In dogs undergoing extrahepatic portosystemic shunt attenuation, does pretreatment with levetiracetam reduce postoperative seizure incidence?

PICO question In dogs undergoing surgical attenuation of a congenital extrahepatic portosystemic shunt, does pretreatment with levetiracetam reduce the incidence of post attenuation seizures?   Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Four papers were critically reviewed. All were retrospective cohort studies Strength of evidence Moderate Outcomes reported In one paper levetiracetam was found to reduce the risk of post-attenuation seizures. In the remaining three papers no difference was found between the frequency of post-attenuation seizures and the use of levetiracetam Conclusion That prophylactic levetiracetam is not indicated for the use of preventing post-attenuation seizures in dogs surgically treated for extrahepatic portosystemic shunts   How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care

Effects of dietary supplementation with krill meal on serum pro-inflammatory markers after the iditarod sled dog race

A seafood-based supplement from krill, rich in omega-3 phospholipids and proteins was tested on a group of dogs competing in the 2016 Iditarod dog sled race to investigate the effects of krill meal on exercise-induced inflammation and muscle damage in comparison to a control group. A single team of 16 dogs received 8% krill meal for 5 weeks prior to the start of race, while another team of 16 dogs received no supplementation. Ten dogs of the treatment and 11 dogs of the control group finished the race and their blood was analyzed for omega-3 index, inflammation (CRP) and muscle damage (CK). The omega-3 index of the krill meal-fed dogs was significantly higher at the beginning of the race (mean 6.2% in the supplemented vs 5.2% in the control group, p < .001). CRP concentrations increased from 7.05 ± 2.27 to 37.04 ± 9.16 μg/ml in the control and from 4.26 ± 0.69 to 16.56 ± 3.03 μg/ml in the treatment group, with a significant difference between the groups (p < .001). CK activity was increased from 90.75 ± 8.15 IU/l to 715.90 ± 218.9 IU/l in the control group and from 99.55 ± 12.15 to 515.69 ± 98.98 in the supplemented group, but there were no differences between groups (p = .266). The results showed that krill meal supplementation led to significantly higher omega-3 index, which correlated with lower inflammation and a tendency for reduced muscle damage after this long-distance sled dog competition. However, these results need to be confirmed by more controlled studies, since it was a field study and effects of race speed or other performance-related factors such as fitness and musher skill on the results cannot be excluded

Postencephalitic epilepsy in dogs with meningoencephalitis of unknown origin: clinical features, risk factors, and long‐term outcome

Background: Although the presence of seizures in dogs with meningoencephalitis of unknown origin (MUO) has been associated with shorter survival times, data regarding the prevalence and risk factors for postencephalitic epilepsy (PEE) is lacking. Objectives: To describe the clinical features, prevalence, risk factors, and long‐term outcome of PEE in dogs with MUO. Animals: Sixty‐one dogs with presumptive diagnosis of MUO based on the clinicopathological and diagnostic imaging findings. Methods: Retrospective study. Cases were identified by search of hospital medical records for dogs with suspected or confirmed MUO. Medical records of dogs meeting inclusion criteria were reviewed. Signalment, seizure history, clinicopathologic, and magnetic resonance imaging (MRI) findings were recorded. Results: Among 61 dogs at risk of PEE, 14 (23%) dogs developed PEE. Three of 14 dogs with PEE (21%) developed drug‐resistant epilepsy. Dogs with PEE were younger (P = .03; ORadjusted = 0.75; 95% confidence interval [CI], 0.58‐0.98) and had significantly shorter survival times (log‐rank test P = .04) when compared to dogs that did not develop epilepsy. The risk factors associated with the development of PEE were the presence of acute symptomatic seizures (ASS; P = .04; ORadjusted = 4.76; 95% CI, 1.11‐20.4) and MRI lesions in the hippocampus (P = .04; ORadjusted = 4.75; 95% CI, 1.07‐21.0). Conclusions and Clinical Importance: Dogs with MUO and seizures at the early stage of the disease (ASS) seem to be at a higher risk of developing PEE

Traumatic skull fractures in dogs and cats: A comparative analysis of neurological and computed tomographic features

Background Traumatic skull fractures (TSF) are relatively frequent in dogs and cats, but little information is available regarding their clinical and imaging features. Hypothesis/Objectives To describe the neurological and computed tomographic (CT) features of a large cohort of dogs and cats with TSF. Animals Ninety‐one dogs and 95 cats with TSF identified on CT. Methods Multicenter retrospective comparative study. Signalment, cause of trauma, fracture locations and characteristics, presence of neurological deficits, and 1‐week survival were recorded. Fractures were classified according to the extent of fragmentation and displacement. Results The cranial vault was affected more frequently in dogs (P = .003), whereas the face and base of the cranium more often was affected in cats (P < .001). Cats presented with multiple fractures more frequently (P < .001). All animals with TSF in the cranial vault were more likely to develop neurological signs (P = .02), especially when depressed fractures were present (95% confidence interval [CI], 1.7‐8.2; P = .001). Animals with TSF located only in the facial region were less likely to have neurological signs (odds ratio with Mantel‐Haenszel's method [ORMH], 0.2; 95% CI, 0.1‐0.6; P = .004). Most affected animals (84.9%) survived the first week post‐trauma. Death was more likely with fractures of the cranial vault (P = .003), especially when fragmented (P = .007) and displaced (P = .004). Conclusions and Clinical Importance Traumatic skull fracture distribution and patterns are different between dogs and cats. Cranial vault fractures were associated with neurological deficits and worse survival. The presence of TSF alone should not be considered a negative prognostic factor because most affected animals survived the first week

Testing of dogs with meningitis and meningoencephalitis of unknown etiology for vector-transmitted microorganisms

Bei vielen Entzündungen des zentralen Nervensystems (ZNS) beim Hund können Erreger nicht nachgewiesen werden. Sie werden daher als Entzündungen unbekannter Genese bezeichnet. Immunpathologische Untersuchungen lassen vermuten, dass ein Antigen eine autoimmune Reaktion auslöst („Hit-and-Run- Prinzip“). Serum, Blut und Liquor cerebrospinalis wurden auf Antikörper bzw. DNA von Vektorübertragenen Erregern hin untersucht, um zu klären, inwieweit Vektor-übertragene Erreger Meningitiden und Enzephalitiden unbekannter Genese beim Hund in Deutschland auslösen oder Teil einer multifaktoriellen Ätiologie sind. Im Zeitraum von Dezember 2009 bis November 2011 wurden 66 Hunde in die prospektive multizentrische Studie aufgenommen. Die Hunde wurden in drei Gruppen eingeteilt: 1) Kontrollgruppe (Trauma-Gruppe) mit nicht-entzündlichen ZNS-Erkrankungen (Rückenmarkstrauma) (n=21), 2) Hunde mit Verdacht auf Meningoenzephalitis unbekannter Ätiologie (MUE) (n=22) und 3) Hunde mit Steroid-Responsive Meningitis-Arteriitis (SRMA) (n=23). Es erfolgten PCR- Untersuchungen auf Anaplasma phagocytophilum, Ehrlichia canis (bei Aufenthalt in endemischen Gebieten bzw. bei unbekannter Herkunft, n=28) und Bartonella spp. in Liquor und EDTA-Blut sowie serologische Untersuchungen auf E. canis (IFAT), Frühsommer-Meningoenzephalitis (FSME)-Virus (ELISA) und Borrelia burgdorferi sensu lato (IFAT, bzw. C6-ELISA bei IFAT-Antikörpertitern ≥ 1:128). Eine eubakterielle PCR wurde aus Liquor durchgeführt. Der Gruppenvergleich wurde mit nicht parametrischen Tests (Kruskal-Wallis-Test) gemacht. Als statistische Software wurde SPSS 17.0 für Windows, SPSS Inc., USA, verwendet. Bei keinem Hund wurde DNA der untersuchten Erreger im Liquor nachgewiesen. Die PCRUntersuchung auf A. phagocytophilum im Blut war bei 4 Hunden aus der SRMA-Gruppe positiv. Bei keinem Hund war die E. canis-PCR bzw. der Antikörpernachweis in Blut bzw. Serum positiv. Bei keinem Hund konnten Antikörper gegen das FSME-Virus nachgewiesen werden. Bei einem Hund aus der SRMA-Gruppe wurde B. henselae-DNA im Blut nachgewiesen. Der Antikörperspiegel (IFAT) gegen B. burgdorferi sensu lato lag bei 14 Hunden bei > 1:128, wobei es keine signifikanten Unterschiede zwischen den Gruppen gab. Bei zwei Hunden der MUE-Gruppe und einem Hund der SRMA-Gruppe wurde ein erhöhter C6-Antikörperspiegel gegen B. burgdorferi sensu lato (> 10 U/ml) gemessen. Bei drei Hunden der Trauma-Gruppe konnte mittels eubakterieller PCR DNA von Pasteurellaceae nachgewiesen werden, was vermutlich auf eine Kontamination der Proben zurückzuführen ist. Es konnte kein Zusammenhang zwischen dem Vorhandensein von E. canis- oder einem erhöhten Antikörperspiegel gegen E. canis und FSME-Virus und entzündlichen ZNSErkrankungen gezeigt werden. Erwähnenswert ist, dass 17 % der Hunde mit SRMA im EDTA-Blut PCR-positiv für A. phagocytophilum waren, was weiterer Untersuchungen bedarf. A. phagocytophilum spielt möglicherweise eine Rolle als Trigger einer sekundären Immunantwort. Inwieweit vereinzelte positive Ergebnisse der Untersuchungen auf B. henselae-DNA und B. burgdorferi sensu lato Antikörper im Serum eine klinische Relevanz haben, bleibt ungeklärt.In many cases of inflammatory diseases of the central nervous system in dogs, no aetiological infectious agent can be found. These inflammatory conditions are thus named inflammations of unknown aetiology. Results of immunpathological studies imply that an antigen may trigger an autoimmune response (Hit-and-Run-Hypothesis). Serum was analyzed for antibodies against vector-transmitted pathogens and blood and cerebrospinal fluid for DNA of such infectious agents in order to further define the role of CVBD-agents in the aetiology of meningitis and meningoencephalitis of unknown aetiology in dogs in Germany. 66 client-owned dogs were included in the prospective multicenter study between december 2009 and november 2011. They were classified in three groups: a.) control-group with dogs with non-inflammatory CNS-disease (e.g. intervertebral disc disease, n=21) (trauma group) b.) dogs with meningoencephalitis of unknown aetiology (MUE) (n=22) c.) dogs with steroid- responsive meningitis-arteritis (SRMA) (n=23) PCR was performed in blood and cerebrospinal fluid to detect A. phagocytophilum, E. canis (for dogs that stayed in an endemic area or dogs with unknown past, n=28) and Bartonella spp. Serological assays targeted E. canis (IFAT), TBEV (ELISA) and Borrelia burgdorferi sensu lato antibodies (IFAT and C6-ELISA for patients with elevated antibody titers in IFAT). Group comparison was done with non parametric tests, using the statistical software SPSS 17.0 for windows, SPSS Inc., USA. No DNA was found in cerebrospinal fluid. In 4 dogs of the SRMA- group, DNA of A. phagocytophilum was found in blood. Serological and PCR analysis for E. canis were negative in all dogs in blood and serum. No elevated antibody-titers against TBEV were measured in any dog. B. henselae DNA was detected in blood of 1 dog of the SRMA-group. 14 dogs had an elevated antibody titer (> 1:128) against B. burgdorferi sensu lato (IFAT). There were no significant differences between the 3 groups. In two dogs of the SRMA-group and in one dog of the MUE-group, an elevated C6-titer was detected via C6-ELISA (> 10 U/ml). DNA of Pasteurellaceae was detected with eubacterial PCR in CSF of 3 dogs of the trauma group, which may be due to a contamination of the samples. No correlation could be determined between the presence of E. canis DNA or elevated antibody-titers against E. canis or TBEV and inflammatory CNS diseases. 17 % of dogs with SRMA had positive PCR results for A. phagocytophilum. A. phagocytophilum may play a role as trigger of a secondary immunopathy. It remains unclear whether the positive test results for Bartonella DNA and Borrelia burgdorferi sensu lato antibodies are clinically relevant

Meningoencephalomyelitis of unknown origin in dogs: investigation on potential cerebrospinal fluid biomarkers and description of breed specific findings in retrievers

Meningoencephalomyelitis of Unknown Origin (MUO) is a non-infectious inflammatory disease of the central nervous system which is probably partially caused by an immune system dysfunction. The complexity of this disease still challenges clinicians and researchers alike: a multidisciplinary approach combining clinical and molecular research may be the key not only to the elucidation of its pathogenesis, but also to improved diagnostic techniques and the development of new treatment strategies. The search for potential cerebrospinal fluid biomarkers in MUO has shown that that the concentrations of some chemokines are higher in cerebrospinal fluid of dogs with this condition. In particular, one interesting candidate, the chemokine Monocyte Chemoattractant Protein-1 was determined using multiplex array, but could not be confirmed using other methods because of methodological issues. This study highlighted several severe limitations we are faced within the study of MUO. One of the limiting factors of this approach is the marked variability in disease phenotypes. The description of this disease in Retriever dogs showed that they presented more commonly than other large and small breed dogs with vestibular signs and abnormal mentation, but rarely with seizures. Magnetic resonance imaging revealed extensive diffuse, bilateral asymmetrical, hyperintense to grey matter intra-axial lesions on T2-weighted sequences with ill-defined margins and an overall heterogeneous “patchy” appearance, with lesions involving the diencephalon and extending to the brainstem. This characteristic lesion pattern was different from the pattern in other small and large-breed dogs. Molecular studies might determine whether a genuine breed-related variation is present, which could provide researchers with a more homogeneous study population

Ischaemic paraspinal myopathy along with myelopathy due to putative fibrocartilaginous embolism in a dog

A 10-year-old German shepherd dog was presented with peracute onset of non-ambulatory paraparesis. Clinical signs and neurological examination revealed lack of proprioception and reduced to absent reflexes in both hind limbs, indicating a lesion to spinal cord segments (SCS) L4–S3. In contrast, MRI identified intramedullary signal changes within the SCS T13–L2 and a sharply demarcated zone of signal changes in the adjacent dorsal lumbar musculature on the left side. The findings were consistent with ischaemic myelopathy, most likely due to fibrocartilaginous embolism (FCE). The lesion also included large areas of presumably ischaemic myopathy which was confirmed by histopathology of biopsies from adjacent muscles. On re-examination, three months after presentation, ambulatory paraparesis remained, proprioceptive deficits improved and spinal reflexes were normal. However, the affected left longissimus lumborum muscle had become markedly atrophic. FCE as the most common cause for ischaemic myelopathy obviously may also induce ischaemic paraspinal myopathy

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Lumbosacral intervertebral disk extrusions in thirteen dogs

Objective: To describe the clinical presentation, magnetic resonance imaging (MRI) findings, and outcome of dogs treated surgically for lumbosacral intervertebral disk extrusion (IVDE). Study Design: Retrospective study. Animals: Thirteen dogs. Methods: Records and MRI studies of dogs with intraoperatively confirmed lumbosacral IVDE were reviewed. MRI features of thoracolumbar IVDE were applied to all cases. Postoperative outcome was subjectively assessed as excellent, good, or poor. Results: All dogs had an acute or subacute onset of lumbosacral pain and nerve root signature. Seven dogs had neurological deficits. MRI revealed lateralized herniated disk material and partial to complete disk degeneration in all cases; the extradural material extended cranial and/or caudally from the disk space in 10 cases. All dogs underwent L7‐S1 dorsal laminectomy and removal of extruded disk material. In six dogs, surgery was complicated by inflammatory changes, including one case of epidural steatitis. On reexamination 4–6 weeks postsurgery, outcome was judged as excellent in 11 dogs and poor in the remaining 2 due to contralateral nerve root signature in one case and nonambulatory paraparesis and urinary incontinence in the case with steatitis. Conclusion: Lumbosacral IVDE in dogs was characterized by acute/subacute onset of lumbosacral pain and nerve root signature and lateralized and often dispersed extradural material over a degenerated L7‐S1 intervertebral disk on MRI. Early decompressive dorsal laminectomy generally resulted in excellent clinical outcome. Clinical Significance: Observation of these clinical and imaging features in dogs should prompt clinical suspicion of lumbosacral IVDE