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 Canine Epilepsy Research Consortium Seizure Survey  
 Thank you for helping with this important research. With your help, we hope to better understand epilepsy in dogs and improve our ability to prevent and treat this devastating disease. Please fill out the following questions. There will be a space at the end to enter additional comments.  

 
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  Information about your veterinarian and your dog's general health
   
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  If yes, please list your current veterinarian and/or the veterinarian who diagnosed your dog with epilepsy. If you consulted with a veterinary neurologist, please list them also.
   
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Blood count (CBC)        
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Liver function (Bile acids or ammonia)        
Thyroid function        
Brain scan (CT or MRI)        
Spinal fluid analysis (spinal tap)        
   
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  Tell us about your dog's seizures
   
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  If yes, please answer the next two questions.
   
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  How are you treating the epilepsy?
   
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Phenobarbital          
Potassium bromide          
Primidone          
Neurontin (gabapentin)          
Felbamate          
Clonazepam (Klonopin)          
   
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  Comments
   
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  When you have completed the above information accurately, click on the "submit" button below to send us the information. In submitting this information, you certify that it is accurate to the best of your knowledge. You understand that this information will be available only to researchers directly involved in the canine epilepsy study and that any publication(s) resulting from this research will refer to dogs by an anonymous code number only. You consent to the use of this information in this manner. You will see a copy of the information after it is submitted and will have the option of printing off a copy for your records.
   
 
 
 
 Done