Epilepsy in horses: Aetiological classification and predictive factors

Juvenile idiopathic epilepsy in Egyptian Arabian foals, a potential animal model of self-limited epilepsy in children

BACKGROUND

Juvenile idiopathic epilepsy (JIE) is categorized as a generalized epilepsy. Epilepsy classification entails electrocortical characterization and localization of epileptic discharges (ED) using electroencephalography (EEG).

HYPOTHESIS/OBJECTIVES

Characterize epilepsy in Egyptian Arabian foals with JIE using EEG.

ANIMALS

Sixty-nine foals (JIE, 48; controls, 21).

METHODS

Retrospective study. Inclusion criteria consisted of Egyptian Arabian foals: (1) JIE group diagnosed based on witnessed or recorded seizures, and neurological and EEG findings, and (2) control group of healthy nonepileptic age-matched foals. Clinical data were obtained in 48 foals. Electroencephalography with photic stimulation was performed under standing sedation in 37 JIE foals and 21 controls.

RESULTS

Abnormalities on EEG were found in 95% of epileptic foals (35 of 37) and in 3 of 21 control asymptomatic foals with affected siblings. Focal ED were detected predominantly in the central vertex with diffusion into the centroparietal or frontocentral regions (n = 35). Generalization of ED occurred in 14 JIE foals. Epileptic discharges commonly were seen during wakefulness (n = 27/37 JIE foals) and sedated sleep (n = 35/37 JIE foals; 3/21 controls). Photic stimulation triggered focal central ED in 15 of 21 JIE foals.

CONCLUSIONS AND CLINICAL IMPORTANCE

Juvenile idiopathic epilepsy has a focal onset of ED at the central vertex with spread resulting in clinical generalized tonic-clonic seizures with facial motor activity and loss of consciousness. Electroencephalography with photic stimulation contributes to accurate phenotyping of epilepsy. Foals with this benign self-limiting disorder might serve as a naturally occurring animal model for self-limited epilepsy in children.

Presumed cholesterinic granulomas detected on CT in horses are associated with increased lateral ventricle height and age

Cholesterinic granulomas are mass‐like lesions that form at the choroid plexus of the ventricular system. Large cholesterinic granulomas within the lateral ventricles have been reported to cause severe neurological signs. However, little data are available about their prevalence or appearance in the overall population. The objective was to report the prevalence of presumed cholesterinic granulomas on CT in a population of horses, and investigate associations between presumed cholesterinic granuloma presence, lateral ventricle size, age, and neurological signs. The study was cross sectional, CT scans of the head were assessed for presumed cholesterinic granuloma presence and size, and lateral ventricle height. Computed tomography findings and clinical information were compared using nonparametric testing. Computed tomography scans of 139 horses were included. Presumed cholesterinic granulomas were found in 22 horses (15.8%), nine were unilateral and 13 bilateral. A significant increase in prevalence was observed with age (P < .0001), with 38% of horses over 15 years old affected. The median volume of presumed cholesterinic granulomas was 242 mm³ with a range from 51 to 2420 mm³. The mean lateral ventricle height was significantly increased in horses with presumed cholesterinic granulomas present (P = .004), with a median of 7.3 mm compared to 4.9 mm without. Neurological signs were not associated with presumed cholesterinic granuloma presence or lateral ventricle height. Fourth ventricle mineralizations were found in seven horses, which may represent cholesterinic granulomas. In conclusion, presumed cholesterinic granulomas occurred in a large proportion of the examined population and are associated with increased lateral ventricle dilation and advanced age.

Ganglioglioma of the Right Cerebrothalamus in a 7-Year-Old Quarter Horse Cross Gelding

Intracranial neoplasia in horses is rare compared to other species. Detailed information such as neurological, electroencephalographic, and histopathological examination of horses with intracranial neoplasia associated with seizures is scarce in the literature. Furthermore, ganglioglioma has not been reported in the horse. A 7-year-old Quarter horse cross Paint gelding was examined due to recurrent seizure-like episodes of 1-year duration. The seizures had been increasing in frequency and length, occurring up to 20 times a day at the time of presentation. Neurological examination revealed intermittent obtundation and multiple left sided abnormalities consisting of upper motor facial and tongue hemiparesis, facial hyperesthesia and cervical hypoesthesia, proprioceptive deficits, thoracic limb hypermetria upon head elevation; and intermittent paroxysmal activity consistent with seizures. Cranial nerve reflexes were normal. Vocalization, conjugate vertical nystagmus, intermittent blindness, left sided head tilt and flexion of neck, and lack of response to environmental stimuli were observed during seizure activity. A right sided cerebrothalamic disease was suspected. An electroencephalogram confirmed seizure activity with main focus on the right side at the central, parietal, and occipital regions further supporting neuroanatomical localization. Additionally, subclinical paroxysmal activity was noted on the electroencephalogram. A ganglioglioma was identified in the right cerebrothalamic area, and other cranial parts of the brainstem based on immunohistochemical examination. To the authors' knowledge this is the first report of intracranial ganglioglioma in the horse. This intracranial neoplasia should be added to the possible causes of intracranial masses and seizures in horses.

Urinary volatile metabolites of amygdala-kindled mice reveal novel biomarkers associated with temporal lobe epilepsy

Epilepsy is a chronic neurological disorder affecting mammals, including humans. Uncontrolled epilepsy is associated with poor quality of life, accidents, and sudden death. In particular, temporal lobe epilepsy (TLE) is the most common type of pharmacoresistant epilepsy, which easily gets out of control in human adults. The aim of this study was to profile urinary volatile organic compounds (VOCs) in a mouse model of TLE using solid-phase microextraction (SPME) gas chromatography mass spectrometry (GC-MS). Thirteen urinary VOCs exhibited differential abundance between epileptic and control mice, and the corresponding areas under the receiver operating characteristic (ROC) curve were greater than 0.8. Principal component analysis (PCA) based on these 13 VOCs separated epileptic from sham operated-mice, suggesting that all these 13 VOCs are epilepsy biomarkers. Promax rotation and dendrogram analysis concordantly separated the 13 VOCs into three groups. Stepwise linear discriminant analysis extracted methanethiol; disulfide, dimethyl; and 2-butanone as predictors. Based on known metabolic systems, the results suggest that TLE induced by amygdala stimulation could affect both endogenous metabolites and the gut flora. Future work will elucidate the physiological meaning of the VOCs as end-products of metabolic networks and assess the impact of the metabolic background involved in development of TLE.

Seizure-like activity after gadolinium administration in an anaesthetised foal undergoing magnetic resonance imaging

The use of MRI has been recently increasing in veterinary patients, and this modality has been adapted for use in large animals with the concurrent use of gadolinium-based contrast media. Possible adverse reactions to its administration have been described in human and veterinary medicine, but there are no reports in foals. This case report describes the occurrence of seizure-like activity following administration of gadolinium to a 1.5-month old Finnish warmblood foal that was admitted for an MRI scan and cerebral spinal fluid collection. After the administration of contrast media, severe muscle twitching was observed. Prompt intervention, facilitated by constant patient monitoring and administration of propofol and diazepam, resulted in the control of the seizure and a favourable outcome. Since no alterations were found during the diagnostic investigation, it was suspected that the seizure-like activity might have been an adverse reaction to the contrast medium.

Investigation of Known Genetic Mutations of Arabian Horses in Egyptian Arabian Foals with Juvenile Idiopathic Epilepsy

Background

The carrier status of lavender foal syndrome (LFS), cerebellar abiotrophy (CA), severe combined immunodeficiency (SCID), and occipitoatlantoaxial malformation (OAAM1) in foals with juvenile idiopathic epilepsy (JIE) is unknown.

Hypothesis/Objectives

To determine the carrier status of LFS, CA, SCID, and OAAM1 in foals with JIE.

Animals

Ten foals with JIE.

Materials and Methods

Archived DNA samples were tested for known genetic mutations causing LFS, CA, SCID, and OAAM1. The inclusion criteria consisted of having been diagnosed with JIE by ruling out other causes of seizures in foals and supported by electroencephalographic examination.

Results

Ten Egyptian Arabian horses (5 females and 5 males) were phenotyped as foals with JIE by electroencephalography (EEG). All foals were negative for the genetic mutations that cause LFS, CA, SCID, and OAAM1 except for 1 foal that was a carrier of CA.

Conclusions and Clinical Importance

Juvenile idiopathic epilepsy of Egyptian Arabian foals and LFS appear to be phenotypically and genetically distinct disorders. There was no apparent association between JIE and LFS, CA, SCID, and OAAM1.

An Ambulatory Electroencephalography System for Freely Moving Horses: An Innovating Approach

Electroencephalography (EEG) that has been extensively studied in humans presents also a large interest for studies on animal brain processes. However, since the quality of the recordings is altered by muscular activity, most EEG recordings on animals are obtained using invasive methods with deeply implanted electrodes. This requires anesthesia and can thus only be used in laboratory or clinical settings. As EEG is a very useful tool both for detecting brain alterations due to diseases or accidents and to evaluate the arousal and attentional state of the animal, it seemed crucial to develop a tool that would make such recordings possible in the horse’s home environment, with a freely moving horse. Such a tool should neither be invasive nor cause discomforts to the horse as the usual other practice which consists, after shaving the zone, in gluing the electrodes to the skin. To fulfill these requirements, we developed a novel EEG headset adapted to the horse’s head that allows an easy and fast positioning of the electrodes and that can be used in the home environment on a freely moving horse. In this study, we show that this EEG headset allows to obtain reliable recordings, and we propose an original evaluation of an animal’s “EEG profile” that allows comparisons between individuals and situations. This EEG headset opens new possibilities of investigation on horse cognition, and it can also become a useful tool for veterinarians to evaluate cerebral disorders or check the anesthesia level during a surgery.

Seizures in horses: diagnosis and classification

Seizures are a diverse and very common set of chronic neurologic disorders in humans and dogs but are less common in horses. Seizures refer to a specific clinical event (described as sudden and severe) regardless of the etiology, which includes both intracranial and extracranial causes. Therefore, after briefly reviewing some definitions, this article aims to describe the use of a standardized classification, which could facilitate a logical approach for the clinician to establish a diagnosis, as well as to use a consistent mode of communication. For instance, seizures can be classified by type (ie, focal vs generalized) or etiology (ie, reactive, symptomatic, cryptogenic, idiopathic). In particular, epilepsy, a brain disorder characterized by recurrent seizures can be classified as primary (ie, genetic origin) or secondary (ie, acquired). This review further discusses the limitations associated with the clinical workup of horses with seizures. This is germane to the fact that the identification of the underlying cause remains challenging due to the technical limitations of imaging the equine adult brain. Indeed, as in man and dogs, epilepsies of unknown cause (ie, cryptogenic) account for the majority of all epilepsies. Therefore, although electroencephalography and advanced brain imaging techniques (eg, computed tomography and magnetic resonance imaging) are becoming increasingly available, information obtained from the history, physical, and neurologic examinations and progression of clinical signs and response to treatment remain essential in the workup of horses with seizures.

Electroencephalogram of Healthy Horses During Inhaled Anesthesia

Background

Previous study of the diagnostic validity of electroencephalography (EEG) to detect abnormalities in equine cerebral cortical function relied on the administration of various drugs for sedation, induction, and maintenance of general anesthesia but used identical criteria to interpret recordings.

Objectives

To determine the effects of 2 inhalation anesthetics on the EEG of healthy horses.

Animals

Six healthy horses.

Methods

Prospective study. After the sole administration of one of either isoflurane or halothane at 1.2, 1.4, and 1.6 times the minimum alveolar concentration, EEG was recorded during controlled ventilation, spontaneous ventilation, and nerve stimulation.

Results

Burst suppression was observed with isoflurane, along with EEG events that resembled epileptiform discharges. Halothane results were variable between horses, with epileptiform‐like discharges and bursts of theta, alpha, and beta recorded intermittently. One horse died and 2 were euthanized as the result of anesthesia‐related complications.

Conclusions and Clinical Importance

The results of this study indicate that the effects of halothane and isoflurane on EEG activity in the normal horse can be quite variable, even when used in the absence of other drugs. It is recommended that equine EEG be performed without the use of these inhalation anesthetics and that general anesthesia be induced and maintained by other contemporary means.

Magnetic resonance imaging characteristics of equine head disorders: 84 cases (2000-2013)

The equine head is an anatomically complex area, therefore advanced tomographic imaging techniques, such as computed tomography or magnetic resonance imaging (MRI), are often required for diagnosis and treatment planning. The purpose of this multicenter retrospective study was to describe MRI characteristics for a large sample of horses with head disorders. Horses imaged over a period of 13 years were recruited. Eighty-four horses met the inclusion criteria, having neurological (n = 65), sinonasal (n = 14), and soft tissue (n = 5) disorders. Magnetic resonance imaging accurately depicted the anatomy and allowed identification of the primary lesion and associated changes. There were good correlations between MRI findings and intraoperative or postmortem results. Magnetic resonance imaging showed the exact localization of the lesions, their size, and relation to surrounding structures. However, in the neurological group, there were 45 horses with no MRI abnormalities, 29 of which had a history of recurrent seizures, related to cryptogenic epilepsy. Magnetic resonance imaging was otherwise a valuable diagnostic tool, and can be used for studying a broad range of head disorders using either low-field or high-field magnets.

Mechanical ventilation and management of an adult horse with presumptive botulism

OBJECTIVE

To describe the clinical course, management, and outcome of a horse with a presumptive diagnosis of botulism treated with long-term mechanical ventilation.

CASE SUMMARY

A 6-year-old Quarter Horse gelding with a history of esophageal obstruction was evaluated for progressive tetraparesis. Generalized and progressive skeletal muscle weakness characterized by recumbency, decreased tongue, tail, eyelid, and anal tone, and respiratory failure was observed. Anticholinergic signs including decreased salivation, xerophthalmia, and ileus were also noted. A presumptive diagnosis of botulism was made, although mouse inoculation and spore identification testing were negative. Pentavalent botulism antitoxin was administered on Day 3. The horse was maintained on a water mattress and was managed with mechanical ventilation for 2 weeks. Complications encountered included necrotic rhinitis, intertrigo, decubital ulceration, jugular and cephalic vein thrombophlebitis, corneal ulceration, and transient ventricular tachycardia. The horse showed marked improvement in skeletal muscle strength and parasympathetic nervous system function, allowing it to be successfully weaned from the ventilator but suffered large colon volvulus on Day 21 and was euthanized.

NEW OR UNIQUE INFORMATION PROVIDED

To the authors' knowledge, this is the first report of successful weaning from long-term mechanical ventilation and management of recumbency using a water mattress in an adult horse with presumptive botulism.

The applicability of ambulatory electroencephalography (AEEG) in healthy horses and horses with abnormal behaviour or clinical signs of epilepsy

BACKGROUND

Short-duration electroencephalography (EEG) recordings in horses are helpful in diagnosing intracranial disorders. Potentially, long-duration ambulatory EEG (AEEG) recordings in horses will enhance the chance of detecting abnormal brain activity independent of the presence of an insult.

OBJECTIVE

The objective of this study was to test if AEEG recordings in unsedated horses can be acquired and benefit diagnosing abnormal brain activity.

ANIMALS AND METHODS

Recordings were taken from 8 adult control horses and 10 patients suspected of intracranial abnormalities. Self-adhesive electrodes and the 'Porti-5' recording system were used. Filter settings were 0.5 Hz high pass and 35 Hz low pass. The records were analysed offline at a 50-200 μV/division and 10 seconds/division scale. Abnormal activity was defined as a spike or sharp wave, a period of generalised slow wave rhythmical activity or a generalised fast rhythmical discharge. The recording time ranged from 5 to 49 hours.

RESULTS

In the control group, one horse showed pathological activity. In the patient group, six out of nine horses showed abnormal activity during the recordings. Magnetic resonance imaging confirmed the presence of an intracranial mass in one patient. Long-term recordings of high quality can be obtained in unsedated horses by allowing daily activity using AEEG, resulting in a reasonable chance of recording (inter)ictal abnormal brain activity indicating epileptic or seizure-like activity in the absence of clinical signs or seizures.

CONCLUSIONS

It is concluded that abnormal behaviour can be expressed intermittently, and with the availability of AEEG a useful tool is added to the diagnostic scenario for horses.

A review on epilepsy in the horse and the potential of Ambulatory EEG as a diagnostic tool

Epilepsy in the horse is diagnosed based on clinical signs, but diagnosing can be difficult if a grand mal is not present. The future prospects of the horse and potentially the safety of the owner depend on an accurate diagnosis. This review presents information on epilepsy and focuses on the diagnostic potential of (Ambulatory) electroencephalography ((A) EEG). An epileptic seizure is a brain disorder, which expresses itself as a recurrent episode of involuntary abnormal behaviour. The aetiology can originate from inside or outside the brain or is idiopathic. Besides those categories, seizures can be classified as generalised or partial. A typical generalised tonic-clonic seizure is characterised by the prodrome, the ictus and the post-ictal phase. EEG is the graphic recording of rhythmic bioelectric activity which originates predominantly from the cerebral cortex. In human medicine, the 10/20 international basis system for electrode placement is used. This makes comparison more reliable and consistent. The normal human brainwaves recorded are alpha, beta, theta and delta waves. In the horse, fewer descriptions of normal signals are available. In humans suffering from epilepsy, spikes, complexes, spike-and-wave discharges and rhythmical multi-spike activity are seen. In horses suffering from epilepsy, spikes, sharp waves and spike-and-wave discharges are seen. In humans, AEEG has numerous advantages above short-duration EEG in diagnosing epilepsy or intracranial pathology. In future, AEEG might be useful to record brain signals in awake horses expressing their behaviour under natural circumstances.