Epilepsy is a common neurological disorder in veterinary practice, complicated by frequent occurrence of medication-resistant epilepsy. In human medicine, it has been noted that some patients with ...medication-resistant epilepsy have in fact other reasons for their apparent medication-resistance. The aim of this retrospective study was to describe the issue of pseudoresistance using as an example a population of dogs presented with presumed medication-resistant epilepsy and provide an in-depth review of what is known in human medicine about pseudoresistant epilepsy. One-hundred fifty-two cases were identified with medication-resistant epilepsy, of which 73% had true medication-resistant epilepsy and 27% patients had pseudoresistance. Low serum anti-seizure medication levels were the most common cause of pseudoresistance, present in almost half of the cases (42%), followed by inadequate choice of drugs or dosages (22%), misclassification (22%) or misdiagnosis (9%) of epilepsy and poor compliance (9%). All cases of pseudoresistance, except for one, responded to a modification of the initial therapy protocol. Pseudoresistance can bias clinical trials, misinform the clinical decision-making process, delay diagnosis and treatment, and misinform owners about their pets’ prognosis. A substantial proportion of these cases can have improvement of their seizure frequency or achieve seizure freedom upon modification of their therapeutic protocol.
Circadian and other physiological rhythms play a key role in both normal homeostasis and disease processes. Such is the case of circadian and infradian seizure patterns observed in epilepsy. However, ...these rhythms are not fully exploited in the design of active implantable medical devices. In this paper we explore a new implantable stimulator that implements chronotherapy as a feedforward input to supplement both open-loop and closed-loop methods. This integrated algorithm allows for stimulation to be adjusted to the ultradian, circadian and infradian patterns observed in patients through slowly-varying temporal adjustments of stimulation and algorithm sub-components, while also enabling adaption of stimulation based on immediate physiological needs such as a breakthrough seizure or change of posture. Embedded physiological sensors in the stimulator can be used to refine the baseline stimulation circadian pattern as a "digital zeitgeber," i.e., a source of stimulus that entrains or synchronizes the subject's natural rhythms. This algorithmic approach is tested on a canine with severe drug-resistant idiopathic generalized epilepsy exhibiting a characteristic diurnal pattern correlated with sleep-wake cycles. Prior to implantation, the canine's cluster seizures evolved to status epilepticus (SE) and required emergency pharmacological intervention. The cranially-mounted system was fully-implanted bilaterally into the centromedian nucleus of the thalamus. Using combinations of time-based modulation, thalamocortical rhythm-specific tuning of frequency parameters as well as fast-adaptive modes based on activity, the canine experienced no further SE events post-implant as of the time of writing (7 months). Importantly, no significant cluster seizures have been observed either, allowing the reduction of rescue medication. The use of digitally-enabled chronotherapy as a feedforward signal to augment adaptive neurostimulators could prove a useful algorithmic method in conditions where sensitivity to temporal patterns are characteristics of the disease state, providing a novel mechanism for tailoring a more patient-specific therapy approach.
Meningoencephalitis of unknown origin is mostly considered a disease of young small dogs and terrier breeds, while older dogs presenting with clinical signs of deteriorating encephalopathy are more ...commonly diagnosed with intracranial neoplasia. In this case series, three Australian shepherd dogs, 7, 10 and 11 years old, were diagnosed with meningoencephalitis of unknown origin; with serial magnetic resonance imaging in two dogs and postmortem examination in one dog. Follow‐up magnetic resonance imaging examination after 4 months showed complete resolution of magnetic resonance imaging abnormalities in one dog treated with prednisolone. The other dog had a recurrence of clinical signs and multifocal de novo lesions noted in magnetic resonance imaging done at 23 months after diagnosis and tapering of prednisolone. In older dogs, a diagnosis of intracranial neoplasia should not be assumed based on clinical signs of deteriorating encephalopathy alone, and meningoencephalitis of unknown origin should be on the differential list. Older dogs diagnosed with meningoencephalitis of unknown origin can have good outcomes with immunomodulatory therapy.
The chondrodystrophic body type predisposes miniature dachshunds to thoracolumbar intervertebral disc extrusion (IVDE). However, the relationship between thoracolumbar IVDE and the relative lengths ...of the thoracic and lumbar vertebral columns has not yet been evaluated.
This prospective multicentre study included 151 miniature dachshunds with (n = 47) and without (n = 104) thoracolumbar IVDE. All dogs had their thoracic and lumbar vertebral columns measured with a tape measure. Detailed descriptions were provided to facilitate consistent measurement. A thoracic to lumbar vertebral column ratio was calculated. Thoracolumbar IVDE was confirmed by magnetic resonance imaging or computed tomography.
The thoracic to lumbar vertebral column length ratio and absolute thoracic vertebral column length were significantly smaller in miniature dachshunds with IVDE than in those without IVDE (p < 0.0001 for both). There were no significant differences in lumbar vertebral column length, age, sex or neuter status between the two groups.
The dogs without IVDE did not undergo a neurological examination and the thoracic and lumbar vertebral column measurements were not validated.
The relative lengths of the thoracic and lumbar vertebral column segments could contribute to the development of thoracolumbar IVDE in miniature dachshunds. Further studies are needed to evaluate ideal thoracic to lumbar vertebral column length ratios in miniature dachshunds.
Objectives
The aim of this study was to evaluate the association between meningeal enhancement (MgE) and cerebrospinal fluid (CSF) analysis results, their individual association with bacteriology ...results from affected ear samples and whether these test results influenced clinicians’ therapeutic choice in cats with otitis media and interna (OMI).
Methods
This was a multicentre retrospective study carried out over an 8-year period. Cats diagnosed with OMI, with or without a nasopharyngeal polyp, leading to peripheral vestibular signs were included. Only cats for which MRI with postcontrast T1-weighted sequences and CSF analyses available were included. Cats with intra-axial MRI lesions or empyema were excluded.
Results
Fifty-eight cats met the inclusion criteria. MgE was reported in 26/58 cases, of which nine had an abnormal CSF result (increased total nucleated cell count TNCC or total protein); 32/58 cases had no MgE, of which 10 showed abnormal CSF results. There was no association between bacteriology results (external ear canal or bulla) and MgE or abnormal CSF results. CSF abnormalities were statistically significantly more common in acute cases (n = 16/37) than in chronic cases (n = 3/21; Fischer’s test P = 0.04). Prednisolone was prescribed in 10/16 cases with increased TNCC. Among the 42 cases with normal TNCC, 15 received prednisolone and 13 received non-steroidal anti-inflammatory drugs. Various antimicrobial drugs were prescribed in 53/58 cats. Duration of antimicrobial treatment was similar, regardless of positive bacterial culture (5.58 vs 4.22 weeks), abnormal CSF (5.83 vs 4.76 weeks) or MgE (5.33 vs 4.90 weeks).
Conclusions and relevance
No association was found between the CSF and MgE results. Furthermore, no association was found between MgE, CSF or bacteriology findings. In addition, abnormal CSF results might lead the clinician to treat with corticosteroids, but they did not have any impact on duration of antimicrobial treatment. CSF abnormalities were seen significantly less frequently in chronic cases. The outcome tended to be poorer when MgE was detected on MRI.
Canine babesiosis is world-wide tick-borne disease characterized by erythrocyte destruction, haemolysis and inflammatory response, with increased serum concentrations of positive acute phase proteins ...and a decrease in negative acute phase proteins. Some of the negative acute phase proteins function as carriers of thyroid hormones, so the goal of this study was to determine the non-thyroidal illness syndrome in dogs with babesiosis. The study included 60 dogs with babesiosis and 26 healthy dogs. Serum concentrations of thyroxine, thyrotropin and transthyretin were determined using ELISA methods, while albumin concentrations were measured using spectrophotometric methods. Statistical analysis of the data demonstrated a significant decrease in thyroxine, transthyretin and albumin in dogs with babesiosis, while thyrotropin concentrations were did not differ significantly in comparison with healthy dogs. The results obtained indicate the presence of a non-thyroidal illness. Decreased albumin and transthyretin probably represent one of the mechanisms which contribute to this syndrome in canine babesiosis. Key words: dogs; babesiosis; nonthyroidal illness; transthyretin Babezioza je cesta bolest pasa. Obiljezava je razaranje eritrocita te upalni odgovor pracen porastom serumske koncentracije pozitivnih akutnofaznih proteina i padom serumske koncentracije negativnih akutnofaznih proteina. Neki od negativnih akutnofaznih proteina imaju funkciju nosaca hormona stitnjace, stoga je cilj istrazivanja bio utvrdivanje sindroma netireoidne upalne bolesti kod pasa oboljelih od babezioze. U istrazivanje je bilo ukljuceno 60 pasa kod kojih je u eritrocitima potvrdena prisutnost parazita B. canis te 26 zdravih pasa. Imunoenzimskim testom u serumu pasa izmjerene su koncentracije tiroksina, tirotropina i transtiretina, a koncentracija albumina izmjerena je spektrofotometrijskom metodom. Statistickom obradom podataka dokazano je statisticki znakovito smanjenje koncentracije tiroksina, transtiretina i albumina u serumu pasa oboljelih od babezioze, dok se koncentracija tirotropina nije znakovito razlikovala u odnosu na kontrolnu skupinu. Dobiveni rezultati upucuju na prisutnost sindroma netireoidne bolesti, pri cemu je pad koncentracije albumina i transtiretina vjerojatno jedan od mehanizama nastanka ovoga sindroma kod babezioze pasa. Kljucne rijeci: pas; babezioza; sindrom netireoidne bolesti; transtiretin
Klinički sindrom hiperadrenokorticizma u pasa (HAC) je jedna od najčešćih endokrinopatija u veterinarskoj medicini. Kliničke manifestacije i laboratorijski nalazi odražavaju utjecaj kronično povišene ...razine cirkulirajućeg kortizola. Dijagnostika započinje utvrđivanjem odgovarajuće anamneze i prisustva jednog ili više karakterističnih kliničkih znakova pri čemu što je broj simptoma veći to je sumnja na HAC utemeljenija. Prema preporukama konsenzusa u veterinarskoj medicini, da bi se povećala pozitivna prediktivna vrijednost endokrinološkog testiranja na HAC, ona bi se trebala provoditi samo u pacijenata s odgovarajućim kliničkim znacima, rezultatima slikovne dijagnostike i u pacijenata s komorbiditetima koji ne reagiraju na adekvatnu terapiju. Radi lažno negativnih i lažno pozitivnih rezultata koji su obično posljedica prisustva drugih bolesti ili uporabe nekih lijekova, niti jedan od trenutno raspoloživih testova nije posve pouzdan. Dijagnostički se testovi za HAC zasnivaju na dokazivanju ili povećane proizvodnje kortizola ili smanjene osjetljivosti osovine hipotalamus-hipofiza-adreni na negativnu povratnu spregu glukokortikoidima. Dostupne testove dijelimo na dijagnostičke testove (ACTH-stimulacijski test, test supresije niskom dozom deksametazona i omjer kortizola i kreatinina u urinu) i razlikovne testove (određivanje koncentracije endogenog ACTH, test supresije niskom dozom deksametazona, test supresije visokom dozom deksametazona i supresija deksametazonom s omjerom kortizola i kreatinina u urinu). Najbolji se dijagnostički rezultati postižu uporabom kombinacije testova adrenalne funkcije i slikovne dijagnostike. Svi se modaliteti slikovne dijagnostike mogu rabiti no razlikuju se, kao i testovi adrenalne funkcije, po svojoj osjetljivosti i specifičnosti. Raspoloživa slikovna dijagnostika za bolesti nadbubrežnih žlijezda uključuje ultrazvučnu pretragu te kompjuteriziranu tomografiju (CT) ili magnetsku rezonanciju (MR) abdomena, dok se za bolesti hipofize najčešće koriste CT ili MR glave. Da bi se došlo do definitivne dijagnoze najčešće se koristi kombinacija ultrazvučne pretrage abdomena s jednim od dijagnostičkih testova adrenalne funkcije. U odabiru optimalne terapije na raspolaganju su zračenje te kirurška i medikamentozna terapija. Operativni zahvati na hipofizi i adrenalnim tumorima, kao i radioterapija hipofize etiološki su oblici liječenja i iako su potencijalno kurativni nisu široko dostupni, skupi su i nose svoje vlastite rizike. Medikamentozna se terapija sastoji ili od davanja adrenokortikolitičkog lijeka mitotana ili inhibitora steroidogeneze trilostana. Oba su lijeka relativno skupa, a njihova primjena podrazumijeva i neki oblik doživotne terapije, a nose i neke vlastite rizike. Da bi se odabrala optimalna terapija ovaj pregledni rad razmatra terapijske opcije HAC-a s obzirom na dostupnost, učinkovitost i moguće nuspojave te uzevši u obzir oblik bolesti, moguće napredovanje te dob i komorbiditete pojedinačnih pacijenata.
Akutni idiopatski poliradikuloneuritis (AIP) je stečena periferna neuropatija koja primarno zahvaća ventralne korijene spinalnih
živaca i periferne živce. Bolest je vrlo slična Guillain-Barré ...sindromu u ljudi, a nema dobne, pasminske ni spolne predispozicije te ne postoji specifična terapija. Oporavak traje 2 - 6 mjeseci. Fizikalna terapija i njega pacijenata preporučuju se kao potporna terapija. Dva psa, križane pasmine u dobi od šest i deset godina zaprimljeni su sa znacima akutne flakcidne tetrapareze/tetraplegije, u bočnom položaju bez mogućnosti da samostalno zauzmu sternalni položaj posljedično
generaliziranoj zahvaćenosti nižih motoričkih neurona. Na svim ekstremitetima mišićni tonus je bio veoma slab. Dijagnoza AIP-a je
bazirana na anamnezi, kliničkoj manifestaciji, neurološkom pregledu, slikovnoj dijagnostici i laboratorijskim testovima. Rehabilitacijski
program je uključivao masažu ekstremiteta i pasivne kretnje zglobova kao važan dio kućnog programa, elektroterapiju, idroterapiju i proprioceptivne vježbe. Nakon dva tjedna fizikalne terapije psi su se mogli samostalno podignuti u sternalni položaj, a na stražnjim nogama pokazivali su i voljne pokrete. Potpomognuto stajanje i voljni pokreti svih ekstemiteta bili su prisutni na kraju trećeg tjedna u jednog psa i krajem petog tjedna u drugog psa. Nakon toga u proces rehabilitacije uključena je hidroterapija. Jedan pas je mogao samostalno hodati dvadeset petog dana od početka fizikalne terapije, dok je drugom psu bilo potrebno pedeset dana. Fizikalna terapija u kombinaciji s adekvatnim kućnim rehabilitacijskim programom može rezultirati skraćenim razdobljem oporavka za pacijente s AIP-om.
PDF
