary-Schaefer & Falcone 2003). In general there is an increase in seizure frequency immediately before or during menses but three distinct patterns of catamenial epilepsy have been described: perimenstrual, periovulatory, and luteal. Increased seizure frequency prior to the menses correlates with decreased progesterone concentrations, and high oestrogen levels before ovulation are associated with increased seizure frequency. If sex hormone secretion during the menstrual cycle influences seizure patterns in women it is likely that similar effects should be demonstrable in domestic pets. Although many therapies have been proposed for catamenial epilepsy, including acetazolamide, cyclical use of benzodiazepines or conventional antiepileptic drugs (AEDs), and hormonal therapy (including medoxyprogesterone acetate), there is not a strong evidence-base for the effectiveness of these treatments.

It is clear that there is scope for further research into the hormonal influence on seizures in domestic pets. The ability to address multiple factors affecting the severity and frequency of seizures may provide a mechanism for better control of seizures in some animals.

There are a number of published studies showing some benefits of acupuncture as an adjunctive treatment for epilepsy in man and animals. The reports of successful use in dogs have been sporadic (Van Niekerk J, 1988; van Neikerk and Eckersley, 1988; Janssesns, 1993; Panzert and Chrisman, 1994.).

In 1993 Janssens reported the use of ear acupuncture in the treatment of eleven dogs with longstanding epilepsy. The summary of the results looks encouraging. However, of the 4 dogs reported to be seizure free for between 13 and 24 months after treatment one was seizure free on anticonvulsant therapy before treatment, and although the 3 others had reduced seizure frequency after treatment, seizure interval in one was sufficiently long for this effect to be a coincidence. Improvement (defined as reduced dose of medication or reduced seizure frequency) was reported in 3 other dogs, a further 2 possibly showed less severe signs and in 2 there was no response. The author concluded that the results were encouraging and should be tested in a larger group of patients.

A new canine auricular acupuncture point for the treatment for epilepsy was studied by Panzert and Chrisman in 1994. The new acupoint was used with a previously reported canine auricular acupoint (van Neikerk and Eckersley, 1988) for the treatment of epilepsy in five dogs. This study reported testimonial evidence only but concluded that “the technique is worthy of scientific investigation, and controlled research is proposed”. Since that time the work does not appear to have continued (at least follow-up results are not reported).

Permanent acupuncture has been advocated as an adjunct to conventional therapies for the management of epilepsy in man. This involves the implantation of gold beads at sites of acupuncture points, under anaesthesia. Some extreme claims are made for this treatment in dogs ‘up to 60% of epileptic dogs are cured’ with little supportive published data.

In one published study from the Veterinary Hospital of the University of Pennsylvania (Klide and others, 1987) five epileptic dogs, unresponsive to high levels of antiepileptic medication were treated at the acupuncture clinic. Small gold implants were placed subcutaneously over the calvaria to provide constant stimulation at specific acupuncture points. All five dogs showed a change in seizure patterns following gold implant placement. Two dogs had decreases in seizure frequency (with their medication continued unchanged), but reverted to their previous seizure pattern approximately five months after treatment. Three dogs continued to have decreased numbers of seizures and were maintained on decreased levels of anticonvulsants.

The data from these reports is difficult to interpret due to the lack of a comparable control population. It would however seem that, provided it is used as an adjunctive to conventional therapy under veterinary control, acupuncture may offer a safe alternative to other unlicensed treatments.

A novel idea in the management of human epilepsy is the use of vagal nerve stimulation (VNS). The vagal nerve is unique among peripheral nerves of the body in that its nuclei begin in the brainstem. It is not known how VNS achieves an anti-epileptic effect. One theory is that the stimulation scrambles some of the synchronous discharges of the brain associated with seizure activity. Periodic scrambling of the discharges may prevent the recruitment phase needed to begin a seizure.

VNS has not been shown to be more effective than any anticonvulsant in man - its advantage lies in its lack of central nervous system side-effects (sedation and ataxia). However, it has its own transient, side-effects of neck pain and voice change. When effective, VNS permits dose reduction, or elimination, of anticonvulsant drugs, and also seems to shorten the duration of seizures and recovery time. Some human patients do well with this treatment but it is not possible to predict which will benefit.

Investigation of this technique in dogs has been sketchy. Digital ocular compression (to stimulate the vagal nerve) has been shown to be effective in some canine epileptics. One study of seven dogs with epilepsy (Speciale and Stahlbrodt, 1999) showed ocular compression to be efficacious for aborting seizures in 3 dogs. Seizure onset was prevented in 2 other dogs.

In 2002 Munana and co-workers took 10 dogs with poorly controlled seizures and surgically implanted a programmable pacemaker-like device delivering intermittent stimulation to the vagus. Dogs were randomly assigned to two 13-week test periods, 1 with nerve stimulation and 1 without nerve stimulation. No significant difference in seizure frequency, duration, or severity was detected between overall 13-week treatment and control periods. However, during the final 4 weeks of the treatment period, a significant decrease (34.4%) in mean seizure frequency was detected, compared with the control period.

For many thousands of years herbal medicines have been used throughout the world in many cultures and the majority of modern drugs are still derived from plants today.

There are a number of herbs that have anti-seizure properties but it is not advisable or necessarily safe to treat dogs using herbal products that have been formulated for people.  Whatever treatment is used for epilepsy appropriate monitoring must be given.  There are a only a few herbal veterinary medicines that are licensed for use in the treatment of epilepsy and these are normally used alongside conventional therapies.

Only licensed veterinary herbal medicines can be guaranteed to have undergone the same rigorous testing procedures as pharmaceuticals. These will have proven their quality, safety and effectiveness for use in animals.  Adverse reactions or side-effects (although extremely low in veterinary herbal medicines) will be reported in the same way as any other medicines. If herbal remedies are to be prescribed you should always use medicines or supplements that have been specifically produced for dogs and shown to be safe in this species.