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Discussion Starter #1 (Edited)
I figure some of you must have dealt with this before, so I'm hoping you have some management suggestions. I'm having trouble coming up with anything, partially because I'm so sleep deprived now.

So my ancient girl Queen is a 17-year-old medium-large terrier mix dog. She started having seizures this spring, and the vet did bloodwork and whatnot and found nothing amiss. Didn't do any imaging because at her age, if we found a brain tumor it's not like we'd do anything other than palliative care anyway, which we can do without knowing whether there's a brain tumor. When she was just having two or three seizures a month, diazepam as needed was the prescription; just recently she started having multiple seizures per week, and so we tried phenobarbital (after discontinuing diazepam, of course) but she had a very adverse reaction to it so that's off the table for managing seizures. CBD oil seems to help somewhat. Her seizures are noisy violent grand mal things and almost always happen in the middle of the night. Lots of thrashing, and she loses control of her bowels, then she has a recovery period where she flails around drunkenly for about an hour, so it's a pretty disruptive event.

Euthanasia feels totally wrong at this point because she's clearly still enjoying life, and has the physical capacity to do so. Very playful, likes to eat, enthusiastic to go for rides in the car and short walks, etc. During the day she's her normal self.

At night she only dozes briefly, on and off. When she's awake at night she wanders around the house being super noisy, making grumbling noises and getting into things. She'll do stuff like try to walk through the coffee table (over the shelf, under the table top), or behind the sofa, and get stuck, then yodel about it. The house is tidy, but she'll still find things to put in her mouth that she shouldn't - like, she pulled down the alarm clock by its cord and was carrying it around. The obvious solution is to crate her, but if you put her in the crate while she's doing this, she just bumps off the walls in there, pacing and yodeling, and sometimes defecating. (Ordinarily she's nicely crate trained and will even go in voluntarily to nap or chew a toy, and she's otherwise housetrained and continent.) I tried giving her a stuffed kong in there, but she's not interested in food while she's in sundown mode. I've tried putting the crate beside my bed, and on the opposite side of the house from my bed - neither was an improvement. She's too big to be contained by something like an exercise pen. This dumb house is open concept so the only rooms that can be closed off are the bedrooms (unhelpful for sleep) and the bathroom (which I'm not sure can be made reliably safe for her).

I'd say to just make the crate as safe and comfortable as possible, then go to sleep with earplugs in or whatever, but it feels wrong with the seizures and the defecating. Between the noise, and getting up to clean up after her or tend to a seizure, I haven't gotten a proper night's sleep in about a month, and it's really starting to affect my daily life. I work during the say so adjusting my own schedule to hers isn't an option.

Anyway. Ideas? Advice? Suggestions? I know it's got to be really confusing and unnerving for her.
 

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Two sections to this reply: one on seizures, and one on the sundowning.

About the seizures:
This link has some really good information about seizures, about the different types and how to treat them. It gives a pretty good over-view of the different types of seizures, the different stages of a grand mal (or tonic-clonic) seizure, although some of the advice elsewhere on the website is incorrect (don't feel ice cream, for example). http://www.canine-epilepsy-guardian-angels.com/seizures_overview_cause_treatment.htm

We're going through something nearly identical with Snowball - he started having seizures, everything else looks great so it's likely a tumor - and we opted to try pheno. I was very hesitant because I used to dog-sit an epileptic golden who was pretty much unable to walk due to the dose of pheno he was on, but my vet reassured me that the side-effects usually resolved within a week or two of starting the medication, and if they didn't it wouldn't be an issue to stop them (something else I was worried about). We gave it a shot and Snowball was pretty well unable to walk for the first few days, but by day 6 he was pretty well back to normal.

Anyway, there are also other medications that you can try, if you want to go that route. Beside phenobarbitol, the next most effective medications at stopping seizures are sodium or potassium bromide, and a drug called keppra. Keppra might be a good option because not only is it a long-acting daily medication, but it can also be used to stop seizures while they are happening. If a seizure lasts for more than 10 minutes, it can be extremely dangerous and can tip over into a condition called "Status Epilepticus" which is basically a state of perpetual seizure that won't stop without medical intervention. This is a pretty good over-view of the different types of seizures, the different stages of a grand mal (or tonic-clonic) seizure.

As an aside, the "drunken flailing" sounds to me a lot like the "clonic" portion of the seizure. The clonic phase of Snowball's seizures involve kind of a swimming motion, almost like he's trying to stand up except he's obviously not aligning his legs right to actually support him, or sometimes he will just kick his back legs. It is often accompanied by high pitched yipping. The way to tell the difference between the clonic phase and an the post-ictal phase (after the seizure has ended) is whether or not the dog responds to outside stimuli. If you can't seem to get their attention at all, then they are likely still seizing.

If you're worried about her having a seizure while crated, plastic airline crate is apparently one of the safest places for a seizing dog to be. She can't hit herself on anything sharp or get stuck under furniture, and it will be easier for you to clean up. Unlike humans, dogs are at low risk of aspirating while seizing because they naturally lay on their side (rather than their back like humans).

About the sundowning
Have you talked to your vet about meds for canine cognitive dysfuntion, if that's something you'd be willing to try?

Otherwise, I would take into account night-time when thinking about her overall quality of life. If she isn't safe to be left wandering the house, and can't be safely/humanely contained at night then that is likely impacting her quality of life as well as yours.
 

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Another possibility for the seizures is Gabapentin, which isn't as sedating as phenobarbital.

When Toby started sundowning we gave him Tramadol at night to help him sleep and stop the wandering. You'd have to ask the vet what effect it would have on his seizures.
 

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Suggestion: Are her seizures too violent for a tie down and a body halter (rather than a collar), to help prevent her from wandering?
 
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