Non Convulsive seizures???

Hello, Summarians!

Some interesting articles today. Hopefully, they can help you with the challenges that you face today or sometime in the future.

Please drop me a line and let me know what you think of the newsletter.

If you enjoy it, please pass it along to a friend. We only grow through the recommendations of our readers 🙂 

Equine Sarcoids Update

This systematic review addresses the treatment of equine sarcoids, a common and challenging skin tumor in horses. Despite their widespread occurrence and significant impact on horse welfare, there's no uniformly effective therapy for sarcoids. The treatments vary greatly due to the diverse clinical behavior of the lesions, and the evidence for effective treatments is limited by a lack of rigorous, prospective trials. 

• Radiotherapy: Considered a gold standard, particularly low-dose rate brachytherapy using radioactive implants. However, it requires general anesthesia, isolation of the horse, and has limited availability. It's most effective for small or superficial sarcoids. 

• Cryotherapy: Reports up to 100% success in some cases, but less effective (9% regression) when used alone without surgical debulking. The number of freeze-thaw cycles varies across studies. 

• Cisplatin: Intralesional cisplatin, especially when combined with surgical excision, shows high success rates (up to 98%). Cisplatin electrochemotherapy also demonstrates high regression rates (91%-100%). However, effectiveness varies based on drug formulations, concentrations, sarcoid type, and location. 

• Topical Treatments: Topical imiquimod and Sanguinaria canadensis show good results, particularly for smaller tumors. 

The review highlights the importance of a multimodal approach, combining treatments like surgical debulking with cryotherapy or electrochemotherapy, or intralesional cisplatin with other therapies. This approach tends to improve complete regression rates. Despite these findings, the review points out significant limitations in the available evidence. Many studies are underpowered, lack control groups, and there's considerable variation in treatment methods, sarcoid types, and locations. Therefore, the evidence quality is rated as very low, and clinical decisions should continue to be made on a case-by-case basis. The review calls for more rigorous, randomized, and controlled trials to establish more definitive treatment guidelines. 

Offer KS, Dixon CE, Sutton DGM. Treatment of equine sarcoids: A systematic review. Equine Vet J. 2024; 56(1): 12–25. https://doi.org/10.1111/evj.13935 

Bottom line — The multimodal approach seems to be best.

Non Convulsive Seizures

Nonconvulsive seizures (NCS) and nonconvulsive status epilepticus (NCSE) are types of epileptic seizures characterized mainly by changes in electrographic patterns observed on electroencephalography (EEG) with minimal or no noticeable motor movements. These conditions are often associated with altered mental states. While NCS and NCSE are common in human medicine, especially in intensive care settings, there is limited data regarding their prevalence in veterinary medicine. 

In dogs and cats, these conditions are notably prevalent in animals with a history of cluster seizures, defined as two or more seizures within a 24-hour period. A significant study in veterinary medicine found that 29% of these animals experienced NCS and 16% experienced NCSE. This is in line with previous findings that reported 20% had electrographic seizures (ESz) and 12% had electrographic status epilepticus (ESE). 

The study highlighted a high mortality rate in dogs and cats with cluster seizures, particularly in those with electrographic seizures. However, the cause of death was often not directly related to the NCS or NCSE but rather due to euthanasia requested by owners due to poor prognosis or lack of clinical improvement. 

Electroencephalography is crucial for detecting NCS and NCSE, particularly soon after a clinical seizure. The study found that seizures are more likely to be detected when EEG is conducted within 12 hours of the last seizure. 

Treatment of cluster seizures in dogs and cats is critical for better outcomes. If standard treatments like benzodiazepines and antiepileptics are ineffective, general anesthesia may be recommended. The study applied an emergency treatment algorithm for status epilepticus, including using propofol and isoflurane for persistent seizure activity. 

However, the study had limitations, including its retrospective nature, the small number of cat cases, and variability in EEG recording durations. These factors underline the need for more comprehensive, prospective studies with longer EEG sessions to better understand and treat NCS and NCSE in veterinary patients.

Tästensen C, Gutmann S, Loderstedt S, Flegel T, Demeny H, Baum P. Prevalence of nonconvulsive seizures and nonconvulsive status epilepticus in dogs and cats with a history of cluster seizures: A retrospective study. J Vet Intern Med. 2024; 38(1): 238-246. doi:10.1111/jvim.16953 

Bottom line — This finding carries a poor prognosis.

Giardia and Biome Interaction in the Dog

The study on Giardia duodenalis (Gd) in dogs aimed to investigate the relationship between fecal microbiome characteristics and the occurrence of clinical giardiasis, specifically diarrhea. Giardiasis is a common parasitic infection in dogs, varying from asymptomatic to severe diarrheal illness, and has public health significance due to its zoonotic potential. While some studies suggest the intestinal microbiome plays a role in the severity of giardiasis, this study aimed to explore this in a controlled, homogeneous cohort of young, healthy dogs naturally infected with Gd, living in similar conditions and without prior nutritional or pharmaceutical interventions. 

Contrary to previous findings, this study found that changes in the fecal microbiome do not differentiate between diarrheic and nondiarrheic dogs infected with Gd. This suggests that the microbiome might have a lesser role in the clinical expression of giardiasis in dogs, with other factors like immunocompetence and parasite virulence possibly being more influential. 

Several factors differentiate this study from previous ones. It focused on a specific cohort of naturally infected dogs, in contrast to earlier studies that often used experimental models or had varied participant characteristics. The study also controlled for factors like age, sex, and environmental conditions. Despite the expectation of microbial dysbiosis in diarrheic dogs, the study found that this was not prevalent, indicating that diarrhea in Gd-infected dogs might not be directly linked to significant changes in the microbiome. 

The study's limitations include the potential impact of its cohort size on statistical power and the lack of a control group of uninfected dogs. Additionally, while Gd infection was confirmed, the study did not identify specific Gd assemblages or investigate possible coinfections. 

In conclusion, the study suggests that while Gd infection in dogs is associated with some changes in the intestinal microbiome, these changes do not significantly differentiate between symptomatic and asymptomatic giardiasis. This implies that other factors are more critical in determining the severity of the disease in dogs. The findings might have broader implications for understanding the role of the microbiome in Gd infections across different species, including humans. However, the study suggests that microbiome manipulation, which has shown promise in experimental settings, may not have the same effectiveness in naturally infected dogs, indicating a need for further research in this area. 

Kuzi S, Zgairy S, Byrne BA, et al. Giardiasis and diarrhea in dogs: Does the microbiome matter? J Vet Intern Med. 2024; 38(1): 152-160. doi:10.1111/jvim.16894

Bottom line — Biome changes occur but do not differentiate between symptomatic and non-symptomatic

Just putting things in perspective …

/