Page 11 - Clinical Connections - Autumn 2020

Research News
CLASSIFICATION, DIAGNOSIS, AND CLINICAL MANAGEMENT OF CANINE SEIZURES
A study led by the RVC VetCompassTM programme has revealed a significant difference between how clinicians diagnose epilepsy compared with current expert recommendations. These results support the call for clearer diagnostic guidelines for application in clinical practice and for the teaching of undergraduates.
The study identified 2,834 incident seizure cases from a population of 455,553 dogs attending VetCompass participating practices during 2013. Key findings from the research included:
• Theannualincidenceriskofseizuresindogswas0.62%.
• Themostcommonbreedsamongseizurecaseswere
Labradorretrievers(8.6%),Staffordshirebullterriers(6.1%),
Jack Russell terriers (5.8%) and Yorkshire terriers (5.0%).
• 579(20.5%)seizurecasesmetthecriteriaforepilepsybased
on the International Veterinary Epilepsy Task Force (IVETF) classification system, while just 245 (8.6%) were formally recorded with epilepsy by the attending veterinary teams. This suggests a lack of confidence in clinicians to formally diagnose epilepsy in dogs.
• Overall,1,415(49.9%)casesreceiveddiagnosticevaluation equivalent to or higher than IVETF Tier 1 diagnostic testing.
• Being under 12 years of age and being insured were risk factorsforreceivingIVETFTier1orhigherdiagnostic evaluation among seizure cases. In addition, being at or above the breed and sex mean bodyweight, a clinically recorded diagnosis of epilepsy and being in the UK Kennel Club terrier breed group were risk factors for receiving Tier 1 or higher.
• DogsthatreceivedIVETFTier1orhigherdiagnostic evaluation, MRI or CSF analysis were more likely to be
MOST COMMON BREEDS AMONG CASES
LABRADOR RETRIEVERS
STAFFORDSHIRE BULL TERRIERS
JACK RUSSELL TERRIERS
YORKSHIRE TERRIERS
ANTI-SEIZUREDRUG (ASD)TREATMENT
SINGLE 25.4% ASD
(Percentagesdonottotal100duetorounding)
8.6% 6.1%
5.8% 5.0%
5.5%ASD COMBINATION
69.2% ASD NOT PRESCRIBED
RISK FACTORS FOR RECEIVING IVETF TIER 1 OR HIGHER EVALUATION
NOVEL CUSHING’S RISK TOOL
RVC VetCompass researchers have developed a scoring tool to evaluate the risk of Cushing’s syndrome in dogs. The freely accessible tool is designed to be used in practice to support decision-making and increase confidence in diagnosis.
The classical clinical signs associated with the disease are well reported, with
affected dogs typically showing various combinations of polyuria, polydipsia, polyphagia, a potbellied appearance, muscle weakness, bilateral alopecia, panting and lethargy. Cushing’s can be difficult to diagnose because these clinical signs are often non-specific to the disease. Additionally, there is no single, highly accurate test for Cushing’s syndrome and tests are often overused, making results difficult to interpret.
The VetCompass tool can be used by vets to assess individual patient risks prior to confirmatory testing. The tool was
developed after the application of advanced statistical methods and is made up of 10 ‘predictive’ factors for Cushing’s syndrome. The tool reports the probability of an individual dog having Cushing’s syndrome. This development was made possible by access to large volumes of anonymised data from the VetCompass programme and funding from Dechra Veterinary Products.
Development and internal validation of a
prediction tool to aid the diagnosis of Cushing's syndrome in dogs attending primary care practice. Schofield, I, Brodbelt, DC, Niessen, SJM, et al. J Vet Intern Med. 2020; 1-10. https://doi.org/10.1111/jvim.15851
as a tool for decision-makers to use when considering food system recommendations, environmentally sustainable food production, food security and equitable access to food. Though the study focused on South Africa, it has global ramifications.
A Systems Analysis and Conceptual System
Dynamics Model of the Livestock-derived Food System in South Africa: A Tool for Policy Guidance. Queenan, K., Sobratee, N., Davids, R., Mabhaudhi, T., Chimonyo, M., Slotow, R., Shankar, B., & Häsler, B. (2020) Journal of Agriculture, Food Systems, and Community Development, 9(4), 275–298. https://doi.org/10.5304/jafscd.2020.094.021.
UNDER ABOVE 12 MEAN YEARS BODY- OF AGE WEIGHT
UK KC TERRIER BREED GROUP
recorded with epilepsy by the attending veterinary teams. • Anti-seizuredrug(ASD)treatmentwasnotprescribedfor
1,960 (69.2%) dogs in association with the incident seizure event. Of the remainder, 719 (25.4%) dogs received 1 ASD, whereas 155 (5.5%) an ASD combination.
Seizures in dogs under primary veterinary care in the United Kingdom: Etiology,
diagnostic testing, and clinical management. Erlen, A, Potschka, H, Volk, HA, Sauter-Louis, C, O'Neill, DG. J Vet Intern Med. 2020; 1– 11. https://doi.org/10.1111/jvim.15911
PREDICTION TOOL
The VetCompass Cushing’s Diagnostic Prediction Tool can be downloaded from rvc.uk.com/cushings-tool
VITAL STUDY ON GLOBAL FOOD SYSTEMS
RVC researchers have led an important study as part of the Wellcome Trust
funded global programme Sustainable
and Healthy Food Systems (SHEFS), highlighting the need for a holistic approach to understanding food systems if significant progress is to be made in producing nutritious food in a sustainable way.
Dr Barbara Häsler, Senior Lecturer
in Agrihealth, and Mr Kevin Queenan, Research Assistant in SHEFS, joined colleagues from SOAS and the University
of KwaZulu-Natal in South Africa to investigate the complex systems that underpin the production, distribution and consumption of livestock-derived food (LDF) in South Africa.
Highlighting the complexity of the system, existing problems and suggesting potential solutions, the researchers created an overview of the LDF system for the benefit of policymakers and stakeholders. The study also demonstrated the use of conceptual system dynamics modelling
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