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  • Facts About Epilepsy
    the seizures themselves 4 Mild side effects are common when first starting treatment with anticonvulsant drugs 5 Therapeutic effects and side effects are related to blood level and not oral dosage of the anticonvulsant drug 6 Oral anticonvulsant drugs may take a long time to be effective so seizure control may not be immediate 7 You must keep accurate record of witnessed or suspected seizures 8 You must be willing

    Original URL path: http://www.canineepilepsy.co.uk/facts-about-epilepsy.html (2016-02-08)
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  • Owners Views
    frequently seizures occurred and 3 what side effects the drugs had The balance between these 3 factors determined the owners overall satisfaction with how well their pet s disease was controlled In general owners thought that less than one seizure every three months was adequate seizure control However nearly half the owners questioned thought that their dogs had a poorer quality of life since becoming epileptic The reasons for this were side effects of medication seven of 12 seizures not well controlled five of 12 and behavioural changes three of 12 Practical considerations of convenience and cost appeared to be less of a concern for owners Although in this survey owners did not report concern about the cost of seizure management this group of dogs were not receiving higher cost novel therapies Whilst most owners did not consider the administration of medication a nuisance nearly two thirds reported that caring for an epileptic dog had an effect on how they organised their free time Quality of Life in epileptic dogs as reported by their owners The preliminary results of a recent study by investigators at the University of Glasgow were presented at the ECVN Congress This study used an owner questionnaire to look at the quality of life of dogs with idiopathic epilepsy and their owners Dogs were included in the study if they were diagnosed with idiopathic epilepsy between 0 5 and 6 years of age and had had seizures for at least 1 year Information from 128 dogs was included in the study 97 128 owners rated their dogs quality of life to be 8 10 or higher Most of the owners in the study were concerned by seizure frequency and severity More than half of the participants 75 127 felt that their dog s quality of life

    Original URL path: http://www.canineepilepsy.co.uk/owners-views.html (2016-02-08)
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  • Useful Resources
    public domain This site has an active discussion forum policed by neurology specialists If you have general questions about your pet s condition you may be able to find the information you need there Another useful feature is the searchable database of neurology specialists in the USA allowing owners and veterinarians to identify a specialist in their area If you would like your pet seen by a neurology specialist in the UK you will need to ask your own vet to make a referral for you Your vet will be happy to do this all you need to do is ask 2 Canine Epilepsy Resource Center http www canine epilepsy com This is the website of Epil K9 the All Breed Canine Epilepsy List founded in 1996 by Alicia Wiersma Aylward It is now co owned and managed by Marion Mitchell Kathi Dvorak Anne Coventry Chris Desmedt Donna Wilt The purpose of Epil K9 is to discuss canine epilepsy and seizures List members are encouraged to ask questions and or give information on these disorders according to their experiences The website has been designed to provide a warm welcoming environment to anyone with a seizuring dog There is a large and very active list with members from over 20 countries In addition there are a number of veterinary neurology specialists on the list who assist in answering questions and providing information This website contains some useful information for owners of epileptic dogs and is a valuable resource There is a chat room for members where you can share your experiences or take comfort from the experience of others This website is based in the USA and contains information about buying drugs direct from compounding pharmacists Owners should be aware that in the UK drugs for treating epileptic pets are only

    Original URL path: http://www.canineepilepsy.co.uk/useful-resources.html (2016-02-08)
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  • Clinical pathology
    diagnostic tests is important in ruling out underlying causes of seizures Routine haematological and biochemical screening is usually performed to rule out metabolic causes eg electrolyte abnormalities hypoglycaemia and hepatic disease pre and post prandial bile salts Hypothyroidism may occur in association with epilepsy and although it is not an accepted cause of seizure activity its presence may make seizure control more difficult Testing of Total T4 Free T4 and endogenous TSH may be appropriate A full database should also include routine urinalysis Serological testing for infectious causes of seizure includes Toxoplasma IgM and IgG and Neospora serology If the history suggests focal seizures there may be an increased likelihood of detecting cerebral pathology and examination of CSF may be appropriate CSF analysis should include protein quantification cell count differential nucleated cell count Distemper virus antibody titre coronavirus antibody titre Where possible PCR for Distemper Toxoplasmosis and Neosporosis should also be performed Access to electroencephalography EEG is not commonly available and is rarely helpful in seizuring dogs Image Sample of CSF from a dog with CNS lymphoma courtesy of Laurent Garosi Davies Veterinary Specialists References Brauer C Jambroszyk M Tipold A 2011 Metabolic and toxic causes of canine seizure disorders

    Original URL path: http://www.canineepilepsy.co.uk/clinical-pathology.html (2016-02-08)
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  • Pathophysiology
    and an action potential is generated Repolarisation occurs through activation of the ATPase pump A seizure occurs when brain cells spontaneously depolarise There are 2 basic pathophysiological processes that can result in the development of seizures These are i excessive excitation of the cells increasing the likelihood of depolarisation or ii loss of inhibition disinhibition of cell depolarisation For example in hypoglycaemia the ATPase pump is deprived of energy so that the cell resting potential is more positive and depolarisation more likely In some diseases eg hepatic encephalopathy the action of some inhibitory transmitters eg GABA at their specific receptors is impaired This lack of inhibition allows depolarisation of cells to be triggered more easily Abnormal electrical activity in the brain is usually confined to a small area by surrounding inhibition For a seizure to be propagated a cell or group of cells must depolarise When depolarisation is of a sufficient magnitude the impulse will be conducted to the entire brain producing a generalised seizure A focal seizure occurs when the electrical discharge does not spread across the brain In dogs seizures often occur in the middle of the night During low levels of awareness drowsiness and dreamless sleep decreased activity in the reticular formation allows reverberating circuits between the thalamus and the cortex to synchronize Additionally some groups of neurons which are only mildly hyperactive when the animal is awake become more excitable during sleep Often seizures arise from the same initial focus each time Two phenomena may affect seizure focus Mirror focus where a seizure focus creates similar activity in a corresponding area of the contralateral hemisphere Kindling where occurrence of one seizure can increase the likelihood of further seizures With time both mirror foci and kindled foci may form a new independent seizure focus Why seizures terminate

    Original URL path: http://www.canineepilepsy.co.uk/pathophysiology.html (2016-02-08)
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  • Seizure investigation
    autonomous and form a new independent seizure focus Why seizures terminate as rapidly as they begin is also unknown Metabolic exhaustion of neurons is not an adequate explanation Extracortical inhibitory centers such as within the cerebellum may play a role ablations of the cerebellum facilitates seizure activity Phenytoin a commonly used anticonvulsant in human beings dramatically increases the rate of firing of Purkinje neurons Other areas such as the caudate and parts of the thalamus and reticular formation may also help to terminate seizure activity It is often noted that seizures occur in the middle of the night in dogs One explanation is that during low levels of awareness drowsiness and dreamless sleep decreased activity in the reticular formation allows for reverberating circuits between the thalamus and the cortex to synchronise Additionally groups of neurons which are only mildly hyperactive in the awake state become excitable and fire consistently during sleep 1 4 Differential diagnoses Seizures can be mimicked by Syncope Weakness Narcolepsy Scottie cramp Vestibular disease Myasthenia gravis Painful focus Approach to evaluation 2 Approach to evaluation 2 1 History important questions A number of questions are important to narrow down differential diagnosis Age at the onset of the first seizure may help to narrow likely differential diagnosis list as different forms of disease more likely at different ages Owner s description of these episodes from start to end may help to confirm the epileptic nature of the events and aid recognition of conditions that mimic an epileptic seizure Frequency of seizures the aim of anti epileptic treatment is not to cure the animal of his epilepsy but to control the seizures with acceptable side effects decision to start treatment should be based on the frequency of the seizures Warning There is no correlation between the actual seizure frequency and underlying disease process as an animal with idiopathic epilepsy might experience seizures on a weekly basis while an animal in the early stage of a brain tumour might be presented with only one recorded seizure event What was the animal doing just before the episode occurred dogs with idiopathic epilepsy typically seizure when they are at rest or sleeping seizures at exercise or associated with excitement are more common with cardiovascular disease or metabolic disease eg hypoglycemia Relationship of episodes to feeding metabolic causes of seizures such as congenital porto systemic shunt may be associated with feeding or fasting Behavior mental status gait between episodes ie interictal period should be normal in case of idiopathic epilepsy The presence of inter ictal abnormality is suggestive of a metabolic or structural intracranial cause for the seizure Presence of other systemic signs Previous medical history sudden cessation of anticonvulsant drugs can trigger seizure activity hepatotoxic drugs can result in liver damage and hepatic encephalopthy some drugs have neurological side effects Vaccination status some infectious viral diseases can result in seizures but are prevented by vaccination Travel history some diseases potentially causing seizures are more common or only present abroad Any familial history of seizures epilepsy may be proven or suspected to be inherited in some breeds eg Labrador retriever Golden Retriever Border Collie German Shepherd Dog 2 2 Examination 2 2 1 General physical examination In all patients the neurological examination should be preceded by a thorough examination of all other body systems This is essential in detecting abnormality in other body systems that might also affect the nervous system e g animal with liver disease presented for epileptic seizures and abnormal mentation mimic a primary neurologic disorder e g severe cardiovascular disease causing syncope or could influence the prognosis 2 2 2 Specific examination An epileptic seizure is not a disease entity in itself but a clinical sign generally indicative of a forebrain disorder Seizure etiology can be classified as intracranial or extracranial Intracranial causes are further subdivided into those where a structural lesion is identified vascular inflammatory infectious traumatic anomalous neoplastic disease and those where no such lesion is present that is primary functional or idiopathic epilepsy The detection of forebrain signs on neurological evaluation in the inter ictal period generally rules out primary epilepsy The only exception to this rule is ischemic necrotic brain lesions secondary to violent seizures excitotoxicity phenomenon Such lesions are particularly found in cats in the NMDA receptor rich brain region such as the hippocampus Inter ictal neurological deficits frequently observed include mainly behavioral changes aggression fear hyperexcitability uncontrolled biting chasing as well as other signs referring to forebrain involvement circling uni or bilateral central blindness decreased mental status Most animals with structural forebrain disorders show neurological signs in the interictal period These signs are often asymmetric and can localise the lesion They can refer to a forebrain disorder ipsilateral circling contralateral postural reaction deficit contralateral menace response loss with normal papillary light reflex contralateral abnormal response to stimulation of the nostril abnormal behavior or to a multifocal disorder cranial nerve or spinal cord involvement The exception to this is a structural lesion in a silent area of the brain region of the brain which causes only seizures with no other localizing signs such as the olfactory lobe or prefrontal lobes or in the early stage of an enlarging and eventually slowly growing mass In case of metabolic or toxic causes the animal may have normal or abnormal neurological examination in the interictal period If neurological signs are seen they are typically symmetrical and non localizing in term of anatomic diagnosis 2 3 Clinical pathology The least invasive diagnostic tests should be performed first Blood tests are indicated to investigate metabolic causes Brain imaging CSF analysis PCR and serology for infectious disease are then indicated to investigate structural brain diseases Tip The diagnosis of primary idiopathic epilepsy is a diagnosis of exclusion after elimination of extracranial causes metabolic or toxic and structural intracranial causes There is no definitive diagnostic test to confirm this condition 2 3 1 Routine screening tests Aim to rule out extracranial metabolic causes liver enzymes AST ALT ALP and bile acid

    Original URL path: http://www.canineepilepsy.co.uk/seizure-investigation.html (2016-02-08)
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  • Imaging introduction
    these are suspected a CSF sample may be required for diagnosis MRI is most likely to be useful in animals in which onset of seizures occurs after the age of 6 years or those in which seizures are refractory to standard treatments In addition to identifying an underlying cause of seizures MRI or CT is required as an aid to treatment planning radiotherapy or surgery for intracranial masses Skull radiography is rarely of any value Screening thoracic and abdominal radiographs are used to help rule out systemic conditions causing seizures Ultrasonography may be useful to further evaluate suspected cardiovascular or metabolic disease eg portosystemic shunts Magnetic resonance imaging of the brain Although it is unlikely that the veterinarian in practice will have to undertake MRI or to interpret the scans it is useful to have an understanding of what can be seen and what diagnoses can be made using this modality Further information on the subject can be found here Brain Image Image MRI scan of the brain after contrast injection gadolinium in a Boxer with a glioma courtesy of Laurent Garosi Davies Veterinary Specialists Imaging referrals There are many clinical indications for referral but imaging referrals are generally made

    Original URL path: http://www.canineepilepsy.co.uk/imaging-introduction.html (2016-02-08)
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  • mri imaging
    bright hyperintense Cortical bone and air in the frontal sinuses appear as a signal void black On T2 weighted scans the brain is seen with a greater degree of contrast with white matter appearing darker than grey matter and CSF is hyperintense Surrounding tissues are usually darker and appear grainier than on T1 weighted images Generally T1WI show better anatomic detail and are used to visualise enhancement of neoplastic or inflamed areas with contrast medium T2WI is sometimes a more sensitive detector of minor pathology since increased water content of tissues which occurs with most disease processes creates dramatic hyperintense signal This is why most studies would include a combination of T1 and T2 weighted scans Variations in normal anatomy Brain anatomy does vary slightly between breeds of dog depending on their head conformation In brachycephalic dogs the frontal sinus is small or absent and the olfactory lobes lie more ventrally than in longer nosed breeds The size of the lateral ventricles of the brain is especially variable and can pose problems in the diagnosis of hydrocephalus Generally they are prominent in domed headed breeds such as bulldogs Yorkshire terriers and Chihuahuas possibly due to breeding selection of dogs with appropriate head conformation due to subclinical hydrocephalus In some patients the septum pellucidum midline septum between the ventricles may be lost The two lateral ventricles may differ in size in some dogs but unless this is associated with a midline shift or other mass effect it is not clinically significant Pathology Brain tumours Brain tumours are surprisingly common in dogs and cats Affected patients are usually middle aged but may occasionally be young adults or even puppies In the dog meningiomas and gliomas are diagnosed with approximately equal frequency In the cat meningiomas are by far the most common type of intracranial tumour The two tumour types can be differentiated with reasonable confidence by their imaging characteristics Inflammatory brain disease Inflammatory brain disease typically produces multiple multifocal lesions of variable size and definition Modest ill defined enhancement may occur on T1W scans but the lesions are usually best seen as ill defined hyperintense zones on T2W scans The diagnosis can often be confirmed by CSF analysis Congenital brain disease The most common congenital condition diagnosed is hydrocephalus May affect the entire ventricular system or only the lateral ventricles It may be hard to be sure that a moderate degree of ventricular dilation in domed headed dogs is the cause of the neurological signs because of the normal ventricular size variation in these dogs Traumatic conditions Useful modality for assessment of brain trauma provided the patient can withstand the necessary anaesthesia Cranial fractures intracranial haematomata parenchymal haemorrhage and parenchymal oedema can be recognised MRI can also be used to exclude the possibility of previous trauma as a cause of epilepsy Miscellaneous brain conditions Brain infarcts Rarely occur in small animals Usually seen as wedge shaped areas of hyperintensity on T2W scans with absent or feeble contrast enhancement on T1W scans If

    Original URL path: http://www.canineepilepsy.co.uk/mri-imaging.html (2016-02-08)
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