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

Luisa De Risio; Sofie Bhatti; Karen Muñana; Jacques Penderis; Veronika Stein; Andrea Tipold; Mette Berendt; Robyn Farqhuar; Andrea Fischer; Sam Long; Paul J J Mandigers; Kaspar Matiasek; Rowena M A Packer; Akos Pakozdy; Ned Patterson; Simon Platt; Michael Podell; Heidrun Potschka; Martí Pumarola Batlle; Clare Rusbridge; Holger A. Volk

doi:10.1186/s12917-015-0462-1

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

Luisa De Risio, Sofie Bhatti, Karen Muñana, Jacques Penderis, Veronika Stein, Andrea Tipold, Mette Berendt, Robyn Farqhuar, Andrea Fischer, Sam Long, Paul J J Mandigers, Kaspar Matiasek, Rowena M A Packer, Akos Pakozdy, Ned Patterson, Simon Platt, Michael Podell, Heidrun Potschka, Martí Pumarola Batlle, Clare RusbridgeHolger A. Volk

Veterinary Clinical Sciences

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147 Scopus citations

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.

Original language	English (US)
Article number	148
Journal	BMC Veterinary Research
Volume	11
Issue number	1
DOIs	https://doi.org/10.1186/s12917-015-0462-1
State	Published - Aug 28 2015

Bibliographical note

Funding Information:
Following reimbursements, fees and funding have been received by the authors in the last three years and have been declared in the competing interest section. CR, RGF, HAV, KM, MP and JP have received fees for acting as a consultant for Boehringer Ingelheim (KM, MP: consultancy during development and approval of imepitoin; CR: pain consultancy; RGF, JP, HAV: consultancy pre and post launch of imepitoin). AT has been an advisor for Boehringer Ingelheim. SFMB, HAV and AT have been responsible principal investigator of several research studies concerning imepitoin financed by Boehringer Ingelheim. SFMB, HAV, JP, HP, MB, CR and AF received speaking fees from Boehringer Ingelheim. HP received consulting and speaking fees and funding for a collaborative project from Eisai Co. LTD. HAV received funding for a collaborative project from Desitin and Nestlé Purina Research. AF and LDR received reimbursements from Boehringer Ingelheim. LDR has received consulting and speaking fees from Vetoquinol. MP has received consultant fees for Aratana. The other authors declared that they have no competing interests.

Funding Information:
The authors are grateful to all owners of epileptic pets and veterinary colleagues who have inspired the group to create consensus statements. The authors also would like to thank the research office for assessing the manuscript according to the Royal Veterinary College’s code of good research practice (Authorisation Number – CCS_ 01025). This study was not financially supported by any organization or grant.

Publisher Copyright:
© 2015 De Risio et al.

Keywords

Diagnosis
Dog
Epilepsy
Idiopathic epilepsy
Seizure

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10.1186/s12917-015-0462-1

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De Risio, L., Bhatti, S., Muñana, K., Penderis, J., Stein, V., Tipold, A., Berendt, M., Farqhuar, R., Fischer, A., Long, S., Mandigers, P. J. J., Matiasek, K., Packer, R. M. A., Pakozdy, A., Patterson, N., Platt, S., Podell, M., Potschka, H., Batlle, M. P., ... Volk, H. A. (2015). International veterinary epilepsy task force consensus proposal: Diagnostic approach to epilepsy in dogs. BMC Veterinary Research, 11(1), [148]. https://doi.org/10.1186/s12917-015-0462-1

De Risio, L, Bhatti, S, Muñana, K, Penderis, J, Stein, V, Tipold, A, Berendt, M, Farqhuar, R, Fischer, A, Long, S, Mandigers, PJJ, Matiasek, K, Packer, RMA, Pakozdy, A, Patterson, N, Platt, S, Podell, M, Potschka, H, Batlle, MP, Rusbridge, C & Volk, HA 2015, 'International veterinary epilepsy task force consensus proposal: Diagnostic approach to epilepsy in dogs', BMC Veterinary Research, vol. 11, no. 1, 148. https://doi.org/10.1186/s12917-015-0462-1

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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.",

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note = "Funding Information: Following reimbursements, fees and funding have been received by the authors in the last three years and have been declared in the competing interest section. CR, RGF, HAV, KM, MP and JP have received fees for acting as a consultant for Boehringer Ingelheim (KM, MP: consultancy during development and approval of imepitoin; CR: pain consultancy; RGF, JP, HAV: consultancy pre and post launch of imepitoin). AT has been an advisor for Boehringer Ingelheim. SFMB, HAV and AT have been responsible principal investigator of several research studies concerning imepitoin financed by Boehringer Ingelheim. SFMB, HAV, JP, HP, MB, CR and AF received speaking fees from Boehringer Ingelheim. HP received consulting and speaking fees and funding for a collaborative project from Eisai Co. LTD. HAV received funding for a collaborative project from Desitin and Nestl{\'e} Purina Research. AF and LDR received reimbursements from Boehringer Ingelheim. LDR has received consulting and speaking fees from Vetoquinol. MP has received consultant fees for Aratana. The other authors declared that they have no competing interests. Funding Information: The authors are grateful to all owners of epileptic pets and veterinary colleagues who have inspired the group to create consensus statements. The authors also would like to thank the research office for assessing the manuscript according to the Royal Veterinary College{\textquoteright}s code of good research practice (Authorisation Number – CCS_ 01025). This study was not financially supported by any organization or grant. Publisher Copyright: {\textcopyright} 2015 De Risio et al.",

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doi = "10.1186/s12917-015-0462-1",

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AU - De Risio, Luisa

AU - Bhatti, Sofie

AU - Muñana, Karen

AU - Penderis, Jacques

AU - Stein, Veronika

AU - Tipold, Andrea

AU - Berendt, Mette

AU - Farqhuar, Robyn

AU - Fischer, Andrea

AU - Long, Sam

AU - Mandigers, Paul J J

AU - Matiasek, Kaspar

AU - Packer, Rowena M A

AU - Pakozdy, Akos

AU - Patterson, Ned

AU - Platt, Simon

AU - Podell, Michael

AU - Potschka, Heidrun

AU - Batlle, Martí Pumarola

AU - Rusbridge, Clare

AU - Volk, Holger A.

N1 - Funding Information: Following reimbursements, fees and funding have been received by the authors in the last three years and have been declared in the competing interest section. CR, RGF, HAV, KM, MP and JP have received fees for acting as a consultant for Boehringer Ingelheim (KM, MP: consultancy during development and approval of imepitoin; CR: pain consultancy; RGF, JP, HAV: consultancy pre and post launch of imepitoin). AT has been an advisor for Boehringer Ingelheim. SFMB, HAV and AT have been responsible principal investigator of several research studies concerning imepitoin financed by Boehringer Ingelheim. SFMB, HAV, JP, HP, MB, CR and AF received speaking fees from Boehringer Ingelheim. HP received consulting and speaking fees and funding for a collaborative project from Eisai Co. LTD. HAV received funding for a collaborative project from Desitin and Nestlé Purina Research. AF and LDR received reimbursements from Boehringer Ingelheim. LDR has received consulting and speaking fees from Vetoquinol. MP has received consultant fees for Aratana. The other authors declared that they have no competing interests. Funding Information: The authors are grateful to all owners of epileptic pets and veterinary colleagues who have inspired the group to create consensus statements. The authors also would like to thank the research office for assessing the manuscript according to the Royal Veterinary College’s code of good research practice (Authorisation Number – CCS_ 01025). This study was not financially supported by any organization or grant. Publisher Copyright: © 2015 De Risio et al.

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N2 - 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.

AB - 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.

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KW - Seizure

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

Abstract

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