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Kajin F, Meyerhoff N, Charalambous M, Volk HA. "Resistance Is Futile": A Pilot Study into Pseudoresistance in Canine Epilepsy. Animals (Basel) 2023; 13:3125. [PMID: 37835731 PMCID: PMC10571656 DOI: 10.3390/ani13193125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 09/30/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
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.
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Affiliation(s)
- Filip Kajin
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, 30559 Hannover, Germany; (F.K.); (N.M.); (M.C.)
- Clinic for Internal Diseases, Faculty of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Nina Meyerhoff
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, 30559 Hannover, Germany; (F.K.); (N.M.); (M.C.)
| | - Marios Charalambous
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, 30559 Hannover, Germany; (F.K.); (N.M.); (M.C.)
| | - Holger Andreas Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, 30559 Hannover, Germany; (F.K.); (N.M.); (M.C.)
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Potschka H, Fischer A, Löscher W, Volk HA. Pathophysiology of drug-resistant canine epilepsy. Vet J 2023; 296-297:105990. [PMID: 37150317 DOI: 10.1016/j.tvjl.2023.105990] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 05/09/2023]
Abstract
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.
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Affiliation(s)
- Heidrun Potschka
- Institute of Pharmacology, Toxicology, and Pharmacy, Ludwig-Maximilians-University, Munich, Germany.
| | - Andrea Fischer
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-University, Munich, Germany
| | - Wolfgang Löscher
- Department of Pharmacology, Toxicology, and Pharmacy, University of Veterinary Medicine, Hannover, Germany; Center for Systems Neuroscience, Hannover, Germany
| | - Holger A Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
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Herzig R, Beckmann K, Körner M, Steffen F, Rohrer Bley C. A shortened whole brain radiation therapy protocol for meningoencephalitis of unknown origin in dogs. Front Vet Sci 2023; 10:1132736. [PMID: 37020978 PMCID: PMC10069678 DOI: 10.3389/fvets.2023.1132736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/28/2023] [Indexed: 04/07/2023] Open
Abstract
Introduction A variety of treatment options have been described for canine meningoencephalitis of unknown origin (MUO). Few studies focused on radiation therapy as a second line immunomodulating treatment, implicating its effective use. However, a standard radiation therapy protocol is lacking, and further research will help to evaluate the effect of different dose regimens. Methods Ten dogs diagnosed with MUO based on MRI and CSF findings were prospectively enrolled. The dogs were treated with a shortened whole brain radiation therapy protocol (5 × 4 Gy) in combination with prednisolone. Neurologic changes were quantified using an established scoring scheme. Follow-up MRI and CSF examination was scheduled three months after radiation therapy. Overall survival and time to progression were calculated. Histopathology of the brain was performed in case of death. Results Seven dogs were diagnosed de novo and three had a history of relapsing MUO. Neurological status improved in all 10 dogs during radiation therapy, with 4/10 returning to normal shortly after radiation therapy. Three dogs died within the first three months after radiation therapy. At follow-up MRI lesions completely resolved in two dogs, partially resolved in five dogs, and progressed in one dog. After follow-up MRI, dogs were further treated with prednisolone monotherapy (two dogs) and additional immunosuppressant drugs (five dogs). Overall, four dogs showed disease progression, with a mean time to progression of 691 days (95%CI: 396-987) and mean overall survival for all dogs was 723 days (95%CI: 436-1011) (both medians not reached). Histopathology confirmed MUO in three dogs but was suggestive for oligodendroglioma in one dog. Radiation induced side effects were not seen. Conclusion Shortened whole-brain radiation therapy could be an additional treatment option for MUO in conjunction to prednisolone, specifically for cases that require rapid relief of symptoms and with relapsing history.
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Affiliation(s)
- Robert Herzig
- Division of Neurology, Department for Small Animals, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
- *Correspondence: Robert Herzig
| | - Katrin Beckmann
- Division of Neurology, Department for Small Animals, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
| | - Maximilian Körner
- Division of Radiation Oncology, Department for Small Animals, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
| | - Frank Steffen
- Division of Neurology, Department for Small Animals, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
| | - Carla Rohrer Bley
- Division of Radiation Oncology, Department for Small Animals, Vetsuisse Faculty, University of Zurich, Zürich, Switzerland
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Phillipps S, Schiborra F, Nagendran A. Late‐onset seizures in a domestic shorthaired cat with global brain ischaemia and cortical laminar necrosis. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Stephanie Phillipps
- Institute of Infection Veterinary and Ecological Sciences Small Animal Teaching Hospital University of Liverpool Neston Cheshire UK
| | - Frederike Schiborra
- Institute of Infection Veterinary and Ecological Sciences Small Animal Teaching Hospital University of Liverpool Neston Cheshire UK
| | - Aran Nagendran
- Institute of Infection Veterinary and Ecological Sciences Small Animal Teaching Hospital University of Liverpool Neston Cheshire UK
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Parker RL, Du J, Shinn RL, Drury AG, Hsu FC, Roberston JL, Cecere TE, Arendse AU, Rossmeisl JH. Incidence, risk factors, and outcomes for early postoperative seizures in dogs with rostrotentorial brain tumors after intracranial surgery. J Vet Intern Med 2022; 36:694-701. [PMID: 35170074 PMCID: PMC8965238 DOI: 10.1111/jvim.16391] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 12/28/2022] Open
Abstract
Background Seizures in the early postoperative period after intracranial surgery may affect outcome in dogs. Objectives To determine the incidence of early postoperative seizures (EPS) in dogs with brain tumors, identify specific risk factors for EPS, and determine if EPS affects outcome. Animals Eighty‐eight dogs that underwent 125 intracranial surgeries for diagnosis and treatment of rostrotentorial brain tumors. Methods Retrospective cohort study. All patients with a diagnosis of rostrotentorial brain tumor from 2006 to 2020 were included. Early postoperative seizures were diagnosed by observation of seizure activity within 14 days of neurosurgery. Previously diagnosed structural epilepsy, perioperative anticonvulsant drug (ACD) use, magnetic resonance imaging (MRI), and tumor characteristics were evaluated. Outcome measures included neurologic and nonneurologic complications, duration of hospitalization, and survival to discharge. Results Dogs with rostrotentorial brain tumors had EPS after 16/125 (12.8%) neurosurgical procedures (95% confidence interval [CI], 7%‐19%). Presence of previous structural epilepsy was not associated with EPS risk (P = 1). Perioperative ACD use also was not associated with EPS (P = .06). Dogs with EPS had longer hospitalization (P < .001), were more likely to have neurologic complications postsurgery (P = .01), and were less likely to survive to discharge (P = .01). Conclusions and Clinical Importance It is difficult to predict which dogs are at risk of EPS because the presence of previous structural epilepsy and the use of perioperative ACDs was not associated with EPS. However, seizures in the early postoperative period are clinically important because affected dogs had prolonged hospitalization, more neurologic complications, and decreased short‐term survival.
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Affiliation(s)
- Rell L Parker
- Veterinary and Comparative Neuro-oncology Laboratory, Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia, USA
| | - John Du
- Veterinary and Comparative Neuro-oncology Laboratory, Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia, USA
| | - Richard L Shinn
- Veterinary and Comparative Neuro-oncology Laboratory, Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia, USA
| | - Adam G Drury
- Veterinary and Comparative Neuro-oncology Laboratory, Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia, USA
| | - Fang-Chi Hsu
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Comprehensive Cancer Center and Brain Tumor Center of Excellence, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - John L Roberston
- Veterinary and Comparative Neuro-oncology Laboratory, Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia, USA.,Comprehensive Cancer Center and Brain Tumor Center of Excellence, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Thomas E Cecere
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia, USA
| | - Avril U Arendse
- Veterinary and Comparative Neuro-oncology Laboratory, Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia, USA
| | - John H Rossmeisl
- Veterinary and Comparative Neuro-oncology Laboratory, Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia, USA.,Comprehensive Cancer Center and Brain Tumor Center of Excellence, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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