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Bruni G, Capsoni D, Pellegrini A, Altomare A, Coduri M, Ferrara C, Galinetto P, Molteni R. New Findings on the Crystal Polymorphism of Imepitoin. Molecules 2024; 29:1724. [PMID: 38675544 PMCID: PMC11052430 DOI: 10.3390/molecules29081724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/21/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Scientific and industrial reasons dictate the study of the solid state of imepitoin, a highly safe and tolerable anticonvulsant drug used in the therapy of epileptic dogs that was approved in the Europe Union in 2013. Our investigations allowed us to discover the existence of a new polymorph of imepitoin, which finds itself in a monotropic relationship with the crystalline form (polymorph I) already known and present on the market. This form (polymorph II), obtained by crystallization from xylene, remains metastable under ambient conditions for at least 1 year. Both solid forms were characterized by thermal (DSC and TGA), spectroscopic (FT-IR and Raman), microscopic (SEM and HSM), and diffractometric techniques. The thermodynamic relationship between the two polymorphs (monotropic) is such that it is not possible to study the melting of polymorph II, not even by adopting appropriate experimental strategies. Our measurements highlighted that the melting peak of imepitoin actually also includes an onset of melt decomposition. The ab initio structure solution, obtained from synchrotron X-ray powder diffraction data collected at room temperature, allowed us to determine the crystal structure of the new polymorph (II). It crystallizes in the monoclinic crystal structure, P21/c space group (#14), with a = 14.8687(6) Å, b = 7.2434(2) Å, c = 12.5592(4) Å, β = 107.5586(8)°, V = 1289.61(8) Å3, and Z = 4.
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Affiliation(s)
- Giovanna Bruni
- Department of Chemistry, Physical Chemistry Section & C.S.G.I. (Consorzio Interuniversitario per lo Sviluppo dei Sistemi a Grande Interfase), University of Pavia, 27100 Pavia, Italy; (D.C.); (A.P.); (M.C.)
| | - Doretta Capsoni
- Department of Chemistry, Physical Chemistry Section & C.S.G.I. (Consorzio Interuniversitario per lo Sviluppo dei Sistemi a Grande Interfase), University of Pavia, 27100 Pavia, Italy; (D.C.); (A.P.); (M.C.)
| | - Anna Pellegrini
- Department of Chemistry, Physical Chemistry Section & C.S.G.I. (Consorzio Interuniversitario per lo Sviluppo dei Sistemi a Grande Interfase), University of Pavia, 27100 Pavia, Italy; (D.C.); (A.P.); (M.C.)
| | - Angela Altomare
- Institute of Crystallography—CNR, Via Amendola 122/o, 70126 Bari, Italy;
| | - Mauro Coduri
- Department of Chemistry, Physical Chemistry Section & C.S.G.I. (Consorzio Interuniversitario per lo Sviluppo dei Sistemi a Grande Interfase), University of Pavia, 27100 Pavia, Italy; (D.C.); (A.P.); (M.C.)
| | - Chiara Ferrara
- Department of Materials Science, University of Milano-Bicocca, Via Cozzi 55, 20125 Milano, Italy;
| | - Pietro Galinetto
- Department of Physics, University of Pavia, Via Bassi 6, 27100 Pavia, Italy;
| | - Renato Molteni
- A.M.S.A. Anonima Materie Sintetiche Affini S.p.A., Viale Giuseppe Di Vittorio 6, 22100 Como, Italy;
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Muñoz Amezcua AC, Jones JM, Griffith EH, Gruen ME. Pilot Study on the Efficacy and Safety of Long-Term Oral Imepitoin Treatment for Control of (Thunder)Storm-Associated Noise Phobia/Noise Aversion in Dogs Using an Individualized-Dose Titration Approach. Animals (Basel) 2024; 14:545. [PMID: 38396513 PMCID: PMC10886229 DOI: 10.3390/ani14040545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/17/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024] Open
Abstract
Imepitoin is a low-affinity partial agonist for benzodiazepine binding sites of gamma-aminobutyric acid receptors with anxiolytic effects. It has been shown to reduce anxiety during noise-related events in dogs when given at 30 mg/kg PO BID, although this dose was associated with ataxia and increased appetite in some cases. The objective of this study was to assess its safety and efficacy for storm anxiety when started at 10 mg/kg PO BID and titrated to effect up to 30 mg/kg PO BID during storm season. Significant decreases in anxiety scores were seen in weekly surveys and storm logs (SLs) at 10, 20 and 30 mg/kg PO BID. Serious adverse events (AEs) were not reported in any subject. Ataxia was the most commonly reported non-serious AE (14/33), followed by increased hunger (13/33). The frequency of AEs was higher in the 20 mg/kg PO BID group than in the 10 mg/kg group PO BID. No clinically significant changes were seen in lab work pre- and post-study. In conclusion, Imepitoin given during storm season at doses ranging from 10 to 30 mg/kg PO BID reduced clinical signs of fear and anxiety during storms for the dogs in this study. These findings support the use of an individually titrated dose.
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Affiliation(s)
- Ana C. Muñoz Amezcua
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA
| | - Jennifer M. Jones
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA
| | - Emily H. Griffith
- Department of Statistics, North Carolina State University, Raleigh, NC 27606, USA;
| | - Margaret E. Gruen
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA
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Peek SI, Meller S, Twele F, Packer RMA, Volk HA. Epilepsy is more than a simple seizure disorder: Parallels between human and canine cognitive and behavioural comorbidities. Vet J 2024; 303:106060. [PMID: 38123061 DOI: 10.1016/j.tvjl.2023.106060] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 12/02/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023]
Abstract
Psychiatric and cognitive comorbidities have been known to play a major role in human epilepsy for a long time. People with epilepsy (PWE) frequently express signs of varying psychiatric and cognitive disorders affecting their quality and quantity of life (QoL/QaoL). Over the last few years, research on behavioural comorbidities and their effect on the underlying disease have been performed in canine epilepsy. The following article reviews manifestations of comorbidities in canine epilepsy with an emphasis on patterns of clinical signs and their effects on QoL and QaoL. Cognitive and behavioural alterations in epileptic dogs are mainly represented by fear-/anxiety related behaviour and cognitive impairment (CI). Reduced trainability and altered reactions to daily situations are common results of comorbid changes posing obstacles in everyday life of owners and their dog. In addition, clinical signs similar to attention deficit hyperactivity disorder (ADHD) in humans have been reported. Canine attention-deficit-hyperactivity-disorder-like (c-ADHD-like) behaviour should, however, be evaluated critically, as there are no official criteria for diagnosis of ADHD or ADHD-like behaviour in dogs, and some of the reported signs of c-ADHD-like behaviour could be confused with anxiety-associated behaviour. Many intrinsic and extrinsic factors could potentially influence the development of behavioural and cognitive comorbidities in canine epilepsy. In particular, seizure frequency/severity, signalment and factors concerning disease management, such as pharmacotherapy and nutrition, are closely linked with the presence of the aforementioned comorbid disorders. Further studies of behavioural alterations in epileptic dogs are needed to comprehend the complexity of clinical signs and their multifactorial origin.
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Affiliation(s)
- Saskia I Peek
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Germany
| | - Sebastian Meller
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Germany
| | - Friederike Twele
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Germany
| | | | - Holger A Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Germany.
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Mandigers PJJ, Santifort KM. Remarkable anecdotes illustrating the nature and effect of seizure-precipitating factors in Border Collies with idiopathic epilepsy. Front Vet Sci 2023; 10:1254279. [PMID: 37781292 PMCID: PMC10538117 DOI: 10.3389/fvets.2023.1254279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Epilepsy is one of the most common chronic neurological syndromes in dogs and has serious implications for the quality of life of both the dogs and owners. Seizure-precipitating factors (SPFs) (also termed "triggers" or "provocative factors") have been studied and reported in both humans and dogs with idiopathic epilepsy. In dogs stress, hormones, sleep deprivation, and the weather have been reported as SPFs. The Border Collie (BC) is a breed of dog that is predisposed to idiopathic epilepsy, and the outcome is often poor. BC is described as a very sensitive dog with a strong focus on their owners, and this may have an influence on their and their owners' stress level. In this article, we described six unrelated BCs with idiopathic epilepsy in which several remarkable SPFs were identified, and avoiding them improved the outcome of these dogs. The possible SPFs were different for each dog. The SPFs were, among others, the other dog in the family, the lack of intellectual challenge, the presence of an autistic child, a busy street, the relation with the owner, and throwing a ball at the beach. These cases illustrate that recognizing the SPF(s) and taking measures with regard to management can lead to a reduction in epileptic seizure frequency or even achieving seizure freedom.
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Affiliation(s)
- Paul J. J. Mandigers
- Evidensia Referral Hospital Arnhem, Arnhem, Netherlands
- Expertise Centre of Genetics, Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
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Charalambous M, Fischer A, Potschka H, Walker MC, Raedt R, Vonck K, Boon P, Lohi H, Löscher W, Worrell G, Leeb T, McEvoy A, Striano P, Kluger G, Galanopoulou AS, Volk HA, Bhatti SFM. Translational veterinary epilepsy: A win-win situation for human and veterinary neurology. Vet J 2023; 293:105956. [PMID: 36791876 DOI: 10.1016/j.tvjl.2023.105956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 02/15/2023]
Abstract
Epilepsy is a challenging multifactorial disorder with a complex genetic background. Our current understanding of the pathophysiology and treatment of epilepsy has substantially increased due to animal model studies, including canine studies, but additional basic and clinical research is required. Drug-resistant epilepsy is an important problem in both dogs and humans, since seizure freedom is not achieved with the available antiseizure medications. The evaluation and exploration of pharmacological and particularly non-pharmacological therapeutic options need to remain a priority in epilepsy research. Combined efforts and sharing knowledge and expertise between human medical and veterinary neurologists are important for improving the treatment outcomes or even curing epilepsy in dogs. Such interactions could offer an exciting approach to translate the knowledge gained from people and rodents to dogs and vice versa. In this article, a panel of experts discusses the similarities and knowledge gaps in human and animal epileptology, with the aim of establishing a common framework and the basis for future translational epilepsy research.
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Affiliation(s)
- Marios Charalambous
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover 30559, Germany.
| | - Andrea Fischer
- Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-University Munich, Munich 80539, Germany
| | - Heidrun Potschka
- Institute of Pharmacology, Toxicology and Pharmacy, Ludwig-Maximilians-University, Munich 80539, Germany
| | - Matthew C Walker
- Institute of Neurology, University College London, London WC1N 3JD, UK
| | - Robrecht Raedt
- Department of Neurology, 4brain, Ghent University, Ghent 9000, Belgium
| | - Kristl Vonck
- Department of Neurology, 4brain, Ghent University, Ghent 9000, Belgium
| | - Paul Boon
- Department of Neurology, 4brain, Ghent University, Ghent 9000, Belgium
| | - Hannes Lohi
- Department of Veterinary Biosciences, Department of Medical and Clinical Genetics, and Folkhälsan Research Center, University of Helsinki, Helsinki 00014, Finland
| | - Wolfgang Löscher
- Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine Hannover, Hannover 30559, Germany
| | | | - Tosso Leeb
- Institute of Genetics, University of Bern, Bern 3001, Switzerland
| | - Andrew McEvoy
- Institute of Neurology, University College London, London WC1N 3JD, UK
| | - Pasquale Striano
- IRCCS 'G. Gaslini', Genova 16147, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Gerhard Kluger
- Research Institute, Rehabilitation, Transition-Palliation', PMU Salzburg, Salzburg 5020, Austria; Clinic for Neuropediatrics and Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schoen Clinic Vogtareuth, Vogtareuth 83569, Germany
| | - Aristea S Galanopoulou
- Saul R Korey Department of Neurology, Isabelle Rapin Division of Child Neurology, Dominick P. Purpura Department of Neuroscience, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Holger A Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover 30559, Germany
| | - Sofie F M Bhatti
- Faculty of Veterinary Medicine, Small Animal Department, Ghent University, Merelbeke 9820, Belgium
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Hamers MFN, Plonek M, Bhatti SFM, Bergknut N, Diaz Espineira MM, Santifort KM, Mandigers PJJ. Quality of life in dogs with idiopathic epilepsy and their owners with an emphasis on breed-A pilot study. Front Vet Sci 2023; 9:1107315. [PMID: 36713869 PMCID: PMC9874297 DOI: 10.3389/fvets.2022.1107315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 12/28/2022] [Indexed: 01/12/2023] Open
Abstract
Epilepsy in dogs is a common chronic and serious disorder and may have an impact on the quality of life of the owners as well as the dogs themselves. The aim of this pilot study was to investigate the QoL score of dogs suffering from idiopathic epilepsy and their owners and if possible, investigate whether a breed specific difference exists. Owners, either Dutch or Belgium, were asked to participate in a web based SurveyMonkey questionnaire. A total of 402 questionnaires representing 402 dogs with epilepsy were suitable for further analysis. Of the 402 dogs, 253 were males and 149 were females. Ninety-nine different breeds were represented. Fourteen breeds (177 dogs in total) were used to calculate breed specific scores; Australian Shepherd (n = 8), Beagle (n = 7), Belgian Tervuren dog (n = 9), Belgian Groenendaeler dog (n = 8), Border Collie (n = 38), Chihuahua (n = 9), Dachshund (n = 13), Drentsche Patrijshond (a Dutch partridge dog) (n = 14), French Bulldog (n = 12), Golden Retriever (n = 17), Labrador Retriever (n = 18), and Rottweiler (n = 12). For the Border Collie, there was a statistically significant correlation between "epilepsy related death," the severity of the seizures (p < 0.001) and cluster seizures (p < 0.001). The quality of life of the Border Collie was scored lower compared to all other dogs (p = 0.02). There were three breeds that had a minimal decrease in the overall quality of life score compared to all other dogs: the Chihuahua (p = 0.03), Dachshund (p = 0.001), and Golden retriever (p = 0.01). The score for "caring for my epileptic dog decreases my own QoL" was high for the Border Collie, Boxer, French Bulldog, and Rottweiler, but was only found to be statistically significantly higher in the Border Collie (p = 0.01). Scores for the Golden Retriever (p = 0.04) and Labrador (p = 0.006) were lower. In conclusion, this study reports breed specific quality of life scores of dogs with epilepsy and their owners, and underlines that breed by itself, is also an important factor when managing epilepsy in dogs.
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Affiliation(s)
- Maud F. N. Hamers
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Marta Plonek
- Evidensia Referral Hospital, Arnhem, Netherlands
| | - Sofie F. M. Bhatti
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | | | | | | | - Paul J. J. Mandigers
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands,Evidensia Referral Hospital, Arnhem, Netherlands,*Correspondence: Paul J. J. Mandigers ✉
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Pergande AE, Belshaw Z, Volk HA, Packer RMA. Owner perspectives on the impact of veterinary surgeons upon their decision making in the management of dogs with idiopathic epilepsy. Vet Rec 2022:e2482. [PMID: 36529783 DOI: 10.1002/vetr.2482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/10/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Idiopathic epilepsy is a prevalent canine condition that can be challenging to manage. A positive vet-owner relationship contributes to satisfaction and compliance, but its impact on management is unclear. The aim of this study was to investigate owner perspectives about the impact of veterinary surgeons on decision making and management. METHODS Qualitative methods were utilised, and semi-structured interviews were completed with 21 owners of dogs with epilepsy who lived in England. Transcripts were thematically analysed, and this study discusses the theme 'influences of the veterinary surgeon'. RESULTS Many owners felt that more precise expectations could have improved interactions with their veterinary surgeon(s), and their experiences of caring for their dog. Most owners referred to a specialist reported a positive experience, often due to specialists being perceived to have greater experience or knowledge. Owners who reported predominantly negative experiences were often less trusting of the veterinary profession, and more likely to perform self-directed research. LIMITATIONS These results represent the experiences of a small subset of owners, and larger scale studies are required to support these findings. CONCLUSION Owners appear to value the formation of partnerships of care with their veterinary surgeon, and greater availability of educational resources could further improve owner satisfaction.
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Affiliation(s)
- Amy E Pergande
- Clinical Science and Services, Royal Veterinary College, Hatfield, Hertfordshire, UK
| | | | - Holger A Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Rowena M A Packer
- Clinical Science and Services, Royal Veterinary College, Hatfield, Hertfordshire, UK
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Green M, Lowrie M, Singleton D, Garosi L, McConnell K. Approach to initial management of canine generalised epileptic seizures in primary-care veterinary practices in the United Kingdom. J Small Anim Pract 2022; 63:801-808. [PMID: 36003061 DOI: 10.1111/jsap.13543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/06/2022] [Accepted: 07/07/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate how primary care clinicians in the UK approach initial management of canine generalised epileptic seizures, including factors potentially associated with prescription and choice of anti-seizure drugs (ASDs). MATERIALS AND METHODS Electronic health records concerning 3,150,713 consultations (917,373 dogs) were collected from 224 veterinary practices by the Small Animal Veterinary Surveillance Network. Free-text clinical narratives were reviewed to identify those consistent with generalised epileptic seizure activity, including only those recording the first presentation for seizures. Dogs older than 6 years were excluded. RESULTS Five hundred and seventeen cases were included. Sixty-seven dogs (13.0%) received anti-seizure drugs at first presentation; this was significantly more likely in dogs presented with cluster seizures (CS) (odds ratio 13.8, 95% confidence interval 7.3 to 26.1). Phenobarbital (n=36) and imepitoin (n=29) were the most frequently chosen anti-seizure drugs. Presentation for a single epileptic seizure occurred in 321 dogs; seven were prescribed anti-seizure drugs. Eighty-six dogs were presented with cluster seizures; 38 were prescribed anti-seizure drugs, most frequently imepitoin (n= 19) and phenobarbital (n=17). Of the dogs presenting with a single seizure and at least 6-month follow-up (n=165), 33 (20%) did not have subsequent seizures recorded. CLINICAL SIGNIFICANCE Primary care clinicians rarely prescribed anti-seizure drugs following a single epileptic seizure in accordance with International Veterinary Epilepsy Task Force recommendations. Less than half of dogs initially presenting with cluster seizures were prescribed anti-seizure drugs. Imepitoin was frequently selected in the treatment of cluster seizures despite no authorisation for this purpose. These findings may ultimately contribute to improved cohesion in the management of canine epileptic seizures between primary care and referral institutions.
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Affiliation(s)
- M Green
- Dovecote Veterinary Hospital, Derby, DE74 2LJ, UK
| | - M Lowrie
- Dovecote Veterinary Hospital, Derby, DE74 2LJ, UK
| | - D Singleton
- University of Liverpool, Liverpool, L69 3BX, UK
| | - L Garosi
- Vet Oracle Teleradiology, Norfolk, IP22 4ER, UK
| | - K McConnell
- Advanced Veterinary Diagnostic Imaging Specialists, Cheshire, SY14 8LQ, UK
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Griffin S, Stabile F, De Risio L. Cross Sectional Survey of Canine Idiopathic Epilepsy Management in Primary Care in the United Kingdom. Front Vet Sci 2022; 9:907313. [PMID: 35795785 PMCID: PMC9251582 DOI: 10.3389/fvets.2022.907313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Sebastian Griffin
- Vet4Life Teddington, Part of Linnaeus Veterinary Limited, Teddington, United Kingdom
- *Correspondence: Sebastian Griffin
| | - Fabio Stabile
- Southfields Veterinary Specialists, Part of Linnaeus Veterinary Limited, Basildon, United Kingdom
| | - Luisa De Risio
- Linnaeus Veterinary Limited, Solihull, United Kingdom
- Nottingham Trent University, Nottingham, United Kingdom
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Hermans M, Charalambous M, Pakozdy A, Eisl-Glantschnigg U, Neßler J, Van Meervenne SAE, Serrano G, Cornelis I, Van Ham L, Paepe D, Broeckx BJG, Bhatti SFM. Evaluation of the effect of phenobarbital administration on the biochemistry profile, with a focus on serum liver values, in epileptic cats. J Feline Med Surg 2022; 24:530-538. [PMID: 34387120 PMCID: PMC11104244 DOI: 10.1177/1098612x211037431] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Phenobarbital (PB) is the most common antiseizure drug (ASD) used for the management of feline epilepsy. In dogs, PB is known to cause serum liver enzyme induction and hepatotoxicity, especially after administration long term or in high concentrations. In cats, insufficient evidence is available to draw similar conclusions. The aim of this study was to evaluate the effect of PB administration on the serum biochemistry profile of epileptic cats. As an additional objective, other adverse effects arising, related to PB treatment, were recorded. METHODS Medical records of four veterinary centres were retrospectively reviewed for epileptic cats receiving PB treatment. Cats were included if they had a diagnosis of idiopathic epilepsy or structural epilepsy; a normal baseline serum biochemistry profile; at least one follow-up serum biochemistry profile; no concurrent disease or had not received medication that could possibly influence liver function or lead to serum liver enzyme induction. Alkaline phosphatase, alanine aminotransferase (ALT), aspartate transaminase and gamma-glutamyl transferase activities, and total bilirubin, bile acids, glucose, albumin, total protein, urea and creatinine concentrations before and during PB administration were recorded. PB serum concentration was also recorded, when available. RESULTS Thirty-three cats (24 males, nine females) with a median age of 3 years (range 2 months to 12 years) met the inclusion criteria. Idiopathic or structural epilepsy was diagnosed in 25 (76%) and eight (24%) cats, respectively. The follow-up period ranged from 9 to 62 months. This study found an increase in ALT in three cats, possibly related to a PB serum concentration >30 µg/ml. No statistically significant increase in serum liver enzymes or other evaluated biochemistry parameters was found by comparing pre- and post-treatment parameters. CONCLUSIONS AND RELEVANCE PB administration did not result in hepatic enzyme induction or other biochemical abnormalities in cats. This strengthens the safety profile of PB as an ASD in cats.
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Affiliation(s)
- Michelle Hermans
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Marios Charalambous
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Akos Pakozdy
- Clinical Unit of Internal Medicine Small Animals, University of Veterinary Medicine, Vienna, Austria
| | - Ursula Eisl-Glantschnigg
- Clinical Unit of Internal Medicine Small Animals, University of Veterinary Medicine, Vienna, Austria
| | - Jasmin Neßler
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | | | - Gonçalo Serrano
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Ine Cornelis
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Luc Van Ham
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Dominique Paepe
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Bart JG Broeckx
- Laboratory of Animal Genetics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Sofie FM Bhatti
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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11
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Green M, Lowrie M. Update on seizure and therapeutic drug monitoring in dogs and cats. IN PRACTICE 2022. [DOI: 10.1002/inpr.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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12
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Perdew I, Emke C, Johnson B, Dixit V, Song Y, Griffith EH, Watson P, Gruen ME. Evaluation of Pexion ® (imepitoin) for treatment of storm anxiety in dogs: A randomised, double-blind, placebo-controlled trial. Vet Rec 2021; 188:e18. [PMID: 33960445 DOI: 10.1002/vetr.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/07/2020] [Accepted: 12/03/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND While often grouped with other noise aversions, fearful behaviour during storms is considered more complex than noise aversion alone. The objective here was to assess the effect of imepitoin for the treatment of storm anxiety in dogs. METHODS In this double-blind, placebo-controlled randomised study, eligible dogs completed a baseline then were randomised to receive either imepitoin (n = 30; 30 mg/kg BID) or placebo (n = 15) for 28 days. During storms, owners rated their dog's intensity for 16 behaviours using a Likert scale. Weekly, owners rated intensity and frequency of these behaviours. Summary scores were compared to baseline and between groups. RESULTS AND CONCLUSIONS Imepitoin was significantly superior to placebo in storm logs and weekly surveys for weeks 2 and 4, and in the end-of-study survey. Mild/moderate adverse events were reported in 26 patients (24 active: two placebo); the most frequent adverse event was ataxia. Owners of dogs in the imepitoin group, compared to placebo, were significantly more likely to report that treatment reduced their dogs fear and anxiety during storms (p < 0.001) and other noise events (p < 0.001). Twice daily administration of imepitoin decreased anxiety scores in dogs with storm anxiety. Future work may evaluate optimal dosage regimens.
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Affiliation(s)
- Irina Perdew
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, North Carolina, USA
| | - Carrie Emke
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, North Carolina, USA
| | - Brianna Johnson
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, North Carolina, USA
| | - Vaidehi Dixit
- Department of Statistics, North Carolina State University College of Sciences, Raleigh, North Carolina, USA
| | - Yukun Song
- Department of Statistics, North Carolina State University College of Sciences, Raleigh, North Carolina, USA
| | - Emily H Griffith
- Department of Statistics, North Carolina State University College of Sciences, Raleigh, North Carolina, USA
| | - Philip Watson
- Ingelheim am Rhein, Boehringer-Ingelheim Vetmedica GmbH, Ludwigshafen am Rhein, Germany
| | - Margaret E Gruen
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, North Carolina, USA
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de Almeida LCN, de Andrade Marques B, Silva RL, Hamoy AO, de Mello VJ, Borges RDS, Brito FSN, Longo E, Anicete-Santos M, Hamoy M. New nanocarried phenobarbital formulation: Maintains better control of pentylenetetrazole-Induced seizures. ACTA ACUST UNITED AC 2020; 28:e00539. [PMID: 33145190 PMCID: PMC7596104 DOI: 10.1016/j.btre.2020.e00539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 09/11/2020] [Accepted: 10/08/2020] [Indexed: 12/27/2022]
Abstract
For the first time, phenobarbital was intercalated in the layered double hydroxide. This study evaluated the slow release efficacy of intercalated phenobarbital. The time of the anticonvulsant effect was verified by electroencephalographic records.
This study aims to evaluate the efficacy of slow release phenobarbital in the control of convulsions triggered by pentylenetetrazole (PTZ), verifying the time of permanence in the anticonvulsant effect through behavior and electroencephalographic records. A total of 162 male Wistar rats weighing between 100 and 120 g were divided into two groups, one for behavior analysis (n = 90) and biochemistry, and another for the acquisition of electrocorticographic record (n = 72). Hepatic enzymes were measured by obtaining a blood sample from the animals studied by means of a biochemical analysis. The procedures for electrode implant and electrocorticographic recordings were performed. The intercalation of phenobarbital in layered double hydroxide (LDH) nanocarrier allowed us to evaluate a new slow release pharmaceutical formulation based on methodologies that have proven longer residence time and lower side effects. This study demonstrates that phenobarbital can be a new perspective pharmaceutical formulation.
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Affiliation(s)
- Lorena Cristina Nunes de Almeida
- Laboratory of Pharmacology and Toxicology of Natural Products, Institute of Biological Sciences, Federal University of Pará, Belém, Brazil
| | - Beatriz de Andrade Marques
- Laboratory of Pharmacology and Toxicology of Natural Products, Institute of Biological Sciences, Federal University of Pará, Belém, Brazil
| | - Rafaela Laranjeira Silva
- Laboratory of Pharmacology and Toxicology of Natural Products, Institute of Biological Sciences, Federal University of Pará, Belém, Brazil
| | - Akira Otake Hamoy
- Laboratory of Pharmacology and Toxicology of Natural Products, Institute of Biological Sciences, Federal University of Pará, Belém, Brazil
| | - Vanessa Jóia de Mello
- Laboratory of Pharmacology and Toxicology of Natural Products, Institute of Biological Sciences, Federal University of Pará, Belém, Brazil
| | | | - Frank Sales Nunes Brito
- Nanobiotechnology Laboratory, Institute of Biological Sciences, Federal University of Pará, P.O. Box 479, 66075-110, Belém, Pará, Brazil
| | - Elson Longo
- Functional Materials Development Center (CDMF) - Federal University of São Carlos, Washington Luis Km 235, P.O. Box 676, 13565-905, São Carlos, São Paulo, Brazil
| | - Marcos Anicete-Santos
- Nanobiotechnology Laboratory, Institute of Biological Sciences, Federal University of Pará, P.O. Box 479, 66075-110, Belém, Pará, Brazil
| | - Moisés Hamoy
- Laboratory of Pharmacology and Toxicology of Natural Products, Institute of Biological Sciences, Federal University of Pará, Belém, Brazil
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14
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Erath JR, Nessler JN, Riese F, Hünerfauth E, Rohn K, Tipold A. Behavioral Changes Under Levetiracetam Treatment in Dogs. Front Vet Sci 2020; 7:169. [PMID: 32318589 PMCID: PMC7146871 DOI: 10.3389/fvets.2020.00169] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 03/10/2020] [Indexed: 11/13/2022] Open
Abstract
In veterinary medicine levetiracetam (LEV) is a well-tolerated antiepileptic drug (AED) with only mild to moderate side effects. Behavioral changes are rarely reported in animals. In contrast, in human medicine the impact of LEV on behavior has frequently been described. Since in the Clinic for Small Animals at the University of Veterinary Medicine Hannover single canine patients were observed with behavioral abnormalities after LEV treatment, it was hypothesized that levetiracetam induces behavioral changes or causes an intensifying of pre-existing behavioral abnormalities in dogs with epileptic seizures. This monocentric retrospective study evaluated the incidence of behavioral changes in epileptic dogs treated with the antiepileptic drug LEV based on information obtained in a questionnaire completed by dog owners. Eighty-four client-owned dogs with recurrent seizures receiving LEV as monotherapy, add on treatment or pulse therapy met inclusion criteria. Approximately half of the dogs in the study population were reported to have preexisting behavioral changes before treatment with LEV, and some of these dogs were reported to experience a worsening of behavioral changes (14/44) or the emergence of new behaviors after initiation of LEV therapy (4/44). One quarter of the dogs without pre-existing behavioral abnormalities developed behavioral changes associated with the administration of LEV (10/40). Based on these results, the authors conclude that behavioral changes can occur in dogs being administered LEV, and this should be taken into consideration when discussing treatment options with owners.
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Affiliation(s)
- Johannes Roland Erath
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hanover, Germany
| | - Jasmin Nicole Nessler
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hanover, Germany
| | - Franziska Riese
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hanover, Germany
| | - Enrice Hünerfauth
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hanover, Germany
| | - Karl Rohn
- Institute for Biometry, Epidemiology and Information Processing, University of Veterinary Medicine, Hanover, Germany
| | - Andrea Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hanover, Germany
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15
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Stabile F, van Dijk J, Barnett CR, De Risio L. Epileptic seizure frequency and semiology in dogs with idiopathic epilepsy after initiation of imepitoin or phenobarbital monotherapy. Vet J 2019; 249:53-57. [PMID: 31239165 DOI: 10.1016/j.tvjl.2019.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 05/20/2019] [Accepted: 05/20/2019] [Indexed: 11/28/2022]
Abstract
The aim of this study was to evaluate changes in epileptic seizures (ES) frequency and semiology in antiepileptic-medication (AEM)-naïve dogs with idiopathic epilepsy (DIE) after initiation of imepitoin (IMP) or phenobarbital (PB) monotherapy. In this observational prospective cohort study, inclusion criteria were as follows: diagnosis of idiopathic epilepsy (based on clinical, laboratory and magnetic resonance imaging investigations) in AEM-naïve dogs and presence of a detailed ES-diary. Exclusion criteria were: occurrence of cluster seizures (CS) or status epilepticus (SE) prior to treatment initiation and concurrent disease and/or treatments. Thirty-one DIE commenced IMP at 10-20mg/kg/12h and 30 dogs commenced PB at 2.50-3.30mg/kg/12h. AEM dosage was increased over time (up to IMP 30mg/kg/12h and PB 5.20mg/kg/12h). All dogs experienced generalised-tonic-clonic ES. In the IMP-group, pre-treatment median ES-frequency was 1.50ES/month (range, 1-4ES/month); post-treatment median ES-frequency was 0.95ES/m (range, 1ES/6m-3ES/m); n=21/31 (67.70%) dogs developed CS 1-18 months after initiation of treatment; n=7/31 (22.60%) dogs experienced unacceptable adverse events in the first month of treatment which required switching to an alternative AEM; and n=3/31(9.70%) dogs did not develop CS with a 3year follow-up. In the PB-group, pre-treatment median ES-frequency was 2.46ES/month (range, 1-7ES/month); post-treatment median ES-frequency was 0.36ES/month (range, 0ES/3years-1ES/month); n=11/30 (36.70%) dogs developed CS between 12-25 months after initiation of treatment. Nineteen of 30 (63.30%) dogs did not develop CS with a 3-year follow-up; three of these 19 dogs were ES free. In this study, AEM-naïve DIE receiving imepitoin-monotherapy developed CS significantly more frequently and earlier in the course of the disease, and developed aggression and required earlier discontinuation of monotherapy than AEM-naïve DIE receiving phenobarbital-monotherapy.
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Affiliation(s)
- F Stabile
- Centre for Small Animal Studies, Animal Health Trust, Lanwades Park, Kentford, Newmarket, Suffolk CB87UU, UK.
| | - J van Dijk
- Centre for Preventive Medicine, Animal Health Trust, Lanwades Park, Kentford, Newmarket, Suffolk CB87UU, UK
| | - C R Barnett
- A2F Associate, 17 Ferry Bank, Southery, Downham Market, Norfolk PE380PL, UK
| | - L De Risio
- Centre for Small Animal Studies, Animal Health Trust, Lanwades Park, Kentford, Newmarket, Suffolk CB87UU, UK
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16
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Stee K, Martlé V, Broeckx B, Royaux E, Van Ham L, Bhatti S. Imepitoin withdrawal in dogs with idiopathic epilepsy well-controlled with imepitoin and phenobarbital and/or potassium bromide does not increase seizure frequency. Vet J 2017; 230:1-5. [DOI: 10.1016/j.tvjl.2017.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 10/04/2017] [Accepted: 10/06/2017] [Indexed: 12/16/2022]
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17
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Gallucci A, Gagliardo T, Menchetti M, Bianchi E, Bucci D, Gandini G. Long-term efficacy of imepitoin in the treatment of naive dogs affected by idiopathic epilepsy. Vet Rec 2017; 181:144. [DOI: 10.1136/vr.104187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2017] [Indexed: 01/21/2023]
Affiliation(s)
- A. Gallucci
- Department of Veterinary Medical Sciences; University of Bologna; Ozzano Emilia Italy
| | - T. Gagliardo
- Department of Veterinary Medical Sciences; University of Bologna; Ozzano Emilia Italy
| | - M. Menchetti
- Department of Veterinary Medical Sciences; University of Bologna; Ozzano Emilia Italy
| | - E. Bianchi
- Department of Veterinary Medical Sciences; University of Parma; Parma Italy
| | - D. Bucci
- Department of Veterinary Medical Sciences; University of Bologna; Ozzano Emilia Italy
| | - G. Gandini
- Department of Veterinary Medical Sciences; University of Bologna; Ozzano Emilia Italy
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18
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McPeake KJ, Mills DS. The use of imepitoin (Pexion™) on fear and anxiety related problems in dogs - a case series. BMC Vet Res 2017; 13:173. [PMID: 28610629 PMCID: PMC5470190 DOI: 10.1186/s12917-017-1098-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 06/06/2017] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Fear and anxiety based problems are common in dogs. Alongside behaviour modification programmes, a range of psychopharmacological agents may be recommended to treat such problems, but few are licensed for use in dogs and the onset of action of some can be delayed. The low affinity partial benzodiazepine receptor agonist imepitoin (Pexion™, Boehringer Ingelheim) is licensed for treating canine epilepsy, has a fast onset of action in dogs and has demonstrated anxiolytic properties in rodent models. This case series reports on the use of imepitoin in a group of dogs identified as having fear/anxiety based problems. Twenty dogs were enrolled into the study, attended a behaviour consultation and underwent routine laboratory evaluation. Nineteen dogs proceeded to be treated with imepitoin orally twice daily (starting dose approximately 10 mg/kg, with alterations as required to a maximum 30 mg/kg) alongside a patient-specific behaviour modification plan for a period of 11-19 weeks. Progress was monitored via owner report through daily diary entries and telephone follow-up every two weeks. A Positive and Negative Activation Scale (PANAS) of temperament was also completed by owners during baseline and at the end of the study. RESULTS The primary outcome measure was average weekly global scores (AWG) from the owner diaries. Average weekly reaction scores (AWR) for each type of eliciting context was used as a secondary outcome. Seventeen dogs completed the trial. Treatment with imepitoin alongside a behaviour modification programme resulted in owner reported improvement with reduced AWG and reduced AWR for anxiety across a range of social and non-social eliciting contexts including noise sensitivities. Significant improvement was apparent within the first week of treatment, and further improvements seen at the 11 week review point. There was a significant reduction in negative activation (PANAS) with 76.5% of owners opting to continue imepitoin at their own expense after completion of the study. CONCLUSIONS This study provides initial evidence indicating the potential value of imepitoin (Pexion™) alongside appropriate behaviour modification for the rapid alleviation of signs of fear and anxiety in dogs. Further research with a larger subject population and a placebo control would be useful to confirm the apparent efficacy reported here.
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Affiliation(s)
- Kevin J. McPeake
- Animal Behaviour, Cognition and Welfare Group, School of Life Sciences, University of Lincoln, Lincoln, Lincolnshire UK
| | - Daniel S. Mills
- Animal Behaviour, Cognition and Welfare Group, School of Life Sciences, University of Lincoln, Lincoln, Lincolnshire UK
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19
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Engel O, von Klopmann T, Maiolini A, Freundt-Revilla J, Tipold A. Imepitoin is well tolerated in healthy and epileptic cats. BMC Vet Res 2017; 13:172. [PMID: 28606140 PMCID: PMC5469074 DOI: 10.1186/s12917-017-1087-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/31/2017] [Indexed: 12/04/2022] Open
Abstract
Background Epilepsy in the cat is a serious medical condition. To date there are no licensed treatments for feline epilepsy and no well-controlled clinical studies on the efficacy or safety of antiepileptic drugs in cats. The aim of this study was to collect tolerability data and first exploratory efficacy data of imepitoin in both healthy and epileptic cats. Results In two tolerability studies, 30 healthy cats received imepition twice daily in doses of 0, 30, 40 or 80 mg/kg bodyweight for 30 days. No serious adverse events were observed in any of the dose groups. In the imepitoin treated groups, emesis was observed in some animals temporarily and intermittently mainly in the second and third weeks of treatment. In a small, single-arm, open label, uncontrolled clinical trial eight cats suffering from idiopathic epilepsy were treated with imepitoin twice daily at doses of 30 mg/kg bodyweight for 30 days. Four of these cats (50%) achieved seizure freedom for at least 8 weeks under treatment. Adverse events, mostly lethargy, decreased appetite and emesis, were often mild and transient. Conclusion In summary, imepitoin was well tolerated in healthy and epileptic cats and showed in a pilot trial indication for efficacy in treating feline epilepsy.
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Affiliation(s)
- Odilo Engel
- Boehringer Ingelheim Vetmedica GmbH, Binger Str. 173, 55216, Ingelheim am Rhein, Germany.
| | | | - Arianna Maiolini
- University of Veterinary Medicine, Department of Small Animal Medicine and Surgery, Bünteweg 9, 30559, Hannover, Germany
| | - Jessica Freundt-Revilla
- University of Veterinary Medicine, Department of Small Animal Medicine and Surgery, Bünteweg 9, 30559, Hannover, Germany
| | - Andrea Tipold
- University of Veterinary Medicine, Department of Small Animal Medicine and Surgery, Bünteweg 9, 30559, Hannover, Germany.,Center for Systems Neuroscience, Hannover, Germany
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20
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Packer RMA, De Risio L, Volk HA. Investigating the potential of the anti-epileptic drug imepitoin as a treatment for co-morbid anxiety in dogs with idiopathic epilepsy. BMC Vet Res 2017; 13:90. [PMID: 28388948 PMCID: PMC5383962 DOI: 10.1186/s12917-017-1000-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 03/24/2017] [Indexed: 01/20/2023] Open
Abstract
Background Behavioural changes associated with idiopathic epilepsy (IE) have been identified in dogs, with fear and anxiety-related problems seen in both drug-naïve dogs and dogs treated with anti-epileptic drugs (AEDs). Treating anxiety-related behaviour in dogs with IE may be challenging, as seizures are a contraindication for many conventional anxiolytic drugs. In addition, many dogs with IE are already treated with AEDs to reduce their seizure frequency, which may have negative effects if used in polytherapy. Imepitoin is low-affinity partial agonist at the benzodiazepine (BDZ) site of the GABAA receptor, and has been demonstrated to have both anticonvulsant and anxiolytic effects in laboratory rodents. Imepitoin has been developed for the treatment of IE in dogs, with demonstrated anticonvulsant effects and high tolerability and safety. To date, imepitoin’s potential to reduce anxiety in dogs with IE has not been investigated. An online survey was conducted to investigate the effect of imepitoin on fear and anxiety-related behaviours in dogs with IE. Eighty-five valid responses were received from owners of dogs with IE currently treated with imepitoin. Anxiety-related behaviour was quantified before and during imepitoin treatment using a validated questionnaire tool (C-BARQ). Results No differences were observed in the five fear/anxiety-related measures between the two time periods (before vs. during treatment) for dog directed fear, stranger directed fear, non-social fear, pain sensitivity and separation related behaviour. A median 45% reduction in seizure frequency/month was observed following imepitoin treatment; however, imepitoin did not appear effective in reducing seizure frequency in a minority of cases. Polyphagia was the most common chronic side effect, and more side effects were reported in polytherapy cases. Conclusions Imepitoin does not appear to improve anxiety-related behaviour in dogs with IE treated with this medication for its anti-epileptic effects. Investigating the effects of imepitoin upon the behaviour of dogs with recognised behavioural anxiety-related problems (e.g. specific fears and phobias, separation related behaviours), in both healthy dogs and dogs with epilepsy is required to further explore any potential anxiolytic effects of this medication.
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Affiliation(s)
- Rowena M A Packer
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, Hertfordshire, AL9 7TA, UK.
| | | | - Holger A Volk
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, Hertfordshire, AL9 7TA, UK
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21
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Nettifee JA, Munana KR, Griffith EH. Evaluation of the Impacts of Epilepsy in Dogs on Their Caregivers. J Am Anim Hosp Assoc 2017; 53:143-149. [PMID: 28291397 DOI: 10.5326/jaaha-ms-6537] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Epilepsy is a common problem in dogs, and management of this chronic disorder requires a substantial commitment on the part of the pet owner. The aim of this study was to evaluate the impact of epilepsy in dogs on their owners, utilizing an online survey tool. A questionnaire was developed to explore a variety of factors, including seizure history, treatment, outcome, quality of life, costs associated with therapy, and sources of support. A total of 225 responses were obtained. The majority of respondents reported positive scores for overall quality of life, although scores were significantly lower for dogs with poorly controlled epilepsy and medication-related adverse effects. The median monthly expenditure for antiepileptic medication was $51-75. Despite the considerable financial burden placed on the dog owner, monthly medication cost was not associated with quality of life score. Few published reports follow dogs with epilepsy after diagnosis, and there is a growing need to understand the issues associated with long-term management of this population. The results of this study provide useful information that can help veterinary professionals educate owners and set expectations regarding treatment of seizures and quality of life for dogs with epilepsy.
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Affiliation(s)
- Julie A. Nettifee
- From the North Carolina State University College of Veterinary Medicine, Raleigh, North Carolina
| | - Karen R. Munana
- From the North Carolina State University College of Veterinary Medicine, Raleigh, North Carolina
| | - Emily H. Griffith
- From the North Carolina State University College of Veterinary Medicine, Raleigh, North Carolina
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22
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Wessmann A. Phenobarbital - a beneficial eight-hourly dosing option? Vet Rec 2017; 180:176-177. [PMID: 28213422 DOI: 10.1136/vr.j705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Annette Wessmann
- Pride Veterinary Centre, Riverside Road, Derby DE24 8HX, UK; e-mail:
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23
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Royaux E, Van Ham L, Broeckx B, Van Soens I, Gielen I, Deforce D, Bhatti S. Phenobarbital or potassium bromide as an add-on antiepileptic drug for the management of canine idiopathic epilepsy refractory to imepitoin. Vet J 2017; 220:51-54. [DOI: 10.1016/j.tvjl.2017.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 12/30/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
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Neßler J, Rundfeldt C, Löscher W, Kostic D, Keefe T, Tipold A. Clinical evaluation of a combination therapy of imepitoin with phenobarbital in dogs with refractory idiopathic epilepsy. BMC Vet Res 2017; 13:33. [PMID: 28118828 PMCID: PMC5264332 DOI: 10.1186/s12917-017-0957-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/17/2017] [Indexed: 01/24/2023] Open
Abstract
Background Imepitoin was tested as a combination treatment with phenobarbital in an open-label mono-centre cohort study in dogs with drug-resistant epilepsy. Diagnosis of idiopathic epilepsy was based on clinical findings, magnetic resonance imaging and cerebrospinal fluid analysis. Three cohorts were treated. In cohort A, dogs not responding to phenobarbital with or without established add-on treatment of potassium bromide or levetiracetam were treated add-on with imepitoin, starting at 10 mg/kg BID, with titration allowed to 30 mg/kg BID. In cohort B, the only difference to cohort A was that the starting dose of imepitoin was reduced to 5 mg/kg BID. In cohort C, animals not responding to imepitoin at >20 mg/kg BID were treated with phenobarbital add-on starting at 0.5 mg/kg BID. Results The add-on treatment resulted in a reduction in monthly seizure frequency (MSF) in all three cohorts. A reduction of ≥50% was obtained in 36-42% of all animals, without significant difference between cohorts. The lower starting dose of 5 mg/kg BID imepitoin was better tolerated, and an up-titration to on average of 15 mg/kg BID was sufficient in cohort A and B. In cohort C, a mean add-on dose of 1.5 mg/kg BID phenobarbital was sufficient to achieve a clinically meaningful effect. Six dogs developed a clinically meaningful increase in MSF of ≥ 50%, mostly in cohort A. Neither imepitoin nor phenobarbital add-on treatment was capable of suppressing cluster seizure activity, making cluster seizure activity an important predictor for drug-resistance. Conclusion A combination treatment of imepitoin and phenobarbital is a useful treatment option for a subpopulation of dogs with drug-resistant epilepsy, a low starting dose with 5 mg/kg BID is recommended.
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Affiliation(s)
- Jasmin Neßler
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, 30559, Hannover, Germany
| | - Chris Rundfeldt
- Department of Pharmacology, Toxicology and Pharmacy, University of Veterinary Medicine Hannover, 30559, Hannover, Germany. .,Drug-Consulting Network, 01445, Coswig, Germany.
| | - Wolfgang Löscher
- Department of Pharmacology, Toxicology and Pharmacy, University of Veterinary Medicine Hannover, 30559, Hannover, Germany.,Center for Systems Neuroscience, 30559, Hannover, Germany
| | - Draginja Kostic
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, 30559, Hannover, Germany.,Center for Systems Neuroscience, 30559, Hannover, Germany
| | - Thomas Keefe
- Department of Environmental & Radiological Health Sciences, College of Veterinary Medicine & Biomedical Sciences, Colorado State University, Fort Collins, USA
| | - Andrea Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, 30559, Hannover, Germany.,Center for Systems Neuroscience, 30559, Hannover, Germany
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25
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Stabile F, Barnett CR, De Risio L. Phenobarbital administration every eight hours: improvement of seizure management in idiopathic epileptic dogs with decreased phenobarbital elimination half-life. Vet Rec 2017; 180:178. [PMID: 28062844 DOI: 10.1136/vr.104051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2016] [Indexed: 01/17/2023]
Abstract
Estimated prevalence of canine idiopathic epilepsy is 0.6 per cent in the first-opinion canine population in the UK. Phenobarbital monotherapy has been reported to reduce/eradicate seizure activity in 60-93 per cent of idiopathic epileptic dogs (IEDs). The objective of this study was to evaluate safety and efficacy of the administration of phenobarbital orally every eight hours in IEDs with phenobarbital elimination half-life less than 20 hours. Medical records of 10 IEDs in which steady state trough serum phenobarbital levels were within the reference range and phenobarbital elimination half-life had become less than 20 hours following prolonged administration every 12 hours were reviewed. Side effects and seizure frequency when phenobarbital was administered every 12 hours or 8 hours were compared. In all dogs the side effects of the antiepileptic medication treatment improved. When phenobarbital was administered every eight hours, 9/10 dogs experienced improvement in seizure frequency and 8/10 dogs maintained seizure freedom for a period three times longer than the longest interictal interval period previously recorded. Reduction in the severity and number of clusters of seizures was recorded in one of the remaining two dogs. The administration of phenobarbital orally every eight hours in IEDs with decreased phenobarbital elimination half-life appears safe and can improve seizure management. The results of this study were presented in abstract form (poster) for the 28th symposium of the European Society of Veterinary Neurology - European College of Veterinary Neurology (ESVN), September 18-19, 2015, Amsterdam, Netherlands.
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Affiliation(s)
- F Stabile
- Centre for Small Animal Studies, Animal Health Trust, Newmarket, Suffolk, UK
| | - C R Barnett
- Euram Limited, 6 Musters Road, West Bridgford, Nottingham NG2 7PL, UK
| | - L De Risio
- Centre for Small Animal Studies, Animal Health Trust, Newmarket, Suffolk, UK
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Epilepsy in Humans and Animals: From Patients to Disease Models. Comp Med 2017. [DOI: 10.1007/978-3-319-47007-8_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Fit for purpose application of currently existing animal models in the discovery of novel epilepsy therapies. Epilepsy Res 2016; 126:157-84. [PMID: 27505294 DOI: 10.1016/j.eplepsyres.2016.05.016] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 03/06/2016] [Accepted: 05/30/2016] [Indexed: 01/10/2023]
Abstract
Animal seizure and epilepsy models continue to play an important role in the early discovery of new therapies for the symptomatic treatment of epilepsy. Since 1937, with the discovery of phenytoin, almost all anti-seizure drugs (ASDs) have been identified by their effects in animal models, and millions of patients world-wide have benefited from the successful translation of animal data into the clinic. However, several unmet clinical needs remain, including resistance to ASDs in about 30% of patients with epilepsy, adverse effects of ASDs that can reduce quality of life, and the lack of treatments that can prevent development of epilepsy in patients at risk following brain injury. The aim of this review is to critically discuss the translational value of currently used animal models of seizures and epilepsy, particularly what animal models can tell us about epilepsy therapies in patients and which limitations exist. Principles of translational medicine will be used for this discussion. An essential requirement for translational medicine to improve success in drug development is the availability of animal models with high predictive validity for a therapeutic drug response. For this requirement, the model, by definition, does not need to be a perfect replication of the clinical condition, but it is important that the validation provided for a given model is fit for purpose. The present review should guide researchers in both academia and industry what can and cannot be expected from animal models in preclinical development of epilepsy therapies, which models are best suited for which purpose, and for which aspects suitable models are as yet not available. Overall further development is needed to improve and validate animal models for the diverse areas in epilepsy research where suitable fit for purpose models are urgently needed in the search for more effective treatments.
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Suiter EJ, Packer RMA, Volk HA. Comparing the effects of first-line antiepileptic drugs on the gait of dogs with idiopathic epilepsy. Vet Rec 2016; 178:652. [PMID: 27302918 DOI: 10.1136/vr.103736] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2016] [Indexed: 01/15/2023]
Abstract
Idiopathic epilepsy (IE) is a common chronic neurological disease of the dog. Previous studies of anti-epileptic drug (AED) treatment have indicated that acceptable AED adverse effects are as important to owners as reductions in seizure frequency. AEDs in both dogs and human beings are frequently associated with the adverse-effect ataxia. The aim of this study was to compare ataxia levels in dogs with IE treated chronically with phenobarbitone or imepitoin, the two currently available first-line AED treatments. The gait of 6 imepitoin-treated dogs, 8 phenobarbitone-treated dogs and 10 age-matched healthy control dogs were compared. Fifty strides from a walking gait were analysed for each dog, quantifying ataxia via the variability in six established gait parameters. Three variables differed significantly between groups: lateral distance between (i) pelvic paw placements, (ii) thoracic paw placements and (iii) stance time, which were significantly more variable in the phenobarbitone-treated dogs than imepitoin-treated or control dogs. These results indicate that dogs treated with phenobarbitone experience ataxia compared with controls and imepitoin-treated dogs. Conversely, there was no difference between imepitoin-treated dogs and controls. These results along with further research are needed to quantify AEDs adverse effects, to help vets and owners make more informed drug-choices.
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Affiliation(s)
- E J Suiter
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - R M A Packer
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - H A Volk
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, Hertfordshire, UK
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Charalambous M, Shivapour SK, Brodbelt DC, Volk HA. Antiepileptic drugs' tolerability and safety--a systematic review and meta-analysis of adverse effects in dogs. BMC Vet Res 2016; 12:79. [PMID: 27206489 PMCID: PMC4875685 DOI: 10.1186/s12917-016-0703-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 05/12/2016] [Indexed: 01/16/2023] Open
Abstract
Background The safety profile of anti-epileptic drugs (AEDs) is an important consideration for the regulatory bodies, owners and prescribing clinicians. Information on their adverse effects still remains limited. A systematic review including a meta-analytic approach was designed to evaluate existing evidence for the safety profile of AEDs in canine patients. Electronic searches of PubMed, CAB Direct and Google scholar were carried out without date or language restrictions. Conference proceedings were also searched. Peer-reviewed full-length studies reporting adverse effects of AEDs in epileptic and healthy non-epileptic dogs were included. Studies were allocated to three groups based on their design. Individual studies were evaluated based on the quality of evidence (study design, study group sizes, subject enrolment quality and overall risk of bias) and the outcome measures reported (proportion of specific adverse effects for each AED, prevalence and 95 % confidence interval of the affected population in each study and comparative odds ratio of adverse effects for AEDs). Results Ninety studies, including six conference proceedings, reporting clinical outcomes of AEDs’ adverse effects were identified. Few studies were designed as blinded randomised controlled clinical trials. Many studies included low canine populations with unclear criteria of subject enrolment and short treatment periods. Direct comparisons suggested that imepitoin and levetiracetam might have a better safety profile than phenobarbital, whilst the latter might have a better safety profile than potassium bromide. However, none of these comparisons showed a statistically significant difference. Comparisons between other AEDs were not possible as a considerable amount of studies lacked power calculations or adequate data to allow further statistical analysis. Individual AED assessments indicated that levetiracetam might be one of the safest AEDs, followed by imepitoin and then phenobarbital and potassium bromide; these findings were all supported by a strong level of evidence. The safety profile in other AEDs was variable, but weak evidence was found to permit firm conclusions or to compare their safety to other AEDs. Conclusions This systematic review provides objective evaluation of the most commonly used AEDs’ adverse effects. Adverse effects usually appeared mild in all AEDs and subsided once doses and/or serum levels were monitored or after the AED was withdrawn. Although phenobarbital might be less safe than imepitoin and levetiracetam, there was insufficient evidence to classify it as an AED with a high risk of major adverse effects. It is important for clinicians to evaluate both AEDs’ effectiveness and safety on an individual basis before the selection of the appropriate monotherapy or adjunctive AED therapy.
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Affiliation(s)
- Marios Charalambous
- Faculty of Brain Sciences, UCL Institute of Neurology, University College London, London, WC1E 6BT, UK.
| | - Sara K Shivapour
- College of Veterinary Medicine, Iowa State University, Ames, Iowa, 50011, USA
| | - David C Brodbelt
- Department of Production and Population Health, Royal Veterinary College, Hawkshead Lane, Hatfield, Herts, AL9 7TA, UK
| | - Holger A Volk
- Department of Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, Hatfield, Herts, AL9 7TA, UK
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Koch T, Mueller RS, Dobenecker B, Fischer A. Cutaneous Adverse Drug Reactions in Dogs Treated with Antiepileptic Drugs. Front Vet Sci 2016; 3:27. [PMID: 27148543 PMCID: PMC4830846 DOI: 10.3389/fvets.2016.00027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 03/14/2016] [Indexed: 11/13/2022] Open
Abstract
Epilepsy is one of the most common neurologic disorders in dogs and life-long treatment with antiepileptic drugs (AED) is frequently required. Adverse events of AED targeting the skin are only rarely reported in veterinary medicine and the true incidence and spectrum of cutaneous reactions in epileptic dogs remains unknown. In this study, we hypothesized that cutaneous reactions commonly occur in epileptic dogs and are related to AED treatment. A retrospective case review of 185 dogs treated for epilepsy identified 20.0% with simultaneous appearance of dermatologic signs. In a subsequent prospective case investigation (n = 137), we identified newly appearing or distinct worsening of skin lesions following initiation of AED therapy in 10.9% of dogs treated for epilepsy (95% CI 6.8–17.7%). Cutaneous lesions were classified as probably drug-induced in 40.0% of these cases. Patch testing and intradermal testing were further investigated as potential diagnostic methods to confirm AED hypersensitivity. They were of high specificity but sensitivity and positive predictive value appeared inappropriate to recommend their routine use in clinical practice.
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Affiliation(s)
- Tina Koch
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, Faculty of Veterinary Medicine, Ludwig Maximilian University Munich , Munich , Germany
| | - Ralf S Mueller
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, Faculty of Veterinary Medicine, Ludwig Maximilian University Munich , Munich , Germany
| | - Britta Dobenecker
- Department of Veterinary Sciences, Ludwig Maximilian University Munich , Munich , Germany
| | - Andrea Fischer
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, Faculty of Veterinary Medicine, Ludwig Maximilian University Munich , Munich , Germany
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31
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Podell M, Volk HA, Berendt M, Löscher W, Muñana K, Patterson EE, Platt SR. 2015 ACVIM Small Animal Consensus Statement on Seizure Management in Dogs. J Vet Intern Med 2016; 30:477-90. [PMID: 26899355 PMCID: PMC4913615 DOI: 10.1111/jvim.13841] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 01/18/2016] [Accepted: 01/18/2016] [Indexed: 11/27/2022] Open
Abstract
This report represents a scientific and working clinical consensus statement on seizure management in dogs based on current literature and clinical expertise. The goal was to establish guidelines for a predetermined, concise, and logical sequential approach to chronic seizure management starting with seizure identification and diagnosis (not included in this report), reviewing decision‐making, treatment strategies, focusing on issues related to chronic antiepileptic drug treatment response and monitoring, and guidelines to enhance patient response and quality of life. Ultimately, we hope to provide a foundation for ongoing and future clinical epilepsy research in veterinary medicine.
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Affiliation(s)
- M Podell
- Medvet Chicago, Medical and Cancer Centers for Pets, Chicago, IL.,Department of Neurosurgery, Pritzker School of Medicine, The University of Chicago, Chicago, IL
| | - H A Volk
- Department of Clinical Sciences and Services, Small Animal Medicine and Surgery Group, The Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - M Berendt
- Department of Veterinary and Clinical Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - W Löscher
- Department of Pharmacology, Toxicology and Pharmacy, University of Veterinary Medicine, Hannover, Germany.,Center for Systems Neuroscience, Hannover, Germany
| | - K Muñana
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
| | - E E Patterson
- Department of Veterinary Clinical Sciences, University of Minnesota College of Veterinary Medicine, St. Paul, MN
| | - S R Platt
- Department of Small Animal Medicine & Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA
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Royaux E, Bhatti S, De Cock H, Van Ham L, Kitshoff A, Vandenabeele S. Cutaneous adverse drug reaction in a dog associated with imepitoin. Vet Dermatol 2016; 27:118-21e32. [PMID: 26799469 DOI: 10.1111/vde.12289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The macroscopic appearance of cutaneous adverse drug reactions can be similar to a plethora of skin diseases and in particular may resemble autoimmune and immune-mediated disorders. The reaction can occur after single or multiple administrations, with the latter varying in durations of up to years of treatment. These reactions are mostly self-limiting with cessation of the offending drug. OBJECTIVES To report a cutaneous adverse drug reaction associated with chronic administration of imepitoin. CASE REPORT A 4-year-old, Jack Russell terrier dog was presented with progressive skin lesions of 1-week duration. The dog had a 6 month history of idiopathic epilepsy treated with imepitoin for the previous 5 months. Imepitoin is an anti-epileptic drug that acts as a low-affinity partial agonist of the benzodiazepine site at the GABAA receptor. The dosage of imepitoin was increased from 20 mg/kg twice daily to 30 mg/kg twice daily, 3 days before the onset of skin lesions, due to uncontrolled seizures. [Correction added on 15 February 2016 after first online publication: In the preceding sentence, the dosage of imepitoin was previously incorrect and has been amended in this current version.] Dermatological examination revealed erythema and exfoliation at the mucocutaneous junctions of the lips, lip folds, philtrum, ears, axillae and the ventral abdomen. Small erosions and depigmentation were visible on the oral mucosa, lip folds and philtrum. Histopathology was supportive of a lupoid drug reaction. Complete resolution of skin lesions was seen after discontinuation of imepitoin and low dose of prednisolone during a period of 4 weeks. No recrudescence of skin lesions was observed during a 6 month follow-up period. CONCLUSION AND CLINICAL IMPORTANCE Imepitoin may result in cutaneous adverse drug reactions in dogs.
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Affiliation(s)
- Emilie Royaux
- Department of Small Animal Medicine and Clinical Biology, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium
| | - Sofie Bhatti
- Department of Small Animal Medicine and Clinical Biology, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium
| | - Hilde De Cock
- AML/Veterinary Pathology Services, EmielVloorsstraat 9, 2020, Antwerp, Belgium
| | - Luc Van Ham
- Department of Small Animal Medicine and Clinical Biology, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium
| | - Adriaan Kitshoff
- Department of Small Animal Medicine and Clinical Biology, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium
| | - Sophie Vandenabeele
- Department of Small Animal Medicine and Clinical Biology, Ghent University, Salisburylaan 133, 9820, Merelbeke, Belgium
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Tipold A. Grand Challenge Veterinary Neurology and Neurosurgery: Veterinary Neurology and Neurosurgery - Research for Animals and Translational Aspects. Front Vet Sci 2015; 2:13. [PMID: 26664942 PMCID: PMC4672178 DOI: 10.3389/fvets.2015.00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 05/07/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
- Andrea Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover , Hannover , Germany
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Fredsø N, Sabers A, Toft N, Møller A, Berendt M. A single-blinded phenobarbital-controlled trial of levetiracetam as mono-therapy in dogs with newly diagnosed epilepsy. Vet J 2015; 208:44-9. [PMID: 26639829 DOI: 10.1016/j.tvjl.2015.10.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 09/28/2015] [Accepted: 10/05/2015] [Indexed: 11/18/2022]
Abstract
Treatment of canine epilepsy is problematic. Few antiepileptic drugs have proven efficacy in dogs and undesirable adverse effects and pharmacoresistance are not uncommon. Consequently, the need for investigation of alternative treatment options is ongoing. The objective of this study was to investigate the efficacy and tolerability of levetiracetam as mono-therapy in dogs with idiopathic epilepsy. The study used a prospective single-blinded parallel group design. Twelve client-owned dogs were included and were randomised to treatment with levetiracetam (30 mg/kg/day or 60 mg/kg/day divided into three daily dosages) or phenobarbital (4 mg/kg/day divided twice daily). Control visits were at days 30, 60 and then every 3 months for up to 1 year. Two or more seizures within 3 months led to an increase in drug dosage (levetiracetam: 10 mg/kg/day, phenobarbital: 1 mg/kg/day). Five of six levetiracetam treated dogs and one of six phenobarbital treated dogs withdrew from the study within 2-5 months due to insufficient seizure control. In the levetiracetam treated dogs there was no significant difference in the monthly number of seizures before and after treatment, whereas in the phenobarbital treated dogs there were significantly (P = 0.013) fewer seizures after treatment. Five phenobarbital treated dogs were classified as true responders (≥50% reduction in seizures/month) whereas none of the levetiracetam treated dogs fulfilled this criterion. Adverse effects were reported in both groups but were more frequent in the phenobarbital group. In this study levetiracetam was well tolerated but was not effective at the given doses as mono-therapy in dogs with idiopathic epilepsy.
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Affiliation(s)
- N Fredsø
- Department of Veterinary Clinical and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlaegevej 16, 1870 Frederiksberg C, Denmark.
| | - A Sabers
- The Epilepsy Clinic, Department of Neurology, University State Hospital (Rigshospitalet), Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - N Toft
- National Veterinary Institute, Section for Epidemiology, Technical University of Denmark, Bülowsvej 27, 1870 Frederiksberg C, Denmark
| | - A Møller
- Centre of Functional Integrative Neuroscience, Aarhus University/Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark
| | - M Berendt
- Department of Veterinary Clinical and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlaegevej 16, 1870 Frederiksberg C, Denmark
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Rundfeldt C, Tipold A, Löscher W. Efficacy, safety, and tolerability of imepitoin in dogs with newly diagnosed epilepsy in a randomized controlled clinical study with long-term follow up. BMC Vet Res 2015; 11:228. [PMID: 26330063 PMCID: PMC4556053 DOI: 10.1186/s12917-015-0548-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 08/26/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Imepitoin is a novel antiepileptic drug for the treatment of canine idiopathic epilepsy. The present study was conducted to demonstrate superior antiepileptic activity of a high dose of 30 mg/kg BID over a low dose of 1 mg/kg BID of imepitoin during 12 weeks of treatment under double blind conditions in a field population of dogs with previously untreated epilepsy. In a consecutive 12 weeks open label follow up (phase 2), all animals received 30 mg/kg BID, to evaluate the persistence of the antiepileptic activity, and to evaluate the effect of a dose step up to 30 mg/kg in the former low-dose animals. RESULTS A treatment with 30 mg/kg BID resulted in a significantly greater reduction in monthly seizure frequency relative to baseline data as compared to the 1 mg/kg dose. Both generalized and partial seizures but not cluster seizures were significantly less frequent in the high dose group. The antiepileptic activity was maintained during study phase 2 in the high dose group. An increase to 30 mg/kg BID in the low- dose animals resulted in a significant reduction in generalized and partial seizures, but not cluster seizures. At the end of study phase 2, 32.1 and 46.8 % of dogs of the former high and former low-dose groups respectively, remained free of generalized tonic-clonic seizures. Imepitoin was well tolerated. The frequency of dogs with any adverse drug reactions was higher in the 30 mg/kg BID dose (59 % vs. 41 %, p = 0.041), and the main target organ was the central nervous system (CNS). The occurrence of CNS related adverse reactions was transient and findings were mostly restricted to the first weeks of treatment. No hepatic enzyme increase and no other organ toxicity were observed. CONCLUSION The administration of imepitoin twice daily at a dose of 30 mg/kg results in significant and persistent antiepileptic effects in patients with newly diagnosed epilepsy and generalized tonic-clonic seizures, as observed over a study period of up to 6 months. Imepitoin was well tolerated. Most CNS related adverse drug reactions were transient. Both the antiepileptic activity and the safety profile make the drug suitable for long-term clinical use.
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Affiliation(s)
- Chris Rundfeldt
- Drug-Consulting Network, 01445, Coswig, Germany. .,Department of Pharmacology, Toxicology and Pharmacy, University of Veterinary Medicine Hannover, 30559, Hannover, Germany.
| | - Andrea Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany. .,Center for Systems Neuroscience, 30559, Hannover, Germany.
| | - Wolfgang Löscher
- Center for Systems Neuroscience, 30559, Hannover, Germany. .,Department of Pharmacology, Toxicology and Pharmacy, University of Veterinary Medicine Hannover, 30559, Hannover, Germany.
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36
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Potschka H, Fischer A, Löscher W, Patterson N, Bhatti S, Berendt M, De Risio L, Farquhar R, Long S, Mandigers P, Matiasek K, Muñana K, Pakozdy A, Penderis J, Platt S, Podell M, Rusbridge C, Stein V, Tipold A, Volk HA. International veterinary epilepsy task force consensus proposal: outcome of therapeutic interventions in canine and feline epilepsy. BMC Vet Res 2015; 11:177. [PMID: 26314300 PMCID: PMC4552098 DOI: 10.1186/s12917-015-0465-y] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 06/29/2015] [Indexed: 12/13/2022] Open
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.
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Affiliation(s)
- Heidrun Potschka
- Department of Pharmacology, Toxicology and Pharmacy, Ludwig-Maximillians-University, Königinstr. 16, 80539, Munich, Germany.
| | - Andrea Fischer
- Service Neurology at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-University, Veterinärstr. 13, 80539, Munich, Germany.
| | - Wolfgang Löscher
- Department of Pharmacology, Toxicology and Pharmacy, University of Veterinary Medicine Hannover, Bünteweg 17, 30559, Hannover, Germany.
| | - Ned Patterson
- University of Minnesota College of Veterinary Medicine, D426 Veterinary Medical Center, 1352 Boyd Avenue, St. Paul, MN, 55108, USA.
| | - Sofie Bhatti
- Department of Small Animal Medicine and Clinical Biology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, Merelbeke, 9820, Belgium.
| | - Mette Berendt
- Department of Veterinary and Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg C, Denmark.
| | - Luisa De Risio
- Animal Health Trust, Lanwades Park, Kentford, Newmarket, CB8 7UU, Suffolk, UK.
| | - Robyn Farquhar
- Fernside Veterinary Centre, 205 Shenley Road, Borehamwood, SG9 0TH, Hertfordshire, UK.
| | - Sam Long
- University of Melbourne, 250 Princes Highway, Weibee, 3015, VIC, Australia.
| | - Paul Mandigers
- Department of Clinical Sciences of Companion Animals, Utrecht University, Yalelaan 108, 3583 CM, Utrecht, The Netherlands.
| | - Kaspar Matiasek
- Section of Clinical & Comparative Neuropathology, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-University, Veterinärstr. 13, 80539, Munich, Germany.
| | - Karen Muñana
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1052 William Moore Drive, Raleigh, NC, 27607, USA.
| | - Akos Pakozdy
- Clinical Unit of Internal Medicine Small Animals, University of Veterinary Medicine, Veterinärplatz 1, 1210, Vienna, Austria.
| | - Jacques Penderis
- Vet Extra Neurology, Broadleys Veterinary Hospital, Craig Leith Road, Stirling, FK7 7LE, Stirlingshire, UK.
| | - Simon Platt
- College of Veterinary Medicine, University of Georgia, 501 DW Brooks Drive, Athens, GA, 30602, USA.
| | - Michael Podell
- Chicago Veterinary Neurology and Neurosurgery, 3123 N. Clybourn Avenue, Chicago, IL, 60618, USA.
| | - Clare Rusbridge
- Fitzpatrick Referrals, Halfway Lane, Eashing, Godalming, GU7 2QQ, Surrey, UK. .,School of Veterinary Medicine, Faculty of Health & Medical Sciences, University of Surrey, Guildford, GU2 7TE, Surrey, UK.
| | - Veronika Stein
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany.
| | - Andrea Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany.
| | - Holger A Volk
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, AL9 7TA, Hertfordshire, UK.
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37
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Bhatti SFM, De Risio L, Muñana K, Penderis J, Stein VM, Tipold A, Berendt M, Farquhar RG, Fischer A, Long S, Löscher W, Mandigers PJJ, Matiasek K, Pakozdy A, Patterson EE, Platt S, Podell M, Potschka H, Rusbridge C, Volk HA. International Veterinary Epilepsy Task Force consensus proposal: medical treatment of canine epilepsy in Europe. BMC Vet Res 2015; 11:176. [PMID: 26316233 PMCID: PMC4552371 DOI: 10.1186/s12917-015-0464-z] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 06/29/2015] [Indexed: 12/14/2022] Open
Abstract
In Europe, the number of antiepileptic drugs (AEDs) licensed for dogs has grown considerably over the last years. Nevertheless, the same questions remain, which include, 1) when to start treatment, 2) which drug is best used initially, 3) which adjunctive AED can be advised if treatment with the initial drug is unsatisfactory, and 4) when treatment changes should be considered. In this consensus proposal, an overview is given on the aim of AED treatment, when to start long-term treatment in canine epilepsy and which veterinary AEDs are currently in use for dogs. The consensus proposal for drug treatment protocols, 1) is based on current published evidence-based literature, 2) considers the current legal framework of the cascade regulation for the prescription of veterinary drugs in Europe, and 3) reflects the authors' experience. With this paper it is aimed to provide a consensus for the management of canine idiopathic epilepsy. Furthermore, for the management of structural epilepsy AEDs are inevitable in addition to treating the underlying cause, if possible.
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Affiliation(s)
- Sofie F M Bhatti
- Department of Small Animal Medicine and Clinical Biology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, Merelbeke, 9820, Belgium.
| | - Luisa De Risio
- Animal Health Trust, Lanwades Park, Kentford, Newmarket, CB8 7UU, Suffolk, United Kingdom.
| | - Karen Muñana
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1052 William Moore Drive, Raleigh, NC, 27607, USA.
| | - Jacques Penderis
- Vet Extra Neurology, Broadleys Veterinary Hospital, Craig Leith Road, Stirling, FK7 7LE, Stirlingshire, United Kingdom.
| | - Veronika M Stein
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany.
| | - Andrea Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559, Hannover, Germany.
| | - Mette Berendt
- Department of Veterinary and Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg C, Denmark.
| | - Robyn G Farquhar
- Fernside Veterinary Centre, 205 Shenley Road, Borehamwood, SG9 0TH, Hertfordshire, United Kingdom.
| | - Andrea Fischer
- Clinical Veterinary Medicine, Ludwig-Maximillians-University, Veterinärstr. 13, 80539, Munich, Germany.
| | - Sam Long
- University of Melbourne, 250 Princes Highway, Weibee, 3015, VIC, Australia.
| | - Wolfgang Löscher
- Department of Pharmacology, Toxicology and Pharmacy, University of Veterinary Medicine Hannover, Bünteweg 17, 30559, Hannover, Germany.
| | - Paul J J Mandigers
- Department of Clinical Sciences of Companion Animals, Utrecht University, Yalelaan 108, 3583 CM, Utrecht, The Netherlands.
| | - Kaspar Matiasek
- Section of Clinical & Comparative Neuropathology, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-University, Veterinärstr. 13, 80539, Munich, Germany.
| | - Akos Pakozdy
- Clinical Unit of Internal Medicine Small Animals, University of Veterinary Medicine, Veterinärplatz 1, 1210, Vienna, Austria.
| | - Edward E Patterson
- University of Minnesota College of Veterinary Medicine, D426 Veterinary Medical Center, 1352 Boyd Avenue, St. Paul, MN, 55108, USA.
| | - Simon Platt
- College of Veterinary Medicine, University of Georgia, 501 DW Brooks Drive, Athens, GA, 30602, USA.
| | - Michael Podell
- Chicago Veterinary Neurology and Neurosurgery, 3123 N. Clybourn Avenue, Chicago, IL, 60618, USA.
| | - Heidrun Potschka
- Department of Pharmacology, Toxicology and Pharmacy, Ludwig-Maximillians-University, Königinstr. 16, 80539, Munich, Germany.
| | - Clare Rusbridge
- Fitzpatrick Referrals, Halfway Lane, Eashing, Godalming, GU7 2QQ, Surrey, United Kingdom.
- School of Veterinary Medicine, Faculty of Health & Medical Sciences, University of Surrey, Guildford, GU2 7TE, Surrey, United Kingdom.
| | - Holger A Volk
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, AL9 7TA, Hertfordshire, UK.
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Barker-Haliski ML, Friedman D, French JA, White HS. Disease Modification in Epilepsy: From Animal Models to Clinical Applications. Drugs 2015; 75:749-67. [DOI: 10.1007/s40265-015-0395-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Charalambous M, Brodbelt D, Volk HA. Treatment in canine epilepsy--a systematic review. BMC Vet Res 2014; 10:257. [PMID: 25338624 PMCID: PMC4209066 DOI: 10.1186/s12917-014-0257-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 10/15/2014] [Indexed: 12/17/2022] Open
Abstract
Background Various antiepileptic drugs (AEDs) are used for the management of canine idiopathic epilepsy (IE). Information on their clinical efficacy remains limited. A systematic review was designed to evaluate existing evidence for the effectiveness of AEDs for presumptive canine IE. Electronic searches of PubMed and CAB Direct were carried out without date or language restrictions. Conference proceedings were also searched. Peer-reviewed full-length studies describing objectively the efficacy of AEDs in dogs with IE were included. Studies were allocated in two groups, i.e. blinded randomized clinical trials (bRCTs), non-blinded randomized clinical trials (nbRCTs) and non-randomized clinical trials (NRCTs) (group A) and uncontrolled clinical trials (UCTs) and case series (group B). Individual studies were evaluated based on the quality of evidence (study design, study group sizes, subject enrolment quality and overall risk of bias) and the outcome measures reported (in particular the proportion of dogs with ≥50% reduction in seizure frequency). Results Twenty-six studies, including two conference proceedings, reporting clinical outcomes of AEDs used for management of IE were identified. Heterogeneity of study designs and outcome measures made meta-analysis inappropriate. Only four bRCTs were identified in group A and were considered to offer higher quality of evidence among the studies. A good level of evidence supported the efficacy of oral phenobarbital and imepitoin and fair level of evidence supported the efficacy of oral potassium bromide and levetiracetam. For the remaining AEDs, favorable results were reported regarding their efficacy, but there was insufficient evidence to support their use due to lack of bRCTs. Conclusions Oral phenobarbital and imepitoin in particular, as well as potassium bromide and levetiracetam are likely to be effective for the treatment of IE. However, variations in baseline characteristics of the dogs involved, significant differences between study designs and several potential sources of bias preclude definitive recommendations. There is a need for greater numbers of adequately sized bRCTs evaluating the efficacy of AEDs for IE.
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Affiliation(s)
- Marios Charalambous
- Department of Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, Hatfield AL9 7TA, Herts, UK.
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