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

Kaczmarska, Adriana; José-López, Roberto; Czopowicz, Michał; Lazzerini, Kali; Leblond, Guillaume; Stalin, Catherine; Gutierrez‐Quintana, Rodrigo

doi:10.1111/jvim.15687

Cited by 12 publications

(10 citation statements)

References 57 publications

(190 reference statements)

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“…Our study population comprised two dogs suffering from epileptic seizures. The prognosis to achieve a good seizure outcome is generally considered poor in dogs with structural epilepsy ( 60 ), including MUO ( 61 ). Despite only one of the dogs in our study had anticonvulsive medication (Levetiracetam 20 mg/kg q8h), both became seizure free.…”

Section: Discussionmentioning

confidence: 99%

A shortened whole brain radiation therapy protocol for meningoencephalitis of unknown origin in dogs

et al. 2023

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IntroductionA variety of treatment options have been described for canine meningoencephalitis of unknown origin (MUO). Few studies focused on radiation therapy as a second line immunomodulating treatment, implicating its effective use. However, a standard radiation therapy protocol is lacking, and further research will help to evaluate the effect of different dose regimens.MethodsTen dogs diagnosed with MUO based on MRI and CSF findings were prospectively enrolled. The dogs were treated with a shortened whole brain radiation therapy protocol (5 × 4 Gy) in combination with prednisolone. Neurologic changes were quantified using an established scoring scheme. Follow-up MRI and CSF examination was scheduled three months after radiation therapy. Overall survival and time to progression were calculated. Histopathology of the brain was performed in case of death.ResultsSeven dogs were diagnosed de novo and three had a history of relapsing MUO. Neurological status improved in all 10 dogs during radiation therapy, with 4/10 returning to normal shortly after radiation therapy. Three dogs died within the first three months after radiation therapy. At follow-up MRI lesions completely resolved in two dogs, partially resolved in five dogs, and progressed in one dog. After follow-up MRI, dogs were further treated with prednisolone monotherapy (two dogs) and additional immunosuppressant drugs (five dogs). Overall, four dogs showed disease progression, with a mean time to progression of 691 days (95%CI: 396–987) and mean overall survival for all dogs was 723 days (95%CI: 436–1011) (both medians not reached). Histopathology confirmed MUO in three dogs but was suggestive for oligodendroglioma in one dog. Radiation induced side effects were not seen.ConclusionShortened whole-brain radiation therapy could be an additional treatment option for MUO in conjunction to prednisolone, specifically for cases that require rapid relief of symptoms and with relapsing history.

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Section: Discussionmentioning

confidence: 99%

A shortened whole brain radiation therapy protocol for meningoencephalitis of unknown origin in dogs

et al. 2023

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“…Nevertheless, seizure as expression of post infection long term sequelae has affected only one of our cases rendering an association with TBE uncertain. Seizures have been recently also described as long-term sequelae in dogs suffering from MEUO ( 38 ).…”

Section: Discussionmentioning

confidence: 99%

Canine Tick-Borne Encephalitis: Clinical Features, Survival Rate and Neurological Sequelae: A Retrospective Study of 54 Cases (1999–2016)

et al. 2021

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Tick-borne encephalitis (TBE) is one of the most important infectious diseases of the central nervous system in dogs from endemic areas. While in humans survival rate and long-term outcomes are well described, these data are lacking in veterinary literature. The aim of the present paper is to characterize the clinical aspects of TBE and to investigate fatality rate, long-term outcome and the long-term neurological sequelae in a population of dogs infected with TBE. We performed a retrospective analysis of 54 dogs diagnosed with TBE at the veterinary hospital of the University of Zurich between 1999 and 2016. Medical data such as signalment, clinical presentation, results of diagnostic procedures, treatment and outcome were collected and analyzed. Statistical analysis including a cox proportional hazard model using a backward stepwise regression approach was performed. In 62% of the TBE cases unspecific signs were described before the onset of neurological signs, resembling a biphasic appearance that is well known in human TBE. Case fatality rate was 33% and all dogs died within the first 4 months after diagnosis. Long-term neurological sequalae were detected in 17% of the TBE cases. For each day of clinical signs before hospital entry the odds of sequalae increased by a factor of 1.88 (CI 1.04–3.15). Older dogs and dogs presented with seizure activity had an increased hazard risk of death (Hazard ration = 1.2, p = 0.03; and 9.38, p = 0.001, respectively). In conclusion, despite TBE being a life-threatening disease with severe clinical signs, the survival rate in our study was 67%. However, long-term sequalae can be of concern especially in dogs with longer clinical course.

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“…Because no specific directly-treatable etiology has been identified, treatment almost exclusively focuses on immunosuppression, although there is frequently a need for adjunctive treatment of associated neurological signs, such as seizures [that occur in 20–25% of cases ( 41 – 43 )]. In this review we will focus only on treatment aimed at the underlying disease process rather than symptomatic therapy aimed specifically at controlling the resulting clinical signs.…”

Section: History Of Treatment Of Muomentioning

confidence: 99%

New insights into the treatment of meningoencephalomyelitis of unknown origin since 2009: A review of 671 cases

Jeffery

Granger

2023

Front. Vet. Sci.

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“Meningoencephalomyelitis of unknown origin” (MUO)—a collective term for a group of clinically-indistinguishable (but pathologically distinct) autoimmune diseases of the CNS—has become increasingly commonly recognized throughout the world. In the 1960s−1980s the focus was primarily on the pathological description of these conditions and, largely anecdotally, their response to glucocorticoids. The subsequent availability of magnetic resonance imaging for companion animals led to a focus on imaging characteristics and response of MUO to various immunosuppressive medications. Previous reviews have not found clear evidence of superiority of any specific treatment regimen. Here, we review outcomes in a further 671 dogs treated with various combinations of glucocorticoids and immunosuppressive drugs and reported since 2009, aiming to determine whether recommendations can be drawn from the material published during more recent decades. We observe that: (i) there is more complete information on outcome of MUO-affected dogs solely receiving glucocorticoids and these reports provide evidence to undermine the dogma that MUO inevitably requires treatment with glucocorticoids plus an immunosuppressive drug; (ii) there is far more information on the pharmacokinetics of cytarabine delivered by a variety of routes, revealing that previous dosing and duration of administration in dogs with MUO may not have been optimal; and, (iii) there is a large number of cases that could be available for entry into multi-institutional randomized controlled trials. Finally, we suggest new research avenues that might aid future clinical trials in MUO through improved understanding of etiological triggers and individual patterns of immune response, such as the impact of the gut microbiome, the potential of CSF flow cytometry, and the establishment of robust clinical scores for evaluation of treatment success.

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

Cited by 12 publications

References 57 publications

A shortened whole brain radiation therapy protocol for meningoencephalitis of unknown origin in dogs

A shortened whole brain radiation therapy protocol for meningoencephalitis of unknown origin in dogs

Canine Tick-Borne Encephalitis: Clinical Features, Survival Rate and Neurological Sequelae: A Retrospective Study of 54 Cases (1999–2016)

New insights into the treatment of meningoencephalomyelitis of unknown origin since 2009: A review of 671 cases

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