Abstract
PICO question
 In horses diagnosed with trigeminal-mediated headshaking, is EquiPENS™ therapy more efficacious when compared to electroacupuncture in terms of remission of clinical signs?
 
 Clinical bottom line
 Category of research question
 Treatment
 The number and type of study designs reviewed
 Three papers were critically reviewed, all three were descriptive case series
 Strength of evidence
 Weak
 Outcomes reported
 Remission was achieved following both EquiPENS™ and electroacupuncture therapy in a proportion of horses for variable lengths of time. Median remission times appear to be longer with repeated treatment of EquiPENS™ compared to electroacupuncture
 Conclusion
 The evidence for EquiPENS™ treatment is more robust than for electroacupuncture, and remission defined more clearly, and so could be recommended with greater confidence
 
 How to apply this evidence in practice
 The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.
 Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.
 
Highlights
EquiPENSTM was carried out on sedated horses: the skin was anaesthetised before the probe was inserted 1 mm superficial to the infraorbital nerve prior to stimulation with frequency alternating between 2 Hz and 100 Hz every 3 seconds
Inclusion: All clinical studies regarding electrical neuromodulation in the treatment of trigeminal-mediated headshaking in horses
Summary
Population: Horses diagnosed with trigeminal-mediated headshaking, referred to Langford Veterinary Services Equine Centre between August 2013 and August 2014. Horses included were not known to be seasonally affected and were all displaying clinical signs at the time of treatment, at least 1 month had elapsed since any prior alternative treatment trials. An initial course of three treatments with further treatments on re-emergence of clinical signs was followed. One horse did not enter remission at all. Median remission: 1st treatment: 3.8 days (range: 0–8 days, n = 7) 2nd treatment: 2.5 weeks (range: 0–8 weeks, n = 7) 3rd treatment: 15.5 weeks (range: 0–24 weeks, n = 5) 4th treatment: 20 weeks (range: 12–28 weeks, n = 2) 12 weeks was the minimum time of remission following the 4th treatment in two horses that received the 4th treatment. One horse was in remission at the time of follow-up
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