International Veterinary Epilepsy Task Force consensus proposal: medical treatment of canine epilepsy in Europe

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Abstract

In Europe, the number of antiepileptic drugs (AEDs) licensed for dogs has grown considerably over the last years. Nevertheless, the same questions remain, which include, 1) when to start treatment, 2) which drug is best used initially, 3) which adjunctive AED can be advised if treatment with the initial drug is unsatisfactory, and 4) when treatment changes should be considered. In this consensus proposal, an overview is given on the aim of AED treatment, when to start long-term treatment in canine epilepsy and which veterinary AEDs are currently in use for dogs. The consensus proposal for drug treatment protocols, 1) is based on current published evidence-based literature, 2) considers the current legal framework of the cascade regulation for the prescription of veterinary drugs in Europe, and 3) reflects the authors’ experience. With this paper it is aimed to provide a consensus for the management of canine idiopathic epilepsy. Furthermore, for the management of structural epilepsy AEDs are inevitable in addition to treating the underlying cause, if possible.

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Most cited references 128

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The mechanisms of action of gabapentin and pregabalin.

Graeme J. Sills (2006)

Gabapentin and pregabalin are structurally related compounds with recognized efficacy in the treatment of both epilepsy and neuropathic pain. The pharmacological mechanisms by which these agents exert their clinical effects have, until recently, remained unclear. The interaction of gabapentin and pregabalin with conventional antiepileptic and analgesic drug targets is likely to be modest, at best, and has been largely dismissed in favour of a selective inhibitory effect on voltage-gated calcium channels containing the alpha2delta-1 subunit. This mechanism is consistently observed in both rodent- and human-based experimental paradigms and may be sufficiently robust to account for much of the clinical activity of these compounds.

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Temporal lobe epilepsy with hippocampal sclerosis: predictors for long-term surgical outcome.

Thomas R. Schulz, Felix A. Ebner, J Janszky … (2005)

Temporal lobe epilepsy (TLE) accompanied by hippocampal sclerosis (HS) is the type of epilepsy most frequently operated on. The predictors for long-term seizure freedom after surgery of TLE-HS are unknown. In this study, we aimed to identify prognostic factors which predict the outcome 6 months and 2, 3 and 5 years after epilepsy surgery of TLE-HS. Our working hypothesis was that the prognostic value of potential predictors depended on the post-operative time interval for which the assessment was made. We included 171 patients (100 females and 71 males, aged 16-59 years) who had undergone presurgical evaluation, including video-EEG, who had had MRI-defined HS, and who had undergone temporal lobectomy. We found that secondarily generalized seizures (SGTCS) and ictal dystonia were associated with a worse 2-year outcome. Both these variables together with older age and longer epilepsy duration were also related to a worse 3-year outcome. Ictal limb dystonia, older age and longer epilepsy duration were associated with long-term surgical failure evaluated 5 years post-operatively. In order to determine the independent predictors of outcomes, we calculated multivariate analyses. The presence of SGTCS and ictal dystonia independently predicted the 2-year outcome. Longer epilepsy duration and ictal dystonia predicted the 3-year outcome. Longer epilepsy duration (P = 0.003) predicted a poor 5-year outcome. Conclusively, predictors for the long-term surgical results of TLE with HS are different from those variables that predict the short-term outcome. Epilepsy duration is the most important predictor for long-term surgical outcome. Our results strongly suggest that surgery for TLE-HS should be performed as early as possible.

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Premature death, risk factors, and life patterns in dogs with epilepsy.

Mette Berendt, Hanne Gredal, Annette Kjær Ersbøll … (2007)

Epilepsy in dogs is often difficult to medically control, resulting in premature death of dogs with epilepsy. However, the risks of premature death are not known. Dogs with epilepsy have an increased risk of premature death as compared to a general population of dogs. Sixty-three dogs diagnosed with epilepsy between 1993 and 1996 were included in this study. A prospective longitudinal study of the population was performed from the diagnosis of epilepsy until the time of euthanasia, death, or a maximum of 12 years to investigate mortality and risk factors. Information about sex, onset, type, frequency, and control of seizures, remission of epilepsy, death, cause of death, and owner's perspective was collected and analyzed. The median age at death of dogs was 7.0 years. The life span of dogs in which euthanasia or death was directly caused by their epileptic condition was significantly shorter as compared with epileptic dogs that were euthanized because of other causes (P = .001). The median number of years that a dog lived with epilepsy was 2.3 years. Females lived longer with epilepsy than males (P = .036). Seizure type (primary generalized versus focal seizures) was not significantly associated with survival time. The remission rate of epilepsy (spontaneous remission and remission with treatment) was 15%. The diagnosis of epilepsy implies an increased risk of premature death. The prognosis for dogs with epilepsy is dependent on a combination of veterinary expertise, therapeutic success, and the owner's motivation.

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Contributors

Sofie F.M. Bhatti: sofie.bhatti@ugent.be

Luisa De Risio: luisa.derisio@aht.org.uk

Karen Muñana: krmunana@ncsu.edu

Jacques Penderis: jacques.penderis@vet-neurology.co.uk

Veronika M. Stein: Veronika.Stein@tiho-hannover.de

Andrea Tipold: Andrea.Tipold@tiho-hannover.de

Mette Berendt: mbe@sund.ku.dk

Robyn G. Farquhar: robyn.fernside@googlemail.com

Andrea Fischer: andreafischer@lmu.de

Sam Long: snlong@unimelb.edu.au

Wolfgang Löscher: Wolfgang.Loescher@tiho-hannover.de

Paul J.J. Mandigers: P.J.J.Mandigers@uu.nl

Kaspar Matiasek: matiasek@patho.vetmed.uni-muenchen.de

Akos Pakozdy: akos.pakozdy@vetmeduni.ac.at

Edward E. Patterson: patte037@umn.edu

Simon Platt: srplatt@uga.edu

Michael Podell: mpodell@comcast.net

Heidrun Potschka: potschka@pharmtox.vetmed.uni-muenchen.de

Clare Rusbridge: ClareR@fitzpatrickreferrals.co.uk

Holger A. Volk: hvolk@rvc.ac.uk

Journal

Journal ID (nlm-ta): BMC Vet Res

Journal ID (iso-abbrev): BMC Vet. Res

Title: BMC Veterinary Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1746-6148

Publication date (Electronic): 28 August 2015

Publication date PMC-release: 28 August 2015

Publication date Collection: 2015

Volume: 11

Electronic Location Identifier: 176

Affiliations

[ ]Department of Small Animal Medicine and Clinical Biology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, Merelbeke, 9820 Belgium

[ ]Animal Health Trust, Lanwades Park, Kentford, Newmarket, CB8 7UU Suffolk, United Kingdom

[ ]Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1052 William Moore Drive, Raleigh, NC 27607 USA

[ ]Vet Extra Neurology, Broadleys Veterinary Hospital, Craig Leith Road, Stirling, FK7 7LE Stirlingshire United Kingdom

[ ]Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Bünteweg 9, 30559 Hannover, Germany

[ ]Department of Veterinary and Clinical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg C, Denmark

[ ]Fernside Veterinary Centre, 205 Shenley Road, Borehamwood, SG9 0TH Hertfordshire, United Kingdom

[ ]Clinical Veterinary Medicine, Ludwig-Maximillians-University, Veterinärstr. 13, 80539 Munich, Germany

[ ]University of Melbourne, 250 Princes Highway, Weibee, 3015 VIC Australia

[ ]Department of Pharmacology, Toxicology and Pharmacy, University of Veterinary Medicine Hannover, Bünteweg 17, 30559 Hannover, Germany

[ ]Department of Clinical Sciences of Companion Animals, Utrecht University, Yalelaan 108, 3583 CM Utrecht, The Netherlands

[ ]Section of Clinical & Comparative Neuropathology, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-University, Veterinärstr. 13, 80539 Munich, Germany

[ ]Clinical Unit of Internal Medicine Small Animals, University of Veterinary Medicine, Veterinärplatz 1, 1210 Vienna, Austria

[ ]University of Minnesota College of Veterinary Medicine, D426 Veterinary Medical Center, 1352 Boyd Avenue, St. Paul, MN 55108 USA

[ ]College of Veterinary Medicine, University of Georgia, 501 DW Brooks Drive, Athens, GA 30602 USA

[ ]Chicago Veterinary Neurology and Neurosurgery, 3123 N. Clybourn Avenue, Chicago, IL 60618 USA

[ ]Department of Pharmacology, Toxicology and Pharmacy, Ludwig-Maximillians-University, Königinstr. 16, 80539 Munich, Germany

[ ]Fitzpatrick Referrals, Halfway Lane, Eashing, Godalming, GU7 2QQ Surrey, United Kingdom

[ ]School of Veterinary Medicine, Faculty of Health & Medical Sciences, University of Surrey, Guildford, GU2 7TE Surrey, United Kingdom

[ ]Department of Clinical Science and Services, Royal Veterinary College, Hatfield, AL9 7TA Hertfordshire UK

Article

Publisher ID: 464

DOI: 10.1186/s12917-015-0464-z

PMC ID: 4552371

PubMed ID: 26316233

SO-VID: 2b0e7a6a-5c3b-45e2-9e25-74dc9f915a20

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 4 June 2015

Date accepted : 29 June 2015

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ScienceOpen disciplines: Veterinary medicine

Keywords: dog,epileptic seizure,epilepsy,treatment

Data availability:

ScienceOpen disciplines: Veterinary medicine

Keywords: dog, epileptic seizure, epilepsy, treatment

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International Veterinary Epilepsy Task Force consensus proposal: medical treatment of canine epilepsy in Europe

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Horses and Humans Research Foundation

Most cited references 128

The mechanisms of action of gabapentin and pregabalin.

Temporal lobe epilepsy with hippocampal sclerosis: predictors for long-term surgical outcome.

Premature death, risk factors, and life patterns in dogs with epilepsy.

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