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Abstract

Objective—To compare efficacy and safety of treatment with phenobarbital or bromide as the first-choice antiepileptic drug (AED) in dogs.

Design—Double-blinded, randomized, parallel, clinical trial.

Animals—46 AED-naïve dogs with naturally occurring epilepsy.

Procedures—Study inclusion was based on age, history, findings on physical and neurologic examinations, and clinicopathologic test results. For either phenobarbital treatment (21 dogs) or bromide treatment (25), a 7-day loading dose period was initiated along with a maintenance dose, which was adjusted on the basis of monthly monitoring. Efficacy and safety outcomes were compared between times (baseline and study end [generally 6 months]) and between drugs.

Results—Phenobarbital treatment resulted in eradication of seizures (17/20 [85%]) significantly more often than did bromide (12/23 [52%]); phenobarbital treatment also resulted in a greater percentage decrease in seizure duration (88 ± 34%), compared with bromide (49 ± 75%). Seizure activity worsened in 3 bromide-treated dogs only. In dogs with seizure eradication, mean ± SD serum phenobarbital concentration was 25 ± 6 μg/mL (phenobarbital dosage, 4.1 ± 1.1 mg/kg [1.9 ± 0.5 mg/lb], PO, q 12 h) and mean serum bromide concentration was 1.8 ± 0.6 mg/mL (bromide dosage, 31 ± 11 mg/kg [14 ± 5 mg/lb], PO, q 12 h). Ataxia, lethargy, and polydipsia were greater at 1 month for phenobarbital-treated dogs; vomiting was greater for bromide-treated dogs at 1 month and study end.

Conclusions and Clinical Relevance—Both phenobarbital and bromide were reasonable first-choice AEDs for dogs, but phenobarbital was more effective and better tolerated during the first 6 months of treatment.

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in Journal of the American Veterinary Medical Association

Abstract

Objective—To determine whether frontal-sinus size is associated with syringohydromyelia.

Sample Population—Medical records and magnetic resonance images of 62 small-breed dogs.

Procedures—Medical records and magnetic resonance images were reviewed retrospectively for evaluation of frontal-sinus size and syringohydromyelia. A Yates-corrected 2-tailed χ2 test was used to determine whether an association existed between absent or miniscule frontal sinuses and syringohydromyelia. The strength of the association was evaluated by means of prevalence and odds ratios.

Results—Absent or miniscule air-filled frontal sinuses were detected in 28 of 62 (45%) dogs, and syringohydromyelia was detected in 12 of 62 (19%) dogs. Syringohydromyelia was detected in 10 of 28 dogs with absent or miniscule frontal sinuses (prevalence, 36%; 95% confidence interval, 16% to 55%) and in 2 of 34 dogs with larger frontal sinuses (prevalence, 6%; confidence interval, 0% to 15%). The probability of detecting syringohy-dromyelia in dogs with absent or miniscule air-filled frontal sinuses was significantly greater than the probability of detecting it in dogs with larger frontal sinuses. The prevalence ratio was 6.1, and the odds ratio was 8.9.

Conclusions and Clinical Relevance—An association between frontal-sinus size and syringohydromyelia was identified in small-breed dogs, suggesting that the pathogenesis of syringohydromyelia in some instances may involve abnormal development of the entire or supratentorial part of the cranium, as opposed to being limited to the infratentorial part.

Full access
in American Journal of Veterinary Research

Abstract

Objective—To assess pharmacokinetics, efficacy, and tolerability of oral levetiracetam administered as an adjunct to phenobarbital treatment in cats with poorly controlled suspected idiopathic epilepsy.

Design—Open-label, noncomparative clinical trial.

Animals—12 cats suspected to have idiopathic epilepsy that was poorly controlled with phenobarbital or that had unacceptable adverse effects when treated with phenobarbital.

Procedures—Cats were treated with levetiracetam (20 mg/kg [9.1 mg/lb], PO, q 8 h). After a minimum of 1 week of treatment, serum levetiracetam concentrations were measured before and 2, 4, and 6 hours after drug administration, and maximum and minimum serum concentrations and elimination half-life were calculated. Seizure frequencies before and after initiation of levetiracetam treatment were compared, and adverse effects were recorded.

Results—Median maximum serum levetiracetam concentration was 25.5 μg/mL, median minimum serum levetiracetam concentration was 8.3 μg/mL, and median elimination half-life was 2.9 hours. Median seizure frequency prior to treatment with levetiracetam (2.1 seizures/mo) was significantly higher than median seizure frequency after initiation of levetiracetam treatment (0.42 seizures/mo), and 7 of 10 cats were classified as having responded to levetiracetam treatment (ie, reduction in seizure frequency of ≥ 50%). Two cats had transient lethargy and inappetence.

Conclusions and Clinical Relevance—Results suggested that levetiracetam is well tolerated in cats and may be useful as an adjunct to phenobarbital treatment in cats with idiopathic epilepsy.

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in Journal of the American Veterinary Medical Association

Abstract

Objective—To objectively describe morphometric features of the craniocervical junction region of Cavalier King Charles Spaniels (CKCSs) and non-CKCS dogs with suspected Chiari-like malformation (CLM) and identify associations between these features and the presence of other malformations in this region.

Animals—216 CKCSs and 58 non-CKCS dogs.

Procedures—Magnetic resonance and computed tomographic images of the head and craniocervical junction region of patients evaluated because of suspected CLM were assessed for cerebellar compression (CC), ventral spinal cord compression at the C1–C2 articulation (medullary kinking), and dorsal spinal cord compression at the C1–C2 articulation (dorsal compression). A compression index was calculated for each of these 3 locations in each dog. Multiple logistic regression analysis was performed to determine whether breed (CKCS vs non-CKCS) and compression index values were associated with the presence of other craniocervical junction abnormalities.

Results—All 274 dogs had CC; medullary kinking was identified in 187 (68.2%) and dorsal compression was identified in 104 (38.0%). Atlantooccipital overlapping (AOO) was identified in 76 (27.7%) dogs. Breed of dog (CKCS vs non-CKCS) and value of CC index were the only significant predictors of AOO. The CKCSs had an almost 5-fold decrease in risk of AOO, compared with the non-CKCS dogs, and the risk of AOO nearly doubled for every 10% increase in CC index.

Conclusions and Clinical Relevance—The anatomic abnormality responsible for CC was AOO in a substantial percentage of dogs suspected to have CLM. The CC index value may be used to help differentiate subtypes of craniocervical junction abnormalities in dogs.

Full access
in American Journal of Veterinary Research

Abstract

OBJECTIVE To determine the usefulness of medical infrared thermal imaging (MITI) as a screening tool for hyperthyroidism in cats, evaluate the need for hair clipping over the ventral aspect of the neck to achieve optimal images, and determine whether there is a change in thermal patterns at 1 and 3 months after radioactive sodium iodide I 131 treatment.

ANIMALS 17 cats with and 12 control cats without hyperthyroidism.

PROCEDURES All cats underwent MITI first with the hair present and then after the hair was clipped. Each cat with hyperthyroidism was subsequently appropriately treated SC with radioiodide; reevaluations, including MITI before and after hair clipping and measurement of serum thyroxine concentration, were performed 1 and 3 months after treatment.

RESULTS The MITI had 80.5% and 87.5% accuracy in differentiating hyperthyroid cats from clinically normal cats before and after the hair over the ventral aspect of the neck was clipped. Among cats with an initial serum thyroxine concentration > 4.0 μg/dL, the success rate for MITI-detected response to radioiodide treatment at the 1-month reevaluation was 92.86% in unshaved cats and 85.71% in shaved cats. The success rate for MITI-detected response to radioiodide treatment at the 3-month reevaluation was 100% in unshaved and shaved cats.

CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that MITI was successful in differentiating between hyperthyroid cats and clinically normal cats and identifying patients with thyroxine concentration within reference interval after radioactive sodium iodide I 131 treatment.

Full access
in American Journal of Veterinary Research

Abstract

Objective—To evaluate clinical features and outcome of dogs with a confirmed spinal cord nephroblastoma and to describe the use of Wilms tumor-1 (WT-1) immunohistochemical staining to confirm a diagnosis of nephroblastoma in dogs.

Design—Retrospective case series.

Animals—11 dogs with a spinal cord nephroblastoma.

Procedures—Medical records of dogs with a spinal cord nephroblastoma were reviewed. Information extracted included signalment, history, clinical signs, results of diagnostic testing, tumor location, treatment, and outcome. The diagnosis was confirmed through histologic review and WT-1 immunohistochemical staining of a tumor sample. In dogs with negative results for staining with WT-1, staining for cytokeratin, vimentin, and glial fibrillar acidic protein was performed.

Results—11 dogs had a spinal cord tumor with a histologic appearance and immunohistochemical staining consistent with a nephroblastoma. Positive results for staining with WT-1 were detected in 9 of 11 dogs. Age at admission ranged from 5 to 48 months (median, 14 months). Nine dogs were female. All had progressive paraparesis, paraplegia, or ataxia. Duration of clinical signs ranged from 2 to 60 days (median, 14 days). Median survival time was 30 days from the time of diagnosis. Median survival time in dogs treated via surgical resection was 70.5 days.

Conclusions and Clinical Relevance—The prognosis for dogs with a spinal cord nephroblastoma appeared to be poor, although combined surgical resection and radiation therapy may provide a good functional outcome. Results for staining with WT-1 can be used to support a diagnosis of nephroblastoma.

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in Journal of the American Veterinary Medical Association

Abstract

Objective—To compare clinical outcome in dogs with serologically diagnosed acquired myasthenia gravis (MG) treated with pyridostigmine bromide (PYR) with that of dogs treated with mycophenolate mofetil (MMF) and PYR (MMF + PYR).

Design—Retrospective case series.

Animals—27 dogs.

Procedures—Medical records from August 1999 through February 2008 were reviewed to identify dogs with serologically diagnosed acquired MG treated with PYR or MMF + PYR. Data collected for each dog included signalment, whether the dog had megaesophagus or pneumonia (or both), thyroid hormone concentration, remission, time to remission, and survival time. Rates for detection of clinical signs and survival time were compared. Survival time was estimated via the Kaplan-Meier method. Influence of drug treatment protocol on likelihood of remission, time to remission, and survival time was examined. Effects of MMF treatment, megaesophagus, pneumonia, and low serum thyroid hormone concentration on time to remission and survival time were also analyzed.

Results—12 dogs were treated with PYR, and 15 were treated with MMF + PYR. Mortality rates were 33% (PYR) and 40% (MMF + PYR). There was pharmacological remission in 5 and 6 dogs in the PYR and MMF + PYR groups, respectively. No significant differences were detected between treatment groups for remission rate, time to remission, or survival time. Megaesophagus, pneumonia, and low serum thyroid hormone concentration had no significant effect on time to remission or survival time for either treatment group.

Conclusions and Clinical Relevance—The results did not support routine use of MMF for the treatment of dogs with acquired MG.

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in Journal of the American Veterinary Medical Association

Abstract

Objective—To assess tolerability and short-term efficacy of oral administration of pregabalin as an adjunct to phenobarbital, potassium bromide, or a combination of phenobarbital and potassium bromide for treatment of dogs with poorly controlled suspected idiopathic epilepsy.

Design—Open-label, noncomparative clinical trial.

Animals—11 client-owned dogs suspected of having idiopathic epilepsy that was inadequately controlled with phenobarbital, potassium bromide, or a combination of these 2 drugs.

Procedures—Dogs were treated with pregabalin (3 to 4 mg/kg [1.4 to 1.8 mg/lb], PO, q 8 h) for 3 months. Number of generalized seizures in the 3 months before and after initiation of pregabalin treatment was recorded. Number of responders (≥ 50% reduction in seizure frequency) was recorded, and seizure frequency before and after initiation of pregabalin treatment was compared by use of a nonparametric Wilcoxon signed rank test.

Results—Seizures were significantly reduced (mean, 57%; median, 50%) after pregabalin administration in the 9 dogs that completed the study; 7 were considered responders with mean and median seizure reductions of 64% and 58%, respectively. Adverse effects for pregabalin were reported in 10 dogs. Mean and median plasma pregabalin concentrations for all dogs were 6.4 and 7.3 μg/mL, respectively.

Conclusions and Clinical Relevance—Pregabalin may hold promise as a safe and effective adjunct anticonvulsant drug for epileptic dogs poorly controlled with the standard drugs phenobarbital or potassium bromide. Adverse effects of pregabalin appeared to be mild. Additional studies with larger numbers of dogs and longer follow-up intervals are warranted.

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in Journal of the American Veterinary Medical Association