Quality-of-life aspects in idiopathic epilepsy in dogs

Prognosis in meningoencephalitis of unknown origin in dogs: Risk factors associated with survival, clinical relapse, and long-term disability

BACKGROUND

Meningoencephalitis of unknown origin (MUO) comprises a group of noninfectious inflammatory diseases affecting the central nervous system of dogs. Previous studies have reported individual risk factors for survival but prognostication for MUO remains challenging.

OBJECTIVES

Identify clinical prognostic variables in dogs with MUO.

ANIMALS

A retrospective study of 447 dogs presented to 2 UK referral hospitals and diagnosed with MUO.

METHODS

Medical records of dogs diagnosed with MUO were retrospectively reviewed. Multivariable logistic regression was used for the identification of risk factors for survival and Cox proportional hazards analysis for the identification of risk factors for clinical relapse.

RESULTS

Eighty-two percent (366/447) of dogs with presumptive MUO survived to discharge and 63.5% (284/447) were alive at 6 months; 36% of the latter (103/284) had persistent neurological deficits. Breed (pugs; P = .03), epileptic seizures (P < .001), paresis (P < .001), and higher neurodisability scale (NDS) score (P < .001) at presentation were negatively associated with survival to 6 months. Dogs with persistent deficits had higher NDS scores on presentation (P = .001). Median follow-up time was 11 months (interquartile range [IQR], 1-24) and 50.6% (160/316) relapsed during treatment (median time to relapse, 7 months; IQR, 2-15). Incomplete resolution of the clinical signs during the 6 months after diagnosis (P < .001), higher NDS score (P < .001), and longer duration of the clinical signs (P < .001) were associated with relapse.

CONCLUSIONS AND CLINICAL IMPORTANCE

Knowledge of risk factors associated with survival, incomplete recovery and clinical relapse in MUO can help guide monitoring and treatment and improve owner communications regarding prognosis for this debilitating disease.

Epilepsy is more than a simple seizure disorder: Parallels between human and canine cognitive and behavioural comorbidities

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.

Idiopathic Epilepsy Risk Allele Trends in Belgian Tervuren: A Longitudinal Genetic Analysis

Idiopathic epilepsy (IE) has been known to be inherited in the Belgian Tervuren for many decades. Risk genotypes for IE in this breed have recently been identified on Canis familiaris chromosomes (CFA) 14 and 37. In the current study, the allele frequencies of these loci were analyzed to determine whether dog breeders had employed a purposeful selection against IE, leading to a reduction in risk-associated allele frequency within the breed over time. The allele frequencies of two generational groupings of Belgian Tervuren with and without IE were compared. Allele frequencies for risk-associated alleles on CFA14 were unchanged between 1985 and 2015, whereas those on CFA37 increased during that time in the control population (p < 0.05). In contrast, dogs with IE showed a decrease (p < 0.05) in the IE risk-associated allele frequency at the CFA37 locus. Seizure prevalence in the Belgian Tervuren appears to be increasing. These results suggest that, despite awareness that IE is inherited, selection against IE has not been successful.

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

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

Feasibility of in-home electroencephalographic and actigraphy recordings in dogs

Introduction

Idiopathic epilepsy is a prevalent neurological disease in dogs. Dogs with epilepsy often present with behavioral comorbidities such as aggression, anxiety, and fear. These behaviors are consistent with pre, post, or interictal behaviors, prodromal changes, seizure-precipitating factors, or absence and focal seizures. The overlap in behavior presentations and lack of objective research methods for quantifying and classifying canine behavior makes determining the cause difficult. Behavioral comorbidities in addition to the task of caring for an epileptic animal have a significant negative impact on dog and caregiver quality of life.

Methods

This pilot study aimed to assess the feasibility of a novel technology combination for behavior classification and epileptic seizure detection for a minimum 24-h recording in the dog's home environment. It was expected that combining electroencephalography (EEG), actigraphy, and questionnaires would be feasible in the majority of trials. A convenience sample of 10 community-owned dogs was instrumented with wireless video-EEG and actigraphy for up to 48 h of recording at their caregiver's home. Three questionnaires (maximum 137 questions) were completed over the recording period by caregivers to describe their dog's everyday behavior and habits.

Results

Six of the 10 included dogs had combined EEG and actigraphy recordings for a minimum of 24 h.

Discussion

This shows that in-home EEG and actigraphy recordings are possible in community-owned dogs and provides a basis for a prospective study examining the same technology combination in a larger sample size.

Tools and techniques for classifying behaviours in canine epilepsy

Idiopathic epilepsy is the most common neurological disease in dogs. Similar to humans, dogs with epilepsy often experience behavioural comorbidities such as increased fear, anxiety, and aggression, as reported by their caregivers. Investigations of behaviour in canine epilepsy have yet to untangle interictal and pre and postictal behaviours, prodromal changes, and seizure-precipitating factors. Under-recognition of absence and focal seizures further complicates these assessments. These complex behavioural presentations in combination with caring for an epileptic animal have a significant negative impact on the dog's and caregiver's quality of life. Despite the growing recognition of behavioural comorbidities and their impact on quality of life in dogs with epilepsy, few objective research methods for classifying and quantifying canine behaviour exist. This narrative review examines the strengths, limitations, and granularity of three tools used in the investigation of canine behaviour and epilepsy; questionnaires, electroencephalography, and actigraphy. It suggests that a prospective combination of these three tools has the potential to offer improvements to the objective classification and quantification of canine behaviour in epilepsy.

"Resistance Is Futile": A Pilot Study into Pseudoresistance in Canine Epilepsy

Epilepsy is a common neurological disorder in veterinary practice, complicated by frequent occurrence of medication-resistant epilepsy. In human medicine, it has been noted that some patients with medication-resistant epilepsy have in fact other reasons for their apparent medication-resistance. The aim of this retrospective study was to describe the issue of pseudoresistance using as an example a population of dogs presented with presumed medication-resistant epilepsy and provide an in-depth review of what is known in human medicine about pseudoresistant epilepsy. One-hundred fifty-two cases were identified with medication-resistant epilepsy, of which 73% had true medication-resistant epilepsy and 27% patients had pseudoresistance. Low serum anti-seizure medication levels were the most common cause of pseudoresistance, present in almost half of the cases (42%), followed by inadequate choice of drugs or dosages (22%), misclassification (22%) or misdiagnosis (9%) of epilepsy and poor compliance (9%). All cases of pseudoresistance, except for one, responded to a modification of the initial therapy protocol. Pseudoresistance can bias clinical trials, misinform the clinical decision-making process, delay diagnosis and treatment, and misinform owners about their pets' prognosis. A substantial proportion of these cases can have improvement of their seizure frequency or achieve seizure freedom upon modification of their therapeutic protocol.

Mild to moderate increases in activity are associated with increased seizure incidence in dogs with idiopathic epilepsy receiving anti-epileptic drugs

OBJECTIVE

Epilepsy is a chronic disorder, and approximately 25% to 30% of dogs with epilepsy are refractory to anti-epileptic drugs. As increased activity has been shown to reduce seizure frequency in people with epilepsy, the goal of this study was to evaluate the relationship between deviation from baseline activity and seizure incidence in dogs with epilepsy.

MATERIALS AND METHODS

Activity and seizure data were obtained using a canine activity monitoring device and owner observed seizure logs in 53 dogs with idiopathic epilepsy receiving anti-epileptic drugs. Each dog's activity was individually measured, and 14-day baseline averages were calculated. Logistic regression was performed to evaluate how an observed increase in activity, ranging from 0% to 50%, above baseline activity, affects the incidence of a seizure in the following 24 hours.

RESULTS

A total of 8540 activity days and 365 seizure days were used in the final analysis with an average of 11 seizures per dog (range 0 to 30 seizures). Seizure incidence was significantly more likely when activity was 10%, 20%, or 30% above baseline activity in the 24 hours before the day of a documented seizure [95% confidence interval (1.02 to 1.60), P=0.033; 95% confidence interval (1.08 to 1.80), P=0.010; 95% confidence interval (1.13 to 2.07), P=0.005, respectively]. However, when activity levels were 40% and 50% above baseline, the effect diminished (95% confidence interval (0.74 to 1.70), P=0.532; or 95% confidence interval (0.56 to 1.66), P=0.988, respectively).

CLINICAL SIGNIFICANCE

Differently than in humans, this study demonstrated that a mild to moderate increase in activity resulted in a higher seizure incidence within 24 hours in dogs with epilepsy.

Remarkable anecdotes illustrating the nature and effect of seizure-precipitating factors in Border Collies with idiopathic epilepsy

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.

Assessing the Quality of Life of Dogs with Inflammatory Bowel Disease and Their Owners

The aim of the study was to assess the quality of life (QoL) of dogs with inflammatory bowel disease (IBD) and the impact on the life and relationship of the owner. An online questionnaire based on a Likert scale score (1-10) was designed to assess items related to dog QoL, owner QoL, and the owner-dog relationship. Responses from 110 dog owners (30 with IBD and 80 healthy dogs) were included in the study. IBD dogs had significantly lower overall QoL (p < 0.001), health (p < 0.0001), and level of activity (p = 0.049). Owners of dogs with IBD reported lower overall QoL (p < 0.001). The scores for how their dog's QoL might affect their own QoL (p = 0.028), how much their dog limited their social life, leisure time, or daily activities (p = 0.015), and how often they felt burdened by caring for their dog (p = 0.006) were significantly higher in the IBD group when compared to the healthy group. In addition, IBD dog owners were more likely to see their dogs as children (p = 0.0004). IBD has a negative impact on affected dogs and their owners regardless of the severity of the disease.

Pathophysiology of drug-resistant canine epilepsy

Drug resistance continues to be a major clinical problem in the therapeutic management of canine epilepsies with substantial implications for quality of life and survival times. Experimental and clinical data from human medicine provided evidence for relevant contributions of intrinsic severity of the disease as well as alterations in pharmacokinetics and -dynamics to failure to respond to antiseizure medications. In addition, several modulatory factors have been identified that can be associated with the level of therapeutic responses. Among others, the list of potential modulatory factors comprises genetic and epigenetic factors, inflammatory mediators, and metabolites. Regarding data from dogs, there are obvious gaps in knowledge when it comes to our understanding of the clinical patterns and the mechanisms of drug-resistant canine epilepsy. So far, seizure density and the occurrence of cluster seizures have been linked with a poor response to antiseizure medications. Moreover, evidence exists that the genetic background and alterations in epigenetic mechanisms might influence the efficacy of antiseizure medications in dogs with epilepsy. Further molecular, cellular, and network alterations that may affect intrinsic severity, pharmacokinetics, and -dynamics have been reported. However, the association with drug responsiveness has not yet been studied in detail. In summary, there is an urgent need to strengthen clinical and experimental research efforts exploring the mechanisms of resistance as well as their association with different etiologies, epilepsy types, and clinical courses.

Quantification of phenobarbital-induced ataxia in dogs with idiopathic epilepsy

Ataxia is a clinical sign seen in several neurological diseases and has been reported as an adverse effect of anti-seizure medication such as phenobarbital (PB). Efforts to objectify canine ataxia in order to provide appropriate treatment or monitor adverse effects of drugs remain limited. Automated quantitative gait analysis can be useful for the acquisition of objective data for the evaluation and monitoring of ataxia in dogs. The aim of this prospective clinical study was to examine the gait characteristics of dogs with PB induced ataxia and compare them with healthy dogs using a computer- and treadmill-based gait analysis system. Six healthy dogs and five dogs with idiopathic epilepsy (IE) with PB-induced ataxia underwent video- and computer-assisted gait analysis during slow walking (maximum speed of 0.7 m/s) on a treadmill with four ground reaction force plates (one plate per limb). Kinetic and spatio-temporal gait parameters of dogs' locomotion were analyzed, including individually calculated coefficients of variation. Dogs with IE treated with PB showed higher variability in spatio-temporal but not in kinetic gait parameters. Double support phase of gait cycles was increased on the cost of single support and swing phases. Body weight standardized ground reaction forces in vertical, craniocaudal, and mediolateral direction were severely affected by ataxia. Compensatory mechanisms in locomotion of dogs with PB-induced ataxia included spatio-temporal and kinetic gait characteristics, most likely in order to compensate imbalance caused by limb incoordination.

Development of a reliable clinical assessment tool for meningoencephalitis in dogs: The neurodisability scale

BACKGROUND

Meningoencephalitis of unknown origin (MUO) comprises a group of debilitating inflammatory diseases affecting the central nervous system of dogs. Currently, no validated clinical scale is available for the objective assessment of MUO severity.

OBJECTIVES

Design a neurodisability scale (NDS) to grade clinical severity and determine its reliability and whether or not the score at presentation correlates with outcome.

ANIMALS

One hundred dogs with MUO were included for retrospective review and 31 dogs were subsequently enrolled for prospective evaluation.

METHODS

Medical records were retrospectively reviewed for 100 dogs diagnosed with MUO to identify the most frequent neurological examination findings. The NDS was designed based on these results and evaluated for prospective and retrospective use in a new population of MUO patients (n = 31) by different groups of independent blinded assessors, including calculation of interobserver agreement and association with outcome.

RESULTS

The most common clinical signs in MUO patients were used to inform categories for scoring in the NDS: seizure activity, ambulatory status, posture and cerebral, cerebellar, brainstem, and visual functions. The intraclass correlation coefficient (ICC) for prospective use of the NDS was 0.83 (95% confidence interval [CI], 0.68-0.91) indicating good agreement, and moderate agreement was found between prospective and retrospective assessors (ICC, 0.71; 95% CI, 0.56-0.83). No association was found between NDS score and long-term outcome.

CONCLUSIONS AND CLINICAL IMPORTANCE

The NDS is a novel clinical measure for objective assessment of neurological dysfunction and showed good reliability when used prospectively in MUO patients but, in this small population, no association with outcome could be identified.

Translational veterinary epilepsy: A win-win situation for human and veterinary neurology

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.

Effect of an intervention of exercise on sleep and seizure frequency in idiopathic epileptic dogs

OBJECTIVE

The goal of this study was to compare sleep and seizure frequency between epileptic dogs prescribed a 20% activity increase and epileptic dogs not prescribed an activity increase.

METHODS

Sixty-nine dogs receiving anti-epileptic drug therapy were enrolled in a 6-month prospective, randomised, placebo-controlled clinical trial with an intention-to-treat analysis. A canine activity monitoring device was used to measure activity levels and sleep scores.

RESULTS

Using an intention-to-treat analysis, the treatment group had an average of 0.381 more seizures per month (95% CI: 0.09 to 0.68) compared with the control group, although the difference in seizure days per month was not statistically significant. In a subgroup analysis of dogs whose activity increased by at least 10%, partial compliers had 0.719 more seizures per month (95% CI: 0.22 to 1.22) and 0.581 seizure days per month (95% CI: 0.001 to 1.16) compared with the control group. Sleep scores increased by 1.2% in the treatment compared with the control group (95% CI: 0.2 to 2.3%).

CONCLUSIONS

Seizure frequency and sleep score increased slightly, but significantly, in dogs with idiopathic epilepsy prescribed an increase in activity, compared with a control group.

Quality of life in dogs with idiopathic epilepsy and their owners with an emphasis on breed-A pilot study

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.

Owner perspectives on the impact of veterinary surgeons upon their decision making in the management of dogs with idiopathic epilepsy

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.

Metabolic fingerprinting of dogs with idiopathic epilepsy receiving a ketogenic medium-chain triglyceride (MCT) oil

Consumption of medium-chain triglycerides (MCT) has been shown to improve seizure control, reduce behavioural comorbidities and improve cognitive function in epileptic dogs. However, the exact metabolic pathways affected by dietary MCT remain poorly understood. In this study, we aimed to identify changes in the metabolome and neurotransmitters levels relevant to epilepsy and behavioural comorbidities associated with the consuming of an MCT supplement (MCT-DS) in dogs with idiopathic epilepsy (IE). Metabolic alterations induced by a commercial MCT-DS in a population of 28 dogs with IE were evaluated in a 6-month multi-centre, prospective, randomised, double-blinded, controlled cross-over trial design. A metabolic energy requirement-based amount of 9% MCT or control oil was supplemented to the dogs' stable base diet for 3 months, followed by the alternative oil for another 3 months. A validated, quantitative nuclear magnetic resonance (NMR) spectroscopy platform was applied to pre- and postprandially collected serum samples to compare the metabolic profile between both DS and baseline. Furthermore, alterations in urinary neurotransmitter levels were explored. Five dogs (30%) had an overall reduction in seizure frequency of ≥50%, and were classified as MCT-responders, while 23 dogs showed a ≤50% reduction, and were defined as MCT non-responders. Amino-acid metabolism was significantly influenced by MCT consumption compared to the control oil. While the serum concentrations of total fatty acids appeared similar during both supplements, the relative concentrations of individual fatty acids differed. During MCT supplementation, the concentrations of polyunsaturated fatty acids and arachidonic acid were significantly higher than under the control oil. β-Hydroxybutyric acid levels were significantly higher under MCT supplementation. In total, four out of nine neurotransmitters were significantly altered: a significantly increased γ-aminobutyric acid (GABA) concentration was detected during the MCT-phase accompanied by a significant shift of the GABA-glutamate balance. MCT-Responders had significantly lowered urinary concentrations of histamine, glutamate, and serotonin under MCT consumption. In conclusion, these novel data highlight metabolic changes in lipid, amino-acid and ketone metabolism due to MCT supplementation. Understanding the metabolic response to MCT provides new avenues to develop better nutritional management with improved anti-seizure and neuroprotective effects for dogs with epilepsy, and other behavioural disorders.

Approach to initial management of canine generalised epileptic seizures in primary-care veterinary practices in the United Kingdom

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.

Measurement of Canine Ataxic Gait Patterns Using Body-Worn Smartphone Sensor Data

Ataxia is an impairment of the coordination of movement or the interaction of associated muscles, accompanied by a disturbance of the gait pattern. Diagnosis of this clinical sign, and evaluation of its severity is usually done using subjective scales during neurological examination. In this exploratory study we investigated if inertial sensors in a smart phone (3 axes of accelerometer and 3 axes of gyroscope) can be used to detect ataxia. The setting involved inertial sensor data collected by smartphone placed on the dog's back while walking in a straight line. A total of 770 walking sessions were evaluated comparing the gait of 55 healthy dogs to the one of 23 dogs with ataxia. Different machine learning techniques were used with the K-nearest neighbors technique reaching 95% accuracy in discriminating between a healthy control group and ataxic dogs, indicating potential use for smartphone apps for canine ataxia diagnosis and monitoring of treatment effect.

The Prospects of Non-EEG Seizure Detection Devices in Dogs

The unpredictable nature of seizures is challenging for caregivers of epileptic dogs, which calls the need for other management strategies such as seizure detection devices. Seizure detection devices are systems that rely on non-electroencephalographic (non-EEG) ictal changes, designed to detect seizures. The aim for its use in dogs would be to provide owners with a more complete history of their dog's seizures and to help install prompt (and potentially life-saving) intervention. Although seizure detection via wearable intracranial EEG recordings is associated with a higher sensitivity in humans, there is robust evidence for reliable detection of generalized tonic-clonic seizures (GTCS) using non-EEG devices. Promising non-EEG changes described in epileptic humans, include heart rate variability (HRV), accelerometry (ACM), electrodermal activity (EDA), and electromyography (EMG). Their sensitivity and false detection rate to detect seizures vary, however direct comparison of studies is nearly impossible, as there are many differences in study design and standards for testing. A way to improve sensitivity and decrease false-positive alarms is to combine the different parameters thereby profiting from the strengths of each one. Given the challenges of using EEG in veterinary clinical practice, non-EEG ictal changes could be a promising alternative to monitor seizures more objectively. This review summarizes various seizure detection devices described in the human literature, discusses their potential use and limitations in veterinary medicine and describes what is currently known in the veterinary literature.

Detection of Generalized Tonic–Clonic Seizures in Dogs With a Seizure Detection System Established Using Acceleration Data and the Mahalanobis Distance: A Preliminary Study

Caregivers of dogs with epilepsy experience severe stress due to unpredictable seizures. Hence, they feel the need for a better management strategy. A seizure detection system (SDS), which can identify seizures and provide notifications to caregivers immediately, is required to address this issue. The current study aimed to establish a wearable automatic SDS using acceleration data and the Mahalanobis distance and to preliminarily investigate its feasibility among dogs. A generalized tonic–clonic seizure (GTCS) was targeted because it is the most common type of seizure and can have serious consequences (i.e., status epilepticus). This study comprised three phases. First, the reference datasets of epileptic and non-epileptic activities were established using acceleration data of GTCSs in 3 dogs and daily activities in 27 dogs. Second, the GTCS-detecting algorithm was created using the reference datasets and was validated using other acceleration data of GTCSs in 4 epileptic dogs and daily activities in 27 dogs. Third, a feasibility test of the SDS prototype was performed in three dogs with epilepsy. The algorithm was effective in identifying all acceleration data of GTCSs as seizures and all acceleration data of daily activities as non-seizure activities. Dogs with epilepsy were monitored with the prototype for 48–72 h, and three GTCSs were identified. The prototype detected all GTCSs accurately. A false positive finding was not obtained unless the accelerometer was displaced. Hence, a method that can detect epileptic seizures, particularly GTCSs, was established. Nevertheless, further large-scale studies must be conducted before the method can be commercialized.

Owner compliance in canine epilepsy

BACKGROUND

Poor medication compliance by human epilepsy patients is one of the leading causes of treatment failure and increased seizure frequency. The aim of this cross-sectional study was to analyse owner compliance in pharmacological treatment of canine idiopathic epilepsy and to identify factors associated with poor compliance.

METHODS

The number of antiseizure drug tablets was recorded to determine if the patient received sufficient tablets to cover the time period between prescriptions and to assess compliant prescription cycles. Additionally, compliance was assessed by an online survey of owners.

RESULTS

For the prescription monitoring data from 94 cases from three small animal practices in the United Kingdom revealed an overall median compliance of 56%. Thirt-three per cent of owners were >80% compliant, while 21% were 100% compliant. During a non-compliant prescription cycle, a patient missed a median of 6 days (0.11-519 days) of treatment. Patients on polytherapy had higher compliance rates than on monotherapy (p = 0.031). The survey (229 respondents from online canine epilepsy groups) showed that low daily dosing was associated with better compliance (p = 0.049).

CONCLUSION

Owner compliance was subpar in this study and could represent a significant issue in epilepsy management, which needs to be considered by veterinary surgeons when treating canine epilepsy.

Understanding the impacts of feline epilepsy on cats and their owners

BACKGROUND

Epilepsy is the most common neurological condition reported in cats. Characterised by recurrent seizures, treatment involves the administration of anti-epileptic drugs up to multiple times a day. Epilepsy and its associated treatments may impact both cats and their owners. The present study aimed to assess factors associated with quality of life (QOL) in cats with epilepsy and the burden of care in their owners.

METHODS

An online survey was developed using demographic information and the following validated measures: cat QOL, Zarit burden interview (ZBI) and the cat owner relationship scale (CORS). Regression analysis was conducted using SPSS 26.

RESULTS

Responses were completed by 141 owners from 22 countries. QOL was significantly higher in cats with controlled seizures, no adverse effects from medication and epilepsy onset before 5 years of age. ZBI was significantly lower in owners who felt supported by their veterinarian, who were over 55 and had cats with controlled seizures. Higher CORS was significantly correlated with both higher cat QOL and lower owner ZBI.

CONCLUSIONS

Adequate seizure control and close cat-owner relationships may play an important role in mitigating the impact of epilepsy on cats and their owners. Further research into understanding cat-owner relationships and successfully controlling epilepsy in cats is needed.

Wellbeing, quality of life, presence of concurrent diseases, and survival times in untreated and treated German Shepherd dogs with dwarfism

BACKGROUND

Pituitary dwarfism (PD) in German Shepherd dogs (GSD) is a rare endocrinopathy. Cause and inheritance of the disease are well characterized, but the overall survival time, presence of concurrent diseases, quality of life (QoL) and influence of different treatment options on those parameters is still not well investigated. The aim of this study was to obtain data regarding the disease pattern of GSD with PD and to investigate the impact of treatment.

METHODS

47 dogs with dwarfism (presumably PD) and 94 unaffected GSD serving as controls were enrolled. Data were collected via a standardized questionnaire, which every owner of a participating dog had completed. Dogs with PD were grouped based on three categories of treatment: Group 1 (untreated), group 2 (treated with levothyroxine), group 3 (treated with thyroxine and progestogens or with growth hormone (GH)). Groups were compared using One-Way-Anova, Kruskal-Wallis test or Wilcoxon-rank-sum test. Categorical analysis was performed using Two-Sample-Chi-Squared-test.

RESULTS

Dogs treated with thyroxine and gestagen or GH were significantly taller and heavier compared to all other dogs with PD. Quality of life was best in dogs with PD treated with thyroxine and similar to unaffected GSD. Treatment increased survival time in dogs with PD independent of the treatment strategy. Dogs receiving thyroxine and progestogens or GH did not develop chronic kidney disease (CKD).

CONCLUSION

GSD with PD should be treated at least for their secondary hypothyroidism to increase survival time. Additional treatment with progestogens or GH improves body size and seems to protect against the occurrence of CKD.

How Owners of Epileptic Dogs Living in Italy Evaluate Their Quality of Life and That of Their Pet: A Survey Study

Epilepsy is the most common chronic neurological disorder of dogs and requires a substantial commitment by the pet owner. The aim of this study was to evaluate how Italian owners of epileptic dogs receiving long-term treatment perceived their own quality of life (QoL) and that of their pet, using a list of key questions. A questionnaire was sent to owners of dogs affected by recurrent seizures and treated with antiepileptic drugs for at least three months. The questions included signalment, medical history and physical, social and psychological aspects associated with managing an epileptic dog. Eighty complete questionnaires were obtained. Most owners surveyed had a positive opinion on their dog's QoL and they did not believe that commitment to managing their animals was a limitation of QoL. Dog QoL, seizure, frequency and severity were considered the most important factors in evaluating the efficacy of the antiepileptic treatment. The evaluation of the different aspects of QoL can help veterinary professionals understand the need for correct and exhaustive information provided to owners and the development of therapeutic plans and follow up, corresponding to the needs of dogs and owners.

Daytime and nocturnal activity in treated dogs with idiopathic epilepsy compared to matched unaffected controls

BACKGROUND

In dogs, antiepileptic drugs (AED) cause lethargy but quantitative data regarding the effects of AED on activity levels are not available, and little is known about how AEDs affect sleep quality.

OBJECTIVE

To quantitatively compare activity levels and nocturnal activity in dogs previously diagnosed with idiopathic epilepsy (IE) receiving AEDs compared to age- and breed-matched control dogs.

ANIMALS

Sixty-two dogs with IE and 310 control dogs.

METHODS

This is a 3-month prospective parallel observational study. An activity monitoring device for dogs was used to measure daily activity levels and sleep scores in all dogs.

RESULTS

Dogs with IE treated with AEDs had an 18% average lower baseline activity level compared to control dogs (P = .005; point estimate = 0.82, 95% confidence interval [CI], 0.75-0.90). The combination of phenobarbital and potassium bromide (KBr) was associated with an average 28% decrease in activity in dogs with IE compared to control dogs (P = .03; point estimate = 0.72; CI, 0.62-0.82). Mean sleep scores were not significantly different in dogs with IE receiving AEDs compared to control dogs (P = .43). However, higher dosages of KBr were associated with lower sleep scores (P = .01).

CONCLUSIONS

Dogs with IE receiving AEDs have lower activity levels, but no difference in sleep scores, compared to controls. The combination of phenobarbital and KBr had the largest decrease in activity between groups. Higher doses of KBr may affect nocturnal activity in epileptic dogs.

Research priorities for idiopathic epilepsy in dogs: Viewpoints of owners, general practice veterinarians, and neurology specialists

BACKGROUND

Epilepsy is the most common chronic neurological disease in dogs that adversely affects the quality of life (QoL) of affected dogs and their owners. Research on epilepsy in dogs is expanding internationally, but where best to focus limited research time, funds, and expertise to achieve better outcomes for affected dogs and their owners has not been studied.

OBJECTIVE

To explore idiopathic epilepsy (IE) research priorities of owners of dogs with IE, general practice veterinarians, and veterinary neurologists.

METHODS

An international online survey was conducted in 2016 and repeated in 2020. Participants rated the absolute importance and relative rank of 18 areas of IE research, which were compared between groups and time points.

RESULTS

Valid responses were received from 414 respondents in 2016 and 414 respondents in 2020. The development of new anti-seizure drugs (ASD) and improving the existing ASD management were considered the most important research priorities. Areas of research with increasing priority between 2016 and 2020 included non-ASD management, with the greatest potential seen in behavioral and dietary-based interventions. Disagreements in priorities were identified between groups; owners prioritized issues that impacted their and their dog's QoL, for example, adverse effects and comorbidities, whereas general practitioner vets and neurologists prioritized clinical issues and longer-term strategies to manage or prevent IE, respectively.

CONCLUSIONS AND CLINICAL IMPORTANCE

Ensuring that voices of owners are heard in the planning of future research should be a broader goal of veterinary medicine, to target research efforts toward areas most likely to improve the QoL of the dog-owner dyad.

Prevalence and clinical characteristics of phenobarbitone-associated adverse effects in epileptic cats

OBJECTIVES

The study objective was to investigate the prevalence and clinical characteristics of phenobarbitone-associated adverse effects in epileptic cats.

METHODS

The medical records of two veterinary referral clinics from 2007 to 2017 were searched for cats fulfilling the inclusion criteria of a diagnosis of epilepsy, treatment with phenobarbitone and available follow-up information on the occurrence of adverse effects. Follow-up information was obtained from the medical records of the primary veterinarian and referral institutions and a questionnaire completed by the cats' owners.

RESULTS

Seventy-seven cats met the inclusion criteria. Fifty-eight were affected by idiopathic epilepsy and 19 by structural epilepsy. One or more of the following adverse effects were reported in 47% of the cats: sedation (89%); ataxia (53%); polyphagia (22%); polydipsia (6%); polyuria (6%); and anorexia (6%). Logistic regression analyses revealed significant associations between adverse effect occurrence and both phenobarbitone starting dosage and administration of a second antiepileptic drug (AED). For each 1 mg/kg q12h increment of phenobarbitone, the likelihood of adverse effects increased 3.1 times. When a second AED was used, the likelihood of adverse effects increased 3.2 times. No association was identified between epilepsy aetiology and adverse effect occurrence. An idiosyncratic adverse effect, characterised by severe neutropenia and granulocytic hypoplasia, was diagnosed in one cat. This resolved following phenobarbitone discontinuation.

CONCLUSIONS AND RELEVANCE

The prevalence of phenobarbitone-associated adverse effects was 47%. Sedation and ataxia were most common. These are type A adverse effects and are predictable from phenobarbitone's known pharmacological properties. In the majority of cases, adverse effects occurred within the first month of treatment and were transient. Idiosyncratic (type B) adverse effects, which were not anticipated given the known properties of the drug, occurred in one cat. Increased phenobarbitone starting dosage and the addition of a second AED were significantly associated with the occurrence of adverse effects.

Medium-chain triglycerides dietary supplement improves cognitive abilities in canine epilepsy

OBJECTIVE

Cognitive impairments (CI) have recently been identified in canine epilepsy patients. A medium-chain triglyceride (MCT) enriched diet has been demonstrated to improve cognition in aged dogs and seizure control in canine epilepsy. This study evaluates the short-term effects of MCT-oil consumption on cognitive abilities in dogs with epilepsy, a naturally occurring animal model.

METHODS

A 6-month multicenter, prospective, randomized, double-blinded, controlled cross-over diet trial was conducted comparing dietary supplementation (DS) of MCT oil to a control oil. Allocation to dietary oil supplements, consisting of 9% total caloric intake, was block-randomized and supplemented into each dogs' diet for 3 months followed by a respective switch of DS-oil for a further 3 months. Noninvasive cognitive tests and a validated psychometric tool were utilized to evaluate cognitive function and perturbations associated with dietary intervention.

RESULTS

Twenty-nine dogs completed the trial, of which 18 completed noninvasive cognitive testing. Spatial-working memory (P = 0.008), problem-solving ability (P = 0.048), and owner-reported trainability (P = 0.041) were significantly improved during MCT-oil supplementation compared to control-DS.

SIGNIFICANCE

MCT-oil DS improves cognition in dogs with epilepsy when compared to a control-DS. MCT supplementation may represent a promising option to address CI associated with epilepsy.

"We have a ticking time bomb": a qualitative exploration of the impact of canine epilepsy on dog owners living in England

BACKGROUND

Idiopathic epilepsy is a common neurological condition in dogs. Previous research has focused on clinical aspects of seizure management in dogs with idiopathic epilepsy with little attention given to the emotional and logistical challenges for their owners. The current study aimed to explore the impacts of owning a dog with idiopathic epilepsy on owner quality of life and lifestyle, using qualitative methods.

METHODS

Owners of dogs with idiopathic epilepsy living in England were recruited via social media and word of mouth, and then selected using purposive sampling to participate in face-to-face semi-structured interviews. Epilepsy management was explored through in-depth accounts of owner experiences and influencing factors. Interviews were recorded and transcribed verbatim and thematic analysis was used to construct key themes.

RESULTS

Twenty-one interviews were completed. Almost all owners had made lifestyle changes in order to care for their dog, including substantial modifications to routines and, in some cases, employment. Many owners discussed a very emotionally close dog-owner bond, and described experiencing frequent feelings of fear, stress and uncertainty regarding their dog's health. Friends, family and colleagues did not always understand the magnitude of commitment required to care for a dog with idiopathic epilepsy. This, combined with a fear of leaving their dog unsupervised, had social implications in some instances and lead to increased use of the Internet and online groups for peer support.

CONCLUSIONS

The commitment required to care for a dog with idiopathic epilepsy, and the lifestyle changes made by their owners, may be far greater than previously estimated. Further consideration of these factors by veterinary professionals and the friends and families of owners of dogs with idiopathic epilepsy could improve owner quality of life, and facilitate the provision of additional support.

Impact of canine epilepsy on judgement and attention biases

Idiopathic epilepsy (IE) is the most common chronic neurological condition in dogs, characterised by recurrent seizure activity and associated with negative behavioural and cognitive changes. We hypothesised that IE would negatively impact putative affective state, with dogs with IE exhibiting a more pessimistic judgement bias and more negative attention bias than controls. Dogs were tested in a previously-validated spatial judgement bias task, and a novel auditory attention bias task testing attention to sounds with different valence or salience (neutral, novel pre-habituated, threatening). Sixty-eight dogs (IE = 33, Control = 35) were tested, of which n = 37 acquired the spatial discrimination and responses to judgement bias probes were tested (IE = 19, Control = 18), and n = 36 were tested for responses to sounds (IE = 20, Control = 16). Study groups did not significantly differ by age, sex, breed or neuter-status (p > 0.05). Main effects of study group were not significant in judgement bias (F_1,102 = 0.20, p = 0.658) or attention bias tasks (F_3,102 = 1.64, p = 0.184). In contrast with our hypotheses, there was no evidence that IE altered cognitive biases in this study population; however, dogs with IE were significantly more likely to be unable to learn the spatial discrimination task (p = 0.019), which may reflect IE-related cognitive deficits. Developing methods to test affective state without excluding cognitively impaired individuals is a future challenge for animal welfare science.

Development and Evaluation of a Caregiver Reported Quality of Life Assessment Instrument in Dogs With Intracranial Disease

In veterinary medicine, quality of life (QOL) assessment instruments, which are important components of the holistic evaluation of treatment success, have largely not included organ-specific concerns that may be broadly relevant to caregivers of dogs with intracranial disease. The objective of this study was to identify core questionnaire items and domains that contribute to health-related QOL (HRQOL) in dogs with intracranial disease. A questionnaire was developed that contained 39 QOL-related items encompassing physical, social/companionship, and brain-specific domains associated with the treatment of dogs with intracranial disease, and administered to caregivers of 56 dogs diagnosed with genetic, inflammatory, neoplastic, traumatic, and vascular brain diseases, 52 healthy dogs, and 20 dogs with non-neurological illnesses. Clinician derived functional measures of each dog's health status including chronic pain, Karnofsky performance, and modified Glasgow coma scale scores were also recorded. Principal component analysis refined the final questionnaire, termed the CanBrainQOL-24, to 24-items within the three domains with a minimum Cronbach's alpha of 0.7, indicative of good internal consistency. The CanBrainQOL-24 discriminated between healthy and diseased dogs. Physical and brain-specific domains were significantly different between dogs with intracranial and non-neurological diseases. Significant correlations were observed between owner reported visual analog scores and CanBrainQOL-24 scores, as well between clinician derived functional status measures and owner reported QOL. The CanBrainQOL-24 contains core questions relevant to caregiver assessment of HRQOL in dogs with a variety of intracranial diseases, and provides information that is complementary to clinician derived functional outcome measures.

Efficacy of medium chain triglyceride oil dietary supplementation in reducing seizure frequency in dogs with idiopathic epilepsy without cluster seizures: a non-blinded, prospective clinical trial

BACKGROUND

Despite appropriate antiseizure drug (ASD) treatment, around two-thirds of dogs with idiopathic epilepsy (IE) have seizures long-term and 20-30per cent of affected dogs remain poorly controlled.

METHODS

The current study aim is to test in a field trial the efficacy and tolerability of a commercially available diet enriched with 6.5per cent medium chain triglyceride (MCT) oil in dogs (n=21) with at least a tier 1 idiopathic epilepsy diagnosis, without cluster seizures, in 10 veterinary practices across Europe. Each dog's quality of life (QoL), ataxia, sedation and frequency and severity of seizures were recorded by owners throughout the study.

RESULTS

The mean seizure frequency per month, averaged over the entire 84-day study, significantly (P=0.04) decreased 32per cent compared with the baseline monthly seizure frequency recorded during the month immediately before feeding the diet. Similarly, the seizure days rate (days/month) also declined (P<0.001) by 42per cent. QoL was reported as very good to excellent (>8.5/10) in 20 of the 21 dogs before starting the diet and this remained unchanged during the trial.

CONCLUSIONS

This study demonstrates the use of a diet enriched with MCTs as an adjunct to ASD treatment may have some antiseizure properties for dogs diagnosed with IE, as demonstrated in previous studies.

Investigating the potential for seizure prediction in dogs with idiopathic epilepsy: owner-reported prodromal changes and seizure triggers

BACKGROUND

Canine idiopathic epilepsy (IE) is characterised by recurrent seizure activity, which can appear unpredictable and uncontrollable. The purpose of this study was to investigate the potential for seizure prediction in dogs by exploring owner-perceived seizure prediction abilities and identifying owner-reported prodromal changes (long-term changes in disposition that indicate forthcoming seizures) and seizure triggers (stimuli that precipitate seizures) in dogs with IE.

METHODS

This is an online, international, cross-sectional survey of 229 owners of dogs diagnosed with IE, meeting the International Veterinary Epilepsy Task Force tier I diagnostic criteria.

RESULTS

Over half (59.6 per cent) of owners believed they were able to predict an upcoming seizure in their dog, of whom nearly half (45.5 per cent) were able to do so at least 30 minutes before the seizure commenced. The most common 'seizure predictors' were preseizure behavioural changes including increased clinginess (25.4 per cent), restlessness (23.1 per cent) and fearful behaviour (19.4 per cent). Nearly two-thirds of owners reported prodromal changes (64.9 per cent), most commonly restlessness (29.2 per cent), and nearly half (43.1 per cent) reported seizure triggers, most commonly stress (39.1 per cent).

CONCLUSIONS

The relatively high prevalence of owner-reported prodromal changes and seizure triggers shows promise for utilising these methods to aid seizure prediction in dogs, which could open a window of time for pre-emptive, individualised drug interventions to abort impending seizure activity.

A multicenter randomized controlled trial of medium-chain triglyceride dietary supplementation on epilepsy in dogs

BACKGROUND

Medium-chain triglyceride (MCT) enriched diet has a positive effect on seizure control and behavior in some dogs with idiopathic epilepsy (IE).

OBJECTIVE

To evaluate the short-term efficacy of MCTs administered as an add-on dietary supplement (DS) to a variable base diet to assess seizure control and antiseizure drug's (ASD) adverse effect profiles.

ANIMALS

Twenty-eight dogs with International Veterinary Epilepsy Task Force Tier II (IVETF) level diagnosis of treated IE with 3 or more seizures in the last 3 months were used.

METHODS

A 6-month multicenter, prospective, randomized, double-blinded, placebo-controlled crossover trial was completed, comparing an MCT-DS with a control-DS. A 9% metabolic energy-based amount of MCT or control oil was supplemented to the dogs' diet for 3 months, followed by a control oil or MCT for another 3 months, respectively. Dogs enrolled in this study satisfied most requirements of IE diagnosis stated by the IVETF II level. If they received an oil DS or drugs that could influence the metabolism of the investigated DS or chronic ASD, the chronic ASD medication was adjusted, or other causes of epilepsy were found, the dogs were excluded from the study.

RESULTS

Seizure frequency (median 2.51/month [0-6.67] versus 2.67/month [0-10.45]; P = .02) and seizure-day frequency were significantly (1.68/month [0-5.60] versus 1.99/month [0-7.42], P = .01) lower when dogs were fed MCT-DS in comparison with the control-DS. Two dogs were free of seizures, 3 had ≥50% and 12 had <50% reductions in seizure frequency, and 11 dogs showed no change or an increase in seizure frequency.

CONCLUSIONS AND CLINICAL IMPORTANCE

These data show antiseizure properties of an MCT-DS compared to a control oil and support former evidence for the efficacy of MCTs as a nutritive, management option for a subpopulation of drug-resistant dogs with epilepsy.

Health-related quality of life in dogs treated with electrochemotherapy and/or interleukin-12 gene electrotransfer

The aim of this study was to evaluate the owners' perception of health‐related quality of life (HRQoL) of dogs after treatment with electrochemotherapy (ECT) alone or combined with interleukin‐12 gene electrotransfer (IL‐12 GET) and/or surgery. The owners of 44 dogs with histologically different tumours were offered the »Cancer Treatment Form« at least one month after treatment. The owners assessed their dogs’ quality of life (QoL) after treatment as good (mean 7.4) (from 1–very poor to 10–excellent) and the general health compared with the initial diagnosis of cancer as improving (mean 3.9) (from 1–worse to 5–better). The assessment of the current QoL was better within the group of dogs treated with non‐invasive treatment (ECT and/or IL‐12 GET only), compared with those that received invasive treatment, where, in addition to ECT and/or IL‐12 GET, surgery was performed (p < .05). The owners of dogs that achieved an objective response (OR) to the treatment assessed the QoL as significantly better compared with those whose dogs did not respond to the treatment (p < .05). The majority of the owners (86.4%) would opt for the therapy again, regardless of the financial costs. In conclusion, the results of this study demonstrate that the majority of the owners of dogs assessed their dogs’ QoL as good and felt that it improved after the treatment, especially in dogs, treated with non‐invasive treatment and in those that responded to the treatment. This supports further use of ECT and IL‐12 GET as suitable methods for the treatment of selected tumours in veterinary medicine.

Behavioural changes in dogs with idiopathic epilepsy

BACKGROUND

Breed-specific and broader cohort studies have shown behavioural changes in dogs following the onset of idiopathic epilepsy (IE).

METHODS

A cross-sectional, case-control questionnaire study was carried out to strengthen this body of evidence. Owners of eight breeds of dog completed an online questionnaire about their dogs' behaviour; once for control dogs and twice for dogs with IE, for both pre-IE and post-IE onset behaviour.

RESULTS

Ninety-six (24.74 per cent) dogs with IE and 292 (75.26 per cent) age and breed-matched control dogs met the inclusion criteria. Control dogs had significantly higher 'Trainability' scores than dogs with IE (P=0.04). After IE, dogs had significantly higher 'Dog-Directed Fear or Aggression' (P=0.02), 'Non-Social Fear' (P=0.01), 'Attachment/Attention-Seeking Behaviour' (P=0.04), 'Attention-Deficit' (P=0.02) and significantly lower 'Trainability' (P=0.02) than prior to the onset of IE. Medication status did not significantly affect any behavioural factor, but drug-resistant dogs had significantly less 'Trainability' than drug-responsive (P=0.04) and partially drug-responsive dogs (P=0.03).

CONCLUSION

Behavioural differences related to cognitive function are seen between dogs with IE and controls. Behavioural changes related to anxiety, attention and cognition are seen in dogs following the onset of IE. The ability to clinically define and diagnose behavioural comorbidities in dogs is much needed from both a clinical and research perspective.

Clinical characteristics, breed differences, and quality of life in North American dogs with acute steroid-responsive meningitis-arteritis

Background

Steroid‐responsive meningitis‐arteritis (SRMA) is a common inflammatory neurologic disorder of dogs for which certain breeds are predisposed.

Objectives

To determine whether breed differences exist in clinical features, treatment response, and relapse in a population of North American dogs with SRMA, and to evaluate the effect of disease on dogs' quality of life (QoL).

Animals

Sixty‐one client‐owned dogs with SRMA: 29 dogs identified through an American Kennel Club‐Canine Health Foundation survey and 32 dogs from North Carolina (NC) State Veterinary Hospital.

Methods

Retrospective case series. Caregivers completed an online survey to assess QoL.

Results

Breeds represented most often included the Golden Retriever (n = 12), Bernese Mountain Dog (10), Wirehaired Pointing Griffon (9), Boxer (9), and Beagle (6). No breed differences were identified with respect to clinical severity, diagnostic findings, or outcome. Twenty‐nine dogs (48%) had ≥1 disease relapse. There was a significant effect of cerebrospinal fluid nucleated cell count on the frequency of disease relapse (P = .003), but no relationship was identified between treatment protocol and relapse. Dogs' QoL was associated with the severity of corticosteroid‐related adverse effects (P = .03), which were dose‐related (r = .24, P = .02) and more prevalent in Wirehaired Pointing Griffons than in other breeds (P = .04).

Conclusion and Clinical Importance

Golden Retrievers and Wirehaired Pointing Griffons should be considered among the breeds recognized to develop SRMA. Treatment with higher corticosteroid dosages is correlated with more severe adverse effects and worse QoL, but it may not improve clinical outcome.

A double-blinded randomised dietary supplement crossover trial design to investigate the short-term influence of medium chain fatty acid (MCT) supplement on canine idiopathic epilepsy: study protocol

Background

Epilepsy is the most common brain disease in dogs. Recently, diets have been reported to have a positive impact on seizure activity and behaviour in various species including dogs with idiopathic epilepsy (IE). Historically, classic high fat ketogenic diets (KD) and medium chain triglycerides (MCT) KD have been successfully used to manage drug-resistant epilepsy. Similarly, an MCT enriched diet has been shown to improve seizure control and behavioural comorbidities in some dogs with IE. However, it is unknown whether an MCT dietary supplement (DS) may provide similar positive effects.

Methods

A 6-month prospective, randomised, double-blinded, placebo-controlled, crossover, multicentre dietary trial is designed comparing a 9% metabolic energy based calculated medium-chain triglyceride (MCT) oil supplement to a conventional ‘control’ DS. Only dogs which will have an International Veterinary Epilepsy Task Force Tier II level like diagnosis of IE which satisfied the following inclusion criteria are included: age between 6 months and ≤ 12 years; weighing between 4 and ≤ 65 kg; unremarkable interictal neurological examinations; no clinically significant findings on routine laboratory diagnostics; unremarkable brain MRI scan; have had at least 3 seizures in the previous 3 months prior to enrolment; treated with at least one ASD and being classified as resistant. All dogs are fed initially for 90 ± 2 days with either the control oil or the MCT oil alongside their normal diet, followed by 97 ± 2 days with the other supplement including a 7-day washout period. Overall, the aim is to recruit thirty-six patients at five different centres and to investigate the effect of MCTs as DS on seizure activity, tolerability, behavioural comorbidities and quality of life (QoL).

Discussion

Dietary interventions are rarely studied in a standardised form in veterinary medicine. The background diet, the cohort of animals and ASD received is standardised in this prospective diet trial to ensure representative data about the potential effect of MCT DS. If the study data confirms former findings, this would provide further evidence for the efficacy of MCTs as a management option for canine epilepsy. This publication should offer a repository of trial conditions and variable description with forecasted statistical analysis.

Electronic supplementary material

The online version of this article (10.1186/s12917-019-1915-8) contains supplementary material, which is available to authorized users.

Common Neurologic Problems: Impact on Patient Welfare, Caregiver Burden and Veterinarian Wellbeing

Most neurologic diseases are incurable. Palliative care is vital in the treatment of companion animals with serious or chronic neurologic disease. A Neuropalliative Care Core Skill Set includes multifaceted communication competencies and symptom management. Because some of the most common clinical signs of neurologic disease are also associated with stress of caregiving, veterinarians should understand their clients' unique potential for caregiver burden. Acknowledging caregiver burden in their clients, means that veterinarians treating patients with neurologic disease must be proactive in building their own resilience to the occupational stress inherent in treating their patients and supporting their patients' caregivers.

Behavioral Interventions as an Adjunctive Treatment for Canine Epilepsy: A Missing Part of the Epilepsy Management Toolkit?

Epilepsy is a common, complex and often challenging neurological disorder to treat in the dog, with 20-30% of dogs resistant to conventional medical therapies, and associated with cognitive and behavioral comorbidities and early death. Behavioral interventions are an emerging area of focus in the adjunctive treatment of drug-resistant human epilepsy patients, with studies indicating positive effects of a variety of interventions including relaxation-based techniques and behavioral therapy interventions. Behavioral interventions have the potential not only to improve seizure control, but also improve behavioral comorbidities and general quality of life in this hard to treat patient group. Despite striking similarities between human and canine epilepsy patients, including the recognition of co-morbid anxiety in epilepsy patients, behavioral interventions have yet to be studied in dogs. This is compounded by several licensed psychopharmaceutical agents for dogs being contra-indicated in epilepsy patients. We present evidence from human studies of the efficacy of behavioral interventions to improve seizure control, psychiatric comorbidities and quality of life, and propose that adapting such interventions for canine patients may be a valuable addition to the epilepsy management toolkit. There is a need for multi-center, double-blinded, placebo-controlled trials to confirm the effects of behavioral interventions on seizure frequency in veterinary medicine. In the absence of such evidence to date, the use of established behavioral medicine techniques to reduce stress and improve the mental health of these often sensitive and challenging patients is advocated, with a greater role for behaviorists in the management of epilepsy patients alongside neurologists and general practitioners.

Seizure occurrence in dogs under primary veterinary care in the UK: prevalence and risk factors

Background

Primary‐care veterinary clinical records can offer data to determine generalizable epidemiological data on seizures occurrence in the dog population.

Objectives

To identify and examine epidemiologic characteristics of seizure occurrence in dogs under primary veterinary care in the UK participating in the VetCompass™ Programme.

Animals

455,553 dogs in VetCompass™’.

Methods

A cross‐sectional analysis estimated the 1‐year period prevalence and risk factors for dogs with seizures during 2013.

Results

The overall 1‐year period prevalence for dogs having at least one seizure during 2013 was 0.82% (95% CI 0.79‐0.84). Multivariable modelling identified breeds with elevated odd ratios [OR] compared with the Labrador Retriever (e.g. Pug OR: 3.41 95% CI 2.71‐4.28, P < 0.001). Males had higher risk for seizures (Male/Entire OR: 1.47 95% CI 1.30–1.66; Male/Neutered OR: 1.34 95% CI 1.19–1.51) compared to entire females. Age (3.00 ‐ ≤ 6.00 OR: 2.13 95% CI 1.90‐2.39, P < 0.001, compared to animals aged 0.50–≤ 3.00 years), and bodyweight (≥ 40.00kg, OR: 1.24 95% CI 1.08–1.41, P = 0.002, compared to animals weighing < 10.0 kg) were identified as risk factors for seizures.

Conclusion and clinical Importance

Seizures are a relatively common clinical finding in dogs. The results for breed, age, sex and bodyweight as risk factors can assist veterinarians in refining differential diagnosis lists for dogs reported with behaviors that may have been seizures. In addition, the prevalence values reported here can support pharmacovigilance with baseline data from the overall population.

Investigating owner use of dietary supplements in dogs with idiopathic epilepsy

Epilepsy is the most common chronic neurological disorder in dogs. Some diets have been shown to have a positive impact upon the seizure activity in dogs with idiopathic epilepsy (IE), while other diets and dietary supplements (DS), although marketed as providing health benefits, lack conclusive scientific evidence on their actual beneficial effects. A web-based owner questionnaire was designed to assess how and why owners of dogs with IE use different dietary regimes and DS. The study cohort, with 297 valid responses, consisted mainly of pure-breed (82.5%) male neutered (52.9%) dogs. Over two-thirds of owners (67.7%) changed their dog's diet after their dog received a diagnosis of IE. Nearly half of the owners (45.8%) reported giving DS, the most common being coconut oil or derived medium-chain triglyceride oil (71.3%). Some owner justifications of DS use included improvement of seizure frequency (88.2%), seizure severity (61.8%) and protection from potential drug side effects (62.5%). Many owners give DS to their dog with IE. The pharmacokinetic properties of anti-epileptic drugs, such as efficacy, absorption and clearance can be influenced by other medications, diets and possibly by DS. We propose that use of DS should be considered and monitored by veterinary surgeons in epilepsy management.

Grey matter volume in healthy and epileptic beagles using voxel-based morphometry - a pilot study

BACKGROUND

One of the most common chronic neurological disorders in dogs is idiopathic epilepsy (IE) diagnosed as epilepsy without structural changes in the brain. In the current study the hypothesis should be proven that subtle grey matter changes occur in epileptic dogs. Therefore, magnetic resonance (MR) images of one dog breed (Beagles) were used to obtain an approximately uniform brain shape. Local differences in grey matter volume (GMV) were compared between 5 healthy Beagles and 10 Beagles with spontaneously recurrent seizures (5 dogs with IE and 5 dogs with structural epilepsy (SE)), using voxel-based morphometry (VBM). T1W images of all dogs were prepared using Amira 6.3.0 for brain extraction, FSL 4.1.8 for registration and SPM12 for realignment. After creation of tissue probability maps of cerebrospinal fluid, grey and white matter from control images to segment all extracted brains, GM templates for each group were constructed to normalize brain images for parametric statistical analysis, which was achieved using SPM12.

RESULTS

Epileptic Beagles (IE and SE Beagles) displayed statistically significant reduced GMV in olfactory bulb, cingulate gyrus, hippocampus and cortex, especially in temporal and occipital lobes. Beagles with IE showed statistically significant decreased GMV in olfactory bulb, cortex of parietal and temporal lobe, hippocampus and cingulate gyrus, Beagles with SE mild statistically significant GMV reduction in temporal lobe (p < 0.05; family- wise error correction).

CONCLUSION

These results suggest that, as reported in epileptic humans, focal reduction in GMV also occurs in epileptic dogs. Furthermore, the current study shows that VBM analysis represents an excellent method to detect GMV differences of the brain between a healthy dog group and dogs with epileptic syndrome, when MR images of one breed are used.

Cognitive dysfunction in naturally occurring canine idiopathic epilepsy

Globally, epilepsy is a common serious brain disorder. In addition to seizure activity, epilepsy is associated with cognitive impairments including static cognitive impairments present at onset, progressive seizure-induced impairments and co-morbid dementia. Epilepsy occurs naturally in domestic dogs but its impact on canine cognition has yet to be studied, despite canine cognitive dysfunction (CCD) recognised as a spontaneous model of dementia. Here we use data from a psychometrically validated tool, the canine cognitive dysfunction rating (CCDR) scale, to compare cognitive dysfunction in dogs diagnosed with idiopathic epilepsy (IE) with controls while accounting for age. An online cross-sectional study resulted in a sample of 4051 dogs, of which n = 286 had been diagnosed with IE. Four factors were significantly associated with a diagnosis of CCD (above the diagnostic cut-off of CCDR ≥50): (i) epilepsy diagnosis: dogs with epilepsy were at higher risk; (ii) age: older dogs were at higher risk; (iii) weight: lighter dogs (kg) were at higher risk; (iv) training history: dogs with more exposure to training activities were at lower risk. Impairments in memory were most common in dogs with IE, but progression of impairments was not observed compared to controls. A significant interaction between epilepsy and age was identified, with IE dogs exhibiting a higher risk of CCD at a young age, while control dogs followed the expected pattern of low-risk throughout middle age, with risk increasing exponentially in geriatric years. Within the IE sub-population, dogs with a history of cluster seizures and high seizure frequency had higher CCDR scores. The age of onset, nature and progression of cognitive impairment in the current IE dogs appear divergent from those classically seen in CCD. Longitudinal monitoring of cognitive function from seizure onset is required to further characterise these impairments.

Physiological reactivity to spontaneously occurring seizure activity in dogs with epilepsy and their carers

There is a complex bidirectional relationship between stress and epilepsy. Stressful stimuli and subsequent cortisol release act as a trigger for seizure activity in some individuals with epilepsy, and seizure activity itself may act as a stressor to the affected individual. Epilepsy is the most common chronic neurological condition in domestic dogs and requires chronic management by their human carers, impacting upon the quality of life of both dog and carer. Seizures occur unpredictably and may be stressful for carers to witness and manage. In the present study we investigated the role of seizure activity as a stressor, measuring the effect of spontaneously occurring seizure activity in dogs with epilepsy upon their own cortisol levels and that of their carers. Furthermore, we tested whether individual differences in HPA reactivity were associated with owner personality characteristics and the quality of the dog-carer relationship. Saliva samples were obtained from sixteen dog-carer dyads in the home setting 20 and 40minute post-seizure, and at time-matched points on the following (non-seizure) day. Significant differences in cortisol levels were found in dogs at 40minute post-seizure (265.1% increase), and at 20minute post-seizure in their carers (40.5% increase). No associations were found between cortisol reactivity and the strength of the dog-carer bond. Carers with higher neuroticism scores exhibited higher cortisol levels at both post-seizure sampling points. As there was a gender bias in the carer sample (15/16 were female), and there are known sex differences in cortisol reactivity in response to psychological stress, the conclusions of this study may be limited to female carers. These findings are the first to objectively demonstrate the acutely stressful effects of seizures in dogs with epilepsy and their carers.

Investigating the potential of the anti-epileptic drug imepitoin as a treatment for co-morbid anxiety in dogs with idiopathic epilepsy

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 GABA_A 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.