Idiopathic epilepsy in dogs: owners' perspectives on management with phenobarbitone and/or potassium bromide

OBJECTIVES: To explore seizure management from the perspective of the owners of dogs with idiopathic epilepsy. METHODS: Questionnaires were mailed to owners of 29 dogs under management for suspected or diagnosed idiopathic epilepsy through the clinics of the Small Animal Hospital of the University of Glasgow Veterinary School, using either phenobarbitone or potassium bromide alone or in combination. RESULTS: The postal survey had an 86 per cent response rate. Analysis of the responses demonstrated that "the dog's quality of life", "adequate seizure frequency" and "acceptable side effects of antiepileptic drugs" were the three greatest concerns for owners; 52 per cent of owners strongly agreed that the seizure management for their dog was adequate, though the seizure frequency reported varied within this group; the majority of owners did not consider the administration of medication a nuisance. However, approximately 60 per cent of owners reported that caring for an epileptic dog had an effect on the organisation of their free time, though this was not dependent on perception of seizure control. Opinions as to the value of further diagnostic procedures, in particular intracranial imaging, were significantly affected by having pet health insurance. CLINICAL SIGNIFICANCE: From the owners' perspective, adequacy of seizure control is determined by the balance between "the dog's quality of life", "adequate seizure frequency" and "acceptable side effects of antiepileptic drugs". A frequency of less than one seizure every three months is associated with the perception by owners of adequate seizure control.     

Prospective study of zonisamide therapy for refractory idiopathic epilepsy in dogs

O bjectives : Investigation of the efficacy of zonisamide as an add-on therapy in dogs with refractory epilepsy.
M ethods : Thirteen dogs fulfilled the inclusion criteria of poor seizure control despite adequate serum levels of phenobarbital, potassium bromide or both. One further dog was treated with zonisamide as monotherapy because of severe blood dyscrasia due to phenobarbital treatment. Various seizure parameters were evaluated retrospectively for a four month period without zonisamide and prospectively for the same time period under zonisamide add-on therapy. The study time period was extended by up to 17 months to evaluate long-term outcome.
R esults : Data of 11 dogs could be evaluated: nine of them were responders. The median reduction of seizure frequency of all dogs on zonisamide add-on therapy was 70 per cent (range 14 to 100 per cent). Only transient central nervous system side effects were reported. No further increase of liver enzymes occurred. In three of the responder dogs, seizure control subsided after individual time periods (between 69 days and seven months).
C linical S ignificance : In dogs with refractory epilepsy, zonisamide may have a beneficial effect on seizure control. In three responder dogs, seizure activity relapsed possibly because of an induction of tolerance. Limiting factors are the high costs.     

Follow-up study of owner attitudes toward home care of paraplegic dogs.

A questionnaire was mailed to 30 owners of paraplegic dogs who had been caring for their dogs at home for 3 to 72 months. It was designed to collect information on demographic variables, duration of ownership and paralysis, age of the pet, pet/owner relationship, owner expectations and perceptions of the pet's quality of life, problems the pet experienced, effect that maintaining a paralyzed pet had on the owners' quality of life, and whether use of a cart was beneficial. Significant correlation was found between prior expectations that the pet would lead a high-quality life and perception that the pet, in fact, had a high quality of life during paralysis (r2 = 0.61, P = 0.01). Owners who had anticipated that extra work would be necessary to care for their paraplegic dog had a more positive attitude toward home care (r2 = 0.55, P = 0.03). Overall, owners involved in the study were satisfied with all aspects of maintaining paraplegic dogs at home. Our findings support the feasibility of dedicated owners successfully maintaining small (average body weight, 9 kg) paraplegic dogs at home for extended periods.     

Owner's perception of carboplatin in conjunction with other palliative treatments for cancer therapy

Objectives : To determine owner's perception of their pet's quality of life during treatment with carboplatin for a variety of canine and feline neoplasms. Methods : Owners were contacted via a postal questionnaire and asked questions regarding their perception of chemotherapy in pets and their perception of carboplatin treatment in their pet. Results : Twenty-eight (59%) of owners responded to the questionnaire. Forty-three percent of owners had not considered chemotherapy in pets before treatment; however, after treatment, 89% of owners supported its use. Sixteen (57%) patients had mild to severe side effects. Most patients experienced mild side effects, including lethargy and loss of appetite. Quality of life during treatment was reduced compared with prediagnosis quality of life however at its best was significantly improved compared with pretreatment quality of life. Eighty-nine per cent of respondents did not regret treating their pet. Clinical Significance : Carboplatin is well tolerated by both owners and pets. Most patients have either no side effects or experience mild lethargy or inappetence. Carboplatin treatment, either alone or in conjunction with other medications, should be considered as a palliative treatment in both dogs and cats with susceptible neoplasms.     

Owners' observations of domestic cats after limb amputation

Questionnaires were distributed to owners of cats that had undergone limb amputation in the UK, through 1000 veterinary clinics or publications relating to companion cats, or online. Between July 2009 and February 2010, responses were received relating to 234 cats, and data for 204 of these were included in subsequent analyses. The responses received provided data on signalment, aetiology, quality of life, behavioural changes and pain observed in cats after partial or total amputation of a limb. Young male domestic shorthair cats were over-represented in the sample; the most common reason for amputation was a fractured bone, and the hindlimb was almost twice as likely to be amputated as the forelimb. Although 89 per cent of the cats received analgesics/anti-inflammatories after discharge, the owners of 35 per cent of the animals observed some signs of pain during recovery. Eighty-nine per cent of the cats were thought to have regained a 'normal' quality of life as defined by the owner and 94 per cent of the owners stated that they would agree with the decision to amputate the affected limb in a pet if faced with the same decision again.     

Epilepsy and seizure classification in 63 dogs: a reappraisal of veterinary epilepsy terminology

The human definitions of epilepsy and seizure classification were applied rigidly to epileptic dogs to investigate whether the distribution of the seizure types and epilepsies of dogs is comparable to that of human beings. Sixty-three dogs were referred because of recurrent (> 2) epileptic seizures. Only dogs without previous or ongoing antiepileptic treatment were included. All dogs had a physical and neurologic examination and blood work that included a CBC and a biochemical profile. All owners were asked to complete a questionnaire, focusing on seizure development. In addition, video recordings of suspected seizure episodes were analyzed if available. In the majority of dogs where an intracranial lesion was suspected, a computerized tomography scan was performed. Sixty-five percent of the dogs experienced partial seizures with or without secondary generalization and 32% exhibited primary generalized seizures; in 3% of the dogs the seizures could not be classified. Twenty-five percent of these cases were classified as idiopathic, 16% as symptomatic, and 45% as cryptogenic epilepsy; in 14% of these a classification was not possible. Applying human definitions, the distribution of seizure types and epilepsy classifications in these dogs differed widely from those in previous reports of canine epilepsy, where generalized seizures and idiopathic epilepsy were most frequently reported. However, our findings are consistent with the results of several large studies of human epilepsy patients. In dogs with epilepsy, closer attention must be given to the detection of a partial onset of seizures. In this study, detailed questioning of the owners and when possible analysis of video recorded seizures, proved to be sufficient for diagnosing seizures with a partial onset in a significant number of dogs. Partial onset of seizures may be an indication of underlying cerebral pathology. Some adjustments of veterinary epilepsy terminology are suggested.     

Owners' assessments of their dog's quality of life during palliative chemotherapy for lymphoma

The owners of 25 dogs with multicentric lymphoma which were treated by multidrug chemotherapy were interviewed to assess the quality of their pet's life during treatment. Sixty-eight per cent of the owners considered their dog's quality of life to be the same as before the lymphoma occurred, and the remaining 32 per cent felt that their pet's quality of life on chemotherapy treatment was acceptable but poorer than before the lymphoma occurred. Treatment complications were reported by 52 per cent of owners. Ninety-two per cent of owners had no regrets about treating their dog with multidrug chemotherapy. The results suggest that, while many dogs developed treatment complications during multidrug chemotherapy, most owners felt that the quality of life of their pets was good during treatment and had no regrets about opting for palliative chemotherapy.     

Owners' assessments of their dog's quality of life during palliative chemotherapy for lymphoma

The owners of 25 dogs with multicentric lymphoma which were treated by multidrug chemotherapy were interviewed to assess the quality of their pet's life during treatment. Sixty-eight per cent of the owners considered their dog's quality of life to be the same as before the lymphoma occurred, and the remaining 32 per cent felt that their pet's quality of life on chemotherapy treatment was acceptable but poorer than before the lymphoma occurred. Treatment complications were reported by 52 per cent of owners. Ninety-two per cent of owners had no regrets about treating their dog with multidrug chemotherapy. The results suggest that, while many dogs developed treatment complications during multidrug chemotherapy, most owners felt that the quality of life of their pets was good during treatment and had no regrets about opting for palliative chemotherapy.     

Clinical and genetic investigations of idiopathic epilepsy in the Bernese mountain dog

A study was conducted to investigate the clinical aspects and to define the mode of inheritance of idiopathic epilepsy in the Bernese mountain dog. Pedigree analyses were carried out on an open, non-preselected population of 4005 dogs. Five different subpopulations with 50 epileptic dogs from 13 generations were included. Almost all epileptic patients showed generalised seizures of the grand-mal type with a well-defined prodromal and postictal phase. The majority (62 per cent) of the epileptic dogs had had their first seizures at between one and three years of age and it was found that the age at first seizure was significantly (P < 0.05) lower in dogs from affected parental animals than in dogs from healthy parental animals. A clear predisposition for males was also noted. Additionally, there was no correlation between inbreeding coefficient and age at first seizure or incidence rate of seizures. The increased occurrence of the disease in different subpopulations and different families of the same sires or dams showed that there was a genetic basis for the condition in the Bernese mountain dog. Furthermore, the results of the pedigree analyses and binomial test support the hypothesis that idiopathic epilepsy has a polygenic, recessive mode of inheritance in the breed. Additional objective test-mating programmes would however be necessary to define the exact mode of inheritance.     

The Use of Diazepam Per Rectum at Home for the Acute Management of Cluster Seizures in Dogs

The use of diazepam per rectum (RDZ) in the home to control generalized cluster seizures in 11 dogs diagnosed with idiopathic epilepsy was evaluated over a 16-month period. All dogs had a prior history of clusters of generalized seizures and were treated with multiple antiepileptic drugs. Owners were instructed to administer diazepam injectable solution (5 mg/mL) per rectum to their dogs at a dose of 0.5 mg/kg when an initial generalized seizure occurred and when a second or third generalized seizure occurred within 24 hours of the first seizure. Seizure activity was recorded by owners in a daily log before the onset of RDZ use and for the duration of RDZ use, which ranged from 57 to 464 days (median = 157 days). The median age at which the first seizure occurred and the median age at the time of enrollment in the study were 19 and 42 months, respectively. All 11 dogs were treated with phenobarbital, with 10 dogs receiving concomitant bromide therapy. No significant correlation between the duration of the first, second, or third antiepileptic drug therapy and the change in the number of cluster seizure events before or after use of RDZ was found. Comparisons of seizure activity were done for the same time interval before and after the onset of RDZ availability. A significant decrease in the total number of seizure events and the total number of cluster seizures events was found after RDZ availability. Similarly, a significant difference in the average number of seizures per cluster seizure event and the total number of isolated seizure events occurred before and after RDZ therapy. Eight of the 11 dogs (73%) that received RDZ for 1 or more times after the first or second seizure had a 100% success rate in prevention of further seizure activity after the first dose. In 3 dogs, success and compliance rates were both equal at 100%, thus suggesting 100% efficacy of RDZ in blocking further seizure activity over the next 24 hours in these dogs. Owners had a large cost-savings because of the decrease in emergency clinic visits after initiating treatment with RDZ. Before RDZ use, the average number of emergency clinic visits was 3, with an average cost of $308 per dog. After RDZ use, the average number of emergency clinic visits was 1, with an average cost of $81 per dog. The results of this study suggest that RDZ may be an effective method of home treatment of generalized cluster seizures in dogs with idiopathic epilepsy, regardless of prior antiepileptic drug history.     

Portosystemic communications: Follow-up of 32 cases

A multicentre retrospective study of dogs that underwent surgical attenuation of portosystemic communications (PSC) was conducted. These dogs were followed from three months after surgery to evaluate the long term effect of surgery on their life span, disease-free interval, and owner assessment of postoperative quality of life of the dogs. Seventy-five per cent of the dogs in this study had no long term postoperative recurrence of clinical signs. Of the 25 per cent of dogs that showed recurrent clinical signs, all but one had partial attenuation of the PSC. The location of the PSC was the only factor that correlated with whether the dogs were still alive. All owners were pleased with the postoperative quality of life of their dogs.     

The quality of life of pet dogs owned by elderly people depends on the living context,not on the owner's age

Social and physical changes associated with human aging may influence the characteristics of the relationship between dogs and their owners and ultimately pets' quality of life. In view of the need of data on this aspect, this study examined the effects of owners' age on the quality of life of dogs. We compared parameters of dogs' quality of life (owners' care and attachment to them and pets' physical condition) between elderly and adult owners living in rural/suburban areas of 2 cities in Northern Italy. Within this context, the only finding was the lower degree of health care provided to dogs by their elderly owners, suggesting a lack of specific information about dog health care, rather than a general effect of the owners' age on the relationship with their pet. Dogs' quality of life parameters were also compared between elderly people living in rural/suburban areas and another sample of elderly people living in city centers. The latter were more attached to their dogs and provided them with a higher level of care. In conclusion, this study found very limited concerns about the adoption of dogs late in their owners' lives. However, in view of the importance of the living context of the elderly on their pets' quality of life, this aspect warrants further investigation.     

Aetiology and long-term outcome of juvenile epilepsy in 136 dogs

The aetiology and outcome of dogs with juvenile-onset seizures were investigated. One hundred and thirty-six dogs whose first seizure occurred before the age of one year were investigated. One hundred and two dogs were diagnosed with idiopathic epilepsy (IE), 23 with symptomatic epilepsy (SE), nine with reactive seizures (RS) and two with probable symptomatic epilepsy (pSE). The outcome was known in 114 dogs; 37 per cent died or were euthanased as a consequence of seizures. The mean survival time of this population of dogs was 7.1 years. Factors that were significantly associated with survival outcome included the diagnosis of SE and the number of antiepileptic drugs (AEDs) used before investigation. The use of one AED before investigation and a diagnosis of SE were associated with a negative outcome, whereas receiving no AED medications before referral was associated with a longer survival. For dogs with IE, survival time was shortened if the dog was a border collie or with a history of status epilepticus;receiving no AEDs before referral in the IE group was associated with a positive outcome. Seizure-free status was achieved in 22 per cent of dogs diagnosed with IE. While the survival times were longer than previously reported in canine epilepsy, similar remission rates to those reported in childhood epilepsy, where a 70 per cent remission rate is documented, were not seen in the canine juvenile population.     

Low concentrations of cerebrospinal fluid GABA correlate to a reduced response to phenobarbital therapy in primary canine epilepsy

In this study, we investigated whether pretreatment cerebrospinal fluid (CSF) neurotransmitter concentrations of gamma-aminobutyric acid (GABA) and glutamate (GLU) were correlated with response to phenobarbital treatment in dogs with primary epilepsy. Eleven untreated dogs, 6 males and 5 females, with a median age of onset of seizures of 3 years (range: 0.5-5 years) were selected for therapy based on progressive or serious seizure patterns. The median interval between the first observed seizure and start of phenobarbital therapy was 485 days (range: 101-1,765 days). All dogs were purebred, with the exception of I male dog. Oral phenobarbital was started at 2.5 mg/kg every 12 hours. Trough serum phenobarbital concentrations were measured at 15, 45, 90, 180, 360, 540, and 720 days after the start of treatment. There was no difference in the mean trough serum concentration or in the mean number of seizures recorded between each time period of phenobarbital measurement over the 2-year evaluation. No correlation was found between CSF GLU, GABA, or GLU: GABA ratio and the total number of seizures recorded before or after initiation of phenobarbital therapy. Lower CSF GABA concentration, however, was correlated with a lower seizure frequency difference (the total number of seizures before phenobarbital therapy minus the total number of seizures after phenobarbital therapy for an identical time period of evaluation) and lower percentage reduction in seizures: ([total number of seizures before phenobarbital therapy minus the total number of seizures after phenobarbital therapy] divided by the total number of seizures before phenobarbital therapy) x 100. There was no correlation between CSF GLU and the seizure frequency difference and percentage reduction in seizures. A negative correlation between the CSF GLU:GABA ratio and seizure frequency difference was found. Thus, dogs with an initial lower CSF GABA concentration before phenobarbital therapy did not respond as well as did dogs with a higher CSF GABA concentration.     

Perceptions and priorities of owners of dogs with heart disease regarding quality versus quantity of life for their pets

OBJECTIVE: To describe the relative importance of pets' quality versus quantity of life among owners of dogs with heart disease. DESIGN: Prospective questionnaire-based clinical study. SAMPLE POPULATION: Owners of 201 dogs with heart disease. PROCEDURES: Owners each completed a questionnaire that was designed to ascertain the relative importance of quality versus quantity of life for their pet and to assess the owners' willingness to trade survival time for quality of life, if that were possible. Analyses were performed to evaluate factors associated with owner willingness to trade time for quality of life. RESULTS: Most owners (170/197 [86%]) were willing to trade survival time for quality of life for their heart disease-affected dogs; of those owners, 88 (52%) were willing to trade 6 months. Owners were highly concerned with detection of perceived pet suffering and their pet's ability to interact with them. Owners whose pets had respiratory difficulty or fainting episodes and were treated on an outpatient basis had a greater willingness to trade survival time than owners of dogs that were treated on an emergency basis. Among owners willing to trade time for quality of life, younger owners and those whose pets had fainting episodes were willing to trade the most amount of time. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that quality of life is highly important to owners of dogs with heart disease. Owners' priorities partly depend on owner age and the pet's clinical circumstances; ongoing client-veterinarian communication is important to optimize treatment success as perceived by owners.     

Anticonvulsant activity and tolerance of ELB138 in dogs with epilepsy: a clinical pilot study

A new antiepileptic and anxiolytic drug, ELB138, was evaluated in a clinical pilot study in dogs with newly diagnosed or chronic idiopathic epilepsy. The purpose was to verify clinically the anticonvulsant effectiveness of this substance, which had already been demonstrated experimentally. Data from 29 dogs treated with ELB138 were compared with results obtained retrospectively from 82 dogs treated with conventional antiepileptic medication. The reduction in seizure frequency using ELB138 in dogs with newly diagnosed idiopathic epilepsy was comparable to the reduction in dogs treated either with phenobarbital or primidone. In dogs with chronic epilepsy and add-on therapy with either ELB138 or potassium bromide, such supplementation reduced the seizure frequency and the duration and severity of seizures. The most obvious difference between ELB138 treatment and conventional medications became clear in the evaluation of side effects, which in those dogs treated with ELB138 were rare, and consisted mostly of transient polyphagia. This pilot study confirmed that ELB138 has a potent anticonvulsant effect in dogs with idiopathic epilepsy. These results will form the basis for a multicentre, blinded study.     

Intestinal parasites of dogs and cats in Australia: The veterinarian’s perspective and pet owner awareness

During a recent national study of intestinal parasites in dogs and cats in Australia, questionnaires were submitted to veterinarians and pet owners to evaluate from a veterinary and public health standpoint the veterinarians’ perception, awareness and knowledge of gastrointestinal parasites in their locality. The study included sourcing information with regard to commonly recommended deworming protocols. The awareness of pet owners regarding parasitic zoonoses and the degree of education provided to them by veterinarians was also determined.Very few veterinarians routinely discussed the zoonotic potential of pet parasites with clients but most recommended regular prophylactic administration of anthelmintics throughout a pet’s life. Some pet owners were unaware of the existence of zoonoses. It is possible that an overreliance on anthelmintics may have led to a certain complacency about the need to educate pet owners about the risks of zoonoses. Veterinarians are important educators in the community and it is important to evaluate their performance if improvements are to be made.     

Efficacy of primidone in dogs with seizures unresponsive to phenobarbital

Fifteen epileptic dogs had been treated with high dosages of phenobarbital but had not achieved adequate control of their seizures. Their treatment was switched to comparable and higher dosages of primidone. Serum concentrations of phenobarbital were measured in all dogs before and after primidone therapy was initiated, to ensure that the primidone dosage achieved comparable or higher values when derived from primidone. Only one dog experienced improvement in seizure control, indicating that there is no advantage to the use of primidone over the use of phenobarbital for the control of seizures in most dogs.