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Mojarradi A, De Decker S, Van Meervenne S. Once-a-day oral treatment with phenobarbital in cats with presumptive idiopathic epilepsy. J Feline Med Surg 2023; 25:1098612X231196806. [PMID: 37747329 PMCID: PMC10812035 DOI: 10.1177/1098612x231196806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
OBJECTIVES Phenobarbital (PB) q12h is the most common treatment recommendation for cats with recurrent epileptic seizures. Medicating cats may be challenging and result in decreased quality of life for both cat and owner. The aim of this retrospective study was to evaluate treatment with oral PB q24h in cats with presumptive idiopathic epilepsy. METHODS Nine cats with presumptive idiopathic epilepsy, receiving oral PB q24h, were included in a retrospective descriptive study. RESULTS Seizure remission was achieved in 88% (8/9) of the cats and good seizure control in 12% (1/9) of the cats, treated with a mean dose of oral PB of 2.6 mg/kg q24h (range 1.4-3.8 mg/kg). No cats required an increase of their PB frequency at any time during a mean follow-up period of 3.5 years (range 1.1-8.0 years). No cats displayed side effects or issues with compliance at the last recorded follow-up. CONCLUSIONS AND RELEVANCE Once-a-day administration of PB for feline epilepsy was safe and resulted in satisfactory seizure control for the nine cats included in this study. The results of this study justify exploring this topic further in larger prospective studies.
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Affiliation(s)
- Abtin Mojarradi
- IVC Evidensia Referral Hospital in Helsingborg, Skåne, Sweden
| | - Steven De Decker
- Department of Clinical Science and Services, Royal Veterinary College, University of London, London, UK
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2
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Hasegawa D, Kanazono S, Chambers JK, Uchida K. Neurosurgery in feline epilepsy, including clinicopathology of feline epilepsy syndromes. Vet J 2022; 290:105928. [PMID: 36347391 DOI: 10.1016/j.tvjl.2022.105928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 11/07/2022]
Abstract
Feline epilepsy is treated with antiseizure medications, which achieves fair to good seizure control. However, a small subset of feline patients with drug-resistant epilepsy requires alternative therapies. Furthermore, approximately 50 % of cats with epileptic seizures are diagnosed with structural epilepsy with or without hippocampal abnormality and may respond to surgical intervention. The presence of hippocampal pathology and intracranial tumors is a key point to consider for surgical treatment. This review describes feline epilepsy syndrome and epilepsy-related pathology, and discusses the indications for and availability of neurosurgery, including lesionectomy, temporal lobectomy with hippocampectomy, and corpus callosotomy, for cats with different epilepsy types.
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Affiliation(s)
- Daisuke Hasegawa
- Laboratory of Veterinary Radiology, Nippon Veterinary and Life Science University, 1-7-1 Kyounancho, Musashino, Tokyo 180-8602, Japan; The Research Center for Animal Life Science, Nippon Veterinary and Life Science University, 1-7-1 Kyounancho, Musashino, Tokyo 180-8602, Japan.
| | - Shinichi Kanazono
- Neurology and Neurosurgery Service, Veterinary Specialists and Emergency Center, 815 Ishigami, Kawaguchi, Saitama 333-0823, Japan
| | - James K Chambers
- Laboratory of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
| | - Kazuyuki Uchida
- Laboratory of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
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3
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Pakozdy A. Improving the quality of life of epileptic cats and their owners through effective medication strategies. Vet Rec 2021; 189:436-437. [PMID: 34860373 DOI: 10.1002/vetr.1240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Akos Pakozdy
- Small Animal Clinic, Department of Internal Medicine, University of Veterinary Medicine, Vienna, Austria
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4
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Baka RD, Soubasis N, Oevermann A, Koutinas CK, Polizopoulou ZS. Severity of neurological signs in feline hypertensive encephalopathy may be reflected through brain histopathological lesions. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Rania D. Baka
- School of Veterinary Medicine Faculty of Health Sciences Aristotle University of Thessaloniki Thessaloniki Greece
| | - Nektarios Soubasis
- School of Veterinary Medicine Faculty of Health Sciences Aristotle University of Thessaloniki Thessaloniki Greece
| | - Anna Oevermann
- Department of Clinical Research and Veterinary Public Health Vetsuisse Faculty University of Bern Bern Switzerland
| | - Christos K. Koutinas
- School of Veterinary Medicine Faculty of Health Sciences Aristotle University of Thessaloniki Thessaloniki Greece
| | - Zoe S. Polizopoulou
- School of Veterinary Medicine Faculty of Health Sciences Aristotle University of Thessaloniki Thessaloniki Greece
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Henning J, Nielson T, Nettifee J, Muñana K, Hazel S. Understanding the impacts of feline epilepsy on cats and their owners. Vet Rec 2021; 189:e836. [PMID: 34426972 DOI: 10.1002/vetr.836] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 07/03/2021] [Accepted: 08/09/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Epilepsy is the most common neurological condition reported in cats. Characterised by recurrent seizures, treatment involves the administration of anti-epileptic drugs up to multiple times a day. Epilepsy and its associated treatments may impact both cats and their owners. The present study aimed to assess factors associated with quality of life (QOL) in cats with epilepsy and the burden of care in their owners. METHODS An online survey was developed using demographic information and the following validated measures: cat QOL, Zarit burden interview (ZBI) and the cat owner relationship scale (CORS). Regression analysis was conducted using SPSS 26. RESULTS Responses were completed by 141 owners from 22 countries. QOL was significantly higher in cats with controlled seizures, no adverse effects from medication and epilepsy onset before 5 years of age. ZBI was significantly lower in owners who felt supported by their veterinarian, who were over 55 and had cats with controlled seizures. Higher CORS was significantly correlated with both higher cat QOL and lower owner ZBI. CONCLUSIONS Adequate seizure control and close cat-owner relationships may play an important role in mitigating the impact of epilepsy on cats and their owners. Further research into understanding cat-owner relationships and successfully controlling epilepsy in cats is needed.
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Affiliation(s)
- Julia Henning
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, Australia
| | - Torben Nielson
- School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, Australia
| | - Julie Nettifee
- NC State College of Veterinary Medicine, North Carolina State University, Raleigh, USA
| | - Karen Muñana
- NC State College of Veterinary Medicine, North Carolina State University, Raleigh, USA
| | - Susan Hazel
- School of Animal and Veterinary Sciences, The University of Adelaide, Adelaide, Australia
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Hermans M, Charalambous M, Pakozdy A, Eisl-Glantschnigg U, Neßler J, Van Meervenne SA, Serrano G, Cornelis I, Van Ham L, Paepe D, Broeckx BJ, Bhatti SF. Evaluation of the effect of phenobarbital administration on the biochemistry profile, with a focus on serum liver values, in epileptic cats. J Feline Med Surg 2021; 24:530-538. [PMID: 34387120 DOI: 10.1177/1098612x211037431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Phenobarbital (PB) is the most common antiseizure drug (ASD) used for the management of feline epilepsy. In dogs, PB is known to cause serum liver enzyme induction and hepatotoxicity, especially after administration long term or in high concentrations. In cats, insufficient evidence is available to draw similar conclusions. The aim of this study was to evaluate the effect of PB administration on the serum biochemistry profile of epileptic cats. As an additional objective, other adverse effects arising, related to PB treatment, were recorded. METHODS Medical records of four veterinary centres were retrospectively reviewed for epileptic cats receiving PB treatment. Cats were included if they had a diagnosis of idiopathic epilepsy or structural epilepsy; a normal baseline serum biochemistry profile; at least one follow-up serum biochemistry profile; no concurrent disease or had not received medication that could possibly influence liver function or lead to serum liver enzyme induction. Alkaline phosphatase, alanine aminotransferase (ALT), aspartate transaminase and gamma-glutamyl transferase activities, and total bilirubin, bile acids, glucose, albumin, total protein, urea and creatinine concentrations before and during PB administration were recorded. PB serum concentration was also recorded, when available. RESULTS Thirty-three cats (24 males, nine females) with a median age of 3 years (range 2 months to 12 years) met the inclusion criteria. Idiopathic or structural epilepsy was diagnosed in 25 (76%) and eight (24%) cats, respectively. The follow-up period ranged from 9 to 62 months. This study found an increase in ALT in three cats, possibly related to a PB serum concentration >30 µg/ml. No statistically significant increase in serum liver enzymes or other evaluated biochemistry parameters was found by comparing pre- and post-treatment parameters. CONCLUSIONS AND RELEVANCE PB administration did not result in hepatic enzyme induction or other biochemical abnormalities in cats. This strengthens the safety profile of PB as an ASD in cats.
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Affiliation(s)
- Michelle Hermans
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Marios Charalambous
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Akos Pakozdy
- Clinical Unit of Internal Medicine Small Animals, University of Veterinary Medicine, Vienna, Austria
| | - Ursula Eisl-Glantschnigg
- Clinical Unit of Internal Medicine Small Animals, University of Veterinary Medicine, Vienna, Austria
| | - Jasmin Neßler
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | | | - Gonçalo Serrano
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Ine Cornelis
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Luc Van Ham
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Dominique Paepe
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Bart Jg Broeckx
- Laboratory of Animal Genetics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Sofie Fm Bhatti
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Marsh O, Corsini G, Van Dijk J, Gutierrez-Quintana R, De Risio L. Prevalence and clinical characteristics of phenobarbitone-associated adverse effects in epileptic cats. J Feline Med Surg 2020; 23:59-66. [PMID: 32484071 DOI: 10.1177/1098612x20924925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The study objective was to investigate the prevalence and clinical characteristics of phenobarbitone-associated adverse effects in epileptic cats. METHODS The medical records of two veterinary referral clinics from 2007 to 2017 were searched for cats fulfilling the inclusion criteria of a diagnosis of epilepsy, treatment with phenobarbitone and available follow-up information on the occurrence of adverse effects. Follow-up information was obtained from the medical records of the primary veterinarian and referral institutions and a questionnaire completed by the cats' owners. RESULTS Seventy-seven cats met the inclusion criteria. Fifty-eight were affected by idiopathic epilepsy and 19 by structural epilepsy. One or more of the following adverse effects were reported in 47% of the cats: sedation (89%); ataxia (53%); polyphagia (22%); polydipsia (6%); polyuria (6%); and anorexia (6%). Logistic regression analyses revealed significant associations between adverse effect occurrence and both phenobarbitone starting dosage and administration of a second antiepileptic drug (AED). For each 1 mg/kg q12h increment of phenobarbitone, the likelihood of adverse effects increased 3.1 times. When a second AED was used, the likelihood of adverse effects increased 3.2 times. No association was identified between epilepsy aetiology and adverse effect occurrence. An idiosyncratic adverse effect, characterised by severe neutropenia and granulocytic hypoplasia, was diagnosed in one cat. This resolved following phenobarbitone discontinuation. CONCLUSIONS AND RELEVANCE The prevalence of phenobarbitone-associated adverse effects was 47%. Sedation and ataxia were most common. These are type A adverse effects and are predictable from phenobarbitone's known pharmacological properties. In the majority of cases, adverse effects occurred within the first month of treatment and were transient. Idiosyncratic (type B) adverse effects, which were not anticipated given the known properties of the drug, occurred in one cat. Increased phenobarbitone starting dosage and the addition of a second AED were significantly associated with the occurrence of adverse effects.
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Affiliation(s)
- Oliver Marsh
- Neurology and Neurosurgery Service, Centre for Small Animal Studies, Animal Health Trust, Newmarket, UK
| | - Giulia Corsini
- Neurology and Neurosurgery Service, Centre for Small Animal Studies, Animal Health Trust, Newmarket, UK
| | - Jan Van Dijk
- Centre for Preventive Medicine, Animal Health Trust, Newmarket, UK
| | | | - Luisa De Risio
- Neurology and Neurosurgery Service, Centre for Small Animal Studies, Animal Health Trust, Newmarket, UK
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Hazenfratz M, Taylor SM. Recurrent seizures in cats: Diagnostic approach - when is it idiopathic epilepsy? J Feline Med Surg 2019; 20:811-823. [PMID: 30139320 DOI: 10.1177/1098612x18791873] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Practical relevance: Seizures are one of the most common neurologic problems recognized in cats, affecting approximately 1-3% of the general population. Treatment options and prognosis are closely related to the underlying cause, so it is important that veterinarians are familiar with the diagnostic approach to cats with seizures and options for medical management. Series outline: This is the first of a two-part article series that reviews the diagnosis and treatment of seizures in cats. Part 1 outlines the classification and terminology used to describe epilepsy and epileptic seizures in cats, and discusses some of the most common and unique causes of recurrent seizures in cats. The diagnostic approach to cats with recurrent seizures is addressed, as are criteria for the diagnosis of idiopathic epilepsy. AUDIENCE This review of recurrent seizures in cats is intended for all veterinarians who are facing the challenges of seizure diagnosis and management in the feline patient. Evidence base: Recommendations for diagnosis and management of feline seizure disorders have historically been extrapolated from the canine and human literature. The information and guidance provided in this two-part series is based on a review of the recent published literature addressing seizure disorders and antiepileptic treatment in cats, as well as the authors' clinical experience.
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Affiliation(s)
- Michal Hazenfratz
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Canada
| | - Susan M Taylor
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK S7N5B4, Canada
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Hazenfratz M, Taylor SM. Recurrent seizures in cats: Treatment - which antiepileptic drugs are recommended? J Feline Med Surg 2019; 20:825-834. [PMID: 30139319 DOI: 10.1177/1098612x18791874] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Practical relevance: Seizures are one of the most common neurological problems recognized in cats, affecting approximately 1-3% of the general population. Treatment options and prognosis are closely related to the underlying cause, so it is important that veterinarians are familiar with the diagnostic approach to cats with seizures and options for medical management. Series outline: This is the second of a two-part article series that reviews the diagnosis and treatment of seizures in cats. Part 2 describes chronic medical treatment options and prognosis for cats with recurrent seizures, and acute treatment of status epilepticus. AUDIENCE This review of recurrent seizures in cats is intended for all veterinarians who are facing the challenges of seizure diagnosis and management in the feline patient. Evidence base: Recommendations for diagnosis and management of feline seizure disorders have historically been extrapolated from the canine and human literature. The information and guidance provided in this two-part series is based on a review of the recent published literature addressing seizure disorders and antiepileptic treatment in cats, as well as the authors' clinical experience.
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Affiliation(s)
- Michal Hazenfratz
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Canada
| | - Susan M Taylor
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK S7N5B4, Canada
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Qahwash M, Heller HLB. Seizure etiologic classification and long-term outcome for cats with juvenile-onset seizures. J Am Vet Med Assoc 2019; 253:763-767. [PMID: 30179086 DOI: 10.2460/javma.253.6.763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To identify seizure etiologic classification for cats that developed seizures at < 12 months of age and describe the long-term outcome of affected cats. DESIGN Retrospective cohort study. ANIMALS 15 client-owned cats with seizures that began at < 12 months of age. PROCEDURES Information on each cat was obtained from the medical records, veterinarians, and owners. Inclusion required an onset of seizures before 12 months of age and a complete medical record, including a final diagnosis. RESULTS 7 of the 15 cats had structural epilepsy, 4 had idiopathic epilepsy, and 4 had reactive seizures. Median age at seizure onset was 27 weeks (range, 0.4 to 41 weeks). Cluster seizures were reported in 6 cats, and status epilepticus was reported in 2. Age at the onset of seizures, presence of cluster seizures, and seizure semiology (ie, generalized vs focal seizures) were not significantly associated with seizure etiologic classification. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that cats that developed seizures at < 12 months of age were more likely to have structural epilepsy than idiopathic epilepsy or reactive seizures. Therefore, advanced diagnostic imaging is recommended in cats with juvenile-onset seizures if metabolic and toxic causes are excluded.
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11
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Reactive seizures in cats: A retrospective study of 64 cases. Vet J 2019; 244:1-6. [DOI: 10.1016/j.tvjl.2018.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 11/11/2018] [Accepted: 11/15/2018] [Indexed: 01/06/2023]
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12
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Barnes Heller HL, Trepanier LA, Robertson M, Mei C. Prospective crossover clinical trial comparing transdermal with oral phenobarbital administration in epileptic cats. J Feline Med Surg 2019; 21:1181-1187. [PMID: 30688552 DOI: 10.1177/1098612x18823577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to compare serum phenobarbital concentrations, adverse events and client satisfaction during 14 weeks of transdermal vs oral phenobarbital administration to epileptic cats. METHODS This was a prospective, fixed-order, crossover pilot study. Nine client-owned cats with presumptive or diagnosed idiopathic epilepsy were enrolled. Oral phenobarbital (PO-PB) was administered for weeks 1-14 (median starting dosage of 3.8 mg/kg [2.0-5.4 mg/kg/day] q12h); transdermal phenobarbital (TD-PB) was administered for weeks 14-28 (median starting dosage 18.8 mg/kg/day [17.6-24.0 mg/kg/day] q12h). Serum phenobarbital concentrations (S-PB) were measured at weeks 2, 14, 16 and 28. Client satisfaction questionnaires and biochemistry were evaluated at 14 and 28 weeks. RESULTS Median S-PB concentrations during oral administration were 21 µg/ml (observed range 11-40 µg/ml) at week 2 and 22 µg/ml (8-35 µg/ml) at week 14, and at the higher TD dosage were 18 µg/ml (0-42 µg/ml) at week 16 and 17 µg/ml (7-50 µg/ml) at week 28. Phenobarbital concentrations were significantly correlated with PO dosage at week 2 (r = 0.75, P = 0.03) but not at weeks 16 and 28. Significantly more dose adjustments were needed during the TD phase (P = 0.03), but 6/9 owners (67%) still preferred TD to PO administration. Adverse effects were mild and comparable in both groups. CONCLUSIONS AND RELEVANCE Therapeutic S-PB concentrations were achievable in some cats using TD-PB at 18 mg/kg/day q12h. Poor correlation between TD dosage and S-PB concentrations was observed and more dosage adjustments were required during TD administration. These findings necessitate close therapeutic drug monitoring if TD-PB is prescribed.
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Affiliation(s)
- Heidi L Barnes Heller
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Lauren A Trepanier
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Michelle Robertson
- UW Veterinary Care Pharmacy, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Chaoqun Mei
- Institute for Clinical and Translational Research, and Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
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Krull DP, Thomovsky SA, Chen AV, Mealey KL, Papich MG. Evaluation of Transdermal Administration of Phenobarbital in Healthy Cats. J Am Anim Hosp Assoc 2018; 55:1-7. [PMID: 30427717 DOI: 10.5326/jaaha-ms-6670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose was to determine the safety and achievable serum concentrations of transdermally administered phenobarbital in healthy cats. The hypothesis was that transdermal phenobarbital would achieve therapeutic serum concentrations (15-45 µg/mL) with minimal short-term adverse effects. Enrolled cats had normal physical and neurologic exams and unremarkable bloodwork. Transdermal phenobarbital in a pluronic lecithin organogel-based vehicle was administered at a dosage of 3.0-3.1 mg/kg per ear pinna (total of 6.0-6.2 mg/kg) every 12 hr for 14 days. Serum phenobarbital concentrations were measured 3-6 hr after dosing at seven different times over 15 days. The mean and median serum concentration of phenobarbital at study completion were 5.57 and 4.08 µg/mL, respectively. Mean peak concentration and mean time to peak concentration were 5.94 µg/mL and 13.3 days, respectively. Mild adverse effects were observed. Potency was analyzed in three replicates of the transdermal phenobarbital gel administered; potencies ranged from 62.98 to 82.02%. Transdermal application of phenobarbital in healthy cats achieves a detectable, but subtherapeutic, serum concentration and appears safe in the short term. The use of therapeutic drug monitoring is recommended when this formulation of phenobarbital is used to ensure therapeutic serum concentrations are achieved.
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Affiliation(s)
- Daniel P Krull
- From the Department of Veterinary Clinical Studies, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (S.A.T.); Columbia River Veterinary Specialists, Vancouver, Washington (D.P.K.); Department of Molecular and Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.G.P.); and Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington (K.L.M., A.V.C.)
| | - Stephanie Ann Thomovsky
- From the Department of Veterinary Clinical Studies, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (S.A.T.); Columbia River Veterinary Specialists, Vancouver, Washington (D.P.K.); Department of Molecular and Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.G.P.); and Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington (K.L.M., A.V.C.)
| | - Annie Vivian Chen
- From the Department of Veterinary Clinical Studies, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (S.A.T.); Columbia River Veterinary Specialists, Vancouver, Washington (D.P.K.); Department of Molecular and Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.G.P.); and Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington (K.L.M., A.V.C.)
| | - Katrina L Mealey
- From the Department of Veterinary Clinical Studies, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (S.A.T.); Columbia River Veterinary Specialists, Vancouver, Washington (D.P.K.); Department of Molecular and Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.G.P.); and Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington (K.L.M., A.V.C.)
| | - Mark G Papich
- From the Department of Veterinary Clinical Studies, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (S.A.T.); Columbia River Veterinary Specialists, Vancouver, Washington (D.P.K.); Department of Molecular and Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.G.P.); and Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington (K.L.M., A.V.C.)
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Collinet A, Sammut V. Suspected zonisamide-related anticonvulsant hypersensitivity syndrome in a cat. J Am Vet Med Assoc 2018; 251:1457-1461. [PMID: 29190192 DOI: 10.2460/javma.251.12.1457] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 2-year-old neutered male domestic shorthair cat was evaluated for sudden onset of cluster seizures. CLINICAL FINDINGS At an emergency clinic, the cat had hyperimmunoglobulinemia and thrombocytopenia. On referral, treatment with levetiracetam, zonisamide, and phenobarbital initially provided good control of cluster seizure activity (attributable to epilepsy of unknow origin). Two weeks later, assessments revealed that serum phenobarbital concentration was within the ideal range but serum zonisamide concentration exceeded the recommended therapeutic range. The dosage of zonisamide was therefore decreased. Four days after dosage reduction, the cat developed generalized lymphadenopathy. Cytologic analysis of lymph node aspirate samples revealed a heterogeneous population of well-differentiated lymphocytes, interpreted as marked reactivity. Although neoplasia could not be ruled out, hypersensitivity to phenobarbital was suspected, and this treatment was discontinued. TREATMENT AND OUTCOME Despite cessation of phenobarbital administration, generalized peripheral lymphadenopathy progressed and hyperglobulinemia and cytopenias developed. These abnormalities resolved after discontinuation of zonisamide administration. The cat remained seizure free with no recurrence of the aforementioned concerns after reinstitution of phenobarbital treatment. CLINICAL RELEVANCE To the authors' knowledge, this is the first reported case of zonisamide-related lymphadenopathy, hyperglobulinemia, and cytopenias in a cat. Anticonvulsant hypersensitivity syndrome is well documented in human medicine, but little information has been published in the veterinary medical literature. Although the effects of anticonvulsant hypersensitivity syndrome in this cat were serious, these effects were reversible with treatment discontinuation.
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Barnes Heller H, Granick M, Van Hesteren M, Boothe DM. Serum levetiracetam concentrations and adverse events after multiple dose extended release levetiracetam administration to healthy cats. J Vet Intern Med 2018; 32:1145-1148. [PMID: 29671898 PMCID: PMC5980453 DOI: 10.1111/jvim.15129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/19/2018] [Accepted: 03/07/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Multiple dose administration of antiepileptic drugs to cats presents a challenge for owners. Extended release levetiracetam (XRL) has once daily recommended dosing interval, but multiple dose administration of XRL has not been evaluated in cats. OBJECTIVE Evaluate serum levetiracetam concentrations and adverse clinical effects after 11 days of once daily XRL administration to healthy cats. ANIMALS Nine healthy privately owned cats, body weight ≥ 5 kg METHODS: Extended release levetiracetam (500 mg/cat) was administered PO q24h for 10 days. On day 11, blood was collected at trough, 4, 6, and 8 hours after tablet administration. Owners maintained records of adverse effects throughout study. Levetiracetam was quantitated in serum using immunoassay validated in cats. RESULTS Median dose 94.3 mg/kg q24h. Median (range) trough, 4, 6, and 8 hour serum levetiracetam concentrations were 7.0 (2.3-14.1), 82.6 (7.8-125.3), 92.3 (13.3-97.3), and 72 (22.8-96.4) μg/mL, respectively. Peak was not observed in 4 cats because of missed samples (n = 2) and failure to reach maximal concentration (Cmax ) by 8 hours (n = 2). Median time of maximal concentration (Tmax ) for the remaining 5 cats 5.2 (range 4-6) hours. Adverse effects were minimal and included ataxia (n = 1), sedation (n = 1), and vomiting or regurgitation (n = 1). All signs resolved without dose adjustment or additional treatment. CONCLUSIONS AND CLINICAL IMPORTANCE Mean trough serum levetiracetam concentrations were ≥5 μg/mL and adverse effects were minimal throughout dosing period, indicating that the drug was well tolerated. Once daily XRL (500 mg/cat) administration may provide an easier alternative to 3 times daily dosing of intermediate-release levetiracetam for epileptic cats.
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Charalambous M, Pakozdy A, Bhatti SFM, Volk HA. Systematic review of antiepileptic drugs' safety and effectiveness in feline epilepsy. BMC Vet Res 2018; 14:64. [PMID: 29499762 PMCID: PMC5834883 DOI: 10.1186/s12917-018-1386-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 02/21/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Understanding the efficacy and safety profile of antiepileptic drugs (AEDs) in feline epilepsy is a crucial consideration for managing this important brain disease. However, there is a lack of information about the treatment of feline epilepsy and therefore a systematic review was constructed to assess current evidence for the AEDs' efficacy and tolerability in cats. The methods and materials of our former systematic reviews in canine epilepsy were mostly mirrored for the current systematic review in cats. Databases of PubMed, CAB Direct and Google scholar were searched to detect peer-reviewed studies reporting efficacy and/or adverse effects of AEDs in cats. The studies were assessed with regards to their quality of evidence, i.e. study design, study population, diagnostic criteria and overall risk of bias and the outcome measures reported, i.e. prevalence and 95% confidence interval of the successful and affected population in each study and in total. RESULTS Forty studies describing clinical outcomes of AEDs' efficacy and safety were included. Only two studies were classified as "blinded randomised controlled trials". The majority of the studies offered high overall risk of bias and described low feline populations with unclear diagnostic criteria and short treatment or follow-up periods. Individual AED assessments of efficacy and safety profile showed that phenobarbital might currently be considered as the first choice AED followed by levetiracetam and imepitoin. Only imepitoin's safety profile was supported by strong level of evidence. Imepitoin's efficacy as well as remaining AEDs' efficacy and safety profile were supported by weak level of evidence. CONCLUSIONS This systematic review reflects an evidence-based assessment of the published data on the AEDs' efficacy and safety for feline epilepsy. Currently, phenobarbital is likely to be the first-line for feline epileptic patients followed by levetiracetam and imepitoin. It is essential that clinicians evaluate both AEDs' effectiveness and tolerability before tailoring AED to the individual patient. Further studies in feline epilepsy treatment are by far crucial in order to establish definite guidelines for AEDs' efficacy and safety.
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Affiliation(s)
- Marios Charalambous
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Akos Pakozdy
- Clinical Unit of Internal Medicine Small Animals, University of Veterinary Medicine, Vienna, Austria
| | - Sofie F. M. Bhatti
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Holger A. Volk
- Department of Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, Brookmans Park, UK
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18
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Lieser J, Schwedes CS. Pseudolymphoma in a cat on phenobarbital treatment. J Small Anim Pract 2017; 59:444-447. [DOI: 10.1111/jsap.12693] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 11/02/2016] [Accepted: 11/25/2016] [Indexed: 11/28/2022]
Affiliation(s)
- J. Lieser
- AniCura Kleintierspezialisten Augsburg; 86157 Augsburg Germany
| | - C. S. Schwedes
- AniCura Kleintierspezialisten Augsburg; 86157 Augsburg Germany
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19
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Raimondi F, Shihab N, Gutierrez-Quintana R, Smith A, Trevail R, Sanchez-Masian D, Smith PM. Magnetic resonance imaging findings in epileptic cats with a normal interictal neurological examination: 188 cases. Vet Rec 2017; 180:610. [DOI: 10.1136/vr.104142] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2017] [Indexed: 12/25/2022]
Affiliation(s)
- F. Raimondi
- Southern Counties Veterinary Specialists (SCVS); 6 Forest Corner Farm, Ringwood Hampshire BH24 3JW UK
| | - N. Shihab
- Southern Counties Veterinary Specialists (SCVS); 6 Forest Corner Farm, Ringwood Hampshire BH24 3JW UK
| | | | - A. Smith
- Langford Small Animal Referral Hospital; Langford Road Bristol BS40 5DU UK
| | - R. Trevail
- Southern Counties Veterinary Specialists (SCVS); 6 Forest Corner Farm, Ringwood Hampshire BH24 3JW UK
| | | | - P. M. Smith
- Davies Veterinary Specialists, Manor Farm Business Park; Higham Gobion Hitchin SG5 3HR UK
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20
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Engel O, von Klopmann T, Maiolini A, Freundt-Revilla J, Tipold A. Imepitoin is well tolerated in healthy and epileptic cats. BMC Vet Res 2017; 13:172. [PMID: 28606140 PMCID: PMC5469074 DOI: 10.1186/s12917-017-1087-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/31/2017] [Indexed: 12/04/2022] Open
Abstract
Background Epilepsy in the cat is a serious medical condition. To date there are no licensed treatments for feline epilepsy and no well-controlled clinical studies on the efficacy or safety of antiepileptic drugs in cats. The aim of this study was to collect tolerability data and first exploratory efficacy data of imepitoin in both healthy and epileptic cats. Results In two tolerability studies, 30 healthy cats received imepition twice daily in doses of 0, 30, 40 or 80 mg/kg bodyweight for 30 days. No serious adverse events were observed in any of the dose groups. In the imepitoin treated groups, emesis was observed in some animals temporarily and intermittently mainly in the second and third weeks of treatment. In a small, single-arm, open label, uncontrolled clinical trial eight cats suffering from idiopathic epilepsy were treated with imepitoin twice daily at doses of 30 mg/kg bodyweight for 30 days. Four of these cats (50%) achieved seizure freedom for at least 8 weeks under treatment. Adverse events, mostly lethargy, decreased appetite and emesis, were often mild and transient. Conclusion In summary, imepitoin was well tolerated in healthy and epileptic cats and showed in a pilot trial indication for efficacy in treating feline epilepsy.
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Affiliation(s)
- Odilo Engel
- Boehringer Ingelheim Vetmedica GmbH, Binger Str. 173, 55216, Ingelheim am Rhein, Germany.
| | | | - Arianna Maiolini
- University of Veterinary Medicine, Department of Small Animal Medicine and Surgery, Bünteweg 9, 30559, Hannover, Germany
| | - Jessica Freundt-Revilla
- University of Veterinary Medicine, Department of Small Animal Medicine and Surgery, Bünteweg 9, 30559, Hannover, Germany
| | - Andrea Tipold
- University of Veterinary Medicine, Department of Small Animal Medicine and Surgery, Bünteweg 9, 30559, Hannover, Germany.,Center for Systems Neuroscience, Hannover, Germany
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21
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Pakozdy A, Gruber A, Kneissl S, Leschnik M, Halasz P, Thalhammer JG. Complex Partial Cluster Seizures in Cats with Orofacial Involvement. J Feline Med Surg 2017; 13:687-93. [DOI: 10.1016/j.jfms.2011.05.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 05/06/2011] [Accepted: 05/13/2011] [Indexed: 10/17/2022]
Abstract
Seventeen cats were presented with acute onset of complex partial seizures with orofacial involvement (salivation, facial twitching, lip smacking, chewing, licking or swallowing), motor arrest (motionless starring) and behavioural changes. In 11 cats hippocampal necrosis (HN) was confirmed by histopathology. In a further six cats hippocampal changes were suggested by magnetic resonance imaging. The mean monitoring time of eight cats which were not euthanased in the acute phase of the disease, was 408 days (60–908): four cats are still alive. In all surviving cases, the owners reported a good quality of life. We conclude that an acute cluster of complex partial seizures with orofacial involvement are often associated with HN and that HN is not necessarily a fatal condition. Supportive and antiepileptic therapy can result in remission. The long-term outcome can be good to excellent; therefore, euthanasia should be avoided in the acute phase of the signs.
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Affiliation(s)
- Akos Pakozdy
- Clinic for Internal Medicine and Infectious Diseases, Vienna, Austria
| | - Andrea Gruber
- Institute of Pathology and Forensic Veterinary Medicine, Vienna, Austria
| | - Sibylle Kneissl
- Clinic for Diagnostic Imaging, University of Veterinary Medicine, Vienna, Austria
| | - Michael Leschnik
- Clinic for Internal Medicine and Infectious Diseases, Vienna, Austria
| | - Peter Halasz
- Institute of Experimental Medicine, Budapest, Hungary
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22
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Balducci F, De Risio L, Shea A, Canal S, Stabile F, Bernardini M. Neurogenic urinary retention in cats following severe cluster seizures. J Feline Med Surg 2016; 19:246-250. [DOI: 10.1177/1098612x15602739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Case series summary Four cats that presented with severe cluster seizures developed neurogenic urinary retention in the postictal phase. None of the cats had previous seizures. Micturition was reported as normal in all cats for 3 or more years before seizure onset. All cats required a continuous rate infusion of propofol to control the seizure activity. In all cats manual bladder expression was performed every 8 h until recovery of normal micturition. One cat was started on phenoxybenzamine to reduce internal urethral sphincter tone. All cats recovered normal micturition within 4 weeks of the last cluster of seizures. Relevance and novel information Transient neurogenic urinary retention has not previously been reported in cats or dogs following severe cluster seizures. Urinary retention should be considered a potential postictal deficit, requiring prompt recognition and treatment to avoid urinary tract infection and detrusor muscle atony.
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Affiliation(s)
- Federica Balducci
- Neurology Unit, Portoni Rossi Veterinary Hospital, Zola Predosa, Bologna, Italy
| | - Luisa De Risio
- Neurology/Neurosurgery Service, Centre for Small Animal Studies, Animal Health Trust, Newmarket, UK
| | - Anita Shea
- Neurology/Neurosurgery Service, Centre for Small Animal Studies, Animal Health Trust, Newmarket, UK
| | - Sara Canal
- Neurology Unit, Portoni Rossi Veterinary Hospital, Zola Predosa, Bologna, Italy
- Department of Animal Medicine, Production and Health, Clinical Section, University of Padua, Legnaro, Padua, Italy
| | - Fabio Stabile
- Neurology/Neurosurgery Service, Centre for Small Animal Studies, Animal Health Trust, Newmarket, UK
| | - Marco Bernardini
- Neurology Unit, Portoni Rossi Veterinary Hospital, Zola Predosa, Bologna, Italy
- Department of Animal Medicine, Production and Health, Clinical Section, University of Padua, Legnaro, Padua, Italy
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Song RB, Glass EN, Kent M, Castro FA, deLahunta A. Magnetic resonance imaging and computed tomography findings of Dyke-Davidoff-Masson-like syndrome in a cat. Aust Vet J 2015; 93:377-80. [PMID: 26412120 DOI: 10.1111/avj.12365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 12/30/2014] [Accepted: 04/13/2015] [Indexed: 11/27/2022]
Abstract
CASE REPORT A 3.5-year-old spayed female Domestic Shorthair cat was evaluated for new onset seizures and lateralising signs indicative of a lesion in the right prosencephalon. Magnetic resonance imaging and computed tomography of the head revealed hypoplasia of the right cerebral hemisphere and changes in the overlying cranium, including hyperostosis and expansion of the diploic space, resulting in an increased pneumatisation of the rostral bones of the cranium. A congenital injury to the cerebral hemisphere and secondary changes of the cranium in response to the decreased brain parenchyma was presumed. Similar changes have been previously recognised in human patients with unilateral anomalies of the cerebral hemispheres, termed Dyke-Davidoff-Masson syndrome (DDMS). CONCLUSION The case presented is the first clinical and imaging description of a cat with a syndrome that closely resembles DDMS in humans. The description of the syndrome allows recognition of an additional differential for seizures in a young patient and informs the clinician of the imaging characteristics of the cranium seen with early loss of brain parenchyma.
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Affiliation(s)
- R B Song
- Department of Neurology and Neurosurgery, Red Bank Veterinary Hospital, Tinton Falls, NJ, USA.
| | - E N Glass
- Department of Neurology and Neurosurgery, Red Bank Veterinary Hospital, Tinton Falls, NJ, USA
| | - M Kent
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, USA
| | - F A Castro
- Department of Radiology, Red Bank Veterinary Hospital, Tinton Falls, NJ, USA
| | - A deLahunta
- Department of Biomedical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA
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24
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Pakozdy A, Patzl M, Zimmermann L, Jokinen TS, Glantschnigg U, Kelemen A, Hasegawa D. LGI Proteins and Epilepsy in Human and Animals. J Vet Intern Med 2015; 29:997-1005. [PMID: 26032921 PMCID: PMC4895363 DOI: 10.1111/jvim.12610] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 03/23/2015] [Accepted: 04/11/2015] [Indexed: 12/16/2022] Open
Abstract
Leucine‐rich glioma‐inactivated (LGI) protein was first thought to have a suppressor effect in the formation of some cancers. Developments in physiology and medicine made it possible to characterize the function of the LGI protein family and its crucial role in different conditions more precisely. These proteins play an important role in synaptic transmission, and dysfunction may cause hyperexcitability. Genetic mutation of LGI1was confirmed to be the cause of autosomal dominant lateral temporal lobe epilepsy in humans. The LGI2 mutation was identified in benign familial juvenile epilepsy in Lagotto Romagnolo (LR) dogs. Cats with familial spontaneous temporal lobe epilepsy have been reported, and the etiology might be associated with LGI protein family dysfunction. In addition, an autoimmune reaction against LGI1 was detected in humans and cats with limbic encephalitis. These advances prompted a review of LGI protein function and its role in different seizure disorders.
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Affiliation(s)
- A Pakozdy
- University Clinic of Small Animals, University of Veterinary Medicine, Vienna, Austria
| | - M Patzl
- Institute of Immunology, University of Veterinary Medicine, Vienna, Austria
| | - L Zimmermann
- Unit of Physiology and Biophysics, University of Veterinary Medicine, Vienna, Austria
| | - T S Jokinen
- Department of Equine and Small Animal Medicine, University of Helsinki, Helsinki, Finland
| | - U Glantschnigg
- University Clinic of Small Animals, University of Veterinary Medicine, Vienna, Austria
| | - A Kelemen
- Epilepsy Center, National Institute of Clinical Neurosciences, Budapest, Hungary
| | - D Hasegawa
- Department of Clinical Veterinary Medicine, Nippon Veterinary and Life Science University, Musashinoshi, Tokyo, Japan
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25
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Delamaide Gasper JA, Barnes Heller HL, Robertson M, Trepanier LA. Therapeutic serum phenobarbital concentrations obtained using chronic transdermal administration of phenobarbital in healthy cats. J Feline Med Surg 2014; 17:359-63. [DOI: 10.1177/1098612x14545141] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Seizures are a common cause of neurologic disease, and phenobarbital (PB) is the most commonly used antiepileptic drug. Chronic oral dosing can be challenging for cat owners, leading to poor compliance. The purpose of this study was to determine if the transdermal administration of PB could achieve serum PB concentrations of between 15 and 45 μg/ml in healthy cats. Nineteen healthy cats were enrolled in three groups. Transdermal PB in pluronic lecithin organogel (PLO) was applied to the pinnae for 14 days at a dosage of 3 mg/kg q12h in group 1 (n = 6 cats) and 9 mg/kg q12h in group 2 (n = 7 cats). Transdermal PB in Lipoderm Activemax was similarly applied at 9 mg/kg q12h for 14 days in group 3 (n = 6 cats). Steady-state serum PB concentrations were measured at trough, and at 2, 4 and 6 h after the morning dose on day 15. In group 1, median concentrations ranged from 6.0–7.5 μg/ml throughout the day (observed range 0–11 μg/ml). Group 2 median concentrations were 26.0 μg/ml (observed range 18.0–37.0 μg/ml). For group 3, median concentrations ranged from 15.0–17.0 μg/ml throughout the day (range 5–29 μg/ml). Side effects were mild. One cat was withdrawn from group 2 owing to ataxia and sedation. These results show therapeutic serum PB concentrations can be achieved in cats following chronic transdermal administration of PB in PLO at a dosage of 9 mg/kg q12h. More individual variation was noted using Lipoderm Activemax. Transdermal administration may be an alternative for cats that are difficult to medicate orally.
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Affiliation(s)
- Joy A Delamaide Gasper
- Department of Medical Sciences, University of Wisconsin–Madison, School of Veterinary Medicine, Madison, WI, USA
| | - Heidi L Barnes Heller
- Department of Medical Sciences, University of Wisconsin–Madison, School of Veterinary Medicine, Madison, WI, USA
| | - Michelle Robertson
- UW Veterinary Care Pharmacy, University of Wisconsin–Madison, School of Veterinary Medicine, Madison, WI, USA
| | - Lauren A Trepanier
- Department of Medical Sciences, University of Wisconsin–Madison, School of Veterinary Medicine, Madison, WI, USA
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26
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Moore SA. Seizures and epilepsy in cats. VETERINARY MEDICINE-RESEARCH AND REPORTS 2014; 5:41-47. [PMID: 32670845 PMCID: PMC7337200 DOI: 10.2147/vmrr.s62077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 04/23/2014] [Indexed: 11/23/2022]
Abstract
Seizures are a common presenting complaint in cats, although causes and options for the treatment of seizures in this species have been historically poorly described in the veterinary literature. Seizure manifestation in cats may be different than what is typically seen in dogs, but the underlying causes of seizure activity are the same. These include primary epilepsies, structural epilepsies, and reactive seizures. Although primary epilepsy was once believed to be rare in cats, we now commonly appreciate this syndrome, albeit at a lower frequency than in dogs. Because of this, a complete diagnostic work-up is recommended for all cats presenting for initial evaluation of seizures. Symptomatic treatment of seizures in cats is similar to dogs, with only a few limitations related to species-specific antiepileptic drug toxicities. The goal of this review is to summarize the recent veterinary literature related to feline seizures, with a focus on seizure classification, clinical manifestation, diagnostic evaluation, and treatment options.
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Affiliation(s)
- Sarah A Moore
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, USA
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27
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Mariani CL. Terminology and classification of seizures and epilepsy in veterinary patients. Top Companion Anim Med 2014; 28:34-41. [PMID: 24070679 DOI: 10.1053/j.tcam.2013.06.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 06/25/2013] [Indexed: 11/11/2022]
Abstract
The classification of epileptic seizures and epilepsy is a controversial and dynamic topic that has undergone many iterations in human medicine. The International League against Epilepsy is a multinational organization that has formed a number of task forces and subcommittees to study this issue, and has ratified several reports outlining recommended terminology and classification schemes for human patients. Veterinary publications on this issue have generally adapted these schemes to fit small animal patients, but a formally endorsed system to classify seizures and epilepsy has never been developed for veterinary patients. This review outlines the classification systems that have been published for human patients and summarizes previous efforts by veterinary authors to utilize these methods. Finally, a set of definitions and terminology for use in veterinary patients is proposed, which includes a glossary of descriptive terminology for ictal semiology and a diagnostic scheme for classification of individual patients. This document is intended as a starting point of discussion, which will hopefully eventually result in a formally ratified document that will be useful for communication between health professionals, the design of clinical trials and for guiding treatment decisions and prognostication for veterinary patients with seizures.
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Affiliation(s)
- Christopher L Mariani
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA.
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28
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Pakozdy A, Halasz P, Klang A. Epilepsy in cats: theory and practice. J Vet Intern Med 2014; 28:255-63. [PMID: 24438024 PMCID: PMC4857998 DOI: 10.1111/jvim.12297] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 11/14/2013] [Accepted: 12/04/2013] [Indexed: 11/29/2022] Open
Abstract
The veterinary literature on epilepsy in cats is less extensive than that for dogs. The present review summarizes the most important human definitions related to epilepsy and discusses the difficulties in applying them in daily veterinary practice. Epileptic seizures can have a wide range of clinical signs and are not necessarily typical in all cases. Whether a seizure event is epileptic can only be suspected based on clinical, laboratory, and neuroimaging findings as electroencephalography diagnostic techniques have not yet been developed to a sufficiently accurate level in veterinary medicine. In addition, the present review aims to describe other diagnoses and nonepileptic conditions that might be mistaken for epileptic seizures. Seizures associated with hippocampal lesions are described and discussed extensively, as they seem to be a special entity only recognized in the past few years. Furthermore, we focus on clinical work‐up and on treatment that can be recommended based on the literature and summarize the limited data available relating to the outcome. Critical commentary is provided as most studies are based on very weak evidence.
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Affiliation(s)
- A Pakozdy
- University Clinic for Small Animals, Clinical Department for Companion Animals and Horses, University of Veterinary Medicine, Vienna, Austria
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29
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Finnerty KE, Heller HLB, Mercier MN, Giovanella CJ, Lau VW, Rylander H. Evaluation of therapeutic phenobarbital concentrations and application of a classification system for seizures in cats: 30 cases (2004–2013). J Am Vet Med Assoc 2014; 244:195-9. [DOI: 10.2460/javma.244.2.195] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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30
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Wahle AM, Brühschwein A, Matiasek K, Putschbach K, Wagner E, Mueller RS, Fischer A. Clinical characterization of epilepsy of unknown cause in cats. J Vet Intern Med 2013; 28:182-8. [PMID: 24237601 PMCID: PMC4895554 DOI: 10.1111/jvim.12250] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 09/15/2013] [Accepted: 10/08/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The diagnosis of feline epilepsy of unknown cause (EUC) requires a thorough diagnostic evaluation, otherwise the prevalence of EUC could be overestimated. HYPOTHESIS Feline EUC is a clinically defined disease entity, which differs from feline hippocampal necrosis by the absence of magnetic resonance imaging (MRI) signal alteration of the hippocampus. The objectives of this study were (1) to evaluate the prevalence of EUC in a hospital population of cats by applying well-defined inclusion criteria, and (2) to describe the clinical course of EUC. ANIMALS Eighty-one cats with recurrent seizures. METHODS Retrospective study--medical records were reviewed for cats presented for evaluation of recurrent seizures (2005-2010). Inclusion criteria were a defined diagnosis based on laboratory data, and either MRI or histopathology. Final outcome was confirmed by telephone interview with the owner. Magnetic resonance images were reviewed to evaluate hippocampal morphology and signal alterations. RESULTS Epilepsy of unknown cause was diagnosed in 22% of cats with epilepsy. Physical, neurologic, and laboratory examinations, and either 1.5 T MRI and cerebrospinal fluid analysis or postmortem examination failed to identify an underlying cause. Cats with EUC had a higher survival rate (P < .05) and seizure remission occurred frequently (44.4%). CONCLUSION AND CLINICAL IMPORTANCE A detailed clinical evaluation and diagnostic imaging with MRI is recommended in any cat with recurrent seizures. The prognosis of cats with normal MRI findings and a clinical diagnosis of EUC are good. Standardized imaging guidelines should be established to assess the hippocampus in cats.
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Affiliation(s)
- A M Wahle
- Clinic of Small Animal Medicine, Ludwig-Maximilians University, Munich, Germany
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Palus V, Eminaga S, Cherubini GB. Seizuring cat: what to ask, what to do? COMPANION ANIMAL 2013. [PMCID: PMC7162338 DOI: 10.12968/coan.2013.18.7.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A seizuring cat can be a challenging case for every veterinarian and, therefore, the correct diagnosis and the appropriate management of such a case requires understanding of the most common causes of feline seizures. The underlying cause of the seizures should be investigated by a thorough questioning of the diagnostic approach and most likely diagnoses. If the cause of the seizures can be found then the appropriate therapeutic approach may improve the prognosis. The treatment of the feline seizures is similar to the canine patients; however, the differences should be kept in mind. This article is tailored to answer the most common questions that veterinary surgeons should ask themselves when dealing with a seizuring cat.
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Affiliation(s)
| | | | - Giunio Bruto Cherubini
- in Veterinary Neurology Dick White Referrals Station Farm, London Road, Six Mile Bottom, Suffolk, CB8 0UH
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Grohmann KS, Schmidt MJ, Moritz A, Kramer M. Prevalence of seizures in cats after head trauma. J Am Vet Med Assoc 2012; 241:1467-70. [DOI: 10.2460/javma.241.11.1467] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Pakozdy A, Sarchahi AA, Leschnik M, Tichy AG, Halasz P, Thalhammer JG. Treatment and long-term follow-up of cats with suspected primary epilepsy. J Feline Med Surg 2012; 15:267-73. [DOI: 10.1177/1098612x12464627] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report an evaluation of the treatment and outcome of cats with suspected primary epilepsy. Phenobarbital therapy was used alone or in combination with other anti-epileptic drugs. Outcome after treatment was evaluated mainly on the basis of number of seizures per year and categorised into four groups: seizure-free, good control (1–5 seizures per year), moderate control (6–10 seizures per year) and poor control (more than 10 seizures per year). About 40–50% of cases became seizure-free, 20–30% were considered good-to-moderately controlled and about 30% were poorly controlled depending on the year of treatment considered. The duration of seizure events after treatment decreased in 26/36 cats and was unchanged in eight cats. The subjective severity of seizure also decreased in 25 cats and was unchanged in nine cats. Twenty-six cats had a good quality of life, nine cats an impaired quality of life and one cat a bad quality of life. Despite being free of seizures for years, cessation of treatment may lead to recurrence of seizures in most cats.
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Affiliation(s)
- Akos Pakozdy
- Department for Companion Animals and Horses, Small Animal Clinic, Internal Medicine, University of Veterinary Medicine, Vienna, Austria
| | - Ali Asghar Sarchahi
- Department of Veterinary Clinical Studies, School of Veterinary Medicine, Shiraz University, Iran
| | - Michael Leschnik
- Department for Companion Animals and Horses, Small Animal Clinic, Internal Medicine, University of Veterinary Medicine, Vienna, Austria
| | - Alexander G Tichy
- Platform Bioinformatics and Biostatistics, University of Veterinary Medicine, Vienna, Austria
| | - Peter Halasz
- Institute of Experimental Medicine, Budapest, Hungary, Budapest, Hungary
| | - Johann G Thalhammer
- Department for Companion Animals and Horses, Small Animal Clinic, Internal Medicine, University of Veterinary Medicine, Vienna, Austria
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Carnes MB, Axlund TW, Boothe DM. Pharmacokinetics of levetiracetam after oral and intravenous administration of a single dose to clinically normal cats. Am J Vet Res 2011; 72:1247-52. [DOI: 10.2460/ajvr.72.9.1247] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Practical relevance Although a relatively uncommon condition, the investigation, diagnosis and initial medical management of feline congenital portosystemic shunts is often undertaken within general practice. Early recognition and appropriate treatment are important to ensure a good outcome. Clinical challenges Clinical signs associated with CPSSs in cats are extremely variable and can be intermittent. Signs can affect a variety of organ systems including the nervous system, and gastrointestinal and urinary tracts. Thus, the differential diagnosis list may be very long and a CPSS may not be suspected initially. More specific diagnostic tests and diagnostic imaging are indicated but may not be 100% accurate and may not be readily available to the general practitioner. Audience This review highlights challenging aspects of the investigation and management of CPSSs for the practising veterinarian, but is also relevant to postgraduate students and provides a practical summary for specialists. Patient group In practice, domestic shorthairs make up the majority of cats with CPSSs. However, Siamese, Persian and Himalayan cats may be more commonly affected than other purebreeds. While cats with CPSSs are typically under 6 months old, the condition is seen in mature animals, which may not have exhibited clinical signs for months or years. Evidence base Despite several retrospective studies of cats with CPSSs, the evidence base for management of the condition remains limited.
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Affiliation(s)
- Michael Tivers
- Department of Veterinary Clinical Sciences, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire AL9 7TA, UK
| | - Victoria Lipscomb
- Department of Veterinary Clinical Sciences, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire AL9 7TA, UK
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Pákozdy Á, Leschnik M, Sarchahi AA, Tichy AG, Thalhammer JG. Clinical comparison of primary versus secondary epilepsy in 125 cats. J Feline Med Surg 2010; 12:910-6. [DOI: 10.1016/j.jfms.2010.07.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Accepted: 07/04/2010] [Indexed: 11/16/2022]
Abstract
In the present study 125 cats with recurrent seizures were analysed. The main goal was to investigate the aetiology and compare primary epilepsy (PE) with secondary epilepsy (SE) regarding signalment, history, ictal pattern, clinical and neurological findings. Seizure aetiology was classified as PE in 47 (38%) and SE in 78 (62%) cats. SE was caused mainly by intracranial neoplasia (16), hippocampal necrosis (14), toxicosis (eight), and encephalitis (seven). A significant difference between PE and SE was found in: age, body weight, duration of seizure, occurrence of status epilepticus and neurological deficits. Status epilepticus, altered interictal neurological status and seizure onset over the age of 7 years indicated SE more frequently than PE. If the seizures occurred during resting conditions and rapid running occurred the aetiology was more likely to be PE than SE.
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Affiliation(s)
- Ákos Pákozdy
- Clinic for Internal Medicine and Infectious Diseases, University of Veterinary Medicine, Neurology Service, Veterinärplatz 1, A-1210 Vienna, Austria
| | - Michael Leschnik
- Clinic for Internal Medicine and Infectious Diseases, University of Veterinary Medicine, Neurology Service, Veterinärplatz 1, A-1210 Vienna, Austria
| | - Ali Asghar Sarchahi
- Department of Veterinary Clinical Studies, School of Veterinary Medicine, Shiraz University, Iran
| | - Alexander G. Tichy
- Institute of Physics and Biostatistics, University of Veterinary Medicine, Vienna, Austria
| | - Johann G. Thalhammer
- Clinic for Internal Medicine and Infectious Diseases, University of Veterinary Medicine, Neurology Service, Veterinärplatz 1, A-1210 Vienna, Austria
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Rusbridge C, Heath S, Gunn-Moore DA, Knowler SP, Johnston N, McFadyen AK. Feline orofacial pain syndrome (FOPS): a retrospective study of 113 cases. J Feline Med Surg 2010; 12:498-508. [PMID: 20451434 PMCID: PMC7128958 DOI: 10.1016/j.jfms.2010.03.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2010] [Indexed: 12/15/2022]
Abstract
Feline orofacial pain syndrome (FOPS) is a pain disorder of cats with behavioural signs of oral discomfort and tongue mutilation. This report describes the findings from a case series of 113 cats including 100 Burmese. FOPS is suspected to be a neuropathic pain disorder and the predominance within the Burmese cat breed suggests an inherited disorder, possibly involving central and/or ganglion processing of sensory trigeminal information. The disease is characterised by an episodic, typically unilateral, discomfort with pain-free intervals. The discomfort is triggered, in many cases, by mouth movements. The disease is often recurrent and with time may become unremitting - 12% of cases in this series were euthanased as a consequence of the condition. Sensitisation of trigeminal nerve endings as a consequence of oral disease or tooth eruption appears to be an important factor in the aetiology - 63% of cases had a history of oral lesions and at least 16% experienced their first sign of discomfort during eruption of permanent teeth. External factors can also influence the disease as FOPS events could be directly linked to a situation causing anxiety in 20% of cats. FOPS can be resistant to traditional analgesics and in some cases successful management required anti-convulsants with an analgesic effect.
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Affiliation(s)
- Clare Rusbridge
- Stone Lion Veterinary Centre, 41 High Street, Wimbledon SW19 5AU, UK.
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