Arrol

Berendt

BrØNden

Casal

Fredso

GullØV

HÜLsmeyer

Miura

Monteiro

Oyama

Packer

Pakozdy

Potschka

Proschowsky

PÁKozdy

Saito

SandØE

Schriefl

Stanciu

Szelecsenyi

Wahle

Weissl

English

Packer, R M A

RVC Research Online

  RVC OPEN ACCESS REPOSITORY – COPYRIGHT NOTICE  This is the peer-reviewed, manuscript version of an article published in Veterinary Record. The final version is available online via http://dx.doi.org/10.1136/vr.j5025.  The full details of the published version of the article are as follows:  TITLE: Survival in feline epilepsy: the long and short of it AUTHORS: Rowena M. A. Packer JOURNAL TITLE: Veterinary Record PUBLISHER: BMJ Publishing Group PUBLICATION DATE: 2 November 2017 (online) DOI: 10.1136/vr.j5025 EDITORIAL  1 Survival in feline epilepsy: the long and short of it 2 Rowena M.A. Packer BSc PhD 3 Royal Veterinary College, Hawkshead Lane, Hatfield, AL9 7TA 4 rpacker@rvc.ac.uk  5 Both quality and quantity of life are of importance to the owners of companion animals (Sandøe and 6 Christiansen 2007), and in ideal circumstances, each veterinary treatment would ensure high quality of 7 life and increase longevity (Oyama and others 2008). Understanding which disease and treatment 8 related factors influence survival in diseased animals may help guide their management, for example, 9 whether a treatment that compromises quality of life provides sufficient additional lifespan to justify its 10 use. In animals with life-limiting diseases, mismatches may exist between owners’ expectations of 11 survival versus reality. For example, in a study of dog and cat owners’ perceptions of medical treatment 12 for cancer, a mismatch was observed between the number of owners expecting treatment to extend their 13 pet’s lifespan (87.0%) and the actual number that experienced this (60.9%) (Brønden and others 2003). 14 As such, robust estimates of survival time are potentially valuable statistics for guiding owner 15 expectations post-diagnosis. Indeed, in a study of owner perceptions of quality versus quantity of life 16 for dogs with heart disease, owners’ reported high levels of concern regarding their inability to know 17 how long their pet was going to live (Oyama and others 2008).  18  19 Survival analysis was developed to examine mortality data and risks associated with time until death, 20 and allows for censoring where the outcome (usually death or euthanasia) is not recorded at a point in 21 time for a particular subject. Canine epilepsy is a common, chronic neurological disorder in dogs and 22 survival analyses have demonstrated that it can significantly reduce lifespan (Berendt and others 2007). 23 Epileptic seizures are also a common presenting complaint in cats, affecting 1-2% of the general feline 24 population (Schriefl and others 2008). Seizure manifestations may be different to those typically seen 25 in dogs, but the underlying causes of seizure activity appear to be similar, with both idiopathic and 26 structural epilepsies described (Pákozdy and others 2010; Stanciu and others 2017). Of those cats 27 presenting with seizures, between 22-54% are classified as idiopathic (also termed ‘epilepsy of 28 unknown cause’, or EUC) (Pákozdy and others 2010; Schriefl and others 2008; Wahle and others 2014).  29 To date, little data have been published documenting survival in feline EUC. In a recent small-scale 30 study of n=18 cats with EUC, the 1-year survival rate was 73%, which was significantly higher than the 31 survival rate of cats with structural epilepsy or acute symptomatic seizures (35%; 22/63 cats) (Wahle 32 and others 2014). A new study is summarised on pX of this issue of Veterinary Record (Szelecsenyi 33 and others 2017) which builds upon these findings in a larger population of 76 cats with EUC. 34  35 In a retrospective study of cats presenting with seizures over a 15 year period, Szelecsenyi and others 36 explored the effects of seizure semiology and type upon treatment outcome and survival. The authors 37 demonstrate that of 76 cats with EUC, the majority were alive at follow up (68%), with a median follow 38 up time of 3.2 years. The longest follow up of a live cat with EUC was 11 years, and from Kaplan-39 Meyer analysis, the median survival time of cats with EUC was 4.9 years. This is markedly higher than 40 studies of canine epilepsy, where in a multi-breed study, the median lifespan with epilepsy was 2.3 41 years (Berendt and others 2007), and in a study of Border Collies with EUC was 2.07 years (Hülsmeyer 42 and others 2010).  Szelecsenyi and others report that of the cats that died during the study period (24/76), 43 the majority were epilepsy-related (66.6%, n=16). This was defined as the authors as euthanasia 44 motivated by circumstances directly associated with seizures. Similar findings have been reported in 45 canine epilepsy, for example more than 60% of Irish Wolfhounds (Casal and others 2006) and 70% of 46 Belgian Shepherds with idiopathic epilepsy were reported to die of epilepsy-related reasons (Gulløv 47 and others 2012). Whether euthanasia was elected for by the cat owners in this study due to uncontrolled 48 seizures, intolerable side effects of AEDs or other factors perceived to impair cat and/or owner quality 49 of life was not investigated in this study, but exploring where owners’ ‘limits’ lie for these factors a 50 priori may aid in the management of owner and feline quality of life. As attitudes to companion animal 51 euthanasia may be culturally driven (Miura and others 2000), and all cats in this study were derived 52 from a hospital population in Switzerland, similar studies from other countries may provide further 53 insights into end of life decision-making in feline epilepsy. 54  55 Szelecsenyi and others identified two major risk factors that predicted survival in cats with EUO: age 56 at time of seizure onset and remission. In contrast, AED treatment, seizure semiology and seizure type 57 were not associated with survival. Seizure freedom is considered the primary treatment goal in the 58 therapeutic management of canine and feline epilepsy patients (Potschka and others 2015), and data 59 suggests that seizure control is also beneficial for survival in canine epilepsy (Weissl and others 2012); 60 although remission rates are generally low in the dog at ~14-15% (Berendt and others 2007; Packer and 61 others 2014).  In contrast, Szelecsenyi and others report relatively high rates of remission in their feline 62 study; complete remission (defined by a seizure-free period of at least one year with or without AED 63 therapy) was achieved in 34% of cats with AED therapy and 79% of cats without AED therapy. In a 64 previous study, 40-50% of phenobarbital treated cats with EUC were reported to become seizure-free 65 (Pakozdy and others 2012), and in a second population of treated and untreated cats, 44% of cats (8/18) 66 became seizure-free (Wahle and others 2014). From these data it appears that feline EUC is manageable 67 and may have a more favourable outcome than canine epilepsy. Remission rates being higher in the 68 untreated group was initially considered unexpected by Szelecsenyi and others; however, a previous 69 canine study did not identify positive effects of AED treatment on remission (Berendt and others 2007). 70 It is likely that untreated animals of both species have a less severe epileptic phenotype and thus a better 71 prognosis for survival compared to those whose epilepsy phenotype necessitated treatment. 72  73 Szelecsenyi and others’ data add to our understanding of survival and treatment outcomes in feline 74 EUC; however, unknown variation in survival remains, and further research is necessary to understand 75 animal, disease and treatment-related risk factors. Clinical variables including a history of status 76 epilepticus (SE) and cluster seizures (SE) have previously been associated with reduced survival time 77 in canine epilepsy patients (Arrol and others 2012; Berendt and others 2007; Fredso and others 2014; 78 Monteiro and others 2012; Saito and others 2001). Several other signalment-based risk factors for 79 survival have been identified in dogs that could be further explored in cats, including sex (bitches lived 80 longer than dogs) (Berendt and others 2007) and neuter status (intact dogs are at an increased risk of 81 epilepsy-related euthanasia compared to neutered) (Berendt and others 2008).  82  83 As recently stated by the International Veterinary Epilepsy Task Force, no information is available yet 84 about SUDEP (sudden unexpected death in epilepsy) and life expectancy in feline epilepsy patients 85 (Potschka and others 2015). Cases of presumed SUDEP have been reported in dogs (Berendt and others 86 2007; Gulløv and others 2012) and life expectancy has been estimated to be around 7 years (Berendt 87 and others 2007; Proschowsky and others 2003). Similar data for cats could aid clinicians in the 88 management of EUC patients, and in managing client expectations of their animal’s disease.  89  90 Clinical importance for practitioners 91  Epilepsy of unknown origin exists in a proportion of cats with seizures and has a good long-term 92 prognosis for many cats, with complete remission in 42% and a median survival time of 4.9 years 93  Cats that achieve complete remission (at least 1 year seizure free) have an increased survival time  94  Epilepsy follows a self-remitting course in a proportion of cats without the use of AEDs, with long 95 (1 year+) seizure free periods; however, previous studies indicate anti-epileptic therapy should be 96 continued to avoid seizure recurrence (Pakozdy and others 2012) 97 References 98 ARROL, L., PENDERIS, J., GAROSI, L., CRIPPS, P., GUTIERREZ-QUINTANA, R. &  99 GONÇALVES, R. (2012) Aetiology and long-term outcome of juvenile epilepsy in 136 dogs. 100 Veterinary Record 170, 335 101 BERENDT, M., GREDAL, H., ERSBØLL, A. K. &  ALVING, J. (2007) Premature Death, Risk 102 Factors, and Life Patterns in Dogs with Epilepsy. Journal of Veterinary Internal Medicine 21, 754-759 103 BERENDT, M., GULLOV, C., CHRISTENSEN, S., GUDMUNDSDOTTIR, H., GREDAL, H., 104 FREDHOLM, M. &  ALBAN, L. (2008) Prevalence and characteristics of epilepsy in the Belgian 105 shepherd variants Groenendael and Tervueren born in Denmark 1995-2004. Acta Veterinaria 106 Scandinavica 50, 51 107 BRØNDEN, L. B., FLAGSTAD, A., RUTTEMAN, G. R. &  TESKE, E. (2003) Study of dog and cat 108 owners' perceptions of medical treatment for cancer. Veterinary Record 152, 77-80 109 CASAL, M. L., MUNUVE, R. M., JANIS, M. A., WERNER, P. &  HENTHORN, P. S. (2006) Epilepsy 110 in Irish Wolfhounds. Journal of Veterinary Internal Medicine 20, 131-135 111 FREDSO, N., KOCH, B. C., TOFT, N. &  BERENDT, M. (2014) Risk Factors for Survival in a 112 University Hospital Population of Dogs with Epilepsy. J Vet Intern Med 113 GULLØV, C. H., TOFT, N. &  BERENDT, M. (2012) A Longitudinal Study of Survival in Belgian 114 Shepherds with Genetic Epilepsy. Journal of Veterinary Internal Medicine 26, 1115-1120 115 HÜLSMEYER, V., ZIMMERMANN, R., BRAUER, C., SAUTER-LOUIS, C. &  FISCHER, A. (2010) 116 Epilepsy in Border Collies: Clinical Manifestation, Outcome, and Mode of Inheritance. Journal of 117 Veterinary Internal Medicine 24, 171-178 118 MIURA, A., BRADSHAW, J. W. S. &  TANIDA, H. (2000) Attitudes Towards Dogs: A Study of 119 University Students in Japan and the UK. Anthrozoös 13, 80-88 120 MONTEIRO, R., ADAMS, V. &  KEYS, D. (2012) Canine idiopathic epilepsy: prevalence, risk factors 121 and outcome associated with cluster seizures and status epilepticus. J Small Anim Pract 53, 526-530 122 OYAMA, M. A., RUSH, J. E., O'SULLIVAN, M. L., WILLIAMS, R. M., ROZANSKI, E. A., PETRIE, 123 J.-P., SLEEPER, M. M. &  BROWN, D. C. (2008) Perceptions and priorities of owners of dogs with 124 heart disease regarding quality versus quantity of life for their pets. Journal of the American Veterinary 125 Medical Association 233, 104-108 126 PACKER, R. M., SHIHAB, N. K., TORRES, B. B. &  VOLK, H. A. (2014) Clinical risk factors 127 associated with anti-epileptic drug responsiveness in canine epilepsy. PLOS ONE 9 128 PÁKOZDY, Á., LESCHNIK, M., SARCHAHI, A. A., TICHY, A. G. &  THALHAMMER, J. G. (2010) 129 Clinical comparison of primary versus secondary epilepsy in 125 cats. Journal of Feline Medicine and 130 Surgery 12, 910-916 131 PAKOZDY, A., SARCHAHI, A. A., LESCHNIK, M., TICHY, A. G., HALASZ, P. &  132 THALHAMMER, J. G. (2012) Treatment and long-term follow-up of cats with suspected primary 133 epilepsy. Journal of Feline Medicine and Surgery 15, 267-273 134 POTSCHKA, H., FISCHER, A., LÖSCHER, W., PATTERSON, N., BHATTI, S., BERENDT, M., DE 135 RISIO, L., FARQUHAR, R., LONG, S., MANDIGERS, P., MATIASEK, K., MUÑANA, K., 136 PAKOZDY, A., PENDERIS, J., PLATT, S., PODELL, M., RUSBRIDGE, C., STEIN, V., TIPOLD, 137 A. &  VOLK, H. A. (2015) International veterinary epilepsy task force consensus proposal: outcome of 138 therapeutic interventions in canine and feline epilepsy. BMC Veterinary Research 11, 177 139 PROSCHOWSKY, H. F., RUGBJERG, H. &  ERSBØLL, A. K. (2003) Mortality of purebred and 140 mixed-breed dogs in Denmark. Preventive Veterinary Medicine 58, 63-74 141 SAITO, M., MUNANA, K. &  NJ, S. (2001) Risk factors for development of status epilepticus in dogs 142 with idiopathic epilepsy and effects of status epilepticus on outcome and survival time: 32 cases (1990-143 1996). J Am Vet Med Assoc 219, 618-623 144 SANDØE, P. &  CHRISTIANSEN, S. B. (2007) The value of animal life: how should we balance 145 quality against quantity? Animal Welfare 16, 109-115 146 SCHRIEFL, S., STEINBERG, T. A., MATIASEK, K., OSSIG, A., N., F. &  FISCHER, A. (2008) 147 Etiologic classification of seizures, signalment, clinical signs, and outcome in cats with seizure 148 disorders: 91 cases (2000–2004). J Am Vet Med Assoc 233, 1591–1597 149 STANCIU, G.-D., PACKER, R. M. A., PAKOZDY, A., SOLCAN, G. &  VOLK, H. A. (2017) Clinical 150 reasoning in feline epilepsy: Which combination of clinical information is useful? The Veterinary 151 Journal 225, 9-12 152 WAHLE, A. M., BRÜHSCHWEIN, A., MATIASEK, K., PUTSCHBACH, K., WAGNER, E., 153 MUELLER, R. S. &  FISCHER, A. (2014) Clinical Characterization of Epilepsy of Unknown Cause in 154 Cats. Journal of Veterinary Internal Medicine 28, 182-188 155 WEISSL, J., HULSMEYER, V., BRAUER, C., TIPOLD, A., KOSKINEN, L. L., KYOSTILA, K., 156 LOHI, H., SAUTER-LOUIS, C., WOLF, M. &  FISCHER, A. (2012) Disease progression and 157 treatment response of idiopathic epilepsy in Australian Shepherd dogs. Journal of veterinary internal 158 medicine / American College of Veterinary Internal Medicine 26, 116-125 159  160 

Survival in feline epilepsy: the long and short of it

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