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Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog
Satisfied Customers: 23810
Experience:  University of California at Davis graduate veterinarian with 44 years of experience
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My elderly silky flinches very frequently, almost

Customer Question

my elderly silky flinches very frequently, almost constantly, when in sunlight so much so that she will not go outside to bathroom if it is sunny. we carry her to shade while covering her eyes.our vet has no idea what is going on. vet recommended seeing a neurologist.
JA: I'm sorry to hear that. Is this new behavior?
Customer: no, it has been going on for several years but getting much worse.
JA: The Veterinarian will know what to do. What is the dog's name?
Customer: abby
JA: Is there anything else important you think the Veterinarian should know about Abby?
Customer: abby is on seizure medication and denamarin and ursodiol for elevated liver enzymes. ultrasound was not grossly abnormal, but showed some abnormalities in the gall bladder.
JA: OK. Got it. I'm sending you to a secure page on JustAnswer so you can place the $5 fully-refundable deposit now. While you're filling out that form, I'll tell the Veterinarian about your situation and then connect you two.
Submitted: 4 months ago.
Category: Dog
Customer: replied 4 months ago.
Posted by JustAnswer at customer's request) Hello. I would like to request the following Expert Service(s) from you: Live Phone Call. Let me know if you need more information, or send me the service offer(s) so we can proceed.
Expert:  Dr. Michael Salkin replied 4 months ago.

Karen, your silkie appears to be experiencing a type of tremor called constant repetitive myoclonus - constant rhythmic jerking. These usually persist during activity, rest, and sleep and can be confused with partial seizures. Many of these patients will respond to an anticonvulsant trial but because Abby hasn't responded to seizure medication another anticonvulsant should be considered. A glucocorticosteroid trial with prednisone might also be considered but her liver condition may preclude such a trial. Having a specialist neurologist attend to Abby is a good idea but I must admit that I would expect the same recommendations as I posted plus MRI which I would find to be unreasonable at Abby's age.

Please respond with further questions or concerns if you wish. I regret that my state board of veterinary examiners doesn't allow me to speak to customers by phone in this venue but other experts in this category may be able to assist you in this regard. Please let me know if you'd like another expert to do so and I'll opt out of this conversation. Please stay in the conversation if you wish.

Customer: replied 4 months ago.
I do not think that you understood me. The major seizures are pretty much under control. Her flinching is not indoors at all. the severe flinching is when she goes into the sun and then it is very repetitive until we cover her eyes or get her in doors.
Expert:  Dr. Michael Salkin replied 4 months ago.

You were clear. Yes, there are many different stimuli for focal seizure or tremor activity including the sunlight you mentioned. These aren't the major seizures (previously called gran mal) you're familiar with. If they're focal seizures they're more consistent with what we used to call petit mal. Please continue our conversation if you wish.

Customer: replied 4 months ago.
i believe that you are saying that the flinching is a type of seizure and is not being successfully treated by her current seizure medication. is that correc?. what are her flinching seizures called? is it what you said earlier and called a tremor "tremor called constant repetitive myoclonus" if these are seizures can you suggest other seizure medication which would be worth trying that would be compatible with her other medications and medical conditions.
Expert:  Dr. Michael Salkin replied 4 months ago.

Correct, that's one important differential diagnosis for such a patient. Her flinching seizures would be called simple partial seizures which are defined as abnormal focal or asymmetric sensory or motor activity affecting any part of the body and which may be associated with autonomic signs, (salivation, vomiting, e.g.). Tremors are different from seizures and it can be a challenge differentiating one from the other. Both can be addressed with anticonvulsive drugs, however; a steroid is more appropriate for tremor syndromes.

Yes, the usual choices of anticonvulsives are phenobarbital, bromides, levetiracetam, and zonisamide. I prefer the newer anticonvulsives levetiracetam and zonisamide because they're not as sedative and better tolerated in advanced geriatrics.

Customer: replied 4 months ago.
I believe that abby has been on at least one other seizure medication which did not effect her seizures. is there any other diagnosis which should be considered?
Customer: replied 4 months ago.
by seizures i meant nothing has reduced her flinching.
Expert:  Dr. Michael Salkin replied 4 months ago.

Yes, a tremor syndrome that might respond to a glucocorticosteroid such a prednisone rather than an anticonvulsive drug. There are no other important differential diagnoses for her behavior. I would very much like to see a video of her behavior. Can you upload one to an external site such as YouTube and then give me the link to it? Remember not to mark it as private.

Customer: replied 4 months ago.
I hope i am sending the right links. Since these videos the flinching is getting worse. Thanks, ***** ***** to your evaluation. If i did not send you the correct links let me know and i will have my son send them
Expert:  Dr. Michael Salkin replied 4 months ago.

Excellent, thank you! Simple partial seizures are the most important differential diagnosis.

Customer: replied 4 months ago.
I guess simple partial seizures are the diagnosis, they are not tremors, constant repetitive myoclonus, so steroids would not be the med to give? I still am a bit mixed up about the diagnosis. is it possible no med may control the flinching? it seems that the video was helpful thank you for suggesting it.
Expert:  Dr. Michael Salkin replied 4 months ago.

While I'm not allowed to diagnose in this venue, I can say that her behavior is most consistent with simple partial seizures. Correct, steroids wouldn't be my first choice of therapy. Yes, some seizures are refractory to therapy. Videos are essential in these cases. Please continue our conversation if you wish.

Customer: replied 4 months ago.
You have been very helpful. I feel that I understand the issues much better. I would like to talk to a specialist, if this conversation can do that without additional cost, because short of an Mir I need to be assured that i do not need to take Abby to a specialist to give Abby complete care.
Expert:  Dr. Michael Salkin replied 4 months ago.

I regret that we don't have a specialist neurologist on this site but I can opt out of this conversation which will allow other experts to enter it if you wish. I won't be able to return to the conversation. Please let me know if you'd like me to opt out.

Customer: replied 4 months ago.
Thanks again. You were great. I would like a second opinion regarding next possible steps that I should take. Now all I can think of is asking our vet to try other seizure meds.
Expert:  Dr. Michael Salkin replied 4 months ago.

I can't set a follow-up in this venue so please return to this conversation - even after rating - with an update at your convenience. You can bookmark this page for ease of return. I'l opt out now.

Expert:  Dr. Michael Salkin replied 4 months ago.

I regret that it doesn't look like my colleagues can add anything to our conversation. May I have an update on Abby, please?

Customer: replied 4 months ago.
We have had abby to two vets and neither had any idea what her flinching was. I want to tell our current vet your opinion but i feel funny about it and thought if i had a specialist's opinion and yours that i might convince her to treat abby and not recommend a dog neurologist. when you told me that there was no specialist i thought a second opinion might work. it is hard for me to simply to tell her that abby most likely has simple partial seizures . i was also hoping to be able to suggest a different medication than levetiracetam, or a higher dose or a combination that has worked with other dogs.
Customer: replied 4 months ago.
I want to thank you for picking up this case again!
Expert:  Dr. Michael Salkin replied 4 months ago.

I would tell your current vet that you've done your due diligence and would like her opinion about Abby possibly suffering simple partial seizures. You needn't mention that you've spoken to me. You're quite welcome.

Customer: replied 4 months ago.
Expert:  Dr. Michael Salkin replied 4 months ago.

It's my pleasure.

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