Owner survey of headshaking in horses

Sensory nerve conduction stimulus threshold measurements of the infraorbital nerve and its applicability as a diagnostic tool in horses with trigeminal-mediated headshaking

BACKGROUND

To determine whether sensory nerve conduction stimulus threshold measurements of the infraorbital nerve are able to differentiate horses with idiopathic trigeminal-mediated headshaking (i-TMHS) from healthy horses and from horses with secondary trigeminal-mediated headshaking (s-TMHS). In a prospective trial, headshaking horses were examined using a standardized diagnostic protocol, including advanced diagnostics such as computed tomography and 3-Tesla-magnetic resonance imaging (MRI), to differentiate s-TMHS from i-TMHS. Clinically healthy horses served as controls. Within this process, patients underwent general anesthesia, and the minimal sensory nerve conduction stimulus threshold (SNCT) of the infraorbital nerve was measured using a bipolar concentric needle electrode. Sensory nerve action potentials (SNAP) were assessed in 2.5-5 mA intervals. Minimal SNCT as well as additional measurements were calculated.

RESULTS

In 60 horses, SNAP could be recorded, of which 43 horses had i-TMHS, six had suspected s-TMHS, three horses had non-facial headshaking, and eight healthy horses served as controls. Controls had a minimal SNCT ≥ 15 mA, whereas 14/43 horses with i-TMHS and 2/6 horses with s-TMHS showed a minimal SNCT ≤ 10 mA. Minimal SNCT ≤ 10 mA showed 100% specificity to distinguish TMHS from controls, but the sensitivity was only 41%.

CONCLUSION

A minimal SNCT of the infraorbital nerve ≤ 10 mA was able to differentiate healthy horses from horses with TMHS. Nevertheless, a higher minimal SNCT did not exclude i-TMHS or s-TMHS and minimal SNCT does not distinguish s-TMHS from i-TMHS.

History, Rest and Exercise Score (HRE-S) for assessment of disease severity in horses with trigeminal-mediated headshaking

BACKGROUND

In horses with trigeminal-mediated headshaking (TMHS), clinical signs are likely to be expression of neuropathic facial pain. Currently, subjective assessment of disease severity is used as measure of compromise of animal's welfare.

OBJECTIVES

To develop and validate a precise scoring system for TMHS: History, Rest and Exercise Score (HRE-S). The HRE-S consists of three subscores: history score (H-S), resting score (R-S) and exercise score (E-S).

STUDY DESIGN

Retrospective observational study.

METHODS

Seven masked observers with different experience used HRE-S to score 40 video recordings taken during rest and lungeing including five duplicates. Video recordings were taken from nine horses with TMHS and three controls. Inter- and intraobserver reliability and practicability of HRE-S were assessed. For every video recording severity of clinical signs was graded by every observer using an intuitive global-type-scale and interobserver reliability was calculated. Convergent validity was evaluated comparing HRE-S to groups created by an existing score (grade 0-3). Discriminant validity was analysed comparing HRE-S to groups created by intuitive global-type-scale.

RESULTS

Reliability for HRE-S was excellent, irrespective of observers experience: Spearman's Rho = 0.946, p < 0.001 (intraobserver reliability) and intraclass correlation coefficient = 0.98, p < 0.001 (interobserver reliability). Interobserver reliability for intuitive global-type-scale was fair to substantial: Fleiss' κappa = 0.48 (R-S) -0.63 (E-S). Groups created by intuitive global-type-scale had significantly different R-S and E-S (p < 0.05), demonstrating discriminant validity. Convergent validity was proven as horses with grade 3/3 had significantly higher average E-S and total scores compared with an existing score than those with grade 0/3 or 1/3 (p < 0.001).

MAIN LIMITATIONS

Retrospective nature, video recordings, sample size.

CONCLUSIONS

HRE-S is a valid and reliable score evaluating disease severity in TMHS, independent of observers' experience.

Application of the HRE-S to 140 horses with trigeminal-mediated headshaking and the association of clinical signs with diagnosis, therapy, and outcome

Background

Horses with trigeminal-mediated headshaking (TMHS) exhibit different headshaking patterns (HSPs), electric shock-like jerking, signs of nasal irritation, and painful facial expressions. The History Rest and Exercise Score (HRE-S) was developed to objectively clarify the severity of the condition in affected horses. This score considers the history and severity of clinical signs at rest and exercise. This study aimed to assess the frequency of different clinical signs and their individual associations with diagnosis, treatment, and outcome in horses diagnosed with TMHS.The clinical records of horses presented with headshaking (HS) at the Clinic for Horses, University of Veterinary Medicine Hannover, between 2006 and 2021 were assessed retrospectively for clinical signs, diagnosis, and treatment. A total of 140 horses were included in the study. Video recordings were evaluated using the HRE-S and compared to the score described by Talbot. Following discharge, owners were interviewed via telephone about the outcome. Correlations between the presence and severity of clinical signs, diagnosis, and outcome were evaluated.

Results

The following clinical signs were significantly correlated with a higher HRE-S and grade by Talbot: HS at walk (independently of HSP) (52.9%, 74/140), increased total number of demonstrated HSP (independent of the dominant HSP) (more than one HSP per horse in 91.4%, 128/140), signs of nasal irritation (75.9%, 104/137), painful facial expression (67.8%, 80/118), and electric shock-like jerking (77.5%, 107/138). Diagnosis and outcome do not correlate with the presence of the above-mentioned clinical signs.

Conclusion

The HRE-S was confirmed as a valid tool to evaluate disease severity in a cohort of 140 horses with HS. Additionally, clinical signs identified as indicators for higher disease severity may have a stronger negative effect on patient welfare, but they do not correlate with diagnosis or outcome.

Impact of Different Diagnostic Procedures on Diagnosis, Therapy, and Outcome in Horses with Headshaking: Recommendations for Fast-Track Advanced Diagnostic and Therapeutic Protocols

Most horses affected by headshaking (HS) are diagnosed with idiopathic trigeminal-mediated headshaking (i-TMHS) when no underlying disease is found. Diagnosis is made by the exclusion of differentials considering history, clinical signs, and diagnostic investigations. Therefore, in horses presented with headshaking, many diagnostic procedures and therapies are conducted. Retrospectively, the digital patient records of 240 horses with HS were analysed regarding the impact of diagnostic procedures on diagnosis, therapy, and outcome. Horses were extensively examined using a standardised protocol including clinical (ophthalmologic, orthopaedic, neurologic, dental) examination, blood analysis, and imaging techniques (endoscopy, radiographs, computed tomography (CT), and magnetic resonance imaging). Many findings were revealed but were of clinical relevance in only 6% of the horses. These horses were, therefore, diagnosed with secondary headshaking (s-HS). In addition, all of these horses demonstrated a positive outcome. The CT of the head revealed 9/10 of the clinically relevant findings. Other diagnostic procedures had no major additional impact. Conclusively, the diagnostic investigation of horses with HS should aim at differentiating i-TMHS from s-HS. The clinical relevance of findings should be verified through diagnostic anaesthesia or targeted therapy depending on risks, invasiveness, and expected benefits. To reduce the multitude of examinations, diagnostic investigations should focus on the CT of the head in those horses with suspicion of i-TMHS based on typical history, clinical signs, and physical examination.

Comparison of the Current Situation of Equine Headshaking Syndrome in France and Switzerland Based on an Online Survey

Simple Summary

Headshaking syndrome is a frustrating health problem in horses whose aetiopathogenesis is poorly understood. This study was dedicated to investigating signalment and therapeutic interventions in headshakers in France and Switzerland. To do this, an online survey was developed and distributed via the Internet. This showed that mainly middle-aged geldings were affected. The breeding distribution matched the breeding distribution of the relevant country. Furthermore, alternative healing methods were used by the horse owners, which have not yet been scientifically examined. Overall, it was possible to formulate conclusions regarding signalment and therapies used in practice.

Abstract

Equine headshaking syndrome (EHS) is characterised as non-physical and involuntary movement of the horse’s head and neck. Although EHS is clinically simple to diagnose, its aetiopathogenesis often remains unclear. The aim of this study was to gain an overview of signalment and therapy possibilities used in France and Switzerland. To do this, an online survey was developed and distributed via newsletters. A total of 933 complete, answered surveys from France (n = 804) and Switzerland (n = 129) were evaluated. The median age in France was 12.4 years (CH = 14.3). Mostly geldings were affected (58.5%_FRA, 57.4%_CH). There was an association with Warmbloods in Switzerland (55.8%_CH), but in France, in addition to Warmbloods (34.4%_FRA), Thoroughbreds (27.2%_FRA) were also affected. Moreover, horses affected by EHS often show stereotypical behaviour (15.7%_FRA, 14.7%_CH). A total of 38.4%_FRA and 67.4%_CH of horse owners utilised therapy measures, with nose covers being most commonly used (19.9%_FRA, 30.2%_CH). Horse owners resorted to alternative treatments that had not previously been studied in context with EHS (15%_FRA, 20.9%_CH). Conservative treatments, such as medication, were used by 5.4%_CH and 1.9%_FRA. This study provides an overview of the status of horses affected by EHS in France and Switzerland and thus offers a fundamental step to understanding the consequences of welfare issues associated with EHS.

Caecal microbiota in horses with trigeminal‐mediated headshaking

Background

Trigeminal‐mediated headshaking (TMHS) in horses is a form of neuropathic pain of undetermined cause that often results in euthanasia. The role of microbiota in TMHS has not been investigated in diseased horses.

Objective

To investigate if gastrointestinal microbiota in the cecum is different in horses with TMHS compared to a control population, during a summer season with clinical manifestations of disease.

Animals

Ten castrated horses: five with TMHS and five neurologically normal controls.

Methods

All horses were sourced from our institution and kept under the same husbandry and dietary conditions. All horses were fed orchard grass hay for 30 days and then were euthanized due to chronic untreatable conditions including TMHS and orthopedic disease (control group). Caecal samples for microbiota analysis were collected within 20 min after euthanasia. Sequencing was performed using an Illumina MiSeq platform and the microbiome was analyzed.

Results

The caecal microbiota of horses with TMHS was similar to control horses in terms of diversity but differed significantly with Methanocorpusculum spp. having higher abundance in horses with TMHS. 

Conclusions and clinical importance

Methanocorpusculum spp. was more abundant in the cecum of horses with TMHS. However, its role in disease is unknown. Furthermore, it could also represent an incidental finding due to our small population size.

Overview of the Current Situation in a Sample of Headshakers and Owner Assessment of Effective Therapeutic Measures Used in Germany

Equine headshaking syndrome is a problematic behavior that has been described in literature for more than 100 years. The signs of headshaking syndrome appear frequently and violently so that riding the horse can be dangerous. The aim of this research was to gain an overview of the underlying causes of equine headshaking syndrome to identify effective treatment options, reduce the distress of horses and, in a second step, potentially improve therapeutic possibilities for horse owners and veterinarians. Most studies on prevalence originate from Anglo-American countries, so this research was to provide an overview of German horses; therefore, an online survey was designed by experts in the field (researchers and veterinarians) and answered by German horse owners. Questionnaires were pretested by a small group of horse owners (n = 5) and redesigned accordingly. The final questionnaire consisted of 27 questions, which were divided into seven open questions with an associated text field and 20 multiple-choice questions (Supplementary Material 1). For some of the multiple-choice questions, multiple answers were permitted. In total, 163 completed questionnaires were obtained from owners of headshaking horses (n_total = 163). Gender distribution of the horses resulted in 64.4% geldings, 33.7% mares, and 1.8% stallions. Most horses were German warmbloods (55.4%). The average age was 12.7 years (with a wide range of 5 to 34 years). The vertical movement of the head was the most frequently mentioned symptom in 75.5% of the evaluated horses. In 18.4% of the cases, the horse owners identified stress as the main trigger for headshaking. Furthermore, 18.4% claimed that their horses suffered from additional stereotypical behavior. The percentages do not refer to the same horses here. 11.0% of the participants in this study tried scientifically evaluated therapies such as surgical therapy (1.2%) or medical treatment (9.8%). In addition, 54.0% of the owners utilized a nose cover to reduce the symptoms of the headshaking syndrome. A high percentage of 84.0% used alternative therapies such as physiotherapy (31.9%), change of equipment (22.7%), or change of riding style (29.4%). Overall, this study provides a useful overview of causes and effective therapies.

The safety and efficacy of neuromodulation using percutaneous electrical nerve stimulation for the management of trigeminal-mediated headshaking in 168 horses

Background

Early results from the use of neuromodulation by percutaneous electrical nerve stimulation for the management of trigeminal‐mediated headshaking in horses were promising but lacked sufficient case numbers and long‐term follow‐up. The neuromodulatory procedure has since been established as EquiPENS™.

Objectives

The aim of this study was to report long‐term results from a larger number of cases and to investigate for predictors of outcome.

Study design

Prospective case series using international, multi‐centre data.

Methods

Eligible cases were horses with a veterinary diagnosis of trigeminal‐mediated headshaking, which received EquiPENS™ neuromodulation at trained centres between August 2013 and November 2017. The standard protocol was an initial three‐procedure course, with additional procedures should a horse go into remission but then relapse. Data collected included signalment, history, diagnostic tests performed, details of any complications, whether horses had gone into remission and the length of remission.

Results

Results were obtained from 168 horses, with 530 procedures. The complication rate was 8.8% of procedures. In all but one case, complications were mild and transient, without self‐trauma. Remission of headshaking following the initial course occurred in 53% (72/136) of horses. Median length of time recorded in remission was 9.5 weeks (range 2 days to 156 weeks ongoing). Where signs recurred, most horses went back into remission following additional procedures, usually for longer than from the previous procedure. No predictors for outcome were determined.

Main limitations

No placebo or control group, owner‐assessed results.

Conclusions

EquiPENS™ neuromodulation can be an effective and safe treatment for the management of trigeminal‐mediated headshaking in some horses. An increased understanding of neuromodulation could help optimise the technique. Advances in treatment for trigeminal‐mediated headshaking will remain limited until there is a greater understanding of the aetiopathogenesis of the condition.

Morphological variations of the infraorbital canal during CT has limited association with headshaking in horses

Headshaking is a common problem in horses. The etiology is unknown but thought to involve sensory input from branches of the trigeminal nerve, some of which are within the infraorbital canal. The objective of this retrospective cross-sectional study was to describe the CT anatomy and variations of the infraorbital canal in horses with local disease processes and normal horses, and to examine associations between those findings and headshaking. Computed tomography scans were reviewed and morphological changes of the infraorbital canal were described. Presence of changes was then tested for association with headshaking prevalence, presence of disease processes in the region of the infraorbital canal, age, and sex. Nonparametric tests were used and a P-value of .05 was considered significant. A total of 218 horses were included, 9% of which had headshaking and 45% had CT lesions in the region of the infraorbital canal. Morphological changes to the bone of the infraorbital canal were found in 121 horses (56%) and included the following: increased mineralization 39 (18%), decreased mineralization 89 (41%), deformed shape 51 (23%), displaced position 43 (20%), and disruption 11 (5%). All changes of the infraorbital canal significantly increased in frequency with the presence of adjacent disease. Increased mineralization and disruption of the infraorbital canal were significantly associated with headshaking in horses with adjacent disease; the latter only reached significance after exclusion of dentally immature horses. No other changes were significantly associated with the presence of headshaking. No association was found between headshaking and the age or sex of the horse.

Is Electrical Nerve Stimulation the Answer for Management of Equine Headshaking?

Horses with trigeminal mediated headshaking (TMHS) have a decreased activation threshold of the trigeminal nerve and clinical signs are suspected to be a manifestation of trigeminal neuralgia. Electrical nerve stimulation (ENS) is used for management of neuralgia in humans and appears to work via gate control theory. Use of an equine specific percutaneous ENS program in over 130 TMHS horses has resulted in approximately 50% success return to previous work. Electroacupuncture may also be useful in the management TMHS. Optimization of ENS procedures for TMHS is likely to require a greater understanding of the etiopathogenesis of the aberrant neurophysiology.

Effects of magnesium with or without boron on headshaking behavior in horses with trigeminal-mediated headshaking

Background

Oral administration of magnesium and boron might have a beneficial effect on headshaking behavior in horses.

Objective

Evaluate the effects of oral magnesium alone or in combination with boron on headshaking behavior in affected horses.

Animals

Twelve geldings (6 healthy controls and 6 affected).

Methods

Prospective randomized controlled dietary trial over 42 days in 12 horses (6 horses diagnosed with trigeminal‐mediated headshaking and 6 unaffected healthy controls). All horses received a hay diet and were randomized into 3 treatment groups: pelleted feed combination (PF), pelleted feed combination with magnesium (M), and pelleted feed combination with magnesium‐boron (MB) with a week washout of hay only between treatments. Headshaking behavior and biochemical blood variables were assessed at baseline (hay only) and then after each week of supplementation.

Results

All 3 diet interventions increased blood ionized and total magnesium. Groups M and MB further increased Mg²⁺ when compared to PF. Horses receiving treatments had a significant reduction in headshaking behavior, as measured by incidence rate ratio (IRR), when compared to unsupplemented hay diet (44% for PF, IRR, 0.558; CI, 0.44, 0.72; P < .001; 52% for M, IRR, 0.476; CI, 0.37, 0.62; P < .001; and 64% for MB, IRR, 0.358; CI, 0.27, 0.48; P < .001).

Conclusions and Clinical Importance

Magnesium in combination with boron had the greatest decrease in headshaking. Oral supplementation with magnesium or magnesium in combination with boron should be considered in horses affected with headshaking.

Luteinizing hormone concentrations in healthy horses and horses with trigeminal-mediated headshaking over an 8-hour period

Background

Trigeminal‐mediated headshaking results from a low threshold for firing of the trigeminal nerve. A seasonal component has been implicated in onset of clinical signs, which occur during the spring and summer months. Geldings are overrepresented in the affected population and hormonal differences as compared to a healthy control population of geldings might contribute to headshaking.

Objective/Hypothesis

To assess concentrations of luteinizing hormone (LH) over an 8‐hour period in gelded healthy controls and horses affected with headshaking. Our hypothesis was that geldings with seasonal headshaking would have higher concentrations of LH over an 8‐hour period compared to control horses during the summer when affected horses manifested headshaking.

Animals

Twelve geldings (6 controls and 6 affected).

Methods

Prospective controlled trial. Blood samples were drawn every 15 minutes over an 8‐hour time period during summer from all horses to measure circulating LH concentrations by using a radioimmunoassay for equine LH. All affected horses were actively affected by headshaking at the time of sample collection.

Results

No statistically significant differences in LH concentrations were found throughout the study period in headshakers as compared to control horses. Time had no significant effect, but a slight decrease in LH concentrations was observed for all horses. The main limitation of the study was the low number of horses.

Conclusions and Clinical Importance

Horses affected with headshaking did not have significant differences in circulating LH during the late summer as compared to control horses.

Intravenous infusion of magnesium sulfate and its effect on horses with trigeminal-mediated headshaking

Background

Trigeminal‐mediated headshaking results from low‐threshold firing of the trigeminal nerve resulting in apparent facial pain. Magnesium may have neuroprotective effects on nerve firing that potentially dampen signs of neuropathic pain. This hypothesis has not been investigated in horses with trigeminal‐mediated headshaking.

Objective

To investigate head‐shaking behavior in affected horses after IV magnesium sulfate infusion.

Animals

Six geldings with trigeminal‐mediated headshaking.

Methods

Prospective randomized crossover study. Horses were controlled for diet and infused IV with 5% dextrose solution (DS; control solution at 2 mL/kg body weight [BW]) and MgSO₄ 50% solution (MSS at 40 mg/kg BW). Head‐shaking behavior was recorded at times T0 (baseline, before infusion) and T15, T30, T60, and T120 minutes post‐infusion. Venous blood variables such as pH, HCO₃⁻, standard base excess (SBE), Na⁺, Cl⁻, K⁺, Ca²⁺, Mg²⁺, total magnesium (tMg), glucose, and lactate were measured; strong ion difference (SID) and anion gap (AG) were calculated for each time point.

Results

Blood variables including pH, Na⁺, Cl⁻, K⁺, SID, AG, lactate, Ca²⁺, tMg, and Mg²⁺ had significant changes with MSS as compared to DS treatment. Glucose, SBE, and HCO₃⁻ did not have significant changes. A 29% reduction in head‐shaking rate occurred after MSS treatment but no change occurred after DS treatment.

Conclusions and Clinical Importance

Administration of MSS IV increased plasma total and ionized magnesium concentrations and significantly decreased head‐shaking behavior in horses with trigeminal‐mediated headshaking.

Trigeminal-mediated headshaking in horses: prevalence, impact, and management strategies

Trigeminal-mediated headshaking is a little-understood neuropathic facial pain condition of the horse. The condition may affect around 1% of the equine population to a degree of severity sufficient to require veterinary attention. As a pain condition, this represents a significant welfare issue. Horses are usually more severely affected at exercise which can leave them unable to perform, or even dangerous to ride and handle. With little known about the condition and variable response to treatments, severely affected horses are often euthanized. This review article considers the literature on trigeminal-mediated headshaking, focusing on what is known, and indeed not known, about the prevalence of the condition and its impact. The current published management options are considered, along with their challenges and limitations.

Horse-keeping practices in Australia: findings from a national online survey of horse owners

OBJECTIVE

To gain an understanding of general horse-keeping practices in Australia, including shelter, social contact, exercise, watering and supplementary feeding.

METHODS

An online survey was conducted with 505 owners in relation to one 'representative' horse in their care.

RESULTS

The majority (83%) of horses were managed at pasture. Approximately one-quarter of those horses were housed alone (26%) or with one companion animal (27%). If horses were confined to a stable or small yard, the most recorded means of exercise was riding (65%) at a daily frequency (60%). Over half of the horse owners provided water in a trough or drinker with an automatic refill system (58%) and most horse owners supplied hay to their horses (82%), most commonly in combination with grazing. Areas of potential concern included one-quarter of stabled horses being prevented from unmediated social and physical contact with conspecifics and one-fifth of stabled horses being exercised less than daily.

CONCLUSION

The horse-keeping profile in this study should be considered in the public communication of guidelines as well as interactions between veterinarians and clients.

Prevalence of headshaking within the equine population in the UK

REASON FOR PERFORMING STUDY

Headshaking in horses has been reported to be most commonly due to idiopathic neuropathic facial pain (trigeminal-mediated headshaking). The prevalence of headshaking in horses in the UK is unknown.

OBJECTIVES

To estimate owner-reported prevalence of headshaking in horses in the UK and to report their case background and disease characteristics, as reported by owners.

STUDY DESIGN

Cross-sectional web based owner questionnaire.

METHODS

The questionnaire was advertised online via social media, horse forums, veterinary websites and equestrian magazines from 17th June 2016, until >1000 responses had been obtained. All UK horse owners were eligible to complete the questionnaire, however only one questionnaire could be completed per owner.

RESULTS

The estimated prevalence of owner-reported headshaking in the sample population of horses (n = 1014), within the last year, was 4.6% (95% confidence interval 3.5-6.1), whereas 6.2% (95% confidence interval 4.9-7.9) of horses were reported by their owners to have shown signs of headshaking at any time-point since ownership. There was no association of sex or breed. Nineteen percent of headshaking horses were reported to show headshaking at rest. Fewer than one-third (30.2%, n = 19) of headshaking horses had been examined by a veterinarian for headshaking. Of horses seen by a veterinarian, the cause for headshaking remained unknown in the majority of cases (57.9% responses) and trigeminal-mediated headshaking was reported as a diagnosis in just one case.

MAIN LIMITATIONS

The accuracy in data reporting by horse owners was not verified in this study. There may be a potential for bias towards over-reporting due to the nature of survey participation.

CONCLUSIONS

Within this sample, owner-reported prevalence of signs of headshaking within the last year, in horses in the UK was 4.6%. Over two-thirds of owners of headshaking horses did not seek veterinary intervention for headshaking. Trigeminal-mediated headshaking was rarely reported by owners as a diagnosis.

Pain Management in Horses

There has been great progress in the understanding of basic neurobiologic mechanisms of pain, but this body of knowledge has not yet translated into new and improved analgesics. Progress has been made regarding pain assessment in horses, but more work is needed until sensitive and accurate pain assessment tools are available for use in clinical practice. This review summarizes and updates the knowledge concerning the cornerstones of pain medicine (understand, assess, prevent, and treat). It highlights the importance of understanding pain mechanisms and expressions to enable a rational approach to pain assessment, prevention, and management in the equine patient.

Trigeminal Nerve Root Demyelination Not Seen in Six Horses Diagnosed with Trigeminal-Mediated Headshaking

Trigeminal-mediated headshaking is an idiopathic neuropathic facial pain syndrome in horses. There are clinical similarities to trigeminal neuralgia, a neuropathic facial pain syndrome in man, which is usually caused by demyelination of trigeminal sensory fibers within either the nerve root or, less commonly, the brainstem. Our hypothesis was that the neuropathological substrate of headshaking in horses is similar to that of trigeminal neuralgia in man. Trigeminal nerves, nerve roots, ganglia, infraorbital, and caudal nasal nerves from horse abattoir specimens and from horses euthanized due to trigeminal-mediated headshaking were removed, fixed, and processed for histological assessment by a veterinary pathologist and a neuropathologist with particular experience of trigeminal neuralgia histology. No histological differences were detected between samples from horses with headshaking and those from normal horses. These results suggest that trigeminal-mediated headshaking may have a different pathological substrate from trigeminal neuralgia in man.

Noseband Use in Equestrian Sports - An International Study

Nosebands are used by riders to prevent the horse from opening its mouth, to increase control and, in some cases, to comply with the competition rules. While equestrian texts traditionally recommend that two adult human fingers should be able to fit under a fastened noseband, noseband tightness levels are not, in general, regulated in competition. Possible detrimental consequences for the horse, of excessively tight nosebands, include discomfort, pain or tissue damage. The current study investigated noseband usage in equestrian competition. Data regarding noseband type, position, width and tightness were collected from 750 horses in eventing (n = 354), dressage (n = 334) and performance hunter (n = 62) competitions in Ireland, England and Belgium. Data were collected immediately before or after the performance. Using the ISES taper gauge as a guide, results were classified according to the number of ‘fingers’ that could fit under the noseband at the nasal planum, and assigned to six groups: greater than 2 fingers; 2 fingers; 1.5 fingers; 1 finger; 0.5 fingers; zero fingers. A calliper was used to measure noseband width and position relative to the facial crest. The data were not normally distributed so Kruskall-Wallis and Mann-Whitney tests were used. In all, 44% of horses fell into the zero fingers classification while only 7% were in the two fingers classification. Significant differences emerged between disciplines (p<0.001), with the highest levels of noseband tightness measured among eventers followed by dressage horses with lowest levels among performance hunters. Noseband tightness did not differ significantly with horse age (p>0.05), which ranged from 4 to 19 years. The flash noseband was the most commonly used noseband (n = 326) and was significantly tighter than the cavesson (p < 0.001), drop noseband (p < 0.001) and the Micklem (p < 0.005). Noseband width ranged from 10 to 50 mm. Noseband position varied widely with the distance between the facial crest and upper noseband margin ranging from 0 to 70 mm. The high proportion of very tight nosebands found in this study raises concerns regarding the short and long term behavioural and physiological consequences of such tight nosebands are for the horse. Although these data are currently lacking, the findings are of concern.

Treatment of idiopathic headshaking in horses with pulsed high-dose dexamethasone

BACKGROUND

Treatment of idiopathic headshaking in horses is complicated by an incomplete understanding of underlying pathophysiology and partially effective treatments. If an inflammatory etiology exists, corticosteroids could be beneficial.

HYPOTHESIS

An anti-inflammatory dose of dexamethasone reduces the signs of idiopathic headshaking in a field setting.

ANIMALS

Convenience sample of 20 adult horses with idiopathic headshaking syndrome. Cases were recruited from the general population and diagnosed by attending veterinarians.

METHODS

Prospective, blinded clinical trial. Pulsed dosing was with oral dexamethasone (60 mg PO Q24h × 4 days, q3 weeks for 4 months) or placebo (inert paste). Owners were blinded and asked to score the headshaking from 0 to 4 (4 = most severe) 3 days per week. The change in headshaking scores (HS) over each treatment pulse was compared between groups by ordinal logistic regression.

RESULTS

Twelve horses completed the trial. There was no significant difference between treated or placebo horses (P = .987). Sun (P ≤ .001), wind (P = .028), and exercise (P ≤ .045) significantly increased HS.

CONCLUSIONS AND CLINICAL IMPORTANCE

No benefit of dexamethasone treatment was detected for idiopathic headshaking. The results confirmed previous reports of common triggers for headshaking behavior

Idiopathic headshaking: is it still idiopathic?

The clinical syndrome of equine idiopathic headshaking (HSK) was first described in the veterinary literature over 100 years ago, and the disorder continues to be a cause of substantial distress for the horse, frustration for the owner and therapeutic challenge for the veterinarian. This review presents a summary of the current knowledge of clinical signs, signalment, aetiopathogenesis, anatomy, diagnosis and treatment of idiopathic HSK. Recent advances in understanding the pathogenesis of the disease will be discussed with reference to human trigeminal neuralgia, along with the implications this may have for potential therapies.

Sensory nerve conduction and somatosensory evoked potentials of the trigeminal nerve in horses with idiopathic headshaking

BACKGROUND

Idiopathic headshaking (HSK) in horses is a distressing disorder in which the etiology and pathophysiology are unknown.

HYPOTHESIS

Differences in sensory function of the trigeminal nerve exist between healthy and affected horses.

ANIMALS

Six healthy mature geldings and 6 mature geldings with idiopathic HSK.

METHODS

Prospective study. Sensory nerve action and somatosensory evoked potentials studies were performed. The stimulus site comprised the gingival mucosa dorsal to the maxillary canine. A pair of recording electrodes was placed along the sensory pathway of the trigeminal complex at the infraorbital nerve (R1), maxillary nerve (R2), spinal tract of trigeminal (R3), and somatosensory cortex (R4). Sensory nerve action potential latency (ms), amplitude (μV), duration (ms), area under the curve (μVms), and conduction velocity (m/s) were calculated.

RESULTS

Threshold for activation of the infraorbital branch of the trigeminal nerve was significantly different between 5 affected (≤ 5 mA) and 6 control horses (≥ 10 mA). After initiation of an action potential, there were no differences in all parameters measured and no differences between left and right sides. A horse with seasonal HSK tested during a time of no clinical manifestations showed a threshold for activation similar to control horses.

CONCLUSIONS AND CLINICAL IMPORTANCE

This study confirms involvement of the trigeminal nerve hyperexcitability in the pathophysiology of disease. Further, results might support a functional rather than a structural alteration in the sensory pathway of the trigeminal complex that can be seasonal. The horse could serve as a natural animal model for humans with idiopathic trigeminal neuralgia.

Caudal anaesthesia of the infraorbital nerve for diagnosis of idiopathic headshaking and caudal compression of the infraorbital nerve for its treatment, in 58 horses

REASONS FOR PERFORMING STUDY

Idiopathic headshaking is often a facial pain syndrome, but a diagnostic protocol has not been described. In a previous study, caudal compression of the infraorbital nerve for treatment offered a fair success rate, but low case numbers and short follow-up time were limitations.

OBJECTIVES

To describe a diagnostic protocol for headshaking, examining the role of bilateral local analgesia of the posterior ethmoidal nerve (PET block). To report longer-term follow-up after surgery of the original cases and further cases and to determine whether changes to the technique influence success rates and complications.

METHODS

Records of horses that had undergone PET block and caudal compression surgery at 3 hospitals were reviewed. Modifications to the surgical technique included placing additional coils into the infraorbital canal and/or performing concurrent laser cautery of the nerve. Follow-up information was obtained by telephone contact with owners.

RESULTS

The PET block was performed in 27 horses, with a positive result in 23 of 27 (85%). Surgery was performed in 58 horses. A successful outcome was initially achieved in 35 of 57 (63%) horses, but recurrence occurred between 9 and 30 months later in 9 (26%). Surgery was repeated in 10 of 31 (32%) horses. Final success rate, considering only response to the last performed surgery, was 28 of 57 (49%) horses with median follow-up time of 18 months (range 2-66 months). Nose-rubbing was reported post operatively in 30 of 48 (63%) horses. This resolved in all but 4 horses, which were subjected to euthanasia. Response to PET block or change in surgical technique did not appear to influence outcome or complications.

CONCLUSIONS AND POTENTIAL RELEVANCE

The diagnostic protocol described is recommended for the investigation of headshakers. Caudal compression offers the best prognosis for a successful outcome compared with other treatments, for horses in which the only alternative is euthanasia. Surgical treatment of the disorder requires refinement, and the pathogenesis of the disorder requires investigation.

Latent equine herpesvirus-1 in trigeminal ganglia and equine idiopathic headshaking

BACKGROUND

Trigeminal neuralgia or neuropathic pain has been regarded as a putative cause of idiopathic headshaking in horses. Equine herpesvirus-1 (EHV-1) infection and resultant postherpetic pain have been suggested as a possible cause of such neuropathic pain.

HYPOTHESIS/OBJECTIVES

To determine the presence of EHV-1 in the trigeminal ganglia of horses with idiopathic headshaking.

ANIMALS

Nineteen horses: control (n = 11, 9 geldings, 2 mares, median age 11 years) and headshaking (n = 8, all geldings, median age 11.5 years) horses were sourced from the equine research herd and caseload at the Veterinary Medical Teaching Hospital.

METHODS

Prospective study to determine the presence of EHV-1 latency in trigeminal ganglia of horses with idiopathic headshaking by real-time PCR detection of the glycoprotein B (gB) gene and the DNA polymerase (ORF 30) gene of EHV-1 in the absence of detectable late structural protein gene (gB gene) mRNA. Control horses were used for comparison. A house keeping gene (equine GAPDH) and positive and negative samples for EHV-1 were used for quality control.

RESULTS

All samples from control horses and 7 of 8 headshaking horses were negative for EHV-1. One headshaking horse tested positive for a single copy of EHV-1 gene.

CONCLUSIONS AND CLINICAL IMPORTANCE

This study does not support a role for EHV-1 infection and presumed postherpetic pain in the etiopathogenesis of equine headshaking.

Use of a gonadotrophin-releasing hormone vaccine in headshaking horses

The aim of this study was to investigate the use of a gonadotrophin-releasing hormone (GnRH) vaccine in the treatment of headshaking in horses. Fifteen geldings received two doses of the GnRH vaccine four weeks apart. Serum was collected before and after vaccination to measure concentrations of luteinising hormone (LH) (10 horses) and follicle-stimulating hormone (FSH) (six horses). Owners recorded the frequency of seven common headshaking behaviours using a visual analogue scale (VAS) before vaccination and at two, four, eight, 12, 16 and 20 weeks after vaccination. Serum LH (P=0.008) and FSH (P=0.03) concentrations decreased significantly following vaccination. Although approximately one-third of the owners reported a subjective improvement in headshaking, serial scoring did not indicate a reduction in headshaking behaviours following vaccination with a commercial GnRH vaccine. Vaccination reactions were observed in four of 15 horses (27 per cent), including one case of severe, presumed immune-mediated, myositis.

Caudal compression of the infraorbital nerve: a novel surgical technique for treatment of idiopathic headshaking and assessment of its efficacy in 24 horses

REASONS FOR DESIGNING AND REPORTING TECHNIQUE: Idiopathic headshaking has remarkable similarities to human neuropathic facial pain syndromes associated with post herpetic and trigeminal neuralgia. These derive from abnormal sensory function within the peripheral or central pathways of the trigeminal nerve (TgN). Limiting input from the TgN can be helpful in controlling the perception of pain. Rhizotomy of the infraorbital branch of the TgN as it emerges from the infraorbital canal has been reported but has a poor efficacy. A novel technique involves compression of the nerve at a more caudal location within the infraorbital canal and the technique requires validation.

HYPOTHESIS

Caudal compression of the infraorbital nerve with platinum coils, performed in horses diagnosed with idiopathic headshaking, results in a decrease in clinical signs.

METHODS

Caudal compression of the infraorbital nerve, using platinum embolisation coils, was performed under fluoroscopic guidance. Clinical records of 24 idiopathic headshakers that had undergone this procedure were reviewed. Follow-up information was obtained by telephone questionnaire with the owner or referring veterinary surgeon.

RESULTS

All 24 horses had at least one surgical procedure. Median follow-up time was 6 months. There were 2 horses which had surgery 2 weeks before follow-up and these were excluded from the analysis of outcome. Following one surgery, 13/22 horses (59.0%) had a successful outcome. Of the 9 horses that did not improve, surgery was repeated in 6 cases. Two of these horses had a successful outcome. Overall, a successful outcome was obtained in 16/19 horses (84.2%).

CONCLUSIONS

This surgical technique is likely to prevent input from the TgN at a more caudal location then the previously described infraorbital neurectomy. The technique requires refinement.

Effects of oral tetrachlorvinphos fly control (Equitrol®) administration in horses: Physiological and behavioural findings

Highly reactive horses may pose risks to humans involved in equestrian activities. Among the factors that may affect horses' reactivity to external stimuli are pesticides used for fly control in equine facilities. The organophosphorus (OP) insecticide tetrachlorvinphos (TCVP) is used as a feed-through larvicide to prevent completion of the fly larval life cycle in horse manure. TCVP exerts its effect by inhibiting the enzyme cholinesterase (ChE) leading to the accumulation of the neurotransmitter acetylcholine (AChE) in synapses of the central and peripheral nervous systems. The aim of the present study was to investigate alterations of whole-blood ChE levels associated with feeding a commercially available product (Equitrol, Farnam Companies, Inc.) to horses for fly control. A second aim was to report neurological, physiological and behavioural findings in addition to profiles of selected immune markers (IFN-gamma, IL-12p40 and COX-2) and serum thyroid hormones during and after a 30-day treatment period of TCVP feeding. The results indicated significant decreases in whole-blood ChE activity and concomitant behavioural alterations, manifested as increased reactivity and decreased controllability in treated horses. No changes were detected in physiological or neurological parameters, immune markers or thyroid hormones in treated (n=6) or control (n=4) horses during the course of the study.

Ophthalmic findings in the geriatric horse

Ophthalmic conditions of the older horse are becoming increasingly common as geriatric care advances. The close relation between the eye and other structures of the head exposes the globe to direct expansion of clinical disease and raises management issues. Integrating an ophthalmic and fundic examination into the annual evaluation should reward the investment, permit enhanced patient care, and potentially provide early identification of systemic conditions. Surgical and medical management of neoplastic conditions is most successful with early identification and therapy. It is hoped that this article prompts the further identification and description of ophthalmic conditions as equine geriatric care increases in importance.