International veterinary epilepsy task force consensus proposal: outcome of therapeutic interventions in canine and feline epilepsy.

Heidrun Potschka,Michael Podell,Kaspar Matiasek,Andrea Tipold,Sam Long,Jacques Penderis,Luisa De Risio,Wolfgang Löscher,Andrea Fischer,Clare Rusbridge,Mette Berendt,Sofie Bhatti,Robyn Farquhar,Karen R Muñana ,Simon R Platt ,N Patterson ,Veronika M Stein ,Ákos Pákozdy ,Paul J J Mandigers ,Holger A Volk

doi:10.1186/s12917-015-0465-y

Abstract

Common criteria for the diagnosis of drug resistance and the assessment of outcome are needed urgently as a prerequisite for standardized evaluation and reporting of individual therapeutic responses in canine epilepsy. Thus, we provide a proposal for the definition of drug resistance and partial therapeutic success in canine patients with epilepsy. This consensus statement also suggests a list of factors and aspects of outcome, which should be considered in addition to the impact on seizures. Moreover, these expert recommendations discuss criteria which determine the validity and informative value of a therapeutic trial in an individual patient and also suggest the application of individual outcome criteria. Agreement on common guidelines does not only render a basis for future optimization of individual patient management, but is also a presupposition for the design and implementation of clinical studies with highly standardized inclusion and exclusion criteria. Respective standardization will improve the comparability of findings from different studies and renders an improved basis for multicenter studies. Therefore, this proposal provides an in-depth discussion of the implications of outcome criteria for clinical studies. In particular ethical aspects and the different options for study design and application of individual patient-centered outcome criteria are considered.

Highlights

Therapeutic management of canine and feline patients with epilepsy poses a particular challenge for the practitioner
For instance if the study plan is to enrol patients, in which epilepsy proved to be resistant to monotherapy with a specific antiepileptic drug, a common definition of resistance as well as common criteria for an adequate and informative trial are needed urgently
In view of the fact that complete vs. incomplete seizure control does not have the same implications and consequences in veterinary patients as it has in human patients due to the socioeconomic impact on daily lifestyles, and that therapeutic decisions have to be balanced with costs and adverse effects, we included the category of partial therapeutic success as a secondary treatment goal in the classification scheme that we suggest in this proposal (Fig. 1; Table 1)