Canine Idiopathic Epilepsy Research Articles

Magnetic resonance imaging in canine idiopathic epilepsy: a mini-review.

Magnetic resonance imaging (MRI) in an integral part of the diagnostic workup in canines with idiopathic epilepsy (IE). While highly sensitive and specific in identifying structural lesions, conventional MRI is unable to detect changes at the microscopic level. Utilizing more advanced neuroimaging techniques may provide further information on changes at the neuronal level in the brain of canines with IE, thus providing crucial information on the pathogenesis of canine epilepsy. Additionally, earlier detection of these changes may aid clinicians in the development of improved and targeted therapies. Advances in MRI techniques are being developed which can assess metabolic, cellular, architectural, and functional alterations; as well alterations in neuronal tissue mechanical properties, some of which are currently being applied in research on canine IE. This mini-review focuses on novel MRI techniques being utilized to better understand canine epilepsy, which include magnetic resonance spectroscopy, diffusion-weighted imaging, diffusion tensor imaging, perfusion-weighted imaging, voxel based morphometry, and functional MRI; as well as techniques applied in human medicine and their potential use in veterinary species.

Fecal supernatants from dogs with idiopathic epilepsy activate enteric neurons.

Alterations in the composition and function of the gut microbiome have been reported in idiopathic epilepsy (IE), however, interactions of gut microbes with the enteric nervous system (ENS) in this context require further study. This pilot study examined how gastrointestinal microbiota (GIM), their metabolites, and nutrients contained in intestinal contents communicate with the ENS. Fecal supernatants (FS) from healthy dogs and dogs with IE, including drug-naïve, phenobarbital (PB) responsive, and PB non-responsive dogs, were applied to cultured myenteric neurons to test their activation using voltage-sensitive dye neuroimaging. Additionally, the concentrations of short-chain fatty acids (SCFAs) in the FS were quantified. Our findings indicate that FS from all examined groups elicited neuronal activation. Notably, FS from PB non-responsive dogs with IE induced action potential discharge in a higher proportion of enteric neurons compared to healthy controls, which exhibited the lowest burst frequency overall. Furthermore, the highest burst frequency in enteric neurons was observed upon exposure to FS from drug-naïve dogs with IE. This frequency was significantly higher compared to that observed in PB non-responsive dogs with IE and showed a tendency to surpass that of healthy controls. Although observed disparities in SCFA concentrations across the various FS samples might be associated with the induced neuronal activity, a direct correlation remains elusive at this point. The obtained results hint at an involvement of the ENS in canine IE and set the basis for future studies.

Analysis of Plasma-Derived Exosomal MicroRNAs as Potential Biomarkers for Canine Idiopathic Epilepsy.

Epilepsy is one of the most prevalent complex neurological diseases in both the canine and human species, with the idiopathic form as its most common diagnosis. MicroRNAs (miRNAs) are small, noncoding RNA molecules that play a role in gene regulation processes and appear to be a promising biological target for convulsion control. These molecules have been reported as constituents of the internal content of exosomes, which are small extracellular vesicles released by cells. In this study, exosome samples were isolated from the plasma of 23 dogs, including 9 dogs with epilepsy responsive to treatment, 6 dogs with drug-resistant epilepsy, and 8 control dogs. Plasma exosomes were then characterized by electron transmission microscopy, nanoparticle tracking analysis, and dot blotting. Afterwards, the microRNA-enriched RNA content of exosomes was isolated, and miRNA quantification was performed by quantitative real-time PCR. Seven circulating miRNAs that have been previously described in the literature as potential diagnostic or prognostic biomarkers for epilepsy were evaluated. We observed significant differences in miR-16 (p < 0.001), miR-93-5p (p < 0.001), miR-142 (p < 0.001), miR-574 (p < 0.01), and miR-27 (p < 0.05) levels in dogs with refractory epilepsy compared to the control group. In drug-sensitive epileptic dogs, miR-142 (p < 0.01) showed significant differences compared to healthy dogs. Moreover, distinct levels of miR-16 (p < 0.05), miR-93-5p (p < 0.01), miR-132 (p < 0.05), and miR-574 (p < 0.05) were also found between drug-sensitive and drug-resistant epileptic dogs. Our results present plasma-circulating exosomes as an advantageous source of epileptic biomarkers, highlighting the potential of miRNAs as prognostic and diagnostic biomarkers of canine idiopathic epilepsy.

Comparative subcutaneous and submuscular implantation of an electroencephalography device for long term electroencephalographic monitoring in dogs.

Implantable electroencephalography (EEG) recording devices have been used for ultra-long-term epilepsy monitoring both in clinical and home settings in people. Objective and accurate seizure detection and recording at home could be of great benefit in diagnosis, management and research in canine idiopathic epilepsy (IE). Continuous EEG monitoring would allow accurate detection of seizure patterns, seizure cycles, and seizure frequency. An EEG acquisition system usable in an "out of clinic" setting could improve owner and veterinary compliance for EEG diagnostics and seizure management. Whether a subcutaneous ultra-long term EEG monitoring device designed for humans could be implanted in dogs. Cadaver study with 8 medium to large breed dogs. Comparatively using a subcutaneous and submuscular approach to implant the UNEEG SubQ-Implant in each dog. Positioning was controlled via CT post implantation and cranial measurements were taken. In four of the eight dogs a submuscular implantation without any complications was possible. Complications were close contact to the optic nerve in the first approaches, before the implantation angle was changed and in the smallest dog contact of the implant with the orbital fat body. Cranial measurements of less than 95 mm length proved to be too small for reliable implantation via this approach. The subcutaneous approach showed severe limitations and the implant was prone to dislocation. The UNEEQ SubQ-Implant can be implanted in dogs, via submuscular approach. CT imaging and cranial measurements should be taken prior to implantation.

The Postictal Phase in Canine Idiopathic Epilepsy: Semiology, Management, and Impact on the Quality of Life from the Owners' Perspective.

Dogs with idiopathic epilepsy experience not only the preictal and ictal seizure phases but also the postictal phase. To date, research has primarily focused on the preictal and ictal semiology and therapeutic control of ictal events. Research into the postictal phase's pathophysiology, as a therapeutic target and how it impacts the quality of life, is sparse across different species. Interestingly, even if anecdotally, owners report the postictal period being an impactful negative factor on their quality of life as well as their dog's quality of life. We aimed to assess the semiology and the impact of postictal signs on the quality of life of owners and dogs. This observational study was carried out using surveys of owners of dogs with seizure disorders. The questionnaire was filled out by 432 dog owners, 292 of whom provided complete responses that could be analysed. More than nine out of ten owners (97%) reported the presence of various postictal clinical signs. The dog's and the owner's quality of life was mainly affected by specific postictal signs, i.e., disorientation (dog: 31%; owner: 20%), compulsive walking (dog: 17%; owner: 22%), ataxia (dog: 12%; owner: 6%), and blindness (dog: 17%; owner: 10%). Nearly 61% of the owners felt that the severity of postictal signs was moderate or severe. Rescue antiseizure medications did not have an effect on controlling the postictal signs based on 71% of the responders. In contrast, 77% of the respondents reported that other measures such as rest, physical closeness, and a quiet and dark environment had a positive impact on the postictal phase. Overall, this survey shows that specific postictal signs are common and have a notable impact on the perceived quality of life of both dogs and their owners. According to the respondents, antiseizure medication might have no influence on the postictal phase in most cases, in contrast to other nonpharmacological measures. Further research on the management of the postictal phase is vital for improving the quality of life of dogs with seizure disorders and their owners.

Diffusion tensor-based analysis of white matter in dogs with idiopathic epilepsy.

The understanding of epileptic seizure pathogenesis has evolved over time, and it is now generally accepted that not only are cortical and subcortical areas involved but also the connection of these regions in the white matter (WM). Recent human neuroimaging studies confirmed the involvement of the WM in several epilepsy syndromes. Neuroimaging studies investigating WM integrity with diffusion tensor imaging (DTI) in canine idiopathic epilepsy are lacking. This study aimed to test the hypothesis that WM diffusion changes can be found in dogs affected by idiopathic epilepsy. Twenty-six dogs with idiopathic epilepsy (15 Border Collies and 11 Greater Swiss Mountain dogs) and 24 healthy controls (11 Beagle dogs, 5 Border Collies, and 8 Greater Swiss Mountain dogs) were prospectively enrolled. Most dogs with idiopathic epilepsy (17/26) were enrolled within 3 months after seizure onset. Diffusion tensor imaging of the brain with 32 diffusion directions (low b value = 0 s/mm2; maximal b value = 800 s/mm2) was performed in a 3 Tesla scanner. Tract-based spatial statistics (TBSS), a voxel-based approach, was used to investigate changes in fractional anisotropy (FA) and mean diffusivity (MD) in the idiopathic epilepsy group compared to the healthy control group. Additionally, FA and MD were investigated in the region of corpus callosum and cingulate white matter in both groups. We observed subtle changes in WM DTI between the idiopathic epilepsy group and the healthy control group limited to cingulate WM, with a significantly lower FA in the idiopathic epilepsy group compared to the healthy control group in the region of interest (ROI) approach (p = 0.027). No significant changes were found between the idiopathic epilepsy group and the healthy control group in the TBSS analysis and in the corpus callosum in the ROI approach. This study supports the cingulate area as a target structure in canine epilepsy. The subtle changes only might be explained by the short duration of epilepsy, small sample sizes, and the higher variability in canine brain anatomy. Furthermore, all included dogs showed generalized tonic-clonic seizures, possibly affected by generalized epilepsy syndrome, which are also associated with less pronounced DTI changes in humans than focal epilepsy syndromes.

Effects of high-dose docosahexaenoic acid supplementation as an add-on therapy for canine idiopathic epilepsy: A pilot study.

The anti-epileptic effects of docosahexaenoic acid (DHA) in dogs and humans remain controversial. The dosage and efficacy of DHA were various in the previous reports. The effects of high-dose DHA supplementation as add-on therapy for idiopathic epilepsy in dogs were evaluated. An open-label clinical trial was designed in this pilot study. Six dogs (median age: 6 years) with idiopathic epilepsy were included. All the patients were diagnosed with idiopathic epilepsy using magnetic MRI and cerebrospinal fluid examination (median: 2.0 years before the trial). They had 5-45 seizures and/or auras (median: 9.0) in the month before starting DHA supplementation. DHA was adjunctively administered at doses of 69-166 mg/kg/day without changing other prescriptions. Four of the six patients completed the 6-month observation period. All the patients showed a decrease in seizure frequency of 50% or more within 2-3 months after the start of the administration, and three patients decreased to a frequency of 0-1 per month after 5-6 months. No clear adverse events were observed in the general condition or blood test results in any patients. Although the sample size was small and the study was not a randomized controlled trial, the data suggest that add-on supplementation of DHA could be useful in reducing the frequency of seizures in canine idiopathic epilepsy.

The role of nutrition in canine idiopathic epilepsy management: Fact or fiction?

In the last decade, nutrition has gained interest in the management of canine idiopathic epilepsy (IE) based on growing scientific evidence. Diets can serve their functions through many pathways. One potential pathway includes the microbiota-gut-brain axis, which highlights the relationship between the brain and the intestines. Changing the brain’s energy source and a number of dietary sourced anti-inflammatory and neuroprotective factors appears to be the basis for improved outcomes in IE. Selecting a diet with anti-seizure effects and avoiding risks of proconvulsant mediators as well as interference with anti-seizure drugs should all be considered in canine IE. This literature review provides information about preclinical and clinical evidence, including a systematic evaluation of the level of evidence, suggested mechanism of action and interaction with anti-seizure drugs as well as pros and cons of each potential dietary adaptation in canine IE.

Role of Gut Microbiota through Gut-Brain Axis in Epileptogenesis: A Systematic Review of Human and Veterinary Medicine.

Simple SummaryEpilepsy is a common chronic neurological disease in both dogs and humans. Despite the elevated prevalence and the many advances in human and veterinary medicine, the etiology and pathophysiology of epilepsy still remain unclear. In this systematic review, the authors discussed the possible role of the gut microbiota in the canine idiopathic epilepsy etiopathogenesis via the gut–brain axis.Canine idiopathic epilepsy is a common neurological disease characterized by the enduring predisposition of the cerebral cortex to generate seizures. An etiological explanation has not been fully identified in humans and dogs, and, among the presumed causes, several studies support the possible involvement of gut microbiota. In this review, the authors summarize the evidence of the reasonable role of gut microbiota in epilepsy through the so-called gut–brain axis. The authors provide an overview of recent clinical and preclinical studies in humans and dogs in which the modulation of intestinal permeability, the alteration of local immune response, and the alteration in production of essential metabolites and neurotransmitters associated with dysbiosis could be responsible for the pathogenesis of canine epilepsy. A systematic review of the literature, following the PRISMA guidelines, was performed in two databases (PubMed and Web of Science). Eleven studies were included and reviewed supporting the connection between gut microbiota and epilepsy via the gut–brain axis.

The effect of phenobarbital treatment on behavioral comorbidities and on the composition and function of the fecal microbiome in dogs with idiopathic epilepsy.

Phenobarbital (PB) is one of the most important antiseizure drugs (ASDs) to treat canine idiopathic epilepsy (IE). The effect of PB on the taxonomic changes in gastrointestinal microbiota (GIM) and their functions is less known, which may explain parts of its pharmacokinetic and pharmacodynamic properties, especially its antiseizure effect and drug responsiveness or drug resistance as well as its effect on behavioral comorbidities. Fecal samples of 12 dogs with IE were collected prior to the initiation of PB treatment and 90 days after oral PB treatment. The fecal samples were analyzed using shallow DNA shotgun sequencing, real-time polymerase chain reaction (qPCR)-based dysbiosis index (DI), and quantification of short-chain fatty acids (SCFAs). Behavioral comorbidities were evaluated using standardized online questionnaires, namely, a canine behavioral assessment and research questionnaire (cBARQ), canine cognitive dysfunction rating scale (CCDR), and an attention deficit hyperactivity disorder (ADHD) questionnaire. The results revealed no significant changes in alpha and beta diversity or in the DI, whereas only the abundance of Clostridiales was significantly decreased after PB treatment. Fecal SCFA measurement showed a significant increase in total fecal SCFA concentration and the concentrations of propionate and butyrate, while acetate concentrations revealed an upward trend after 90 days of treatment. In addition, the PB-Responder (PB-R) group had significantly higher butyrate levels compared to the PB-Non-Responder (PB-NR) group. Metagenomics of functional pathway genes demonstrated a significant increase in genes in trehalose biosynthesis, ribosomal synthesis, and gluconeogenesis, but a decrease in V-ATPase-related oxidative phosphorylation. For behavioral assessment, cBARQ analysis showed improvement in stranger-directed fear, non-social fear, and trainability, while there were no differences in ADHD-like behavior and canine cognitive dysfunction (CCD) scores after 90 days of PB treatment. While only very minor shifts in bacterial taxonomy were detected, the higher SCFA concentrations after PB treatment could be one of the key differences between PB-R and PB-NR. These results suggest functional changes in GIM in canine IE treatment.

Treatment of Canine Idiopathic Epilepsy - Clinical Picture after Drug Interaction

Background: The large number of diseases demand perennial development of the pharmaceutical industry. The drug-testing phase is essential to make them available safely. Awareness of pharmacological properties, adverse effects and drug interactions is required. Drug interactions are common in veterinary medicine and should be avoided. At times, epileptic seizures require polydrug therapy, predisposing patients to drug interactions. The interaction between carbamazepine and phenobarbital reported in the literature is an example. The aim of this paper is to report a clinical picture of drug interaction in the treatment of idiopathic epilepsy. Case: A 1-year-old Border Collie male dog, was admitted at the Veterinary Hospital of the Federal University of Lavras in post-ictal. The tutor reported that a year ago the animal had epileptic seizures and clusters with intervals of 21 to 25 days. Despite the continued use of previously prescribed phenobarbital (7.4 mg/kg, v.o., BID, until new recommendations) and carbamazepine (7.5 mg/kg, v.o., BID, until new recommendations), seizure control was not achieved. The physical examination indicated, tachypnea, ptialism, mydriasis, intense fatigue, and alienation from the environment. The patient did not respond to the threat-reflex test. Blood count, hepatic and renal blood chemistry, serum electrolyte (potassium, sodium, calcium and phosphorus), and phenobarbital dosages were requested. Based on the animal's history, breed characteristics, and alterations in the physical examination associated with normal results in complementary exams, idiopathic epilepsy was diagnosed. After analyzing the case, it was observed that the inefficiency in the control of seizures was possibly due to the drug interaction between phenobarbital and carbamazepine. Carbamazepine and phenobarbital reciprocally reduce their half-lives. To confirm the raised hypothesis, the serum concentration of carbamazepine was gradually reduced through weaning from its dose administered to the patient. Serial dosage of the concentration of phenobarbital in the bloodstream was performed. As a result, the serum phenobarbital, previously dosed at a concentration of 13.3 mg/dL with concomitant administration of carbamazepine, increased to 22 mg/dL 40 days after the beginning of weaning from carbamazepine (T0), and then to 36 mg/dL 100 days after T0. There was an increase in the concentration of phenobarbital in the bloodstream while the serum concentration of carbamazepine declined. The patient spaced out his seizures to every 50 to 60 days with phenobarbital monotherapy at a dose of 6 mg/kg. Discussion: Efficient control of clusters, such as the reduction of seizures by 50%, was only possible due to the meticulous perception of the possible interaction reported in medicine. Carbamazepine and phenobarbital are P450 isoenzyme inducers. The concomitant administration of both drugs potentiated the action of isoenzymes in the hepatic microsomal system, which led to an accelerated metabolic processing of the drugs. After weaning from carbamazepine, that is, reducing the action of carbamazepine on the isoenzymes of the P450 enzyme system, the concentration of phenobarbital normalized at 36 mg/dL. Such concentration is within the reference range reported in the literature: 25 mg/dL to 35 mg/dL of serum phenobarbital for treatment efficacy. Therefore, the control of convulsive crises was achieved. The increase in the concentration of phenobarbital due only to weaning from carbamazepine, even after decreasing the daily dose of barbiturate prescribed to the animal, contributed to evidence of the interaction of these drugs. It is noted that prior knowledge of pharmacological properties, careful study of the patient's history, and the cooperation of the tutor were essential for the therapeutic success and practice of evidence-based veterinary medicine. Keywords: drug interaction, carbamazepine, phenobarbital, P450 enzyme. Título: Tratamento da epilepsia idiopática canina - quadro clínico após interação medicamentosa. Descritores: interação medicamentosa, carbamazepina, fenobarbital, enzima P450.

Pregabalin Add-On vs. Dose Increase in Levetiracetam Add-On Treatment: A Real-Life Trial in Dogs With Drug-Resistant Epilepsy.

Epilepsy is a common neurological disorder affecting 0.6–0.75% of dogs in veterinary practice. Treatment is frequently complicated by the occurrence of drug-resistant epilepsy and cluster seizures in dogs with idiopathic epilepsy. Only few studies are available to guide treatment choices beyond licensed veterinary drugs. The aim of the study was to compare antiseizure efficacy and tolerability of two add-on treatment strategies in dogs with drug-resistant idiopathic epilepsy. The study design was a prospective, open-label, non-blinded, comparative treatment trial. Treatment success was defined as a 3-fold extension of the longest baseline interseizure interval and to a minimum of 3 months. To avoid prolonged adherence to a presumably ineffective treatment strategy, dog owners could leave the study after the third day with generalized seizures if the interseizure interval failed to show a relevant increase. Twenty-six dogs (mean age 5.5 years, mean seizure frequency 4/month) with drug-resistant idiopathic epilepsy and a history of cluster seizures were included. Dogs received either add-on treatment with pregabalin (PGB) 4 mg/kg twice daily (14 dogs) or a dose increase in levetiracetam (LEV) add-on treatment (12 dogs). Thirteen dogs in the PGB group had drug levels within the therapeutic range for humans. Two dogs in the PGB group (14.3%; 2/14) and one dog in the LEV group (8.3%; 1/12) achieved treatment success with long seizure-free intervals from 122 to 219 days but then relapsed to their early seizure frequency 10 months after the study inclusion. The overall low success rates with both treatment strategies likely reflect a real-life situation in canine drug-resistant idiopathic epilepsy in everyday veterinary practice. These results delineate the need for research on better pharmacologic and non-pharmacologic treatment strategies in dogs with drug-resistant epilepsy.

Validation of a Chromosome 14 Risk Haplotype for Idiopathic Epilepsy in the Belgian Shepherd Dog Found to Be Associated with an Insertion in the RAPGEF5 Gene.

An idiopathic epilepsy (IE) risk haplotype on canine chromosome (CFA) 14 has been reported to interact with the CFA37 common risk haplotype in the Belgian shepherd (BS). Additional IE cases and control dogs were genotyped for the risk haplotypes to validate these previous findings. In the new cohort, the interaction between the two regions significantly elevated IE risk. When the haplotypes were analyzed individually, particular haplotypes on both CFA14 (ACTG) and 37 (GG) were associated with elevated IE risk, though only the CFA37 AA was significantly associated (p < 0.003) with reduced risk in the new cohort. However, the CFA14 ACTG risk was statistically significant when the new and previous cohort data were combined. The frequency of the ACTG haplotype was four-fold higher in BS dogs than in other breeds. Whole genome sequence analysis revealed that a 3-base pair predicted disruptive insertion in the RAPGEF5 gene, which is adjacent to the CFA14 risk haplotype. RAPGEF5 is involved in the Wnt-β-catenin signaling pathway that is crucial for normal brain function. Although this risk variant does not fully predict the likelihood of a BS developing IE, the association with a variant in a candidate gene may provide insight into the genetic control of canine IE.

Cross Sectional Survey of Canine Idiopathic Epilepsy Management in Primary Care in the United Kingdom.

The aims of this study are to gain insight on how primary care veterinarians in the UK diagnose and treat canine idiopathic epilepsy (IE) and what they perceive as challenges in the management of canine IE. Two hundred and thirty-five primary care veterinarians took part in this survey. The questionnaire asked about the type of practice the respondent worked in, any relevant post-graduate qualifications, how many years' experience they had in practice and the participant's canine IE caseload. Participants were asked how they diagnose canine IE, how they select antiseizure drugs (ASDs) and how they assess outcome. The questionnaire also explored which information sources they have access to for deciding on canine IE treatment, challenges that may be faced when managing these cases and areas in which more support can be provided. 94.5% of participants (n = 222/235) managed <10 canine IE cases in a year and 87.8% (n = 206/235) used phenobarbital as their first line ASD. The reported mean initial phenobarbital dose was 2.1 mg/kg (standard deviation = 0.71) every 12 h. When considering how closely participants aligned with IVETF guidelines on the topics of diagnosis, ASD initiation and outcome assessment, on average participants would score around half of the available points. 53.2% (n = 125/235) of respondents recommended neutering in canine IE and 46.8% (n = 110/235) did not. 53.2% (n = 125/235) did not recommend any additional treatments for canine IE beyond use of ASDs. 23.4% recommended Purina Neurocare diet (n = 55/235), 12.8% recommended environmental modification (n = 30/235), and 6.8% (n = 16/235) recommend medium chain triglyceride supplements. In this study participants found managing client expectations to be most challenging alongside canine IE emergency management. The main limitation of this study is the relatively low response rate and therefore the results may not reflect the entire small animal veterinary profession in the UK. However, the results of this study represent a starting point to inform educational resources and support strategies to improve quality care of canine IE in primary care.

Th17 cell-mediated immune response in a subpopulation of dogs with idiopathic epilepsy.

BackgroundCanine idiopathic epilepsy (IE) is a common neurological disease with severe impact on the owner´s and the dog’s quality of life. A subpopulation of dogs with IE does not respond to antiseizure drugs (non-responder). Th17 cells (T helper cells) and their proinflammatory Interleukin-17 (IL-17) are part of the immune system and previous studies showed their involvement in the pathogenesis of several autoimmune diseases. Non-responder might have an abnormal immune response against structures of the central nervous system. To discover a new aetiology of canine IE and thereby optimising the therapy of intractable IE, this prospective study aimed to investigate Th17 cells and IL-17 in dogs with IE. The underlying hypothesis was that in some dogs with IE a Th17 cell-mediated immune response could be detectable.Methods57 dogs with IE and 10 healthy dogs (control group, C) were enrolled in the study. EDTA blood was taken to measure Th17 cells by flow cytometry. IL-17 was measured in 35 cerebrospinal fluid (CSF) and 33 serum samples using an enzyme-linked immunosorbent assay (ELISA). It was investigated whether there was a significant increase of stimulated Th17 cells in blood samples or of IL-17 in serum and CSF samples of dogs with IE in comparison to C. Correlations between the amount of Th17 cells/μL or IL-17 and different clinical parameters e.g. seizure frequency, seizure type, seizure severity or treatment response were evaluated. Additionally, Th17 cells/μL were randomly controlled of 17 dogs with IE and were examined for changes over time and in relation to treatment response.ResultsTen dogs with IE had strongly elevated stimulated Th17 cells/μL within the blood (>100 Th17 cells/μL). A slight positive correlation between stimulated Th17 cells/μL and seizure severity (p = 0.046; rSpear = 0.27) was proven in these dogs. In addition, 4/10 dogs with elevated Th17 levels experienced cluster seizures and status epilepticus in comparison to 9% of the dogs with non-elevated Th17 levels (<100 Th17 cells/μL). Dogs with IE had significantly higher IL-17 values in CSF and serum samples compared to C (p<0.001; p<0.002; respectively).ConclusionIn single dogs with IE, strongly increased amounts of Th17 cells were detectable and dogs with elevated Th17 cells seemed to have a greater risk for experiencing a combination of cluster seizures and status epilepticus. Therefore, an underlying Th17-cell mediated immune response was suspected and hence anti-inflammatory drugs could be indicated in these single cases with intractable epilepsy.

Gut Microbiota in Canine Idiopathic Epilepsy: Effects of Disease and Treatment.

Simple SummaryThere is evidence that supports the existence of a gut-brain axis system through which bi-directional communication occurs between gut bacteria and the brain. Epilepsy is one of the most common neurological disorders in humans and dogs. The role of microbiota in epilepsy remains unknown but it has been suggested that it is a possible influence of gut bacteria in controlling seizures. The aim of this study was to investigate the changes in gut microbiota from dogs with idiopathic epilepsy and the possible effect of antiepileptic drugs on the modulation of the composition of this microbiota. In comparison with control dogs, drug-naive epileptic individuals showed a significantly reduced abundance of GABA and SCFAs-producing bacteria, as well as bacteria associated with reduced risk for brain disease. Moreover, the use of phenobarbital or imepitoin monotherapy during one month in epileptic dogs did not modify the gut microbiota composition. These results open up the possibility of studying probiotic interventions in epilepsy. Considering the phylogenetic and metabolic similarities in intestinal microbiome between humans and dogs, this study contributes to the understanding of epilepsy both in human and veterinary medicine.Epilepsy is one of the most common neurological disorders in humans and dogs. The structure and composition of gut microbiome associated to this disorder has not yet been analyzed in depth but there is evidence that suggests a possible influence of gut bacteria in controlling seizures. The aim of this study was to investigate the changes in gut microbiota associated to canine idiopathic epilepsy (IE) and the possible influence of antiepileptic drugs (AEDs) on the modulation of this microbiota. Faecal microbiota composition was analyzed using sequencing of bacterial 16S rRNA gene in a group of healthy controls (n = 12) and a group of epileptic dogs both before (n = 10) and after a 30-day single treatment with phenobarbital or imepitoin (n = 9). Epileptic dogs showed significantly reduced abundance of GABA (Pseudomonadales, Pseudomonadaceae, Pseudomonas and Pseudomona_graminis) and SCFAs-producing bacteria (Peptococcaceae, Ruminococcaceae and Anaerotruncus) as well as bacteria associated with reduced risk for brain disease (Prevotellaceae) than control dogs. The administration of AEDs during 30 days did not modify the gut microbiota composition. These results are expected to contribute to the understanding of canine idiopathic epilepsy and open up the possibility of studying new therapeutic approaches for this disorder, including probiotic intervention to restore gut microbiota in epileptic individuals.

Computerised decision support in veterinary medicine, exemplified in a canine idiopathic epilepsy care pathway.

Computerised decision support is of emerging and increasing importance in human medicine, but as yet has not been thoroughly applied or evaluated in veterinary medicine. In this essay, the authors report on the first example of a veterinary care pathway, a specific form of computerised decision support, which guides clinicians through a clinical workflow and incorporates individual patient data to inform patient-specific decision recommendations. The veterinary care pathway was designed using consensus statements and specialist neurologist opinion to create a decision support tool concerning canine idiopathic epilepsy. The authors evaluated the care pathway by comparing 35 clinical decisions made by referral clinicians in historical cases of idiopathic epilepsy to decisions recommended by the care pathway when presented with the same clinical case. Their results show that in 77.1% (95% confidence interval [59.9, 89.6]) of cases the care pathway recommended a decision that was the same or similar to a specialist neurologist's decision. Whilst further studies are needed to explore the potential use of such technology in clinical practice, the authors believe this first application provides great promise of a new and alternative method of clinical decision support.

Owner compliance in canine epilepsy.

Poor medication compliance by human epilepsy patients is one of the leading causes of treatment failure and increased seizure frequency. The aim of this cross-sectional study was to analyse owner compliance in pharmacological treatment of canine idiopathic epilepsy and to identify factors associated with poor compliance. The number of antiseizure drug tablets was recorded to determine if the patient received sufficient tablets to cover the time period between prescriptions and to assess compliant prescription cycles. Additionally, compliance was assessed by an online survey of owners. For the prescription monitoring data from 94 cases from three small animal practices in the United Kingdom revealed an overall median compliance of 56%. Thirt-three per cent of owners were >80% compliant, while 21% were 100% compliant. During a non-compliant prescription cycle, a patient missed a median of 6 days (0.11-519 days) of treatment. Patients on polytherapy had higher compliance rates than on monotherapy (p = 0.031). The survey (229 respondents from online canine epilepsy groups) showed that low daily dosing was associated with better compliance (p = 0.049). Owner compliance was subpar in this study and could represent a significant issue in epilepsy management, which needs to be considered by veterinary surgeons when treating canine epilepsy.

Relationship between interictal epileptiform discharges under medetomidine sedation and clinical seizures in canine idiopathic epilepsy

BackgroundElectroencephalography (EEG) is required for the diagnosis of canine idiopathic epilepsy as a highest confidence level of diagnosis by the International Veterinary Epilepsy Task Force; however, EEG is seldom used...

The seizuring canine patient

Seizures are very common in dogs and cats — the estimated prevalence of canine idiopathic epilepsy is 0.6% in the first opinion canine population in the UK. Patients that seizure due to metabolic disturbances or poisonong can be treated short term until imbalances are corrected. This artical explores the many types of seizures, where they originate from, and the importance of nursing care for the neurological seizure patient.