Clinical Risk Factors for Early Seizure Recurrence in Dogs Hospitalized for Seizure Evaluation

Abstract

BackgroundEpileptic seizures are a common cause for neurological evaluations in dogs.Hypothesis/ObjectivesTo determine the timing, frequency, and risk factors for early seizure recurrence (ESR) among dogs admitted to the hospital for seizure evaluation and to facilitate rapid decision making about whether dogs should be placed in the intensive care unit (ICU) or day ward.AnimalsNine‐hundred twenty‐two dogs referred for seizure investigation; 214 patients were included.MethodsRetrospective study. Medical records between 2000 and 2017 were reviewed to determine risk factors for ESR. Findings were compared among dogs diagnosed with idiopathic epilepsy (IE), structural epilepsy (StE) and reactive seizures (RS), as well as in all selected cases together.ResultsFifty percent of dogs had a seizure while hospitalized. In the group 53.1 and 52.2% in the StE group, whereas in the RS 40.44% had ESR. The average time to ESR was 7 hours. In IE group, abnormal postictal neurological examination with prosencephalon signs predicted ESR. In StE group, a single generalized or focal seizure 72 hours before hospital admission and abnormal neurologic examination predicted ESR. In the RS group, ERS was predicted by long‐term antiepileptic monotheraphy. When all dogs were analyzed together, abnormal neurological examination, the occurrence of cluster seizures, status epilepticus, or combination of them 72 hours before presentation predicted ESR.Conclusions and Clinical ImportanceEpileptic seizures recurred in 50% of patients within a mean time of 7 hours. In general, when cluster seizures, status epilepticus or both occurred 72 hours before presentation and neurological examination was abnormal upon presentation, the dog should be placed in ICU for observation.

Epidemiology of recurrent seizure disorders and epilepsy in cats under primary veterinary care in the United Kingdom

“…These results confirm that although RSD are less frequently diagnosed in cats than in dogs, 7,8,37 RSD are a relatively common clinical presentation for cats evaluated by veterinary practitioners, which is consistent with previous reports. 38,39 Numerically, despite the relatively low prevalence of these disorders, an estimated 10.9 million cats are owned in the UK with 24% of UK adults owning a cat, 40 which equates to a substantial number of potentially affected cats in the UK. Our findings are substantially lower than the 2.1% and 3.5% prevalences of seizures previously reported in referral feline populations.…”

“…41 Considering the differences between cats and dogs, although the prevalence for RSD in cats is considerably lower than the prevalence in dogs with at least 1 seizure reported previously, 8 the inclusion criteria for RSD in our study required cats to have had at least 2 seizure events separated by at least 24 hours, an epilepsy diagnosis, or treatment using ASD. Given that toxicity and metabolic disturbances (reactive seizures) are responsible for many single seizure events, 3,38,39 this situation may account for a proportion of the differences reported between the species. Additionally, recognition of seizures in cats often is complicated by the heterogenous semiology of the condition in this species, 4,13,42,43 such that the true proportion of cats with RSD may be higher than that reported by owners.…”

“…Furthermore, compared to dogs, many UK cats spend a considerable proportion of their time outdoors, where owners are less likely to witness seizure events. 39 Despite substantial progress in recent decades on the classification of neurological diseases in companion animals 5 although it is likely that many more of these cases met the internationally-agreed definition for epilepsy despite not being recorded as such by the attending veterinarians. 19 The precise clinical criteria applied for the epilepsy diagnoses recorded in the clinical records was not explored in our study, but these could be the topic of future research exploring how closely primary care clinicians apply IVETF diagnosis guidelines.…”

“…cases were comprehensively evaluated by complete serum biochemistry, urinalysis and blood pressure measurement. Because reactive seizures are also predominantly caused by conditions that preferentially affect older animals,39 potential retention of some misclassified reactive seizure cases in our study may have increased the apparent probability of RSD in older cats. Seizures therefore should be considered as a common cause of paroxysmal events in cats, particularly with increasing age.…”

Probable Sudden Unexpected Death in Dogs With Epilepsy (pSUDED)

“…Of the 12 sudden unexpected deaths in the present study in dogs, 7 occurred during the night and 5 during daytime. Kwiatkowska et al described that during hospitalization 50% of dogs showed another seizure event within 7 h after in house placement ( 50 ). Consequently, intensive monitoring during the clinical stay of dogs with IE, especially at night, is absolutely necessary and advisable ( 51 ).…”