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Musteata M, Ștefănescu R, Borcea DG, Solcan G. Very-Low-Frequency Spike-Wave Complex Partial Motor Seizure Mimicking Canine Idiopathic Head Tremor Syndrome in a Dog. Vet Sci 2023; 10:472. [PMID: 37505876 PMCID: PMC10383875 DOI: 10.3390/vetsci10070472] [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: 06/01/2023] [Revised: 07/12/2023] [Accepted: 07/18/2023] [Indexed: 07/29/2023] Open
Abstract
Canine idiopathic head tremor syndrome (CIHTS) represents a benign condition characterized by episodic, uncontrolled movement of the head. Even though the condition might be an expression of a partial motor epilepsy, to date, there is a limited number of studies describing the electroencephalographic features. In this report, we describe the case of a dog diagnosed with partial motor epilepsy resembling CIHTS symptomatology, a new slow spike-wave complex pattern similar to that of Lennox-Gastaut syndrome in humans identified on electroencephalographic examination. We also studied the efficacy of phenobarbitone therapy over a period of two years.
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Affiliation(s)
- Mihai Musteata
- Neurology Service, Faculty of Veterinary Medicine, Ion Ionescu de la Brad Iași University of Life Sciences, 700489 Iași, Romania
| | - Raluca Ștefănescu
- Neurology Service, Faculty of Veterinary Medicine, Ion Ionescu de la Brad Iași University of Life Sciences, 700489 Iași, Romania
| | - Denis Gabriel Borcea
- Neurology Service, Faculty of Veterinary Medicine, Ion Ionescu de la Brad Iași University of Life Sciences, 700489 Iași, Romania
| | - Gheorghe Solcan
- Internal Medicine Clinic, Faculty of Veterinary Medicine, Ion Ionescu de la Brad Iași University of Life Sciences, 700489 Iași, Romania
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Kriechbaumer SRP, Jurina K, Wielaender F, Schenk HC, Steinberg TA, Reese S, Buhmann G, Doerfelt S, Potschka H, Fischer A. Pregabalin Add-On vs. Dose Increase in Levetiracetam Add-On Treatment: A Real-Life Trial in Dogs With Drug-Resistant Epilepsy. Front Vet Sci 2022; 9:910038. [PMID: 35873699 PMCID: PMC9298511 DOI: 10.3389/fvets.2022.910038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Epilepsy is a common neurological disorder affecting 0.6–0.75% of dogs in veterinary practice. Treatment is frequently complicated by the occurrence of drug-resistant epilepsy and cluster seizures in dogs with idiopathic epilepsy. Only few studies are available to guide treatment choices beyond licensed veterinary drugs. The aim of the study was to compare antiseizure efficacy and tolerability of two add-on treatment strategies in dogs with drug-resistant idiopathic epilepsy. The study design was a prospective, open-label, non-blinded, comparative treatment trial. Treatment success was defined as a 3-fold extension of the longest baseline interseizure interval and to a minimum of 3 months. To avoid prolonged adherence to a presumably ineffective treatment strategy, dog owners could leave the study after the third day with generalized seizures if the interseizure interval failed to show a relevant increase. Twenty-six dogs (mean age 5.5 years, mean seizure frequency 4/month) with drug-resistant idiopathic epilepsy and a history of cluster seizures were included. Dogs received either add-on treatment with pregabalin (PGB) 4 mg/kg twice daily (14 dogs) or a dose increase in levetiracetam (LEV) add-on treatment (12 dogs). Thirteen dogs in the PGB group had drug levels within the therapeutic range for humans. Two dogs in the PGB group (14.3%; 2/14) and one dog in the LEV group (8.3%; 1/12) achieved treatment success with long seizure-free intervals from 122 to 219 days but then relapsed to their early seizure frequency 10 months after the study inclusion. The overall low success rates with both treatment strategies likely reflect a real-life situation in canine drug-resistant idiopathic epilepsy in everyday veterinary practice. These results delineate the need for research on better pharmacologic and non-pharmacologic treatment strategies in dogs with drug-resistant epilepsy.
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Affiliation(s)
- Sandra R. P. Kriechbaumer
- Centre for Clinical Veterinary Medicine, Clinic of Small Animal Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
- AniCura Small Animal Clinic Haar, Haar, Germany
| | | | - Franziska Wielaender
- Centre for Clinical Veterinary Medicine, Clinic of Small Animal Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Henning C. Schenk
- Centre for Clinical Veterinary Medicine, Clinic of Small Animal Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
- Small Animal Clinic Lüneburg, Lüneburg, Germany
| | | | - Sven Reese
- Department of Veterinary Sciences, Institute of Anatomy, Histology and Embryology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Gesine Buhmann
- Centre for Clinical Veterinary Medicine, Clinic of Small Animal Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Stefanie Doerfelt
- Centre for Clinical Veterinary Medicine, Clinic of Small Animal Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
- AniCura Small Animal Clinic Haar, Haar, Germany
| | - Heidrun Potschka
- Department of Veterinary Sciences, Institute of Pharmacology, Toxicology, and Pharmacy, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Andrea Fischer
- Centre for Clinical Veterinary Medicine, Clinic of Small Animal Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
- *Correspondence: Andrea Fischer
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Fischer A, Hülsmeyer VI, Munoz Schmieder VP, Tipold A, Kornberg M, König F, Gesell FK, Ahrend LK, Volk HA, Potschka H. Cyclooxygenase-2 Inhibition as an Add-On Strategy in Drug Resistant Epilepsy—A Canine Translational Study. Front Vet Sci 2022; 9:864293. [PMID: 35464372 PMCID: PMC9021788 DOI: 10.3389/fvets.2022.864293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Drug-resistant epilepsy is a common complaint in dogs and affects up to 30% of dogs with idiopathic epilepsy. Experimental data suggest that targeting cyclooxygenase-2 (COX-2) mediated signaling might limit excessive excitability and prevent ictogenesis. Moreover, the role of COX-2 signaling in the seizure-associated induction of P-glycoprotein has been described. Thus, targeting this pathway may improve seizure control based on disease-modifying effects as well as enhancement of brain access and efficacy of the co-administered antiseizure medication. The present open-label non-controlled pilot study investigated the efficacy and tolerability of a COX-2 inhibitor (firocoxib) add-on therapy in a translational natural occurring chronic epilepsy animal model (client-owned dogs with phenobarbital-resistant idiopathic epilepsy). The study cohort was characterized by frequent tonic–clonic seizures and cluster seizures despite adequate phenobarbital treatment. Enrolled dogs (n = 17) received a firocoxib add-on therapy for 6 months. Tonic–clonic seizure and cluster seizure frequencies were analyzed at baseline (6 months) months during the study (6 months). The responders were defined by a substantial reduction of tonic–clonic seizure and cluster seizure frequency (≥50%). In total, eleven dogs completed the study and were considered for the statistical analysis. Two dogs (18%, 2/11) were classified as responders based on their change in seizure frequency. Interestingly, those two dogs had the highest baseline seizure frequency. The overall tolerability was good. However, given the low percentage of responders, the present data do not support an overall considerable efficacy of COX-2 inhibitor add-on therapy to overcome naturally occurring phenobarbital-resistant epilepsy in dogs. Further translational evaluation should only be considered in the canine patients with a very high baseline seizure density.
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Affiliation(s)
- Andrea Fischer
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-University Munich (LMU), Munich, Germany
- *Correspondence: Andrea Fischer
| | - Velia-Isabel Hülsmeyer
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-University Munich (LMU), Munich, Germany
| | - Viviana P. Munoz Schmieder
- Clinic of Small Animal Medicine, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-University Munich (LMU), Munich, Germany
| | - Andrea Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
| | | | - Florian König
- Small Animal Practice Dr. Florian König, Wiesbaden, Germany
| | - Felix K. Gesell
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
| | - Liza K. Ahrend
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
| | - Holger A. Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hannover, Germany
| | - Heidrun Potschka
- Institute of Pharmacology, Toxicology, and Pharmacy, Ludwig-Maximilians-University Munich, Munich, Germany
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Erath JR, Nessler JN, Riese F, Hünerfauth E, Rohn K, Tipold A. Behavioral Changes Under Levetiracetam Treatment in Dogs. Front Vet Sci 2020; 7:169. [PMID: 32318589 PMCID: PMC7146871 DOI: 10.3389/fvets.2020.00169] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 03/10/2020] [Indexed: 11/13/2022] Open
Abstract
In veterinary medicine levetiracetam (LEV) is a well-tolerated antiepileptic drug (AED) with only mild to moderate side effects. Behavioral changes are rarely reported in animals. In contrast, in human medicine the impact of LEV on behavior has frequently been described. Since in the Clinic for Small Animals at the University of Veterinary Medicine Hannover single canine patients were observed with behavioral abnormalities after LEV treatment, it was hypothesized that levetiracetam induces behavioral changes or causes an intensifying of pre-existing behavioral abnormalities in dogs with epileptic seizures. This monocentric retrospective study evaluated the incidence of behavioral changes in epileptic dogs treated with the antiepileptic drug LEV based on information obtained in a questionnaire completed by dog owners. Eighty-four client-owned dogs with recurrent seizures receiving LEV as monotherapy, add on treatment or pulse therapy met inclusion criteria. Approximately half of the dogs in the study population were reported to have preexisting behavioral changes before treatment with LEV, and some of these dogs were reported to experience a worsening of behavioral changes (14/44) or the emergence of new behaviors after initiation of LEV therapy (4/44). One quarter of the dogs without pre-existing behavioral abnormalities developed behavioral changes associated with the administration of LEV (10/40). Based on these results, the authors conclude that behavioral changes can occur in dogs being administered LEV, and this should be taken into consideration when discussing treatment options with owners.
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Affiliation(s)
- Johannes Roland Erath
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hanover, Germany
| | - Jasmin Nicole Nessler
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hanover, Germany
| | - Franziska Riese
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hanover, Germany
| | - Enrice Hünerfauth
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hanover, Germany
| | - Karl Rohn
- Institute for Biometry, Epidemiology and Information Processing, University of Veterinary Medicine, Hanover, Germany
| | - Andrea Tipold
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine, Hanover, Germany
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Fukunaga K, Matsumoto H, Wate M, Misawa K, Saito M, Matsuda H, Orito K. Effects of three infusion fluids with different sodium chloride contents on steady-state serum concentrations of bromide in dogs. J Vet Pharmacol Ther 2018; 41:684-690. [PMID: 30020534 DOI: 10.1111/jvp.12680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/08/2018] [Indexed: 12/18/2022]
Abstract
Potassium bromide overdose (bromism) in the management of canine epilepsy has been known. However, a protocol to reduce bromide concentrations rapidly has not been previously established. The effects of three infusion fluids with different chloride contents on the steady-state serum concentrations of bromide in beagles were determined. After stabilization of the serum bromide concentrations, seven dogs were infused with saline (Na+ 154 mmol/L; Cl- 154 mmol/L), lactated Ringer's (Na+ 131 mmol/L; Cl- 110 mmol/L), or maintenance solutions (Na+ 35 mmol/L; Cl- 35 mmol/L) at a rate of 2 or 10 ml kg-1 hr-1 for 5 hr. Serum and urine were collected hourly, and the bromide concentrations were measured. When saline and lactated Ringer's solutions were infused at a rate of 10 ml kg-1 hr-1 for 5 hr, serum bromide concentrations were decreased by 14.24% and urine bromide concentrations by 17.63%, respectively. Of all compositions of infusion fluids, only sodium and chloride contents were associated with the decreased serum concentrations and the increased renal clearance of bromide. In summary, saline and lactated Ringer's solutions reduced serum bromide concentrations in a sodium chloride-dependent manner in dogs were found when infused at 10 ml kg-1 hr-1 for 5 hr.
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Affiliation(s)
- Koya Fukunaga
- Laboratory for Pharmacogenomics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan.,Department of Physiology II, School of Veterinary Medicine, Azabu University, Sagamihara, Japan
| | - Hikaru Matsumoto
- Department of Physiology II, School of Veterinary Medicine, Azabu University, Sagamihara, Japan
| | - Michiko Wate
- Laboratory of Veterinary Surgery II, School of Veterinary Medicine, Azabu University, Sagamihara, Japan
| | - Karin Misawa
- Laboratory of Veterinary Surgery II, School of Veterinary Medicine, Azabu University, Sagamihara, Japan
| | - Miyoko Saito
- Laboratory of Veterinary Surgery II, School of Veterinary Medicine, Azabu University, Sagamihara, Japan
| | - Hiroshi Matsuda
- Laboratory of Veterinary Molecular Pathology and Therapeutics, Institute of Agriculture, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Kensuke Orito
- Department of Physiology II, School of Veterinary Medicine, Azabu University, Sagamihara, Japan
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Packer RMA, De Risio L, Volk HA. Investigating the potential of the anti-epileptic drug imepitoin as a treatment for co-morbid anxiety in dogs with idiopathic epilepsy. BMC Vet Res 2017; 13:90. [PMID: 28388948 PMCID: PMC5383962 DOI: 10.1186/s12917-017-1000-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 03/24/2017] [Indexed: 01/20/2023] Open
Abstract
Background Behavioural changes associated with idiopathic epilepsy (IE) have been identified in dogs, with fear and anxiety-related problems seen in both drug-naïve dogs and dogs treated with anti-epileptic drugs (AEDs). Treating anxiety-related behaviour in dogs with IE may be challenging, as seizures are a contraindication for many conventional anxiolytic drugs. In addition, many dogs with IE are already treated with AEDs to reduce their seizure frequency, which may have negative effects if used in polytherapy. Imepitoin is low-affinity partial agonist at the benzodiazepine (BDZ) site of the GABAA receptor, and has been demonstrated to have both anticonvulsant and anxiolytic effects in laboratory rodents. Imepitoin has been developed for the treatment of IE in dogs, with demonstrated anticonvulsant effects and high tolerability and safety. To date, imepitoin’s potential to reduce anxiety in dogs with IE has not been investigated. An online survey was conducted to investigate the effect of imepitoin on fear and anxiety-related behaviours in dogs with IE. Eighty-five valid responses were received from owners of dogs with IE currently treated with imepitoin. Anxiety-related behaviour was quantified before and during imepitoin treatment using a validated questionnaire tool (C-BARQ). Results No differences were observed in the five fear/anxiety-related measures between the two time periods (before vs. during treatment) for dog directed fear, stranger directed fear, non-social fear, pain sensitivity and separation related behaviour. A median 45% reduction in seizure frequency/month was observed following imepitoin treatment; however, imepitoin did not appear effective in reducing seizure frequency in a minority of cases. Polyphagia was the most common chronic side effect, and more side effects were reported in polytherapy cases. Conclusions Imepitoin does not appear to improve anxiety-related behaviour in dogs with IE treated with this medication for its anti-epileptic effects. Investigating the effects of imepitoin upon the behaviour of dogs with recognised behavioural anxiety-related problems (e.g. specific fears and phobias, separation related behaviours), in both healthy dogs and dogs with epilepsy is required to further explore any potential anxiolytic effects of this medication.
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Affiliation(s)
- Rowena M A Packer
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, Hertfordshire, AL9 7TA, UK.
| | | | - Holger A Volk
- Department of Clinical Science and Services, Royal Veterinary College, Hatfield, Hertfordshire, AL9 7TA, UK
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