Epilepsy — characterised by recurrent, unprovoked seizures — is one of the most common neurological conditions in dogs, with a prevalence ranging from 0.5% in non-referral populations to 2.6% in referral hospital settings, with higher rates in predisposed breeds including Border Collies, Labrador Retrievers, Belgian Tervurens, and German Shepherd Dogs. In cats, recurrent seizure disorders have a 1-year period prevalence of approximately 0.16% in UK primary care. Managing epilepsy requires lifelong anticonvulsant therapy in most patients, with drug level monitoring, clinical sign assessment, and periodic dose adjustment based on seizure frequency and side effect profile. Owner-maintained seizure diaries are the most important monitoring tool between clinic appointments — and a follow-up system that captures diary information regularly provides the clinical picture that blood levels alone cannot.
Why epilepsy follow-up centres on two parallel monitoring tracks
Track 1: Medication efficacy. The goal of anticonvulsant therapy is to reduce seizure frequency and severity to a level that maintains acceptable quality of life — ideally seizure-free, but practically often fewer and less severe seizures. Phenobarbital — the most commonly prescribed first-line anticonvulsant in dogs — requires serum level monitoring at 2 weeks post-initiation (to assess trough level) and then every 6 months. Serum levels that are subtherapeutic explain ongoing seizures; levels that are supratherapeutic explain sedation, ataxia, and polyphagia. Both require dose adjustment that cannot be made without the monitoring data.
Track 2: Medication safety. Long-term phenobarbital use carries hepatotoxicity risk, which requires liver enzyme monitoring every 6 months alongside serum level assessment. Potassium bromide — used as a second anticonvulsant in dogs — causes sedation, ataxia, and polydipsia. Levetiracetam, used in both species, has a short half-life (approximately 3 hours) and requires tight adherence to dosing intervals. For each drug, the follow-up call that asks about side effects is as clinically important as the serum level result.
Owner-reported seizure frequency is the primary outcome measure. Only 14% of treated dogs achieve complete seizure-free remission in published series. For the remaining 86%, the question is not “are seizures happening?” but “how frequently and how severe?” — and this answer comes only from the owner, who witnesses the seizures between clinic appointments. A seizure diary that records date, time, duration, and recovery period provides the data needed for rational dose adjustment.
The epilepsy follow-up timeline
| Timepoint | What to check | Red flags |
|---|---|---|
| 2 weeks post-initiation | Phenobarbital serum trough level, any side effects — sedation, ataxia, polydipsia, polyphagia, any improvement in seizure frequency, owner comfortable with diary keeping and emergency protocol | Supratherapeutic levels with significant sedation — dose reduction needed; seizures continuing at same or higher frequency — may need additional drug or dose increase |
| 6 weeks | Seizure diary reviewed — frequency, duration, recovery; any change in side effects; dose adjustment response if applicable | Cluster seizures (multiple seizures within 24 hours) or status epilepticus — emergency medication protocol review; owner not keeping seizure diary |
| Every 6 months (stable) | Serum drug level, liver enzymes (phenobarbital), full biochemistry, seizure frequency from diary, body weight | Elevated liver enzymes with phenobarbital — hepatotoxicity monitoring, dose review; breakthrough seizures after period of control |
| After cluster seizures or status epilepticus | Rescue medication used correctly, recovery complete, dose adjustment made | Status epilepticus >5 minutes or cluster seizures — emergency assessment and medication protocol revision |
What to ask owners during epilepsy follow-up
- Has [dog/cat name] had any seizures since the last visit — and if so, how many, and how long did they last?
- Have you been keeping the seizure diary — can you describe what the seizures looked like?
- Are you giving the anticonvulsant medication at the correct dose and timing every day?
- Has [pet name] seemed more sedated, wobbly, or uncoordinated since starting the medication?
- Has the water intake or appetite changed significantly — particularly increased thirst or ravenous hunger?
- Have there been any episodes of cluster seizures — more than one seizure within 24 hours?
- Do you have the emergency medication (diazepam or midazolam) available, and do you know when and how to use it?
- Has [pet name]‘s quality of life between seizures been good — is he alert, engaged, and enjoying normal activities?
- Have you noticed any triggers for the seizures — particular activities, times of day, or situations?
- Do you have your 6-month blood monitoring appointment booked?
Common epilepsy follow-up mistakes clinics make
Not establishing a seizure diary at the first appointment. Owners who are not given a specific tool for recording seizures — date, time, duration, recovery description — rely on memory, which is unreliable and inaccurate. A seizure diary (even a simple notes app) produces far more useful clinical data. A follow-up call at 2 weeks that asks “have you been recording the seizures in your diary?” reinforces this from the start.
Not establishing the emergency protocol explicitly. All epileptic dogs and cats should have an emergency medication available at home — typically rectal diazepam or intranasal midazolam — with specific instructions on when to use it: “if a seizure lasts more than 5 minutes, or if there are more than 2 seizures within 24 hours.” Owners who have not been briefed on this explicitly may wait until the animal is in status epilepticus before contacting the clinic. A follow-up call that asks “do you have the emergency medication and do you know when to use it?” confirms this protocol is in place.
Not re-evaluating the diagnosis when seizures are not controlled. Treatment failure — seizures continuing despite therapeutic drug levels — should prompt reconsideration of the underlying diagnosis. Structural epilepsy (from brain tumour, encephalitis, or vascular accident) requires MRI and CSF analysis that idiopathic epilepsy does not. A follow-up call that asks about seizure frequency and character, and flags cases where control is not achieved, keeps this differential in view.
How to automate epilepsy follow-up without adding to your team’s workload
Nidana Loop schedules a 2-week serum level reminder and a monthly seizure diary check call for newly diagnosed epileptic patients. The monthly calls ask specifically about seizure frequency, duration, and recovery, as well as medication side effects and emergency medication availability. For stable patients, Loop schedules 6-monthly blood monitoring reminders. Cluster seizure or status epilepticus events reported during a call trigger an immediate urgent flag.
See how Loop handles epilepsy follow-up calls → Book a 20-minute demo
Related: IVDD follow-up · Vestibular disease aftercare · Toxin ingestion follow-up