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DIAGNOSTIC WORKUP · IDIOPATHIC EPILEPSY
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Diagnostic Workup

Ruling out non-IE causes of seizure

A complete record of every test performed to systematically exclude non-idiopathic causes — structural, metabolic, infectious, toxic, endocrine, genetic, and nutritional. Idiopathic epilepsy is a diagnosis of exclusion; this is the documentation that supports it.

Tests Completed
21
across 7 specialty areas
Period Covered
10 mo
Jul 2025 – Feb 2026
Providers
5
AHWC · MedVet · OSU · MSU · IDEXX
Open Items
4
recommended next steps
Detailed Workup

Every test, every result, every rule-out

Chronological record of all diagnostics performed. Each row documents what was tested, where, the result, and which seizure causes that test ruled out.

Date Test Lab / Provider Result What it Ruled Out
7/15/25 CBC + Chemistry (in-house) Animal Hospital of West Chester · Catalyst One/ProCyte All values within normal limits Acute metabolic/organ dysfunction at presentation; uremic encephalopathy; hepatic encephalopathy; hypoglycemic seizure
7/15/25 Heavy Metal Panel IDEXX → Michigan State University All below toxic thresholds. Lead <1, Mercury <5, Arsenic 2, Cadmium <1, Thallium <1 ppb. Selenium 482 ppb (slightly elevated, dietary) Lead poisoning; mercury, arsenic, cadmium, thallium toxicity; selenium toxicity
7/17/25 4Dx Plus IDEXX Heartworm, Ehrlichia, Lyme, Anaplasma all negative Heartworm disease; ehrlichiosis; Lyme disease; anaplasmosis; tick-borne CNS infection
7/17/25 Thyroid Panel 12 with Cholesterol IDEXX TT4 1.3, fT4 1.0 ng/dL, cTSH 0.15 normal; TT3 39 (low) Primary hypothyroidism (low T3 attributed to non-thyroidal illness from seizures)
7/22/25 Thyroglobulin Autoantibody IDEXX 17% (negative) Autoimmune thyroiditis
7/24/25 Cortisol (resting) IDEXX 9.9 µg/dL (elevated, peri-anesthesia) Cushing's not seriously suspected; elevation attributed to anesthesia stress
7/24/25 MRI Brain MedVet · Dr. Baron-Chapman, DACVR No significant abnormalities. Incidental partial absence of septum pellucidum (anatomic variant); mild retropharyngeal LN heterogeneity (insignificant) Brain tumor (primary or metastatic); meningioma; gliomas; hydrocephalus; congenital malformation; vascular event/stroke; granuloma; structural epileptogenic lesion
7/24/25 CSF Tap with Cytology IDEXX · Dr. Fisher, DACVP Nucleated cells 0/µL; no infectious agents; no neoplastic cells. Protein 89.3 mg/dL (elevated; ref 0–35) — open question Active CNS inflammation (cellular); CNS infection (bacterial, fungal, protozoal); CNS lymphoma; meningitis (cellular). Not fully ruled out: MUE/GME, early or treated meningoencephalitis (due to elevated protein)
9/26/25 CBC + Chemistry IDEXX All WNL except BUN 29 (slightly high — likely dietary), K 3.4 (slightly low) Ongoing organ dysfunction; persistent metabolic derangement
9/26/25 Aspergillus Galactomannan EIA MiraVista Diagnostics 0.18 (negative; positive ≥0.5) Aspergillosis (CNS or systemic)
9/30/25 Histoplasma Urine Antigen MiraVista Diagnostics None detected (negative) Histoplasmosis (CNS or disseminated)
9/30/25 Blastomyces Urine Antigen MiraVista Diagnostics None detected (negative) Blastomycosis (CNS or disseminated)
9/30/25 Repeat Thyroid Panel Michigan State University TT4 20 nmol/L, fT4 16 pmol/L, TSH 0.33 normal; TT3 0.5 (low end); TgAA 6% negative Hypothyroidism (confirmed sick-euthyroid pattern); autoimmune thyroiditis
1/23/26 Embark Genetic Panel (273 health variants) Embark Clear for LGI2 Juvenile Epilepsy, DIRAS1 Juvenile Myoclonic Epilepsy, all other neurodegenerative variants tested. One copy ATP7B (copper toxicosis carrier — uncertain significance in GSD) Juvenile Epilepsy (LGI2); Juvenile Myoclonic Epilepsy (DIRAS1); Lagotto Storage Disease; Alaskan Husky Encephalopathy; Neonatal Encephalopathy with Seizures; Spinocerebellar Ataxia with Seizures (KCNJ10); GM1/GM2 gangliosidoses; Neuronal Ceroid Lipofuscinoses; L-2-Hydroxyglutaricaciduria; Succinic Semialdehyde Dehydrogenase Deficiency; Episodic Falling Syndrome; Paroxysmal Dyskinesia; Degenerative Myelopathy
2/23/26 Total Health Profile (CBC + Chemistry) IDEXX ALT 49, ALP 23, AST 33, GGT 5 all normal; ionized Ca 1.27 normal; SDMA 9 normal; albumin/globulin/protein normal; bilirubin normal Liver dysfunction (per enzymes; bile acids not done); kidney dysfunction; hypocalcemic/hypercalcemic seizure; hepatic encephalopathy (per enzymes only)
2/23/26 Cobalamin (Vitamin B12) IDEXX 608 ng/L (normal; ref 284–836) B12 deficiency-related neurological dysfunction; cobalamin malabsorption; methylation deficiency from low B12
2/23/26 Folate (Vitamin B9) IDEXX 9.8 µg/L (normal; ref 4.8–19.0) Folate deficiency; methylation deficiency from low folate; small intestinal dysfunction (low folate pattern)
2/23/26 Trypsin-Like Immunoreactivity (TLI) IDEXX 19.7 µg/L (normal; ref 5.0–35.0) Exocrine pancreatic insufficiency
2/23/26 Vitamin D (25-OH) VDI Lab Services 163 ng/mL (elevated; sufficient is 100–150) Vitamin D deficiency (not a seizure cause here); flagged for diet review
2/23/26 Repeat Thyroid Panel + TgAA Michigan State University TT4 29 nmol/L, fT4 20, TSH 0.39, TgAA 7% all normal; TT3 1.0 (low end) Hypothyroidism (sick-euthyroid pattern persistent and stable); autoimmune thyroiditis
Confirmed Exclusions

What's been ruled out

Comprehensive summary of seizure causes systematically excluded by the workup above. Idiopathic epilepsy remains the working diagnosis by exclusion.

Structural brain disease
MRI clean (7/24/25) — no tumor, malformation, vascular event, or epileptogenic lesion
CNS cellular inflammation
CSF cytology clean — but elevated protein (89.3) leaves MUE as an open question
Heavy metal toxicity
All metals well below toxic thresholds — lead, mercury, arsenic, cadmium, thallium
Endemic systemic fungal disease
Histoplasmosis, blastomycosis, aspergillosis all negative via MiraVista
Tick-borne / vector-borne disease
4Dx Plus negative — no heartworm, ehrlichia, Lyme, or anaplasma
Liver / kidney dysfunction
Bloodwork normal across 4 panels (bile acids not yet done)
Endocrine causes
Euthyroid confirmed (sick-euthyroid pattern); cortisol non-revealing; no Cushing's signs
Metabolic causes
Glucose, calcium, electrolytes all normal across multiple draws
Vitamin deficiency causes
B12 normal, folate normal, vitamin D not deficient (slightly elevated)
GI absorption issues
TLI normal (rules out EPI); B12/folate combination supports normal small intestinal absorption
Known monogenic canine epilepsies
LGI2, DIRAS1 negative via Embark — clear of common inherited epilepsy variants
Storage diseases & neurodegenerative conditions
Embark clear — gangliosidoses, NCLs, L2HGA, SSADH, paroxysmal dyskinesia all ruled out
⚠ Open Items / Not Yet Tested
📝 Note on B12 / Folate combination

Testing B12 and folate together is more informative than either alone. The pattern of "normal B12, normal folate" rules out cobalamin malabsorption (which would show as low B12, sometimes high folate from bacterial overgrowth), small intestinal disease, and the methylation cofactor deficiencies that can lower seizure threshold.

So while the test was framed as part of the GI workup, it also incidentally addresses several neurological-relevant deficiencies.