Feline Epilepsy: An update

Epileptic seizures are the most common neurological disorder in the clinical setting. Their etiology is multifactorial and is mainly divided into structural, reactive and idiopathic epilepsy. Structural epilepsy can be caused by vascular events, inflammatory conditions (encephalitis), traumatic injuries, neoplasia, congenital and inherited (degenerative) disorders. Reactive epilepsy is caused by exposure in toxins or metabolic derangements. Although idiopathic epilepsy was thought to be rare in cats, it is now established as a common cause. Epileptic seizures in cats appear with various clinical presentations including generalized, focal with or without secondary generalization epileptic seizures. Diagnostic investigation is crucial in order to establish final diagnosis and to determine the therapeutic plan. Diagnostics include physical and neurological examination with detailed history (drug or toxin exposure), routine hematology (CBC, biochemistry, urinalysis), specific laboratory tests if concurrent or metabolic disease are suspected, advanced diagnostic imaging (CT/MRI) whether intracranial disease is suspected and cerebrospinal fluid (CSF) analysis. Most commonly used antiepileptic drugs (AED) in cats are phenobarbital and levetiracetam. Bromide is contraindicated in cats due to severe respiratory disease caused as an adverse life-threatening reaction. Diazepam is an emergency AED used to eliminate cluster seizures or status epilepticus but it should be avoided as a long-term medication because it has been associated with fatal hepatotoxicity. Gabapentin in another potential antiepileptic drug however its longterm efficacy has to be evaluated. Prognosis depends on the underlying etiology and treatment response. In most cats quality of life is improved and (>50% reduction of epileptic seizures) regardless of etiology. The complete remission of epileptic seizures in cats is rare and most cats should be maintained on anti-epileptic therapy.

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Estimation of the prevalence of idiopathic epilepsy and structural epilepsy in a general population of 900 dogs undergoing MRI for epileptic seizures

Veterinary Record ◽

10.1136/vr.105647 ◽

2020 ◽

Vol 187 (10) ◽

pp. e89-e89 ◽

Cited By ~ 2

Author(s):

Rachel Hall ◽

Julien Labruyere ◽

Holger Volk ◽

Thomas James Cardy

Keyword(s):

Neurological Examination ◽

Large Population ◽

Epileptic Seizures ◽

Clinical History ◽

Idiopathic Epilepsy ◽

Mri Findings ◽

Detailed Clinical History ◽

Mri Scans ◽

Structural Epilepsy ◽

Study Designs

Due to variation in study designs the prevalence of idiopathic epilepsy (IE) and structural epilepsy (SE) in dogs is largely unknown. The objective was to provide estimates of the prevalence of IE and SE in a large population of dogs undergoing MRI for epileptic seizures. A retrospective study on 900 dogs undergoing MRI for seizures was performed. MRI scans, summary clinical history and neurological examination from the VetCT database were reviewed and a diagnosis assigned by board-certified radiologists. Structural lesions were identified as a cause of seizures in 45.1 per cent (n=406) of cases. No structural lesions were identified in 54.9 per cent (n=494) of cases with presumed IE diagnosed in 53.8 per cent (n=484) of dogs. Dogs between six months and six years were more often associated with IE (P<0.001), small breeds were overrepresented with suspected inflammatory brain disease (P=0.001) and large entire dogs more often diagnosed with extra-axial neoplasms (P=0.001). Over 31.0 per cent of dogs with suspected IE were six years or older. This study is the largest of its kind in dogs and provides accurate estimates of underlying causes of epilepsy. MRI findings should be considered in the context of a detailed clinical history and neurological examination.

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Diagnostic value of cerebrospinal fluid analysis in a population of dogs with suspected idiopathic epilepsy

Veterinary Record ◽

10.1136/vr.105438 ◽

2019 ◽

Vol 185 (17) ◽

pp. 539-539 ◽

Cited By ~ 2

Author(s):

Ana Maria Coelho ◽

Thomas W Maddox ◽

Daniel Sanchez-Masian ◽

Rita Gonçalves

Keyword(s):

Cerebrospinal Fluid ◽

Neurological Examination ◽

Complete Blood Count ◽

Epileptic Seizures ◽

Diagnostic Value ◽

Idiopathic Epilepsy ◽

Time Interval ◽

Diagnostic Investigation ◽

Fluid Analysis ◽

Csf Analysis

Cerebrospinal fluid (CSF) analysis is commonly used in the diagnostic investigation of seizure disorders in order to exclude possible inflammatory underlying aetiology. The medical records were searched for dogs presenting with epileptic seizures (ES) that had normal interictal neurological examination, normal complete blood count and biochemistry analysis, unremarkable MRI of the brain and had CSF analysis performed as part of the diagnostic investigation. A total of 200 dogs met the inclusion criteria. The CSF was abnormal in 30 dogs with a median total nucleated cell count of two cells/µl (IQR 1.5–6) and median protein concentration of 0.37 g/l (IQR 0.31–0.41). Pleocytosis was recorded in 14/30 dogs and the CSF protein was increased in 22/30. There was no correlation between abnormal CSF and the type or number of seizures or the time interval between the last seizure and CSF collection. A significant correlation was found between the number of red blood cells on CSF and having an abnormal CSF. The prevalence of having a diagnosis other than suspected idiopathic epilepsy (IE) was 0.5 per cent (1/200). These results suggest that performing CSF analysis in dogs with recurrent ES that have normal interictal neurological examination and unremarkable MRI has a low diagnostic value.

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Epilepsy in British Shorthair cats in Sweden

Journal of Feline Medicine and Surgery ◽

10.1177/1098612x211036795 ◽

2021 ◽

pp. 1098612X2110367

Author(s):

Marianne Tenger ◽

Sofie Van Meervenne ◽

Katarina Varjonen ◽

Anna Tidholm ◽

Cecilia Rohdin

Keyword(s):

Status Epilepticus ◽

Epileptic Seizure ◽

Clinical Characteristics ◽

Telephone Interview ◽

Unknown Origin ◽

Epileptic Seizures ◽

Primary Objective ◽

Idiopathic Epilepsy ◽

Secondary Objective ◽

Cluster Seizures

Objectives The primary objective of this study was to investigate the prevalence of epileptic seizures and of presumed idiopathic epilepsy (PIE, describing epilepsy of unknown origin) in a cohort of British Shorthair (BSH) cats in Sweden. The secondary objective was to describe epileptic seizure characteristics and outcome for cats with PIE. Methods Owners of BSH cats born between 2006 and 2016 and registered with SVERAK (the Swedish Cat Clubs’ National Association) were invited to reply to a questionnaire about their cat’s general health. Owners who indicated that their cat had experienced epileptic seizures were invited to participate in an in-depth telephone interview about the epileptic seizures. The clinical characteristics of epileptic seizures in BSH cats were determined from the results of the interview. Results In this population comprising 1645 BSH cats (representing 28% of registered BSHs), the prevalence of epileptic seizures was 0.9% and for PIE it was 0.7%. BSH cats with PIE presented with infrequent but consistent epileptic seizures. Twenty-seven percent of BSH cats with epileptic seizures had cluster seizures but none presented with status epilepticus. None of the BSH cats was treated with antiepileptic drugs, and none of the owners reported epileptic seizure remission in their cat. Conclusions and relevance The prevalence of PIE in this population of BSH cats was 0.7%. The prevalence of epileptic seizures was 0.9%. In general, PIE in the BSH cat displayed a relatively benign phenotype where progression of epileptic seizures was uncommon.

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An unusual presentation of acute myocardial infarction in physiotherapy direct access: findings from a case report

Archives of Physiotherapy ◽

10.1186/s40945-021-00099-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Lorenzo Storari ◽

Valerio Barbari ◽

Fabrizio Brindisino ◽

Marco Testa ◽

Maselli Filippo

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Case Report ◽

Visceral Pain ◽

Signs And Symptoms ◽

Final Diagnosis ◽

Outpatient Setting ◽

Direct Access ◽

Life Threatening ◽

Medical Referral

Abstract Background Shoulder pain (SP) may originate from both musculoskeletal and visceral conditions. Physiotherapists (PT) may encounter patients with life-threatening pathologies that mimic musculoskeletal pain such as Acute Myocardial Infarction (AMI). A trained PT should be able to distinguish between signs and symptoms of musculoskeletal or visceral origin aimed at performing proper medical referral. Case presentation A 46-y-old male with acute SP lasting from a week was diagnosed with right painful musculoskeletal shoulder syndrome, in two successive examinations by the emergency department physicians. However, after having experienced a shift of the pain on the left side, the patient presented to a PT. The PT recognized the signs and symptoms of visceral pain and referred him to the general practitioner, which identified a cardiac disease. The final diagnosis was acute myocardial infarction. Conclusion This case report highlights the importance of a thorough patient screening examination, especially for patients treated in an outpatient setting, which allow distinguishing between signs and symptoms of musculoskeletal from visceral diseases.

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Rolipram Prevents the Formation of Abdominal Aortic Aneurysm (AAA) in Mice: PDE4B as a Target in AAA

Antioxidants ◽

10.3390/antiox10030460 ◽

2021 ◽

Vol 10 (3) ◽

pp. 460

Author(s):

Saray Varona ◽

Lídia Puertas ◽

María Galán ◽

Mar Orriols ◽

Laia Cañes ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Inflammatory Cells ◽

Progressive Increase ◽

Phosphodiesterase 4 ◽

Inflammatory Conditions ◽

Abdominal Aortic ◽

Threatening Condition ◽

Life Threatening ◽

Effective Therapeutic Strategy

Abdominal aortic aneurysm (AAA) is a common life-threatening condition characterized by exacerbated inflammation and the generation of reactive oxygen species. Pharmacological treatments to slow AAA progression or to prevent its rupture remain a challenge. Targeting phosphodiesterase 4 (PDE4) has been verified as an effective therapeutic strategy for an array of inflammatory conditions; however, no studies have assessed yet PDE4 in AAA. Here, we used angiotensin II (AngII)-infused apolipoprotein E deficient mice to study the involvement of the PDE4 subfamily in aneurysmal disease. PDE4B but not PDE4D was upregulated in inflammatory cells from both experimental and human AAA. The administration of the PDE4 selective inhibitor rolipram (3 mg/kg/day) to AngII-challenged mice (1000 ng/kg bodyweight/min) protected against AAA formation, limiting the progressive increase in the aortic diameter without affecting the blood pressure. The drug strongly attenuated the rise in vascular oxidative stress (superoxide anion) induced by AngII, and decreased the expression of inflammatory markers, as well as the recruitment of macrophages (MAC3+), lymphocytes (CD3+), and neutrophils (ELANE+) into the vessel wall. Rolipram also normalized the vascular MMP2 expression and MMP activity, preserving the elastin integrity and improving the vascular remodelling. These results point to PDE4B as a new therapeutic target for AAA.

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Drug Induced Pneumonitis Secondary to Treatment with Paritaprevir/Ritonavir/Ombitasvir and Dasabuvir (VIEKIRA PAK®) for Chronic Hepatitis C: Case Report of an Unexpected Life-Threatening Adverse Reaction

Case Reports in Medicine ◽

10.1155/2017/4895736 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Shih Yea Sylvia Wu ◽

Bridget Faire ◽

Edward Gane

Keyword(s):

Chronic Hepatitis ◽

Hepatitis C ◽

Chronic Hepatitis C ◽

Kidney Injury ◽

Complete Recovery ◽

Final Diagnosis ◽

Community Acquired Pneumonia ◽

Drug Induced ◽

First Case ◽

Life Threatening

VIEKIRA PAK (ritonavir-boosted paritaprevir/ombitasvir and dasabuvir) is an approved treatment for compensated patients with genotype 1 (GT1) chronic hepatitis C virus (HCV) infection. This oral regimen has minimal adverse effects and is well tolerated. Cure rates are 97% in patients infected with HCV GT 1a and 99% in those with HCV GT 1b. We report the first case of life-threatening allergic pneumonitis associated with VIEKIRA PAK. This unexpected serious adverse event occurred in a 68-year-old Chinese female with genotype 1b chronic hepatitis C and Child-Pugh A cirrhosis. One week into treatment with VIEKIRA PAK without ribavirin, she was admitted to hospital with respiratory distress and acute kidney injury requiring intensive care input. She was initially diagnosed with community acquired pneumonia and improved promptly with intravenous antibiotics and supported care. No bacterial or viral pathogens were cultured. Following complete recovery, she recommenced VIEKIRA PAK but represented 5 days later with more rapidly progressive respiratory failure, requiring intubation and ventilation, inotropic support, and haemodialysis. The final diagnosis was drug induced pneumonitis.

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Clinical features of psychogenic non-epileptic seizures in prepubertal and pubertal patients with idiopathic epilepsy

Neurological Sciences ◽

10.1007/s10072-009-0107-x ◽

2009 ◽

Vol 30 (4) ◽

pp. 319-323 ◽

Cited By ~ 23

Author(s):

Alberto Verrotti ◽

Sergio Agostinelli ◽

Angelika Mohn ◽

Rossella Manco ◽

Giangennaro Coppola ◽

...

Keyword(s):

Clinical Features ◽

Epileptic Seizures ◽

Idiopathic Epilepsy

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Primary leptomeningeal lymphoma masquerading as infectious tubercular meningitis

BMJ Case Reports ◽

10.1136/bcr-2021-243574 ◽

2021 ◽

Vol 14 (9) ◽

pp. e243574

Author(s):

Salini Sumangala ◽

Thidar Htwe ◽

Yousuf Ansari ◽

Lidia Martinez- Alvarez

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Correct Diagnosis ◽

Central Nervous System Lymphoma ◽

Final Diagnosis ◽

Csf Analysis ◽

Antitubercular Treatment ◽

Lymphoma Treatment ◽

Work Up ◽

Timely Treatment

Primary central nervous system lymphoma (PCNSL) is infrequent and often poses diagnostic conundrums due to its protean manifestations. We present the case of a South Asian young man presenting with raised intracranial pressure and a lymphocytic cerebrospinal fluid (CSF) with pronounced hypoglycorrhachia. Progression of the neuro-ophthalmic signs while on early stages of antitubercular treatment led to additional investigations that produced a final diagnosis of primary leptomeningeal lymphoma. Treatment with chemoimmunotherapy (methotrexate, cytarabine, thiotepa and rituximab (MATRix)) achieved full radiological remission followed by successful autologous transplant. This case highlights the difficulties and diagnostic dilemmas when PCNSL presents as a chronic meningeal infiltrative process. While contextually this CSF is most often indicative of central nervous system tuberculosis and justifies empirical treatment initiation alone, it is essential to include differential diagnoses in the investigation work-up, which also carry poor prognosis without timely treatment. High suspicion, multidisciplinary collaboration and appropriate CSF analysis were the key for a correct diagnosis.

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Unusual dyspnea in a hemodialysis patient: A case report

International Archives of Medicine ◽

10.3823/2607 ◽

2019 ◽

Vol 12 ◽

Author(s):

Ching-Hsiang Wang ◽

Jenq-Shyong Chan ◽

Chung-Chi Yang ◽

Po-Jen Hsiao

Keyword(s):

Hemodialysis Patient ◽

Pleural Cavity ◽

Middle Age ◽

Clinical Symptoms ◽

Rapid Development ◽

Previous History ◽

Final Diagnosis ◽

Spontaneous Hemothorax ◽

Life Threatening ◽

History Of

The typical clinical symptoms of hemothorax include a rapid development of chest pain or dyspnea, which may be life-threatening without immediate management. As we know, spontaneous hemothorax, a collection of blood within the pleural cavity without previous history of trauma or other cause, which usually onsets suddenly. The early and accurate diagnosis of spontaneous hemothorax is imperative in clinical practice. We reported a middle-age male undergoing regular hemodialysis was referred to our emergency department due to unknown cause of dyspnea and acute respiratory failure. Chest radiography revealed bilateral patchy infiltration of lung. Pleural tap analysis showed exudative pleural effusion with numerous red blood cells. Video-assisted thoracic surgery (VATS) were performed and confirmed the final diagnosis of spontaneous hemothorax. He was then successfully treated with the surgery of VATS combined chest tube thoracostomy.

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Exosomal delivery of therapeutic modulators through the blood–brain barrier; promise and pitfalls

Cell & Bioscience ◽

10.1186/s13578-021-00650-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Morteza Heidarzadeh ◽

Yasemin Gürsoy-Özdemir ◽

Mehmet Kaya ◽

Aysan Eslami Abriz ◽

Amir Zarebkohan ◽

...

Keyword(s):

Molecular Mechanisms ◽

Large Population ◽

Drug Carriers ◽

The Elderly ◽

Brain Parenchyma ◽

Main Question ◽

Inflammatory Conditions ◽

Degenerative Disorders ◽

Delivery Strategies ◽

The Brain

AbstractNowadays, a large population around the world, especially the elderly, suffers from neurological inflammatory and degenerative disorders/diseases. Current drug delivery strategies are facing different challenges because of the presence of the BBB, which limits the transport of various substances and cells to brain parenchyma. Additionally, the low rate of successful cell transplantation to the brain injury sites leads to efforts to find alternative therapies. Stem cell byproducts such as exosomes are touted as natural nano-drug carriers with 50–100 nm in diameter. These nano-sized particles could harbor and transfer a plethora of therapeutic agents and biological cargos to the brain. These nanoparticles would offer a solution to maintain paracrine cell-to-cell communications under healthy and inflammatory conditions. The main question is that the existence of the intact BBB could limit exosomal trafficking. Does BBB possess some molecular mechanisms that facilitate the exosomal delivery compared to the circulating cell? Although preliminary studies have shown that exosomes could cross the BBB, the exact molecular mechanism(s) beyond this phenomenon remains unclear. In this review, we tried to compile some facts about exosome delivery through the BBB and propose some mechanisms that regulate exosomal cross in pathological and physiological conditions.

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