Research priorities for idiopathic epilepsy in dogs: Viewpoints of owners, general practice veterinarians, and neurology specialists

Jones, GB; Volk, Holger A.; Packer, Rowena M. A.

doi:10.1111/jvim.16144

Cited by 16 publications

(16 citation statements)

References 72 publications

(136 reference statements)

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“…A recent survey of research priorities for idiopathic epilepsy in dogs revealed that non-ASD management, including epilepsy surgery, is highly expected by dog owners, general practice veterinarians, and veterinary neurologists (11). However, research on epilepsy surgery in the veterinary field is generally limited to experimental studies, with the majority concerning neuromodulation (12)(13)(14)(15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

Focal Cortical Resection and Hippocampectomy in a Cat With Drug-Resistant Structural Epilepsy

et al. 2021

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Epilepsy surgery is a common therapeutic option in humans with drug-resistant epilepsy. However, there are few reports of intracranial epilepsy surgery for naturally occurring epilepsy in veterinary medicine. A 12-year-old neutered female domestic shorthair cat with presumed congenital cortical abnormalities (atrophy) in the right temporo-occipital cortex and hippocampus had been affected with epilepsy from 3 months of age. In addition to recurrent epileptic seizures, the cat exhibited cognitive dysfunction, bilateral blindness, and right forebrain signs. Seizures had been partially controlled (approximately 0.3–0.7 seizures per month) by phenobarbital, zonisamide, diazepam, and gabapentin until 10 years of age; however, they gradually became uncontrollable (approximately 2–3 seizures per month). In order to plan epilepsy surgery, presurgical evaluations including advanced structural magnetic resonance imaging and long-term intracranial video-electroencephalography monitoring were conducted to identify the epileptogenic zone. The epileptogenic zone was suspected in the right atrophied temporo-occipital cortex and hippocampus. Two-step surgery was planned, and a focal cortical resection of that area was performed initially. After the first surgery, seizures were not observed for 2 months, but they then recurred. The second surgery was performed to remove the right atrophic hippocampus and extended area of the right cortex, which showed spikes on intraoperative electrocorticography. After the second operation, although epileptogenic spikes remained in the contralateral occipital lobe, which was suspected as the second epileptogenic focus, seizure frequency decreased to <0.3 seizure per month under treatment with antiseizure drugs at 1.5 years after surgery. There were no apparent complications associated with either operation, although the original neurological signs were unchanged. This is the first exploratory study of intracranial epilepsy surgery for naturally occurring epilepsy, with modern electroclinical and imaging evidence, in veterinary medicine. Along with the spread of advanced diagnostic modalities and neurosurgical devices in veterinary medicine, epilepsy surgery may be an alternative treatment option for drug-resistant epilepsy in cats.

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Section: Introductionmentioning

confidence: 99%

Focal Cortical Resection and Hippocampectomy in a Cat With Drug-Resistant Structural Epilepsy

et al. 2021

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“…The dogs in this study represent canine patients in veterinary practice with a need for treatment strategies beyond the drugs licensed for use in dogs with idiopathic epilepsy ( 9 ). In humans, older studies reported a chance of ≥50% decrease in seizure frequency in 19–29% of patients after two previously failed ASM trials ( 61 , 62 ).…”

Section: Discussionmentioning

confidence: 99%

“…Its efficacy for cluster seizures is a matter of ongoing debate (5)(6)(7)(8). Dog owners and veterinarians considered the development of new ASMs among the three most important research topics for the future (9). Evidence for the efficacy of non-licensed ASMs in dogs is poor as there are only few prospective controlled studies evaluating treatment strategies in dogs with drug-resistant epilepsy (10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Pregabalin Add-On vs. Dose Increase in Levetiracetam Add-On Treatment: A Real-Life Trial in Dogs With Drug-Resistant Epilepsy

Kriechbaumer

Jurina²,

Wielaender

et al. 2022

Front. Vet. Sci.

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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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“…This possibility is substantiated by several other MRI studies in large numbers of epileptic dogs ( 132 – 134 , 136 , 137 ). However, in contrast to human patients, from which epileptic tissue for electrophysiologic and molecular studies can be obtained during epilepsy surgery by resection of epileptogenic focal tissue, such resective surgery is in its infancy in veterinary medicine ( 66 , 138 – 140 ).…”

Section: Pathogenesis Of Epilepsy In Dogsmentioning

confidence: 99%

Dogs as a Natural Animal Model of Epilepsy

Löscher

2022

Front. Vet. Sci.

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Epilepsy is a common neurological disease in both humans and domestic dogs, making dogs an ideal translational model of epilepsy. In both species, epilepsy is a complex brain disease characterized by an enduring predisposition to generate spontaneous recurrent epileptic seizures. Furthermore, as in humans, status epilepticus is one of the more common neurological emergencies in dogs with epilepsy. In both species, epilepsy is not a single disease but a group of disorders characterized by a broad array of clinical signs, age of onset, and underlying causes. Brain imaging suggests that the limbic system, including the hippocampus and cingulate gyrus, is often affected in canine epilepsy, which could explain the high incidence of comorbid behavioral problems such as anxiety and cognitive alterations. Resistance to antiseizure medications is a significant problem in both canine and human epilepsy, so dogs can be used to study mechanisms of drug resistance and develop novel therapeutic strategies to benefit both species. Importantly, dogs are large enough to accommodate intracranial EEG and responsive neurostimulation devices designed for humans. Studies in epileptic dogs with such devices have reported ictal and interictal events that are remarkably similar to those occurring in human epilepsy. Continuous (24/7) EEG recordings in a select group of epileptic dogs for >1 year have provided a rich dataset of unprecedented length for studying seizure periodicities and developing new methods for seizure forecasting. The data presented in this review substantiate that canine epilepsy is an excellent translational model for several facets of epilepsy research. Furthermore, several techniques of inducing seizures in laboratory dogs are discussed as related to therapeutic advances. Importantly, the development of vagus nerve stimulation as a novel therapy for drug-resistant epilepsy in people was based on a series of studies in dogs with induced seizures. Dogs with naturally occurring or induced seizures provide excellent large-animal models to bridge the translational gap between rodents and humans in the development of novel therapies. Furthermore, because the dog is not only a preclinical species for human medicine but also a potential patient and pet, research on this species serves both veterinary and human medicine.

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Research priorities for idiopathic epilepsy in dogs: Viewpoints of owners, general practice veterinarians, and neurology specialists

Cited by 16 publications

References 72 publications

Focal Cortical Resection and Hippocampectomy in a Cat With Drug-Resistant Structural Epilepsy

Focal Cortical Resection and Hippocampectomy in a Cat With Drug-Resistant Structural Epilepsy

Pregabalin Add-On vs. Dose Increase in Levetiracetam Add-On Treatment: A Real-Life Trial in Dogs With Drug-Resistant Epilepsy

Dogs as a Natural Animal Model of Epilepsy

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