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Clinical management of idiopathic epilepsy in dogs with homeopathic Belladonna 200C: a case series
Abstract
Epilepsy is an important neurological disorder in dogs. Belladonna 200C was evaluated in 10 dogs with idiopathic epilepsy. During the seizure phase, 3-4 drops of Belladonna 200C were administered orally at 15 min intervals until considerable reduction in seizure activity, then four times daily. Four dogs with head shaking syndrome in addition to seizures were given Cocculus 6C, 3-4 drops orally weekly for 3 months in addition. Numbers of fits reduced to 2-3 during first 2 weeks post-therapy and then became occasional in next 2 weeks. With continuation of Belladonna therapy, no fits were observed during 2-7 months follow-up. In two cases epileptic fits reappeared within 15-25 days of cessation of therapy. Belladonna therapy was resumed and seizure control was again achieved. Owners were advised to continue the therapy at least twice daily until there were no fits for 2-3 months. Liver specific enzymes were monitored, no abnormalities were observed.
... Belladonna: Convulsions during teething, with fever; comes on suddenly, head hot, feet cold rush of blood to head and face As per a previous study on dogs, considerable reduction was seen in seizure activity with belladonna, gradually there was disappearance of fits with continuous therapy [16] . A wide range of fruitful benefits were being observed on Animals and pets from Hahnemannian era to till date [15,16] . ...
... Belladonna: Convulsions during teething, with fever; comes on suddenly, head hot, feet cold rush of blood to head and face As per a previous study on dogs, considerable reduction was seen in seizure activity with belladonna, gradually there was disappearance of fits with continuous therapy [16] . A wide range of fruitful benefits were being observed on Animals and pets from Hahnemannian era to till date [15,16] . ...
... Many studies report the effects of phytotherapics in dogs while only few reports their effects on cats. Phytotherapic remedies can be useful for respiratory [5], digestive [6,7,8] (table 2) and skin [9] (table 3) pathologies; urinary [10] and cardiac diseases [11], in the control of stress and chronic diseases, as idiopatic epilexy [12], and to avoid risks of possible side effects derived from a prolonged ingestion of synthetic drugs. Significant reductions of severity and resolution of clinical symptoms, of clear nasal secretions, enlargement of lymph nodes, dry cough, dyspnea and dry lung sounds, are evident after 4 weeks of treatment with Echinacea powder suggesting this preparation as alternative remedy of canine upper respiratory tract infections [5]. ...
... Recently it has been reported the stimulatory effects of Panax ginseng in combination with brewers' yeast (Gerivet) as a stimulant for geriatric dogs [23] and the reduction of behavioural disturbances in elderly dogs supplemented with a standardized Ginkgo leaf extract [24]. Also epilexy is an important neurological disorder in dog and homeopathic Belladonna it has been shown to reduce number of fits in dogs affected by idiopatic epilexy [12]. ...
... The therapeutic effect of Tarentulacubensis extract (Theranekron®) in foot-andmouth disease in cattle: a randomised trial in an endemic setting. 20 Cattles ...
... For this purpose, a homeopathic medicine called Belladonna 200C has been applied orally 3-4 drops four times a day, and a significant reduction in epileptic seizures was observed. During epileptic seizures, in addition to animals with neurologic findings, Cocculus 6C was administered 3-4 drops weekly for three months, and these findings were regressed (Varshney, 2007). In another study, due to the treatment of false pregnancy in dogs with a homeopathic medicine called Thuja D30, significant improvements were found in the symptoms of the disease. ...
In this study, an improved Susceptible-Infected-Recovered (SIR) epidemic diffusion model for cholera is extended by including migration for susceptible people. This model is applied to a metapopulation that consists of two isolated cities where just susceptible individuals can migrate between the cities. The disease-free equilibrium, the endemic equilibrium points, and the basic reproductive number with unequal migration rates are analyzed for this metapopulation. Firstly, the study showed that the basic reproductive number depends on the migration rates between the cities. Then, showed that when the epidemic SIR system is stable, then the infected cases for cholera outbreak can reach zero in one city, but the infected cases in the other city still can stay positive. Finally, discussed three scenarios that depend on population sizes and migration rates of susceptible people between the cities and showed how important the migration rates are in the diffusion of the cholera outbreak by visualizing these three scenarios. Mathematics Subject Classification Primary: 92B05; Secondary: 92D40
... For example, sulfur 30C has undergone 30 steps of dilution, each step has been a one to one hundred dilution (indicated by the letter "C" meaning centesimal) [12,13]. Homeopathic drugs are recently used in treating conditions such as canine atopic dermatitis [14], canine babesiosis [15], idiopathic epilepsy in dogs [16], bovine mastitis [17,18], endometritis in dairy cows [19], diarrhea in neonatal piglets [20], and bovine papillomatosis [21] in animals. ...
Aim:
A study was conducted to evaluate the ameliorative potential of homeopathic drugs in combination (Sulfur 30C, Thuja 30C, Graphites 30C, and Psorinum 30C) in 16 dogs affected with oral papillomatosis which was not undergone any previous treatment.
Materials and methods:
Dogs affected with oral papillomatosis, which have not undergone any initial treatment and fed with a regular diet. Dogs (total=16) were randomly divided into two groups, namely, homeopathic treatment group (n=8) and placebo control group (n=8). Random number table was used for allocation. Homeopathic combination of drugs and placebo drug (distilled water) was administered orally twice daily for 15 days. Clinical evaluation in both groups of dogs was performed by the same investigator throughout the period of study (12 months). Dogs were clinically scored for oral lesions on days 0, 5, 7, 10, 15, 20, 25, 30, 45, 60, 90, 120, and 150 after initiation of treatment.
Results:
The homeopathic treatment group showed early recovery with a significant reduction in oral lesions reflected by clinical score (p<0.001) in comparison to placebo-treated group. Oral papillomatous lesions regressed in the homeopathic group between 7 and 15 days, whereas regression of papilloma in the placebo group occurred between 90 and 150 days. The homeopathic treated group was observed for 12 months post-treatment period and no recurrence of oral papilloma was observed.
Conclusion:
The current study proves that the combination of homeopathy drugs aids in fastening the regression of canine oral papilloma and proved to be safe and cost-effective.
... In case of epilepsy management, there are several homeopathic remedies reported in scientific publications as well as homeopathic literature. 10,11,12,13 Homeopathic remedy Nux vomica has also been reported to affect entire gray matter of the Cerebrospinal Nervous System (CNS), especially centering upon tubular gray matter of pons, medulla, and cervical portion of spinal cord. 14 Pharmacognosy Journal, Vol 10, Issue 2, Mar-Apr, 2018 ...
Objective:To investigate the antiepileptic effect of homeopathic remedy Nux vomica on mice and its comparison with standard therapeutic diazepam. Methods: BALB-c mice were taken and divided into three groups comprising ten mice in each group.The first group was treated as control; the second group received standard therapeutics (diazepam, i.p.) and the third group received Nux vomica CH7. All groups were treated with strychnine intra peritoneally. Following parameters were observed; start time of convulsions, the number of animals had convulsions, and survival time until death. Results: Nux vomica CH7 homeopathic preparation was found effective in suspending onset of convulsions (P 0.01), and extending survival time until death (P 0.01) in comparison to control mice. It also increased percentage survival in comparison to control as well as diazepam treated animals. Conclusion: Our study demonstrated efficacy of Nux vomica in epilepsy management.
... Evidence to support the use of these treatments currently is lacking. 118,119 What are the Guidelines for Success and Quality of Life Parameters? ...
This report represents a scientific and working clinical consensus statement on seizure management in dogs based on current literature and clinical expertise. The goal was to establish guidelines for a predetermined, concise, and logical sequential approach to chronic seizure management starting with seizure identification and diagnosis (not included in this report), reviewing decision-making, treatment strategies, focusing on issues related to chronic antiepileptic drug treatment response and monitoring, and guidelines to enhance patient response and quality of life. Ultimately, we hope to provide a foundation for ongoing and future clinical epilepsy research in veterinary medicine.
... Recently many herbal drugs have been proven clinically for treatment of idiopathic epilepsy including Atropa belladonna (Varshney 2007) and Ginkgo biloba (Harms et al. 2006). Hence, it could be deduced that FVEE bears a profile similar to an agents elevating inhibitory neurotransmitters in brain and restoring the excitatory neurochemistry behind epileptic seizures. ...
... Recently many herbal drugs have been proven clinically for treatment of idiopathic epilepsy including Atropa belladonna (Varshney 2007) and Ginkgo biloba (Harms et al. 2006). Hence, it could be deduced that FVEE bears a profile similar to an agents elevating inhibitory neurotransmitters in brain and restoring the excitatory neurochemistry behind epileptic seizures. ...
The aim of the present study was to investigate anticonvulsant effect of Fragaria vesca L. ethanolic etract in chemically induced epilepsy.Fragaria vesca L. ethanolic extract (FVEE) was prepared by extracting the fruit with 95 % ethanol. Seizures were induced by intraperitoneal injection of pentylenetetrazole, strychnine, isoniazid and subcutaneous injection of picrotoxin in male swiss albino mice. The in-vitro parameters were also determined including brain gamma amino butyric acid, nitric oxide.Single dose of PTZ, PTX, STR and INH resulted in resulted in hind-limb, tonic-clonic convulsion along with mortality in mice. Treatment with FVEE (250 and 500 mg/kg, p.o.) significantly and dose dependently (P < 0.01 and P < 0.001 respectively) attenuated onset of convulsion and duration of tonic convulsion induced by PTZ, PTX and INH. It also significantly inhibited the incidence of convulsion and mortality in the mice. Mice treated with FVEE (250 and 500 mg/kg, p.o.) showed significant elevation in brain GABA level and lowering in NO level as compared to vehicle treated mice. Mice treated with FVEE showed significant reduction in the locomotor activity. Treatment with FVEE failed to produce any significant change in STR induced convulsion.The findings of present investigation suggest that FVEE bears a profile similar to agent elevating the inhibitory neurotransmitter in brain and restoring the excitatory neurochemistry behind epileptic seizures. Further investigations are being carried out to characterize the biochemical nature to understand the active principles along with structure activity relationship.
Figure
Anticonvulsant activity of Fragaria vesca L. ethanolic extract: Role of GABA and NO.
Huntington's disease (HD) is a neurological disorder characterized by abnormal body movements (chorea) associated with cognitive and motor dysfunctions, neuropsychiatric disturbances, and striatal damage. 3-Nitropropionic acid (3-NP) triggers cellular energy deficit, nitric oxide (NO) mechanisms, and oxidative stress (OS)-induced neurotoxicity by inhibiting the activity of mitochondrial complex II enzyme and succinate dehydrogenase in irreversible fashion. Chronic systemic administration of 3-NP to animals produces preferential degeneration of the striatum, leading to motor and cognitive deficits, closely resembling HD. Besides 3-NP model of striatal neurodegeneration, a number of transgenic animal models expressing mutant proteins are routinely used in preclinical trials exploring anti-HD therapeutics. In this review, the roles of a number of plant extracts, fractions, and isolated compounds investigated in various neurotoxic animal models and transgenics are discussed, highlighting on their ability to influence signaling pathways, leading to neuromodulation and probable neuroprotection. Since mitochondrial involvement and OS are also common phenomena in etiopathogenesis of a number of neurodegenerative disorders such as Alzheimer's disease (AD) and Parkinson's disease (PD), a few plant-based anti-HD natural products have been found efficacious against such diseases. Therapeutic advancement in screening of natural products against HD suffers from constraints such as limited animal models and giving maximum emphasis on cellular models during experimentations. However, recent progress in animal HD transgenic models expressing mutant proteins may reveal the therapeutic efficacy of natural products against HD, a disease with less elucidated pathogenesis and inadequate treatment strategies.
Oral phenobarbital and imepitoin in particular, followed by potassium bromide and levetiracetam are likely to be effective for the treatment of canine idiopathic epilepsy. There is strong evidence supporting the use of oral phenobarbital and imepitoin as ‘first line’ medications. However, there remains a lack of evidence for targeted treatment for the various individual epileptic phenotypes and quite limited evidence on direct comparisons of the efficacy between various anti-epileptic drugs.
Homeopathic Pulsatilla 30C was evaluated in 4 clinical cases of ophthalmic complications with concomitant separation anxiety in dogs. Separation anxiety in dogs is excessive anxiety regarding to the separation from owners and is one of the most common behavioral problems in dog. In addition, ocular diseases is sometimes related with abnormal behaviors. Holistic approach is good alternative method to treat dogs with physical problem associated behavior problem. Homeopathy is one of the complementary and alternative medicines and bases on healing of patients themselves which includes mind healing, not the disease itself. Among the material medical remedy of homeopathy, the Pulsatilla is used as homeopathic remedy for ocular problems, earache, cough, cold, and anxiety from lost attention. These case studies described the successful treatment of ocular diseases and separation anxiety by application of Pulsatilla 30C as homeopathy in 4 dogs. During the homeopathy, these dogs did not receive any other treatments, and were performed the physical exam to check the ocular problems. These dogs were completely cured of physical and behavior problem within 10 days. On following up, any clinical signs were not observed at one month after the last therapy. In addition, as from the treatment the anxiety problem of patients has been much better improved. According to these case studies, we know that an application of homeopathic remedy may be useful therapeutic choice to treat both problems of physical and behavior.
Psychological/behavioural treatmentsExerciseMusicHerbal medicineDietary measuresHomeopathyAcupunctureTranscranial magnetic stimulationChiropractic treatmentConclusions
References
Many epileptic patients will have satisfactory seizure control using the first-line anticonvulsants phenobarbital and/or bromide, as discussed in the first article of this series (In Practice, March 2013, vol 35, pp 106-113). However, some patients will continue to have an unacceptable number or severity of seizures despite adequate drug serum concentrations. Some patients have a compromised quality of life because of the adverse effects of their medication. In this article, the anticonvulsant drugs used for second-line therapy are discussed, together with other anticonvulsants and alternative therapies.
Paper aims at considering all important aspects of the scientific framework of homeopathic practice, looking at the levels of scientific evidence of each aspect in an objective way, through an extensive review of literature. Levels of evidence considered are: I) existence of meta-analyses and/or systematic positive reviews of literature; IIa) multiple positive randomized controlled trials (RCTs); IIb) some positive RCTs; IIIa) positive multiple cohorts studies; IIIb) positive studies with some cohorts; IV) opinion of experts (clinical and daily practice cases). Conclusions are clear: homeopathy must stay within the framework of medical practice, and it is even a necessity for public health.
Aim of present investigation was to evaluate anticonvulsant profile of Argentum Metallicum a homeopathic
preparation in various models of convulsion by assessing various behavioral and biochemical parameters in laboratory animals. Anticonvulsant activity of Argentum Metallicum (30 CH, 200 CH and 1 M) was evaluated against pentylenetetrazole (PTZ), picrotoxin (PTX), strychnine (STR), isoniazid (INH) and maximal electroshock (MES) induced convulsions in mice as well as electrical kindling model in rats. The various in-vitro parameters were also determined including brain gamma amino butyric acid (GABA), nitric oxide (NO) and xanthine oxidase (XO). Diazepam and Phenytoin were used as reference anticonvulsant drugs for comparison. A single intraperitoneal injection of PTZ (90mg/kg), STR (5 mg/kg) and Isoniazid (300 mg/kg) and subcutaneous injection of PTX (3.5 mg/kg) resulted in hind-limb, tonic-clonic convulsion along with lethality in mice, whereas twice daily auricular stimulation resulted progressive severity of seizures in rats. It also significantly decreased (P < 0.001) brain GABA level in PTZ, PTX and INH model as well as significantly elevated (P < 0.001) brain NO and XO level in PTZ, PTX, INH as well as STR model. Mice treated with Argentum Metallicum (200 CH and 1 M) delayed onset of convulsion along with duration of tonic-clonic convulsions. It also significantly reduced mortality in mice. Rats treated with Argentum Metallicum (200 CH and 1 M) showed significant and dose dependant (P < 0.05 and P < 0.001) amelioration in severity of electrically kindled seizures and total number of rats seizure per group. Treatment with Argentum Metallicum (200 CH and 1 M) significantly (P < 0.01 and P < 0.001) elevated the brain GABA level and decreased brain NO and XO level in dose dependant manner. Argentum Metallicum exhibits its antiepileptic activity through GABAegic mechanism and by modulation of endogenous antioxidants like NO and XO.
Complementary and alternative medical therapies include herbs, acupuncture, and mind-body therapies. This review highlights the findings of recently published studies of complementary and alternative medical therapies and epilepsy, and provides an update of the US Food and Drug Administration's role in regulating herbal products.
Complementary and alternative medical therapies are often tried by patients with epilepsy, frequently without physician knowledge. Many modalities have been evaluated in patients with epilepsy, though methodological issues preclude any firm conclusions of efficacy or safety. Some herbal medicines have been shown experimentally to have mechanisms of action relevant to epilepsy and promising actions in animal models.
There is currently a paucity of credible evidence to support the use of complementary and alternative medical therapies in patients with epilepsy. Herbal medicines traditionally used for epilepsy and compounds isolated from them, as well as other herbal medicines and their constituent compounds that have been shown experimentally to have mechanisms of action relevant to epilepsy, should undergo further preclinical evaluation with a view towards clinical development under the new US Food and Drug Administration guidelines. Additional studies of other, nonherbal complementary and alternative medical therapies are also warranted based on anecdotal observations or pilot studies that suggest a favorable risk-benefit ratio.
The medical records of 18 dogs that had hepatic disease and received phenobarbital as an anticonvulsant for 5 to 82 months were reviewed. Clinical signs included sedation and ataxia in all dogs, 5 dogs were also anorectic, 2 had coagulopathy, 3 were icteric, and 5 had ascites. Serum biochemical analysis revealed serum albumin concentration ≤ 2.2 g/dl in 12 dogs, serum alkaline phosphatase activity ≥ 169 U/L in 18 dogs, serum alanine transaminase activity ≥ 57 U/L in 15 dogs, and total bilirubin concentration ≥ 1 mg/dl (in the absence of lipemia) in 7 dogs.
Serum phenobarbital concentration was ≥ 40 μg/ml in 12 of 17 dogs. Sulfobromophthalein excretion was prolonged in 8 of 10 dogs. Preprandial serum bile acid concentrations were high in 8 of 10 dogs, and 2-hour postprandial serum bile acid concentrations were high in 9 of 10 dogs. Two of 4 dogs tested had resting plasma ammonia concentrations > 200 mg/dl. An ammonia tolerance test was performed on 2 other dogs; both had ammonia concentration ≥ 200 mg/dl in the plasma 30 minutes after receiving 100 mg of ammonium chloride/kg of body weight, po .
Nine dogs died, 1 was euthanatized, and necropsies were performed on these 10 dogs. Biopsies and necropsies of 6 dogs revealed chronic hepatic fibrosis with nodular regeneration (cirrhosis). One dog had hepatocellular carcinoma and mild cirrhosis. In 1 dog, after phenobarbital had been withheld, necropsy revealed complete recovery of the previously observed lesions.
Status epilepticus (SE) has been defined as continuous seizure activity lasting at least 5 minutes or two or more discrete seizures between which there is incomplete recovery of consciousness. SE is a medical emergency that requires prompt treatment to avoid neurologic morbidity. The etiologies of SE are similar to those for individual generalized convulsive seizures. The pathophysiology of SE is also similar to that of an individual seizure event; however, loss of the inhibitory mechanisms responsible for the cessation of an isolated event is suspected. Systemic effects of continuous seizure activity can be damaging if not identified and treated promptly. This article discusses the clinical and physiologic features of SE as well as the pathophysiology of this disorder.
The medical records of 18 dogs that had hepatic disease and received phenobarbital as an anticonvulsant for 5 to 82 months were reviewed. Clinical signs included sedation and ataxia in all dogs, 5 dogs were also anorectic, 2 had coagulopathy, 3 were icteric, and 5 had ascites. Serum biochemical analysis revealed serum albumin concentration less than or equal to 2.2. g/dl in 12 dogs, serum alkaline phosphatase activity greater than or equal to 169 U/L in 18 dogs, serum alanine transaminase activity greater than or equal to 57 U/L in 15 dogs, and total bilirubin concentration greater than or equal to 1 mg/dl (in the absence of lipemia) in 7 dogs. Serum phenobarbital concentration was greater than or equal to 40 micrograms/ml in 12 of 17 dogs. Sulfobromophthalein excretion was prolonged in 8 of 10 dogs. Preprandial serum bile acid concentrations were high in 8 of 10 dogs, and 2-hour postprandial serum bile acid concentrations were high in 9 of 10 dogs. Two of 4 dogs tested had resting plasma ammonia concentrations greater than 200 mg/dl. An ammonia tolerance test was performed on 2 other dogs; both had ammonia concentration greater than or equal to 200 mg/dl in the plasma 30 minutes after receiving 100 mg of ammonium chloride/kg of body weight, PO. Nine dogs died, 1 was euthanatized, and necropsies were performed on these 10 dogs. Biopsies and necropsies of 6 dogs revealed chronic hepatic fibrosis with nodular regeneration (cirrhosis). One dog had hepatocellular carcinoma and mild cirrhosis. In 1 dog, after phenobarbital had been withheld, necropsy revealed complete recovery of the previously observed lesions.
Hepatic function tests were performed on 48 dogs that had been given primidone, phenytoin, or a combination of anticonvulsant drugs for 6 months or longer. Except for histories of seizures, 44 of the dogs were healthy at the time the tests were performed. Abnormal test results were observed most frequently in dogs given only primidone and in dogs given combinations of anticonvulsant drugs. The test results that were abnormal most often were those for alanine transaminase and alkaline phosphatase activities, and sulfobromophthalein excretion. The dosage of anticonvulsant drug was found to modify certain test results. Statistically significant positive correlations were found between the dosage of primidone and serum alanine transaminase activity and between the dosage of phenytoin and serum alkaline phosphatase activity. Four of the dogs were examined because of signs of weakness and anorexia and 2 also had ascites. Three of the 4 dogs were euthanatized 2 to 49 days after admission with clinical signs compatible with hepatic failure, and cirrhosis of the liver was confirmed at necropsy. The fourth dog died at home and was not necropsied. Four of the remaining 44 dogs that apparently were healthy at the time of examination had abnormalities in hepatic biochemical test results that were comparable with those in the 4 dogs with clinical illness. We concluded that, although results of hepatic biochemical tests frequently may be abnormal in dogs given anticonvulsant drugs long-term, severe hepatic injury is observed less often.(ABSTRACT TRUNCATED AT 250 WORDS)
To report clinical findings, treatments, and outcomes of dogs admitted to the hospital for status epilepticus or cluster seizures and evaluate factors associated with outcome.
Retrospective study.
156 dogs admitted for status epilepticus or cluster seizures.
Medical records were reviewed for seizure and medication history, diagnostic test results, types of treatment, hospitalization costs, and outcome of hospital visits.
Dogs were admitted for seizures on 194 occasions. Of 194 admissions, 128 (66%), 2 (1%), 32 (16.5%), 2 (1%), and 30 (15.5%) were of dogs with a history of clusters of generalized seizures, clusters of partial complex seizures, convulsive status epilepticus, partial status epilepticus, and > 1 type of seizure, respectively. Underlying causes of seizures were primary epilepsy (26.8%; 52/194), secondary epilepsy (35.1%; 68), reactive epileptic seizures (6.7%; 13), primary or secondary epilepsy with low serum antiepileptic drug concentrations (5.7%; 11), and undetermined (25.8%; 50). One hundred and eighty-six hospital visits resulted in admission to the intensive care unit (ICU). Treatments with continuous i.v. infusions of diazepam or phenobarbital were initiated during 66.8% (124/186) and 18.7% (35) of ICU hospital stays for 22.3 +/- 16.1 hours (mean +/- SD) and 21.9 +/- 15.4 hours, respectively. Of 194 admissions, 74.7% (145) resulted in discharge from the hospital, 2.1% (4) in death, and 23.2% (45) in euthanasia. A poor outcome (death or euthanasia) was significantly associated with granulomatous meningoencephalitis, loss of seizure control after 6 hours of hospitalization, and the development of partial status epilepticus.
Granulomatous meningoencephalitis, loss of seizure control after 6 hours of hospitalization, or the development of partial status epilepticus may indicate a poor prognosis for dogs with seizures.
The medical records of 50 dogs that exhibited generalised convulsive tonic-clonic (GCTC) status epilepticus (SE) were reviewed and compared with the records of 50 dogs that exhibited non-SE GCTC seizures. The mean age, bodyweight and gender of the patients in both groups were not significantly different. Dogs in the non-SE group were two times more likely to be an idiopathic epileptic than to have secondary epileptic seizures. The SE group was more likely to have abnormalities on cerebrospinal fluid analysis, but not more likely to have abnormalities detected on computed tomography, when compared with the non-SE group. SE was 1.57 times more likely if the cause for the seizures was secondary or reactive epilepsy rather than idiopathic or primary epilepsy. In conclusion, dogs that exhibit SE should be thoroughly investigated for secondary causes.