International veterinary epilepsy task force consensus proposal: outcome of therapeutic interventions in canine and feline epilepsy

Abstract

Common criteria for the diagnosis of drug resistance and the assessment of outcome are needed urgently as a prerequisite for standardized evaluation and reporting of individual therapeutic responses in canine epilepsy. Thus, we provide a proposal for the definition of drug resistance and partial therapeutic success in canine patients with epilepsy. This consensus statement also suggests a list of factors and aspects of outcome, which should be considered in addition to the impact on seizures. Moreover, these expert recommendations discuss criteria which determine the validity and informative value of a therapeutic trial in an individual patient and also suggest the application of individual outcome criteria. Agreement on common guidelines does not only render a basis for future optimization of individual patient management, but is also a presupposition for the design and implementation of clinical studies with highly standardized inclusion and exclusion criteria. Respective standardization will improve the comparability of findings from different studies and renders an improved basis for multicenter studies. Therefore, this proposal provides an in-depth discussion of the implications of outcome criteria for clinical studies. In particular ethical aspects and the different options for study design and application of individual patient-centered outcome criteria are considered.

Retrospective epidemiological study of canine epilepsy in Japan using the International Veterinary Epilepsy Task Force classification 2015 (2003–2013): etiological distribution, risk factors, survival time, and lifespan

“…In addition, we showed that use of multiple AEDs (polytherapy) was not a risk factor affecting survival time in IdE. The IVETF proposal states that the effect of drug-resistant epilepsy on outcome is not precisely understood [9]. Furthermore, some studies [12, 32] have shown that survival of dogs receiving multiple AED treatments does not differ significantly from that of dogs receiving single AED treatment (monotherapy).…”

“…In order to incorporate seizure frequency at the last follow-up into the log-rank test, it was divided for survival analysis into <0.3 and ≥0.3 sz/month. This baseline of 0.3 sz/month was decided from the ‘acceptable seizure frequency’ (less than one seizure in 3 months) suggested in the IVTEF proposal [9, 17]. To assess the risk factor for survival time in all epilepsy cases and IdE, the Cox proportional hazard model was employed using the forced-entry method.…”

Long‐term efficacy of imepitoin in the treatment of naive dogs affected by idiopathic epilepsy

“…Not many reports detail the seizure-free state at a specific follow-up end point (De Risio 2014a) and the recent revision of the definition of seizure-free state (Potschka and others 2015) prevents an effective comparison of their results with those of previous studies. According to the results at six-month follow-up of a randomised clinical trial, PB and Br seem to have higher percentages of seizures-free dogs (85 per cent and 52 per cent, respectively) compared with those with IMP (Boothe and others 2012).…”

“…Primary treatment success (PTS) was defined as the achievement of a seizure-free interval three times longer than the pretreatment interictal interval and lasting at least three months. Secondary treatment success (STS) was defined as the prevention of CS and SE, relevant reduction of seizures frequency considering pretreatment seizures frequency and reduction in seizures severity (Potschka and others 2015). In this study, due to the lack of an objective threshold to define STS and according to the previous definition of therapeutic success, the decrease in seizure frequency ≥50 per cent compared with the pretreatment frequency was used to define STS (Volk and others 2008; Dewey and others 2009; Muñana and others 2012a,b; Packer and others 2014).…”

Phenobarbital administration every eight hours: improvement of seizure management in idiopathic epileptic dogs with decreased phenobarbital elimination half‐life

“…Partial therapeutic success was considered if cluster seizures or status epilepticus were prevented, if SF was reduced by 50 per cent compared with pretreatment SF or if seizure severity was reduced (Potschka and others 2015). In addition the antiepileptic medication (AEM) had to be well tolerated during this time.…”