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International veterinary epilepsy task force consensus proposal: diagnostic approach to epilepsy in dogs.

De Risio L, Bhatti S, Muñana K, Penderis J, Stein V, Tipold A, Berendt M, Farqhuar R, Fischer A, Long S, Mandigers PJ, Matiasek K, Packer RM, Pakozdy A, Patterson N, Platt S, Podell M, Potschka H, Batlle MP, Rusbridge C, Volk HA - BMC Vet. Res. (2015)

Bottom Line: Tier I confidence level for the diagnosis of IE is based on a history of two or more unprovoked epileptic seizures occurring at least 24 h apart, age at epileptic seizure onset of between six months and six years, unremarkable inter-ictal physical and neurological examination, and no significant abnormalities on minimum data base blood tests and urinalysis.Tier II confidence level for the diagnosis of IE is based on the factors listed in tier I and unremarkable fasting and post-prandial bile acids, magnetic resonance imaging (MRI) of the brain (based on an epilepsy-specific brain MRI protocol) and cerebrospinal fluid (CSF) analysis.Tier III confidence level for the diagnosis of IE is based on the factors listed in tier I and II and identification of electroencephalographic abnormalities characteristic for seizure disorders.

View Article: PubMed Central - PubMed

Affiliation: Animal Health Trust, Lanwades Park, Kentford, Newmarket, CB8 7UU, Suffolk, UK. luisa.derisio@aht.org.uk.

ABSTRACT
This article outlines the consensus proposal on diagnosis of epilepsy in dogs by the International Veterinary Epilepsy Task Force. The aim of this consensus proposal is to improve consistency in the diagnosis of epilepsy in the clinical and research settings. The diagnostic approach to the patient presenting with a history of suspected epileptic seizures incorporates two fundamental steps: to establish if the events the animal is demonstrating truly represent epileptic seizures and if so, to identify their underlying cause. Differentiation of epileptic seizures from other non-epileptic episodic paroxysmal events can be challenging. Criteria that can be used to make this differentiation are presented in detail and discussed. Criteria for the diagnosis of idiopathic epilepsy (IE) are described in a three-tier system. Tier I confidence level for the diagnosis of IE is based on a history of two or more unprovoked epileptic seizures occurring at least 24 h apart, age at epileptic seizure onset of between six months and six years, unremarkable inter-ictal physical and neurological examination, and no significant abnormalities on minimum data base blood tests and urinalysis. Tier II confidence level for the diagnosis of IE is based on the factors listed in tier I and unremarkable fasting and post-prandial bile acids, magnetic resonance imaging (MRI) of the brain (based on an epilepsy-specific brain MRI protocol) and cerebrospinal fluid (CSF) analysis. Tier III confidence level for the diagnosis of IE is based on the factors listed in tier I and II and identification of electroencephalographic abnormalities characteristic for seizure disorders. The authors recommend performing MRI of the brain and routine CSF analysis, after exclusion of reactive seizures, in dogs with age at epileptic seizure onset <6 months or >6 years, inter-ictal neurological abnormalities consistent with intracranial neurolocalisation, status epilepticus or cluster seizure at epileptic seizure onset, or a previous presumptive diagnosis of IE and drug-resistance with a single antiepileptic drug titrated to the highest tolerable dose.This consensus article represents the basis for a more standardised diagnostic approach to the seizure patient. These recommendations will evolve over time with advances in neuroimaging, electroencephalography, and molecular genetics of canine epilepsy.

No MeSH data available.


Related in: MedlinePlus

Proportion of dogs with idiopathic and structural epilepsy stratified by age at epileptic seizure onset (< 1 year versus 1 to 6 years)
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Fig2: Proportion of dogs with idiopathic and structural epilepsy stratified by age at epileptic seizure onset (< 1 year versus 1 to 6 years)

Mentions: To further investigate the predictive value of age at epileptic seizure onset to differentiate between idiopathic and structural epilepsy, the data from the studies performed by Pakozdy [6] and Armaşu [24] have been combined and analysed. There were 372 dogs with IE and 236 dogs with structural epilepsy. There was a significant association between age of onset and cause of epilepsy for dogs under 6 years of age at epileptic seizure onset (Chi-squared = 5.136, n = 431, p = 0.023) when the cut-off was set at 6 months (Fig. 1). Dogs between 6 months and 6 years were significantly more likely to be affected by idiopathic than symptomatic epilepsy compared to dogs under 6 months. Whereas, there was no significant association between age of onset and cause of epilepsy for dogs under 6 years of age at epileptic seizure onset (Chi-squared = 2.95, n = 431, p = 0.086) when the cut-off was set at 1 year (Fig. 2). A binary logistic regression demonstrated that dogs aged between 6 months and 6 years at epileptic seizure onset were 2.65 times more likely to be affected by IE than SE (p = 0.03) than those under 6 months of age at epileptic seizure onset. Whereas, a binary logistic regression demonstrated that there was no significant association between age of onset and cause of epilepsy for dogs under 6 years of age at epileptic seizure onset (p > 0.05) when the cut-off was set at 1 year. When comparing the 5 versus 6 years of age at epileptic seizure onset as upper cut off, the 6 year cut off was a better predictor (77.3 % accuracy versus 74.5 %) and had a better model fit with a lower Akaike Information Criteria (AIC) value. A binary logistic regression demonstrated that dogs under 6 at age at epileptic seizure onset were 10.89 times more likely to be affected by IE than structural epilepsy (p < 0.001). Whereas, a binary logistic regression demonstrated that dogs under 5 of age at epileptic seizure onset were 8.00 times more likely to be affected by IE than structural epilepsy (p < 0.001).Figure 1


International veterinary epilepsy task force consensus proposal: diagnostic approach to epilepsy in dogs.

De Risio L, Bhatti S, Muñana K, Penderis J, Stein V, Tipold A, Berendt M, Farqhuar R, Fischer A, Long S, Mandigers PJ, Matiasek K, Packer RM, Pakozdy A, Patterson N, Platt S, Podell M, Potschka H, Batlle MP, Rusbridge C, Volk HA - BMC Vet. Res. (2015)

Proportion of dogs with idiopathic and structural epilepsy stratified by age at epileptic seizure onset (< 1 year versus 1 to 6 years)
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4552251&req=5

Fig2: Proportion of dogs with idiopathic and structural epilepsy stratified by age at epileptic seizure onset (< 1 year versus 1 to 6 years)
Mentions: To further investigate the predictive value of age at epileptic seizure onset to differentiate between idiopathic and structural epilepsy, the data from the studies performed by Pakozdy [6] and Armaşu [24] have been combined and analysed. There were 372 dogs with IE and 236 dogs with structural epilepsy. There was a significant association between age of onset and cause of epilepsy for dogs under 6 years of age at epileptic seizure onset (Chi-squared = 5.136, n = 431, p = 0.023) when the cut-off was set at 6 months (Fig. 1). Dogs between 6 months and 6 years were significantly more likely to be affected by idiopathic than symptomatic epilepsy compared to dogs under 6 months. Whereas, there was no significant association between age of onset and cause of epilepsy for dogs under 6 years of age at epileptic seizure onset (Chi-squared = 2.95, n = 431, p = 0.086) when the cut-off was set at 1 year (Fig. 2). A binary logistic regression demonstrated that dogs aged between 6 months and 6 years at epileptic seizure onset were 2.65 times more likely to be affected by IE than SE (p = 0.03) than those under 6 months of age at epileptic seizure onset. Whereas, a binary logistic regression demonstrated that there was no significant association between age of onset and cause of epilepsy for dogs under 6 years of age at epileptic seizure onset (p > 0.05) when the cut-off was set at 1 year. When comparing the 5 versus 6 years of age at epileptic seizure onset as upper cut off, the 6 year cut off was a better predictor (77.3 % accuracy versus 74.5 %) and had a better model fit with a lower Akaike Information Criteria (AIC) value. A binary logistic regression demonstrated that dogs under 6 at age at epileptic seizure onset were 10.89 times more likely to be affected by IE than structural epilepsy (p < 0.001). Whereas, a binary logistic regression demonstrated that dogs under 5 of age at epileptic seizure onset were 8.00 times more likely to be affected by IE than structural epilepsy (p < 0.001).Figure 1

Bottom Line: Tier I confidence level for the diagnosis of IE is based on a history of two or more unprovoked epileptic seizures occurring at least 24 h apart, age at epileptic seizure onset of between six months and six years, unremarkable inter-ictal physical and neurological examination, and no significant abnormalities on minimum data base blood tests and urinalysis.Tier II confidence level for the diagnosis of IE is based on the factors listed in tier I and unremarkable fasting and post-prandial bile acids, magnetic resonance imaging (MRI) of the brain (based on an epilepsy-specific brain MRI protocol) and cerebrospinal fluid (CSF) analysis.Tier III confidence level for the diagnosis of IE is based on the factors listed in tier I and II and identification of electroencephalographic abnormalities characteristic for seizure disorders.

View Article: PubMed Central - PubMed

Affiliation: Animal Health Trust, Lanwades Park, Kentford, Newmarket, CB8 7UU, Suffolk, UK. luisa.derisio@aht.org.uk.

ABSTRACT
This article outlines the consensus proposal on diagnosis of epilepsy in dogs by the International Veterinary Epilepsy Task Force. The aim of this consensus proposal is to improve consistency in the diagnosis of epilepsy in the clinical and research settings. The diagnostic approach to the patient presenting with a history of suspected epileptic seizures incorporates two fundamental steps: to establish if the events the animal is demonstrating truly represent epileptic seizures and if so, to identify their underlying cause. Differentiation of epileptic seizures from other non-epileptic episodic paroxysmal events can be challenging. Criteria that can be used to make this differentiation are presented in detail and discussed. Criteria for the diagnosis of idiopathic epilepsy (IE) are described in a three-tier system. Tier I confidence level for the diagnosis of IE is based on a history of two or more unprovoked epileptic seizures occurring at least 24 h apart, age at epileptic seizure onset of between six months and six years, unremarkable inter-ictal physical and neurological examination, and no significant abnormalities on minimum data base blood tests and urinalysis. Tier II confidence level for the diagnosis of IE is based on the factors listed in tier I and unremarkable fasting and post-prandial bile acids, magnetic resonance imaging (MRI) of the brain (based on an epilepsy-specific brain MRI protocol) and cerebrospinal fluid (CSF) analysis. Tier III confidence level for the diagnosis of IE is based on the factors listed in tier I and II and identification of electroencephalographic abnormalities characteristic for seizure disorders. The authors recommend performing MRI of the brain and routine CSF analysis, after exclusion of reactive seizures, in dogs with age at epileptic seizure onset <6 months or >6 years, inter-ictal neurological abnormalities consistent with intracranial neurolocalisation, status epilepticus or cluster seizure at epileptic seizure onset, or a previous presumptive diagnosis of IE and drug-resistance with a single antiepileptic drug titrated to the highest tolerable dose.This consensus article represents the basis for a more standardised diagnostic approach to the seizure patient. These recommendations will evolve over time with advances in neuroimaging, electroencephalography, and molecular genetics of canine epilepsy.

No MeSH data available.


Related in: MedlinePlus