Misdiagnoses in Canine Epilepsy: Common Mimics, Causes, and How to Get an Accurate Diagnosis

Canine epilepsy is one of the most prevalent neurological disorders in dogs, affecting an estimated 0.5% to 5% of the population. However, not all episodic events are true seizures—misdiagnoses are alarmingly common, leading to inappropriate treatments, unnecessary medications, and delayed care for underlying issues.

Studies indicate that up to 30% of cases referred to neurologists may involve non-epileptic paroxysmal events mistaken for epilepsy. This comprehensive guide explores the pitfalls of diagnosing canine epilepsy, common mimics, reasons for errors, proper diagnostic protocols, and best practices to ensure your dog receives accurate care.

Why Misdiagnosis Matters

Misdiagnosing epilepsy has serious consequences:

• Inappropriate medications with side effects but no benefit
• Delayed treatment for the actual underlying condition
• Emotional and financial strain on pet parents
• Worsened prognosis when true conditions go untreated

Understanding what can mimic seizures helps you advocate for your dog and ensures they receive the right diagnosis and treatment.

Common Conditions Mimicking Seizures

A key challenge in diagnosing epilepsy is distinguishing true seizures—abnormal electrical discharges in the brain—from paroxysmal events that mimic them. These imposters often involve collapse, tremors, or altered behavior without cerebral involvement.

Syncope (Fainting)

Syncope, or fainting, is one of the most common seizure mimics. Triggered by cardiovascular issues like arrhythmias or bradycardia, dogs may suddenly collapse flaccidly with brief unconsciousness.

Key differences from seizures:

• Lack of rigidity or tonic-clonic movements
• Rapid recovery without post-ictal disorientation
• Exertion- or excitement-related episodes
• No drooling or paddling typically

Intermittent cardiac arrhythmias can cause confusion and weakness mistaken for seizures, but a cardiac workup (e.g., Holter monitoring) reveals the truth. This is critical because untreated heart conditions can be life-threatening.

Movement Disorders (Paroxysmal Dyskinesias)

Movement disorders, or paroxysmal dyskinesias (PD), are another frequent mimic. These involuntary motions occur without loss of consciousness—dogs remain responsive and aware throughout the episode.

Breed-specific examples:

• Scottish Terriers: "Scottie cramps" exhibit stress-induced spinal arching and limb rigidity, resolving in minutes, possibly due to serotonin deficits and treatable with SSRIs
• Cavalier King Charles Spaniels: Episodic hypertonicity, stiffening during exercise, an autosomal-recessive trait managed with clonazepam
• Border Terriers: Cramping with dystonia and tremors, linked to gluten sensitivity and improved by diet changes
• Miniature Wire-Haired Dachshunds: Lafora disease shows stimulus-triggered contractions, diagnosed via biopsy
• Dancing Doberman disease: Involves pelvic limb flexion mimicking tremors
• Orthostatic tremors in Great Danes: Postural shaking treatable with gabapentin

These are variably called atypical epilepsy or episodic dyskinesia, with significant numbers undiagnosed initially.

Exercise-Induced Neuromuscular Collapse

Exercise-induced neuromuscular collapse in Retrievers presents as hindlimb weakness post-activity, often mislabeled as seizures due to rapid onset. This condition requires different management than epilepsy.

Sleep Disorders

Sleep disorders like narcolepsy and cataplexy also deceive:

• Narcolepsy: Causes sudden REM sleep collapse from excitement
• Cataplexy: Induces conscious paralysis—dogs freeze but remain alert

Inherited in Dobermans and Labrador Retrievers, these are managed with imipramine or methylphenidate, not antiepileptics. REM-phase movements, such as limb twitching or howling in Golden Retrievers, mimic seizures but occur only during sleep.

Behavioral Disorders

Behavioral disorders, including compulsive pacing or aggression from stress or genetics, add to the confusion, requiring behavioral therapy over seizure medications. These episodes may look like focal seizures but have different underlying causes.

Other Common Mimics

• Tremors: Idiopathic head bobbing in Dobermans
• Vertigo: From vestibular disease causing disorientation
• Painful muscle spasms: From injury or inflammation
• Neuromuscular issues: Like myasthenia gravis causing collapse
• Metabolic tremors: From hypoglycemia or hypocalcemia
• Toxin exposures: Chocolate, xylitol, or other poisons

Reasons for Misdiagnosis: Why Errors Happen

Understanding why misdiagnoses occur helps you advocate for proper evaluation.

Reliance on Owner Descriptions

Primarily, reliance on owner descriptions without objective evidence like video recordings leads to errors, as veterinarians rarely witness events. Owners may misinterpret:

• Shivering or muscle tremors as seizures (especially in cold or anxious dogs)
• Normal sleep movements as seizures
• Behavioral episodes as neurological events

A 2021 study highlighted discrepancies: subjective owner-reported seizure frequency weakly correlated with objective EEG data, with owners over- or under-reporting. Even neurologists agree only 30% on video classifications, underscoring subjectivity.

This is why video recording is so critical. If your dog has an episode, record it immediately. This single piece of evidence can dramatically improve diagnostic accuracy.

Incomplete Diagnostics

Epilepsy is a diagnosis of exclusion, requiring ruling out extracranial (metabolic/toxic) and intracranial (tumors, encephalitis) causes. Yet, rushed evaluations may skip:

• Complete bloodwork
• Advanced imaging (MRI/CT)
• CSF analysis
• Cardiac evaluation

Comprehensive testing is essential to avoid misdiagnosis.

Breed and Age Biases

Breed and age biases—assuming idiopathic epilepsy in young purebreds—ignore mimics like:

• Congenital defects in puppies
• Brain tumors in seniors
• Breed-specific movement disorders

Every dog deserves a thorough evaluation regardless of breed or age.

Pseudoresistance

Pseudoresistance, where seizures seem drug-resistant but aren't, affects 27% of cases:

• Low serum drug levels (42%): Medication not reaching therapeutic levels
• Wrong drug/dose (22%): Inappropriate medication or dosing
• Misclassification (22%): Not true epilepsy at all
• Poor compliance (9%): Missed doses or inconsistent administration

This leads to escalating unnecessary therapies when the real issue is misdiagnosis or medication management.

Symptom Overlap

Symptom overlap is inherent: Focal seizures mimic behavioral quirks, while generalized ones resemble syncope. Without objective testing, distinguishing between them is challenging.

Lack of EEG Access

Lack of EEG access in general practice hinders confirmation, as EEG abnormalities define Tier III confidence in idiopathic epilepsy. Most general practice veterinarians don't have EEG equipment, making referral to a neurologist important for complex cases.

Proper Diagnostic Approach: Getting It Right

Accurate diagnosis follows a structured protocol. Here's what proper evaluation should include:

Comprehensive History

Start with detailed history:

• Two or more unprovoked seizures more than 24 hours apart
• Onset between 6 months and 6 years (typical for idiopathic epilepsy)
• Normal inter-ictal exam (dog appears normal between episodes)
• Detailed episode descriptions from owners

Video Documentation

Video recording is invaluable. Encourage owners to record episodes, detailing:

• Pre-ictal phase (aura): Restlessness, seeking owner, behavioral changes
• Ictal phase: Tonic-clonic movements, loss of consciousness, duration
• Post-ictal phase: Recovery time, disorientation, behavior changes

This objective evidence dramatically improves diagnostic accuracy.

Physical and Neurological Examination

Physical/neurological exams assess thalamocortical function:

• Menace response
• Proprioception
• Cranial nerve function
• Reflexes

Abnormalities suggest structural causes rather than idiopathic epilepsy.

Tiered Diagnostic Confidence (IVETF Protocol)

The International Veterinary Epilepsy Task Force (IVETF) uses a tiered approach:

Tier I (Basic):

• Normal bloodwork (CBC, biochemistry, urinalysis)
• Rules out metabolic issues
• Minimum for presumptive diagnosis

Tier II (Advanced):

• Adds MRI/CSF analysis
• Excludes structural/inflammatory diseases
• Recommended for atypical cases

Tier III (Definitive):

• Includes EEG
• Confirms abnormal brain electrical activity
• Highest confidence in diagnosis

Differential Diagnosis Workup

For differentials:

Extracranial causes:

• Hypoglycemia, toxins, metabolic disorders
• Diagnosed via blood tests

Intracranial causes:

• Brain tumors, encephalitis, strokes
• Diagnosed via MRI/CT

Advanced imaging is crucial for atypical onsets or refractory cases.

Case Studies and Statistics: Real-World Impact

A 2023 pilot study of 152 "resistant" epilepsy dogs found 27% were pseudoresistant, improving post-correction. This means over a quarter of dogs thought to have drug-resistant epilepsy actually had:

• Misdiagnosed conditions
• Medication management issues
• Non-epileptic events

Real-world examples:

• A 13-year-old Australian Shepherd's short "seizures" were suspected non-epileptic, avoiding unnecessary MRI due to age
• Cases where dogs with clusters were misdiagnosed, suggesting milder medications might have been appropriate

Statistics show 20-30% refractory epilepsy, but many are actually misdiagnosed mimics. Proper evaluation can prevent years of inappropriate treatment.

Consequences of Misdiagnosis: Why Accuracy Matters

Errors lead to serious consequences:

Inappropriate Medications

Antiepileptic medications have side effects:

• Sedation and lethargy
• Liver toxicity (especially with phenobarbital)
• Behavioral changes
• Increased thirst and appetite

When given for non-epileptic conditions, dogs experience these side effects without any benefit.

Masking True Issues

Misdiagnosis can mask true issues:

• Heart disease (syncope) risks sudden death if untreated
• Brain tumors may be missed, worsening prognosis
• Metabolic disorders can progress without proper treatment
• Movement disorders require different management

Emotional and Financial Strain

Owners face:

• Emotional distress from watching their dog on ineffective medications
• Financial burden from unnecessary medications and tests
• Frustration when treatments don't work
• Delayed appropriate care for the actual condition

Best Practices and Prevention: How to Avoid Misdiagnosis

Encourage Video Logging

Video recording is the single most important tool for accurate diagnosis. If your dog has an episode:

1. Record it immediately (even if brief)
2. Note what happened before, during, and after
3. Share the video with your veterinarian
4. Keep a log of all episodes

Track episodes with PupPal – Our comprehensive system helps you log every episode with video links, detailed descriptions, and timing. When you bring organized data and videos to your veterinarian, you enable more accurate diagnosis. Start tracking today. Understanding what triggers seizures in your dog can also help distinguish between true seizures and other conditions.

Early Referral to Specialists

For complex or unclear cases, refer to veterinary neurologists early. They have:

• Advanced diagnostic equipment (MRI, EEG)
• Specialized training in neurological conditions
• Experience with rare mimics and movement disorders

Don't hesitate to ask for a referral if diagnosis is uncertain.

Comprehensive Testing

Use comprehensive testing protocols:

• Don't skip diagnostic steps
• Follow tiered IVETF protocols
• Rule out mimics systematically
• Consider breed-specific conditions

Avoid Premature Labels

Avoid premature epilepsy labels. Remember:

• Epilepsy is a diagnosis of exclusion
• Multiple conditions can mimic seizures
• Proper evaluation takes time
• It's better to be thorough than fast

Education on Mimics

Education on mimics reduces errors. Understanding that:

• Not all episodes are seizures
• Many conditions look similar
• Proper testing is essential
• Video evidence is invaluable

This knowledge helps you advocate for your dog.

What to Do If You Suspect Misdiagnosis

If you suspect your dog may have been misdiagnosed:

1. Gather evidence: Record episodes, keep detailed logs, document all symptoms
2. Review medications: Are they helping? Are side effects worth it?
3. Seek second opinion: Consult a veterinary neurologist
4. Request comprehensive testing: Don't accept assumptions
5. Ask questions: Why this diagnosis? What else could it be? What tests were done?

Your dog deserves accurate diagnosis and appropriate treatment. Don't hesitate to advocate for thorough evaluation.

Frequently Asked Questions

How common is misdiagnosis in canine epilepsy?

Studies suggest up to 30% of cases referred to neurologists may involve non-epileptic events mistaken for epilepsy. Pseudoresistance (appearing drug-resistant when not) affects 27% of cases.

What's the most important thing I can do to help with diagnosis?

Record videos of episodes. This objective evidence dramatically improves diagnostic accuracy. Veterinarians rarely witness events, so video is invaluable.

Can my dog have both epilepsy and a condition that mimics seizures?

Yes, though it's uncommon. Some dogs may have true epilepsy plus episodes of syncope or movement disorders. Comprehensive evaluation helps distinguish between different types of episodes.

Should I get a second opinion if my dog isn't responding to seizure medications?

Absolutely. If your dog isn't responding well to medications, consider:

• Medication levels may be too low
• Wrong medication or dose
• Possible misdiagnosis
• Need for specialist evaluation

What tests should be done before diagnosing epilepsy?

At minimum: complete bloodwork, physical and neurological exam, and detailed history. For higher confidence: MRI, CSF analysis, and potentially EEG. Follow IVETF tiered protocols.

Can movement disorders be treated?

Yes, many movement disorders are treatable with:

• Specific medications (SSRIs, clonazepam, gabapentin)
• Diet changes (for gluten-sensitive conditions)
• Stress management
• Breed-specific treatments

Proper diagnosis is essential for appropriate treatment.

Conclusion: The Importance of Accurate Diagnosis

Misdiagnoses in canine epilepsy arise from symptom mimicry by syncope, dyskinesias, sleep disorders, and more, compounded by diagnostic gaps. Adhering to tiered protocols, encouraging video documentation, and seeking specialist evaluation when needed ensures accuracy, improving outcomes for dogs and their families.

Remember:

• Not all episodes are seizures
• Video recording is critical
• Comprehensive testing is essential
• Early referral to specialists helps
• You are your dog's advocate

As research advances, tools like portable EEG may further demystify this disorder, sparing dogs unnecessary hardship. For now, thorough evaluation, video evidence, and proper diagnostic protocols remain our best tools for accurate diagnosis.

Your dog deserves the right diagnosis and appropriate treatment. By understanding what can mimic seizures and advocating for proper evaluation, you're giving them the best chance at effective care.

Ready to track your dog's episodes accurately? Start using PupPal to log every episode with detailed descriptions, video links, timing, and circumstances. Our comprehensive tracking system helps you and your veterinarian distinguish between different types of episodes and identify patterns that lead to accurate diagnosis.

Related Reading:

• Understanding Canine Epilepsy – Complete guide to causes, types, and diagnosis
• What Triggers Seizures in Dogs – Learn about seizure triggers and patterns
• Medication Management for Dogs with Epilepsy – How to manage anti-seizure medications effectively