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Magnetic resonance (MR)imaging or computed tomog-raphy (CT) yielded positivefindings in 19 (76%) of 25dogs with either SE or clusterseizures.
12
Of the 50 dogs eval-uated for SE in our hospital,CT was used in 28, 13 (46%)cases of which showed abnor-mal findings.
14
Although no evidence existsto indicate that early initia-tion of appropriate treatmentimproves outcome in dogs with seizures, such evidencedoes exist in human medicineand remains an important ba-sic tenet of treatment.
12
In ad-dition to the above correla-tions, hospital visits during which partial motor SE wasdocumented had a significantassociation with poor out-come for dogs.
12
The mean duration of hospitalization for dogs withSE or cluster seizures is 51.6 ±42.6 hours with a meancost per hospital visit of $320 ±$175 (range, $45 to$1131).
12
These figures are biased by the year of thestudy and the types of seizures treated; however, they are a good indication of the financial commitment thatmay be required to successfully treat a patient with SE.
CLINICAL FEATURES
In Bateman and Parent’s study of 156 dogs admittedto a veterinary hospital (between 1990 to 1995) withSE or cluster seizures, the mean patient age was 4.2 ±3.3 years (range, 1.9 to 13.9 years).
12
In our study, themean age of the 50 dogs evaluated for SE at our hospi-tal over the course of 9 years (1990 to 1999) was 5.05years (range, 0.15 to 15 years), with no statistical gen-der prevalence
14
; however, the results of the Raw andGaskell study indicate that there is a male sex predilec-tion for primary epilepsy.
16
In the Bateman and Parentstudy, the sex distribution for severe seizures (i.e., SEand cluster seizures) was broken down as follows:23.7% were castrated, 35.3% were sexually intactmales, 26.3% were spayed, and 14.7% were sexually in-tact females.
12
The English foxhound, pug, teacup poo-dle, Boston terrier, and Lakeland terrier were signifi-cantly overrepresented in the Bateman and Parentstudy, but the authors urge cautious interpretation of this finding.
12
The English foxhound, Lakeland terrier,and teacup poodle had low numbers of their respectivebreeds found in the overallhospital population; all of thepugs and Boston terriers— with one exception—had sec-ondary epilepsy, to whichthese breeds are consideredpredisposed.
12
Patients with SE usually have clinically obvious sei-zures, such as tonic, clonic, ortonic–clonic movements of the extremities.
7
This activity is classified as generalized con-vulsiveor grand mal seizuresand is usually accompanied by marked impairment of con-sciousness.
7,8
Typically, there isgradual recovery of conscious-ness following each convul-sion, but if the patient has notrecovered fully to baseline be-fore the next convulsion oc-curs, the patient is consideredto be in generalized convul-sive or tonic–clonic SE. Nonconvulsive SE is well recog-nized in humans (in whom patients are classified as hav-ing complex partial SE and absent SE).
7
In veterinary medicine, these types of SE have not been well docu-mented clinically or electroencephalographically. Howev-er, veterinary patients have been documented to have fo-cal motor seizure activity without loss of consciousness.Focal motor activity is classified as a partial seizure indi-cating involvement of only a focal area of the brain.
17
There is the possibility of this activity being prolongedenough to be classified as partial motor SE or that it willbe followed by generalized (tonic–clonic) SE.
17
Human patients who have electroencephalographicevidence of SE with little or no visible motor activity are still at risk for central nervous system injury and re-quire immediate attention.
10
Ongoing SE can produceneuronal death in experimental models of SE even when metabolic factors are corrected and in paralyzedanimals that are ventilated.
3,7
In our clinical experience, we have found that nonconvulsive SE does occur in pa-tients with resultant poor outcomes if intervention isnot instituted.
PHYSIOLOGIC FEATURES
Several physiologic changes occur during the courseof SE, including hypertension, tachycardia, hypo-glycemia, acidosis, and hyperthermia (Figure 1). Theinitial physiologic response is a massive release of epinephrine and norepinephrine into the circulation.
4,7
Small Animal/Exotics
Compendium
July 2000
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