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von Rüden EL, Potschka H, Tipold A, Stein VM. The role of neuroinflammation in canine epilepsy. Vet J 2023; 298-299:106014. [PMID: 37393038 DOI: 10.1016/j.tvjl.2023.106014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 07/03/2023]
Abstract
The lack of therapeutics that prevent the development of epilepsy, improve disease prognosis or overcome drug resistance represents an unmet clinical need in veterinary as well as in human medicine. Over the past decade, experimental studies and studies in human epilepsy patients have demonstrated that neuroinflammatory processes are involved in epilepsy development and play a key role in neuronal hyperexcitability that underlies seizure generation. Targeting neuroinflammatory signaling pathways may provide a basis for clinically relevant disease-modification strategies in general, and moreover, could open up new therapeutic avenues for human and veterinary patients with drug-resistant epilepsy. A sound understanding of the neuroinflammatory mechanisms underlying seizure pathogenesis in canine patients is therefore essential for mechanism-based discovery of selective epilepsy therapies that may enable the development of new disease-modifying treatments. In particular, subgroups of canine patients in urgent needs, e.g. dogs with drug-resistant epilepsy, might benefit from more intensive research in this area. Moreover, canine epilepsy shares remarkable similarities in etiology, disease manifestation, and disease progression with human epilepsy. Thus, canine epilepsy is discussed as a translational model for the human disease and epileptic dogs could provide a complementary species for the evaluation of antiepileptic and antiseizure drugs. This review reports key preclinical and clinical findings from experimental research and human medicine supporting the role of neuroinflammation in the pathogenesis of epilepsy. Moreover, the article provides an overview of the current state of knowledge regarding neuroinflammatory processes in canine epilepsy emphasizing the urgent need for further research in this specific field. It also highlights possible functional impact, translational potential and future perspectives of targeting specific inflammatory pathways as disease-modifying and multi-target treatment options for canine epilepsy.
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Affiliation(s)
- Eva-Lotta von Rüden
- Institute of Pharmacology, Toxicology, and Pharmacy, Ludwig-Maximilians-University (LMU) Munich, Germany.
| | - Heidrun Potschka
- Institute of Pharmacology, Toxicology, and Pharmacy, Ludwig-Maximilians-University (LMU) Munich, Germany
| | - Andrea Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
| | - Veronika M Stein
- Department for Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
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Hanael E, Chai O, Konstanitin L, Gibeon L, Rapaport K, Ruggeri M, Friedman A, Shamir MH. Telmisartan as an add-on treatment for dogs with refractory idiopathic epilepsy: a nonrandomized, uncontrolled, open-label clinical trial. J Am Vet Med Assoc 2022; 260:735-740. [PMID: 35201995 DOI: 10.2460/javma.20.12.0683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate the effect on seizure frequency of add-on telmisartan treatment in dogs with refractory idiopathic epilepsy. ANIMALS 11 client-owned dogs with idiopathic epilepsy and ≥ 2 generalized seizures/mon that were currently being treated with ≥ 2 antiepileptic drugs. PROCEDURES Telmisartan was administered at a dosage of 0.25 to 1 mg/kg, PO, every 12 hours for 4 to 16 months. Seizure frequencies before and during telmisartan treatment were recorded. RESULTS 10 dogs completed the 4-month treatment protocol. One dog was excluded owing to a transient increase in serum creatinine concentration; no adverse effects of telmisartan were observed in the remaining 10 dogs. A reduction in seizure frequency greater than an estimated expected placebo effect of 30% was evident in 7 of the 10 dogs. Long-term (12 to 16 months) follow-up information was available for 6 dogs, of which 4 had a further reduction in seizure frequency. Differences in seizure frequency were not statistically significant. No significant difference was found in serum phenobarbital concentration throughout the treatment period in the 7 dogs that were tested. CLINICAL RELEVANCE Telmisartan has the potential to reduce seizure frequency when administered as an add-on antiepileptic drug in dogs with refractory idiopathic epilepsy. A randomized, double-blind, placebo-controlled trial is needed to determine the true efficacy of telmisartan. On the basis of our results, a sample size of 54 dogs with refractory idiopathic epilepsy would be needed.
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Affiliation(s)
- Erez Hanael
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, Israel
| | - Orit Chai
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, Israel
| | - Lilach Konstanitin
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, Israel
| | | | - Kira Rapaport
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, Israel
| | - Marco Ruggeri
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, Israel
| | - Alon Friedman
- Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Department of Medical Neuroscience, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Merav H Shamir
- Veterinary Teaching Hospital, Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Rehovot, Israel
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Lipsitz LA, Habtemariam D, Gagnon M, Iloputaife I, Sorond F, Tchalla AE, Dantoine TF, Travison TG. Reexamining the Effect of Antihypertensive Medications on Falls in Old Age. Hypertension 2015; 66:183-9. [PMID: 25941341 DOI: 10.1161/hypertensionaha.115.05513] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 04/14/2015] [Indexed: 12/29/2022]
Abstract
Conflicting data on the relationship between antihypertensive medications and falls in elderly people may lead to inappropriate undertreatment of hypertension in an effort to prevent falls. We aimed to clarify the relationships between the chronic use of different classes of antihypertensive medications and different types of falls, to determine the effect of medication dose, and to assess whether the risk of falls is associated with differences in cerebral blood flow. We assessed demographics, clinical characteristics, and chronic antihypertensive medication use in 598 community-dwelling people with hypertension, aged 70 to 97 years, then followed them prospectively for self-reported falls using monthly calendar postcards and telephone interviews. Antihypertensive medication use was not associated with an increased risk of falls. Participants reporting use of angiotensin-converting enzyme inhibitors had a significantly decreased 1-year risk of injurious falls (odds ratio, 0.62; 95% confidence interval, 0.39-0.96), whereas those using calcium channel blockers had a decreased risk of all falls (odds ratio, 0.62; 95% confidence interval, 0.42-0.91) and indoor falls (odds ratio, 0.57; 95% confidence interval, 0.36-0.91), compared with participants not taking these drugs. Larger doses of these classes were associated with a lower fall risk. Participants taking calcium channel blockers had higher cerebral blood flow than those not taking these medications. In relatively healthy community-dwelling elderly people, high doses of antihypertensive agents are not associated with an increased risk of falls.
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Affiliation(s)
- Lewis A Lipsitz
- From the Hebrew SeniorLife Institute for Aging Research (L.A.L., D.H., M.G., I.I., T.G.T.), Boston, MA; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L., T.G.T.); Harvard Medical School (L.A.L., F.S., T.G.T.), Boston, MA; Department of Neurology, Brigham and Women's Hospital, Boston, MA (F.S.); and Geriatric Medicine Department, Limoges University, Limoges, France (A.E.T., T.F.D.).
| | - Daniel Habtemariam
- From the Hebrew SeniorLife Institute for Aging Research (L.A.L., D.H., M.G., I.I., T.G.T.), Boston, MA; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L., T.G.T.); Harvard Medical School (L.A.L., F.S., T.G.T.), Boston, MA; Department of Neurology, Brigham and Women's Hospital, Boston, MA (F.S.); and Geriatric Medicine Department, Limoges University, Limoges, France (A.E.T., T.F.D.)
| | - Margaret Gagnon
- From the Hebrew SeniorLife Institute for Aging Research (L.A.L., D.H., M.G., I.I., T.G.T.), Boston, MA; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L., T.G.T.); Harvard Medical School (L.A.L., F.S., T.G.T.), Boston, MA; Department of Neurology, Brigham and Women's Hospital, Boston, MA (F.S.); and Geriatric Medicine Department, Limoges University, Limoges, France (A.E.T., T.F.D.)
| | - Ikechukwu Iloputaife
- From the Hebrew SeniorLife Institute for Aging Research (L.A.L., D.H., M.G., I.I., T.G.T.), Boston, MA; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L., T.G.T.); Harvard Medical School (L.A.L., F.S., T.G.T.), Boston, MA; Department of Neurology, Brigham and Women's Hospital, Boston, MA (F.S.); and Geriatric Medicine Department, Limoges University, Limoges, France (A.E.T., T.F.D.)
| | - Farzaneh Sorond
- From the Hebrew SeniorLife Institute for Aging Research (L.A.L., D.H., M.G., I.I., T.G.T.), Boston, MA; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L., T.G.T.); Harvard Medical School (L.A.L., F.S., T.G.T.), Boston, MA; Department of Neurology, Brigham and Women's Hospital, Boston, MA (F.S.); and Geriatric Medicine Department, Limoges University, Limoges, France (A.E.T., T.F.D.)
| | - Achille E Tchalla
- From the Hebrew SeniorLife Institute for Aging Research (L.A.L., D.H., M.G., I.I., T.G.T.), Boston, MA; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L., T.G.T.); Harvard Medical School (L.A.L., F.S., T.G.T.), Boston, MA; Department of Neurology, Brigham and Women's Hospital, Boston, MA (F.S.); and Geriatric Medicine Department, Limoges University, Limoges, France (A.E.T., T.F.D.)
| | - Thierry F Dantoine
- From the Hebrew SeniorLife Institute for Aging Research (L.A.L., D.H., M.G., I.I., T.G.T.), Boston, MA; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L., T.G.T.); Harvard Medical School (L.A.L., F.S., T.G.T.), Boston, MA; Department of Neurology, Brigham and Women's Hospital, Boston, MA (F.S.); and Geriatric Medicine Department, Limoges University, Limoges, France (A.E.T., T.F.D.)
| | - Thomas G Travison
- From the Hebrew SeniorLife Institute for Aging Research (L.A.L., D.H., M.G., I.I., T.G.T.), Boston, MA; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (L.A.L., T.G.T.); Harvard Medical School (L.A.L., F.S., T.G.T.), Boston, MA; Department of Neurology, Brigham and Women's Hospital, Boston, MA (F.S.); and Geriatric Medicine Department, Limoges University, Limoges, France (A.E.T., T.F.D.)
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