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International Collaboration for Dog Health - Epilepsy

Brenda Bonnett

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The Press Office of The Royal Veterinary College has reported that:

"Veterinary neurology experts collaborate for first ever global consensus on pets with epilepsy

 

"Made up of 26 veterinary practitioner, neuropharmacology, neuropathology and neurology experts from around the world, the International Veterinary Epilepsy Task Force (IVETF) has produced seven ‘consensus statements’ that outline a number of recommendations and classifications on all aspects of the condition. It is the first time this many veterinary neurology clinicians and neuroscientists have formally agreed on the key aspects of canine and feline epilepsy. "

 

Here at IPFD we are, of course, very happy to see international approaches to understanding and managing disease in companion animals.  We hope to see a similar approach taken with other diseases and including an even wider range of discipline experts.  The eight consensus statements of the epilepsy group cover a wide breadth of information on the clinical aspects of epilepsy - including definition and classification, diagnosis, treatment and more.  This is a leap forward in our communication on this widespread condition and the participants are to be commended.

 

I was particularly interested in the breed-specific aspects and this is addressed in one of the papers: International Veterinary Epilepsy Task Force’s current understanding of idiopathic epilepsy of genetic or suspected genetic origin in purebred dogs.  This article contains a review of current information on various breeds - lots of good information.

Unfortunately, and now I am wearing my 'epidemiologist hat', there is a rather liberal use of the word prevalence - more or less used across the board to describe the occurrence of epilepsy from many different study designs, e.g. whether estimates were population or hospital-based or describing the proportion of epilepsy cases among diseased dogs.  Not all these estimates accurately reflect the real risk of the condition in a given breed.  To make sense of the range of numbers, one needs a critical appraisal of the study details - the sort of discussion that makes most peoples' brains ache.  Nonetheless, without clarifying the sources of information we are left confused as to the meaning.  And wondering how to compare information from various studies, across breeds, countries, etc. 

 

It seems that quantifying disease occurrence remains a challenge in the companion animal world - as we have so few good population-based studies.  Elsewhere on DogWellNet.com we are struggling with the same issue relative to problems in brachycephalic breeds. In the meantime, if you are puzzled by the range in estimates from different studies, know that sometimes it is due at least partly to issues of the study design, the study population, the method of analysis and the interpretation and not entirely reflective of the actual situation in the dogs or breed or population.

 

Confused? Well, you are not alone.  Good estimates of the occurrence of disease in national populations of dogs are rather few and far between.  We mostly have proportions from among dogs seen at veterinary teaching hospitals.  A consensus from the 2nd International Dog Health Workshop is that there is a great need for better information on the occurrence of many diseases.  Hopefully, ongoing international collaborations will focus on this need.  The paper from the Vet Compass group (elsewhere on DogWellNet.com): Prevalence and risk factors for canine epilepsy of unknown origin in the UK is a relevant population-based study, as is a Swedish study: A cohort study of epilepsy among 665,000 insured dogs: incidence, mortality and survival after diagnosis, referenced in the consensus statement.

 

We hope to be able to incorporate pertinent findings into the breed database for some of the breeds discussed... and to provide new information from the Swedish Insurance Data - Agria Dog Breed Updates.  So, keep tuned!

 

 


 

 



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In epidemiology, prevalence refers to the proportion (or percentage) of animals affected. But  it all gets confusing when we may be talking about different denominator populations. So, we can have lots of prevalence values for epilepsy that are all different but may also all be correct: they just relate to different denominator populations.

 

As a rule, most people would like to know the proportion of animals affected in the general population. But differing denominator populations between studies complicate the interpretation of reported prevalence values. For example, denominator populations may live in different countries or come from long ago or just relate to subsets of the overall dog population. For instance, while many publications report the prevalence of disorders among referral denominator groups of dogs, it is only a minority of dogs that are referred (and they are nearly all ill) and therefore it is debatable how safely these values can be generalized to the wider population of dogs.

One way to try to get the benefit of high quality veterinary diagnoses and also still relate to the general population of dogs is to identify the prevalence of disease in the primary-care veterinary population. Projects such as VetCompass at the RVC have taken this approach to report a prevalence of 0.62% for epilepsy of unknown origin in dogs attending veterinary primary care in the UK.

When we report prevalence values, we definitely need to be more explicit about numerator  (ie exactly what diseases are we talking about) and the denominator (ie who, what, when and where are these overall study dogs). Specifics, specifics, specifics. 

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