Page 6 - Clinical Connections - Spring 2021

RVC RESEARCH STUDY VETERINARY SERVICES RVC.AC.UK Advances
RVC’S EPILEPSY JOURNEY
Rowena Packer, Lecturer in Companion Animal Behaviour and Welfare Science and BBSRC Research
Rimportant milestones, and looks to the future.
esearchers and clinicians at owners’ managing dogs with this often- the RVC have devoted over a distressing disease.
decade of work to improving our Detailed in the timeline below, the RVC
understanding of epilepsy in dogs and has been pivotal in reframing both the
RVCs groundbreaking clinical trials have demonstrated the positive effects of MCTs on not only seizure frequency, but also on behaviour and cognition. Robust clinical trials of both commercially available complete diets (developed based on RVC research) and of MCT dietary supplements (added to a dog’s existing diet) ensures these findings can be implemented by the widest possible patient base.
RVC’s pioneering epilepsy research has been enabled by a range of sources including the BBSRC, American Kennel Club Canine Health Foundation, Animal Care Trust, UFAW, and a number of industrial partners, including Boehringer Ingelheim and Nestlé Purina Pet Care.
In addition to clinical research at the RVC, our understanding of canine and feline epilepsy has benefited from RVC’s VetCompass project, which has identified how common epilepsy and seizures are in the general population, while identifying a number of important risk factors for epilepsy, including breed predispositions.
cats, including better characterisation of this chronic disorder and its comorbidities, developing technology to aid its long-term management for vets and owners, and identifying fresh new ways to manage this age-old disorder.
Epilepsy in the most common chronic neurological disease in dogs, affecting around 0.6% of the 8.9 million dogs in the UK (around 53,000 dogs). Dogs with epilepsy experience recurrent seizures, which are most commonly managed by anti-seizure drugs (ASDs) with the aim of reducing how often, and how severely, affected dogs have seizures.
Unfortunately, around a third of these dogs will continue to seizure despite medical treatment, sparking a quest for ‘adjunctive’ non-drug therapies to improve the quality of life of the hardest-to-treat dogs, while also effectively supporting
wider understanding of epilepsy as a brain disease, and in pioneering new approaches to its treatment. We now know that
epilepsy is not only a seizure disorder, and instead, seizures are just one clinical sign in a complex network of brain changes, including behavioural comorbidities such
as anxiety, and cognitive changes such as impaired learning ability. Based on these findings, behavioural and cognitive outcome measures are now embedded in epilepsy clinical trial design, alongside traditional measures of seizure frequency and severity, and the impact of existing anti-seizure therapies on behaviour and cognition are being considered.
RVC has been pivotal in the game- changing development of dietary therapies for canine epilepsy, providing an evidence base for medium-chain triglyceride
(MCT) enriched or supplemented diets.
2008
RVC research describes the efficacy and tolerability of levetiracetam, a human epilepsy drug, in the treatment of drug-resistant canine epilepsy patients. This drug is now commonly used for drug-resistant dogs with epilepsy as an adjunctive therapy.
2015
Landmark publication of International Veterinary Epilepsy Task Force (IVETF) consensus papers on canine epilepsy, including epilepsy classification, diagnostic approaches, treatment and outcomes
2015
RVC launches the smartphone app Pet Epilepsy Tracker, the first app to facilitate owner monitoring and improvement of the lives of their epileptic pets, which is now used in >80 countries and has been downloaded >30,000 times
2013
RVC uses VetCompass ‘Big Data’ to identify the prevalence and risk factors for idiopathic epilepsy in the UK, finding 0.6% of the canine population are affected
2015
RVC publishes the first review to explore the concept of “Epilepsy beyond seizures”, reviewing the impact of epilepsy and its comorbidities on health-related quality of life in dogs
2014
First large-scale quantitative study describing the impact of epilepsy on canine quality of life is published (the EpiQOL) by RVC and collaborators
2008 2011 2013 2014
2015
2011
RVC publishes the first findings indicating that dogs with epilepsy experience behavioural changes following their epilepsy diagnosis, mirroring psychiatric comorbidities such as anxiety seen in people with epilepsy
2014
Pivotal systematic review is published defining the evidence base for antiepileptic drug efficacy
2014
RVC publishes a key report identifying clinical features of dogs with drug-resistant epilepsy, highlighting the importance of high seizure density rather than high seizure frequency per se as a risk factor for drug- resistance
2015
RVC publishes the first paper demonstrating positive effects of
a medium-chain triglyceride (MCT) enriched diet on seizure frequency in dogs with epilepsy
2015
RVC host an owner education event “21st Century Management of Canine Epilepsy”, with speakers including human neurologists and people with epilepsy, as well
as internationally renowned neurologists
2016
Publication of American College
of Veterinary Internal Medicine (ACVIM) consensus statement on seizure management in dogs, where >10% of original papers cited providing the evidence for these recommendations were co-authored by the RVC group
6 Spring 2021