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Charalambous M, Muñana K, Patterson EE, Platt SR, Volk HA. ACVIM Consensus Statement on the management of status epilepticus and cluster seizures in dogs and cats. J Vet Intern Med 2024; 38:19-40. [PMID: 37921621 PMCID: PMC10800221 DOI: 10.1111/jvim.16928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/19/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Seizure emergencies (ie, status epilepticus [SE] and cluster seizures [CS]), are common challenging disorders with complex pathophysiology, rapidly progressive drug-resistant and self-sustaining character, and high morbidity and mortality. Current treatment approaches are characterized by considerable variations, but official guidelines are lacking. OBJECTIVES To establish evidence-based guidelines and an agreement among board-certified specialists for the appropriate management of SE and CS in dogs and cats. ANIMALS None. MATERIALS AND METHODS A panel of 5 specialists was formed to assess and summarize evidence in the peer-reviewed literature with the aim to establish consensus clinical recommendations. Evidence from veterinary pharmacokinetic studies, basic research, and human medicine also was used to support the panel's recommendations, especially for the interventions where veterinary clinical evidence was lacking. RESULTS The majority of the evidence was on the first-line management (ie, benzodiazepines and their various administration routes) in both species. Overall, there was less evidence available on the management of emergency seizure disorders in cats in contrast to dogs. Most recommendations made by the panel were supported by a combination of a moderate level of veterinary clinical evidence and pharmacokinetic data as well as studies in humans and basic research studies. CONCLUSIONS AND CLINICAL RELEVANCE Successful management of seizure emergencies should include an early, rapid, and stage-based treatment approach consisting of interventions with moderate to preferably high ACVIM recommendations; management of complications and underlying causes related to seizure emergencies should accompany antiseizure medications.
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Affiliation(s)
| | - Karen Muñana
- North Carolina State UniversityRaleighNorth CarolinaUSA
| | | | | | - Holger A. Volk
- University of Veterinary Medicine HannoverHannoverGermany
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Cagnotti G, Ferrini S, Muro GD, Borriello G, Corona C, Manassero L, Avilii E, Bellino C, D'Angelo A. Constant rate infusion of diazepam or propofol for the management of canine cluster seizures or status epilepticus. Front Vet Sci 2022; 9:1005948. [PMID: 36467660 PMCID: PMC9713018 DOI: 10.3389/fvets.2022.1005948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/04/2022] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION Cluster seizures (CS) and status epilepticus (SE) in dogs are severe neurological emergencies that require immediate treatment. Practical guidelines call for constant rate infusion (CRI) of benzodiazepines or propofol (PPF) in patients with seizures not responding to first-line treatment, but to date only few studies have investigated the use of CRI in dogs with epilepsy. STUDY DESIGN Retrospective clinical study. METHODS Dogs that received CRI of diazepam (DZP) or PPF for antiepileptic treatment during hospitalization at the Veterinary Teaching Hospital of the University of Turin for CS or SE between September 2016 and December 2019 were eligible for inclusion. Favorable outcome was defined as cessation of clinically visible seizure activity within few minutes from the initiation of the CRI, no seizure recurrence within 24 h after discontinuation of CRI through to hospital discharge, and clinical recovery. Poor outcome was defined as recurrence of seizure activity despite treatment or death in hospital because of recurrent seizures, catastrophic consequences of prolonged seizures or no return to an acceptable neurological and clinical baseline, despite apparent control of seizure activity. Comparisons between the number of patients with favorable outcome and those with poor outcome in relation to type of CRI, seizure etiology, reason for presentation (CS or SE), sex, previous AED therapy and dose of PPF CRI were carried out. RESULTS A total of 37 dogs, with 50 instances of hospitalization and CRI administered for CS or SE were included in the study. CRI of diazepam (DZP) or PPF was administered in 29/50 (58%) and in 21/50 (42%) instances of hospitalization, respectively. Idiopathic epilepsy was diagnosed in 21/37 (57%), (13/21 tier I and 8/21 tier II); structural epilepsy was diagnosed in 6/37 (16%) of which 4/6 confirmed and 2/6 suspected. A metabolic or toxic cause of seizure activity was recorded in 7/37 (19%). A total of 38/50 (76%) hospitalizations were noted for CS and 12/50 (24%) for SE. In 30/50 (60%) instances of hospitalization, the patient responded well to CRI with cessation of seizure activity, no recurrence in the 24 h after discontinuation of CRI through to hospital discharge, whereas a poor outcome was recorded for 20/50 (40%) cases (DZP CRI in 12/50 and PPF CRI in 8/50). Comparison between the number of patients with favorable outcome and those with poor outcome in relation to type of CRI, seizure etiology, reason for presentation (CS or SE), sex and previous AED therapy was carried out but no statistically significant differences were found. CONCLUSIONS The present study is the first to document administration of CRI of DZP or PPF in a large sample of dogs with epilepsy. The medications appeared to be tolerated without major side effects and helped control seizure activity in most patients regardless of seizure etiology. Further studies are needed to evaluate the effects of CRI duration on outcome and complications.
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Affiliation(s)
- Giulia Cagnotti
- Department of Veterinary Science, University of Turin, Torino, Italy
| | - Sara Ferrini
- Department of Veterinary Science, University of Turin, Torino, Italy
| | - Giorgia Di Muro
- Department of Veterinary Science, University of Turin, Torino, Italy
| | | | - Cristiano Corona
- Istituto Zooprofilattico del Piemonte, Liguria e Valle d'Aosta, Torino, Italy
| | - Luca Manassero
- Department of Veterinary Science, University of Turin, Torino, Italy
| | - Eleonora Avilii
- Department of Veterinary Science, University of Turin, Torino, Italy
| | - Claudio Bellino
- Department of Veterinary Science, University of Turin, Torino, Italy
| | - Antonio D'Angelo
- Department of Veterinary Science, University of Turin, Torino, Italy
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Escribano Carrera A, Morrissey AM, Lipscomb VJ, Tivers MS, Chan A, Lisa Pinel Pisco V, Anderson DM, Fox-Alvarez WA, Kirby Dvm BM, de Rooster H, Nurra G, Yool DA, Singh A, Olive M, Phillipe Billet J, Mullins RA. Long-term outcome and quality of life of dogs that developed neurologic signs after surgical treatment of a congenital portosystemic shunt: 50 cases (2005-2020). J Am Vet Med Assoc 2021; 260:326-334. [PMID: 34793328 DOI: 10.2460/javma.20.11.0606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine survival time and quality of life of dogs that developed postattenuation neurologic signs (PANS) after surgical treatment of a single congenital portosystemic shunt and survived at least 30 days and identify whether neurologic signs present at the time of discharge would resolve or reoccur. ANIMALS 50 client-owned dogs. PROCEDURES Medical records were retrospectively reviewed, and follow-up data relating to neurologic signs and seizure activity were obtained. Owners were asked to complete a questionnaire related to the presence of neurologic signs, including seizures, and their dog's quality of life. RESULTS Thirty of the 50 (60%) dogs had postattenuation seizures with or without other nonseizure neurologic signs, and 20 (40%) had neurologic signs other than seizures. Neurologic signs had fully resolved by the time of discharge in 24 (48%) dogs. Signs resolved in 18 of the remaining 26 (69%) dogs that still had PANS other than seizures at the time of discharge. Seizures reoccurred in 15 of the 30 dogs that had postattenuation seizures. Twenty-seven of 33 (82%) owners graded their dog's long-term (> 30 days after surgery) quality-of-life as high. Forty-five (90%) dogs survived > 6 months. Most (29/43 [67%]) neurologic signs (other than seizures) present at the time of hospital discharge resolved. CLINICAL RELEVANCE Findings highlighted that survival times of > 6 months and a high QOL can be achieved in most dogs with PANS that survive at least 30 days. Most neurologic signs other than seizures resolved within 1 month postoperatively. Half of the dogs with postattenuation seizures had a reoccurrence.
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Affiliation(s)
- Antía Escribano Carrera
- Section of Small Animal Clinical Studies, School of Veterinary Medicine, University College Dublin, Dublin, Ireland
| | - Anya M Morrissey
- Department of Clinical Sciences and Services, Royal Veterinary College, Hatfield, UK
| | - Victoria J Lipscomb
- Department of Clinical Sciences and Services, Royal Veterinary College, Hatfield, UK
| | - Michael S Tivers
- Bristol Veterinary School, University of Bristol, Langford House, Langford, Bristol, UK
| | - Alex Chan
- Bristol Veterinary School, University of Bristol, Langford House, Langford, Bristol, UK
| | | | | | - William A Fox-Alvarez
- Department of Small Animal Clinical Science, College of Veterinary Medicine, University of Florida, Gainesville, FL
| | - Barbara M Kirby Dvm
- Section of Small Animal Clinical Studies, School of Veterinary Medicine, University College Dublin, Dublin, Ireland
| | - Hilde de Rooster
- Small Animal Department, Faculty of Veterinary Medicine, University of Ghent, Merelbeke, Belgium
| | - Genziana Nurra
- School of Veterinary Medicine, University of Glasgow, Bearsden, Glasgow, UK
| | - Donald A Yool
- School of Veterinary Medicine, University of Glasgow, Bearsden, Glasgow, UK
| | - Ameet Singh
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Melanie Olive
- Centre Hospitalier Vétérinaire Atlantia, Nantes, France
| | | | - Ronan A Mullins
- Section of Small Animal Clinical Studies, School of Veterinary Medicine, University College Dublin, Dublin, Ireland
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Mullins RA, Escribano Carrera A, Anderson DM, Billet JP, Brissot H, Broome C, de Rooster H, Kirby BM, Pratschke KM, Tivers MS, White RN, Yool DA, Youmans KR. Postattenuation neurologic signs after surgical attenuation of congenital portosystemic shunts in dogs: A review. Vet Surg 2021; 51:23-33. [PMID: 34585759 DOI: 10.1111/vsu.13729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/26/2021] [Accepted: 03/18/2021] [Indexed: 11/27/2022]
Abstract
The development of postattenuation neurologic signs (PANS) is a poorly understood and potentially devastating complication after surgical attenuation of congenital portosystemic shunts in dogs. Postattenuation neurologic signs include seizures but also more subtle neurologic signs such as depression, behavioral changes, tremors, and twitching. They most commonly occur within 7 days postoperatively and are typically unrelated to hyperammonemia, hypoglycemia, or electrolyte disturbances. This narrative review summarizes the findings of 50 publications from 1988-2020 that report occurrence of PANS. While most published reports included only dogs affected by postattenuation seizures (PAS), others included dogs with any form of PANS. Overall, PANS (including PAS) affected 1.6%-27.3% of dogs, whereas incidence of PAS ranged from 0%-18.2%. The etiology of PANS remains unknown; however, several theories have been proposed. Risk factors include preoperative hepatic encephalopathy, increasing age, and possibly certain breeds and extrahepatic shunt morphology. There is increasing evidence that prophylactic antiepileptic drugs do not prevent PANS. Treatment is centered around controlling neurologic signs with antiepileptic drugs and providing supportive intensive care. The 30-day survival rate in studies that included a minimum of four dogs affected by PANS was 0%-100% (median, 50.0%) and 0%-75.0% (median, 37.5%) for those with PAS. Mortality associated with PANS was typically related to occurrence of generalized seizure activity. Prognostic factors positively associated with short-term survival included having a history of preoperative seizures and development of focal seizures only. If affected dogs survived to discharge, survival for several years was possible, and the majority of neurologic signs manifested as part of the phenomenon of PANS appeared to resolve.
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Affiliation(s)
- Ronan A Mullins
- Section of Small Animal Clinical Sciences, University College Dublin, Dublin, Ireland
| | | | | | | | | | - Cameron Broome
- Veterinary Referral Hospital, Melbourne, Victoria, Australia
| | - Hilde de Rooster
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Barbara M Kirby
- Section of Small Animal Clinical Sciences, University College Dublin, Dublin, Ireland
| | - Kathryn M Pratschke
- Veterinary Clinical Services, The Royal (Dick) School of Veterinary Studies and The Roslin Institute, Easter Bush Campus, Midlothian EH25 9RG, UK
| | - Michael S Tivers
- Paragon Veterinary Referrals, Paragon Business Village, Red Hall Crescent, Wakefield, UK
| | - Robert N White
- School of Veterinary Medicine & Science, University of Nottingham, Sutton Bonington Campus, Loughborough, UK
| | - Donald A Yool
- University of Glasgow, School of Veterinary Medicine, Glasgow, UK
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Gioeni D, Di Cesare F, D'Urso ES, Rabbogliatti V, Ravasio G. Ketamine-dexmedetomidine combination and controlled mild hypothermia for the treatment of long-lasting and super-refractory status epilepticus in 3 dogs suffering from idiopathic epilepsy. J Vet Emerg Crit Care (San Antonio) 2020; 30:455-460. [PMID: 32372564 DOI: 10.1111/vec.12956] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 10/04/2018] [Accepted: 10/31/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To describe the use of a ketamine-dexmedetomidine combination and mild hypothermia for the treatment of status epilepticus in 3 dogs that did not respond to GABAergic medication. CASE SERIES SUMMARY Three dogs, each with a diagnosis of idiopathic epilepsy, were presented to the emergency department in a state of status epilepticus. The dogs were treated unsuccessfully with benzodiazepine as a first-line therapy that was followed by IV propofol anesthesia maintained for at least 12 hours. When general anesthesia was discontinued, seizures reoccurred. All 3 dogs then received a bolus of ketamine (1 mg/kg, IV) over a period of 5 minutes that was followed by a bolus of dexmedetomidine (3 μg/kg, IV) over the same time period and then followed by a continuous infusion for 12 hours of ketamine at a constant rate of 1 mg/kg/h and dexmedetomidine at a variable rate of 3-7 μg/kg/h. Body temperature was maintained between 36.7 and 37.7°C at a state of mild hypothermia throughout treatment. The dogs recovered uneventfully over 48 hours after treatment was discontinued with no evidence of seizures. No notable alterations in physiological parameters were observed during the drug infusions. All dogs were discharged following examinations that showed normal neurological function. NEW OR UNIQUE INFORMATION PROVIDED This case series highlights the potential benefits of a ketamine-dexmedetomidine infusion combined with mild hypothermia for the treatment of status epilepticus refractory to GABAergic therapy in dogs suffering from idiopathic epilepsy. After the dogs were weaned from the ketamine-dexmedetomidine infusion, all dogs experienced complete recovery. Thus, this case series introduces a novel approach to treat this intense condition.
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Affiliation(s)
- Daniela Gioeni
- Department of Veterinary Medicine, Università degli Studi di Milano, Milan, Italy
| | - Federica Di Cesare
- Department of Health, Animal Science and Food safety, Università degli Studi di Milano, Milan, Italy
| | - Elisa Silvia D'Urso
- Department of Veterinary Medicine, Università degli Studi di Milano, Milan, Italy
| | - Vanessa Rabbogliatti
- Department of Veterinary Medicine, Università degli Studi di Milano, Milan, Italy
| | - Giuliano Ravasio
- Department of Veterinary Medicine, Università degli Studi di Milano, Milan, Italy
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Mullins RA, Sanchez Villamil C, Selmic LE, Tivers MS, Case JB, Singh A, Thieman Mankin KM, Anderson DM, White RN, Pratschke KM, de Rooster H, Kummeling A, Yool DA, Olive M, Dr Vét JPB, Gordo I, Brissot H, Broome C, Kirby BM. Prognostic factors for short-term survival of dogs that experience postattenuation seizures after surgical correction of single congenital extrahepatic portosystemic shunts: 93 cases (2005-2018). Vet Surg 2020; 49:958-970. [PMID: 32246785 DOI: 10.1111/vsu.13422] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/03/2018] [Accepted: 01/26/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To identify prognostic factors for short-term survival of dogs that experience seizures within 7 days after surgical correction of single congenital extrahepatic portosystemic shunts (cEHPSS). STUDY DESIGN Multi-institutional retrospective study. SAMPLE POPULATION Ninety-three client-owned dogs. METHODS Medical records at 14 veterinary institutions were reviewed to identify dogs that underwent surgical attenuation of a single cEHPSS from January 1, 2005 through February 28, 2018 and experienced postattenuation seizures (PAS) within 7 days postoperatively. Logistic regression analysis was performed to identify factors associated with 1-month survival. Factors investigated included participating institution, signalment, shunt morphology, concurrent/historical conditions, presence of preoperative neurologic signs, presence of preoperative seizures, aspects of preoperative medical management, surgical details including method and degree of shunt attenuation, type of PAS (focal only or generalized ± focal), drugs administered as part of the treatment of PAS, and development of complications during treatment of PAS. RESULTS Thirty (32.3%) dogs survived to 30 days. Seventy-six (81.7%) dogs experienced generalized PAS. Factors positively associated with short-term survival included having a history of preoperative seizures (P = .004) and development of focal PAS only (P = .0003). Most nonsurvivors were humanely euthanized because of uncontrolled or recurrent seizures. CONCLUSION Dogs that experienced PAS that had a history of preoperative seizures and those that experienced focal PAS only had significantly improved short-term survival. CLINICAL SIGNIFICANCE The results of this study provide information that will help in the counseling of owners who seek treatment for PAS after surgical correction of cEHPSS. © 2020 The American College of Veterinary Surgeons.
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Affiliation(s)
- Ronan A Mullins
- Section of Veterinary Clinical Sciences, University College Dublin, Belfield, Dublin, Ireland
| | - Carlos Sanchez Villamil
- Section of Veterinary Clinical Sciences, University College Dublin, Belfield, Dublin, Ireland
| | - Laura E Selmic
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio
| | - Michael S Tivers
- Bristol Veterinary School, University of Bristol, Langford House, Langford, Bristol, United Kingdom
| | - J Brad Case
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Ameet Singh
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Ontario, Canada
| | - Kelley M Thieman Mankin
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Davina M Anderson
- Anderson Moores Veterinary Specialists, Hursley, Winchester, United Kingdom
| | - Robert N White
- Willows Veterinary Centre and Referral Service, Solihull, West Midlands, United Kingdom.,School of Veterinary Medicine & Science, University of Nottingham, Sutton Bonington Campus, Loughborough, United Kingdom
| | - Kathryn M Pratschke
- University of Glasgow, School of Veterinary Medicine, Bearsden, Glasgow, United Kingdom
| | - Hilde de Rooster
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Anne Kummeling
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, The Netherlands
| | - Donald A Yool
- The Royal (Dick) School of Veterinary Studies, Easter Bush Campus, Midlothian, Edinburgh, United Kingdom
| | - Melanie Olive
- Centre Hospitalier Vétérinaire Atlantia, Nantes, France
| | | | - Ines Gordo
- Pride Veterinary Centre, Derby, Derbyshire, United Kingdom
| | - Herve Brissot
- Pride Veterinary Centre, Derby, Derbyshire, United Kingdom
| | - Cameron Broome
- University of Glasgow, School of Veterinary Medicine, Bearsden, Glasgow, United Kingdom
| | - Barbara M Kirby
- Section of Veterinary Clinical Sciences, University College Dublin, Belfield, Dublin, Ireland
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7
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Mullins RA, Sanchez Villamil C, de Rooster H, Kummeling A, White RN, Thieman Mankin KM, Tivers MS, Yool DA, Anderson DM, Pratschke KM, Gordo I, Brissot H, Singh A, Olive M, Billet JP, Selmic LE, Kirby BM. Effect of prophylactic treatment with levetiracetam on the incidence of postattenuation seizures in dogs undergoing surgical management of single congenital extrahepatic portosystemic shunts. Vet Surg 2018; 48:164-172. [DOI: 10.1111/vsu.13141] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 10/12/2018] [Accepted: 11/06/2018] [Indexed: 02/01/2023]
Affiliation(s)
- Ronan A. Mullins
- Section of Veterinary Clinical Sciences; University College Dublin; Belfield Dublin Ireland
| | | | - Hilde de Rooster
- Small Animal Department, Faculty of Veterinary Medicine; Ghent University; Merelbeke Belgium
| | - Anne Kummeling
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine; Utrecht University; Utrecht The Netherlands
| | - Robert N. White
- Willows Veterinary Centre and Referral Service; Shirley, Solihull West Midlands United Kingdom
- Abbey House Veterinary Hospital; Morley Leeds United Kingdom
- School of Veterinary Medicine & Science; University of Nottingham, Sutton Bonington Campus; Loughborough United Kingdom
| | - Kelley M. Thieman Mankin
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences; Texas A&M University; College Station Texas
| | - Michael S. Tivers
- Bristol Veterinary School; University of Bristol, Langford House; Langford Bristol United Kingdom
| | - Donald A. Yool
- The Royal (Dick) School of Veterinary Studies, Easter Bush Campus; Midlothian Edinburgh United Kingdom
| | - Davina M. Anderson
- Anderson Moores Veterinary Specialists; Hursley Winchester United Kingdom
| | - Kathryn M. Pratschke
- North East Veterinary Referrals, Northumberland Business Park West; Cramlington Northumberland United Kingdom
- University of Glasgow School of Veterinary Medicine; Bearsden Glasgow United Kingdom
| | - Ines Gordo
- Pride Veterinary Centre; Derby Derbyshire United Kingdom
| | - Herve Brissot
- Pride Veterinary Centre; Derby Derbyshire United Kingdom
| | - Ameet Singh
- Department of Clinical Studies, Ontario Veterinary College; University of Guelph; Guelph Ontario Canada
| | - Melanie Olive
- Centre Hospitalier Vétérinaire Atlantia; Nantes France
| | | | - Laura E. Selmic
- Department of Veterinary Clinical Sciences; The Ohio State University, 601 Vernon L Tharp St; Columbus OH 43210
| | - Barbara M. Kirby
- Section of Veterinary Clinical Sciences; University College Dublin; Belfield Dublin Ireland
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