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CLINICAL PERSPECTIVE
This Week’s Sticky Case
Provide Your Clinical Insight
Patient’s Presenting Symptoms
Patient
“Finn” — 4-year-old neutered male Australian Shepherd
Presenting Complaint
Multiple generalized seizures over a six-hour period.
History
Finn was diagnosed with presumed idiopathic epilepsy approximately one year ago following recurrent generalized seizures and an otherwise unremarkable diagnostic evaluation.
He currently receives phenobarbital twice daily.
Until recently, his seizures occurred approximately once every two to three months.
Today, Finn experienced three generalized tonic-clonic seizures over six hours. Each lasted approximately 60–90 seconds.
He recovered consciousness between episodes but remained mildly disoriented.
His owners report that he has received all scheduled medications.
Physical Examination
- Bright but mildly disoriented
- Temperature: 102.7°F
- Heart rate: 126 bpm
- Mild postictal ataxia
- No persistent focal neurologic deficits identified
- No active seizure activity at the time of examination
Initial Diagnostics
- Blood glucose: 104 mg/dL
- Electrolytes: Within reference intervals
- CBC and serum biochemistry: No clinically significant abnormalities
- Phenobarbital concentration: 22 µg/mL, within the laboratory’s therapeutic reference interval
- No known toxin exposure
Finn experiences another generalized seizure approximately 30 minutes after arriving at the hospital.
The seizure stops after administration of IV midazolam.
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