An Entire Day of Educational Talks

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 Meet and Greet Symposium Schedule

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10:00 – 10:10
 Welcome- Philip Jull

 

10:10 – 11:00

 Neurology Presentation– Philip Jull "Spinal Cord Disease I”

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11:00 – 11:10

 COFFEE BREAK and Q&A

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11:10 – 12:00

Neurology presentation – Philip Jull "Spinal cord disease II"

 

12:00 – 1:00

 LUNCH IS SERVED

Visit vendor booths

12:40 - TD presentation

12:50 - Hills presentation

 

1:00 – 1:50

Neurology presentation –Serene Lai. "Seizures"

 

1:50 – 2:00

COFFEE BREAK and Q&A

 

2:00 – 2:50

Neurology presentation – Serene Lai. "Seizures"

 

2:50 –3:00

COFFEE BREAK and Q&A

 

3:00 – 3:50

Anesthesia presentation – Stefania Grasso

 

3:50 – 4:00

COFFEE BREAK and Q&A

 

4:00 – 4:50

Anesthesia presentation – Stefania Grasso

 

4:50 – 5:30

Q&A. Visit vendor booths. Mingle

 

Seizures

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Serene Ruth Lai, DVM, MS, Dip ACVIM (Neurology)

Neurology and Neurosurgery

The VSCAN

 

A seizure patient walks into the clinic (or often carried in due to recumbency). What should we do now? What are we dealing with? Are these even seizures? How shall we proceed? This scenario is inevitable. The presentation is in two parts and provides the general practitioner with information on underlying causes for seizures, because targeted treatment depends on the diagnosis.

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The etiologies for seizures are numerous. Several breeds such as the German Shepherd Dog, Border Collies, and Labrador Retrievers, have a genetic predisposition to developing epilepsy. While genetic mutations have been identified in some breeds predisposed to epilepsy, many seizure patients that come into our clinics fall outside of the breed paradigm. Most especially in these cases, it is pure guesswork without diagnostics as to the underlying etiology of the seizures. Understanding the etiology of seizures is critical in managing both the underlying disease process should there be any, and the seizures themselves. The earlier the disease process is identified, the better control we may gain with treatment. It cannot be overstated how understanding the etiology of seizures provides vital information to the clinician regarding how to adjust anti-seizure medications should the patient continue to seizure despite medications.

 

Before magnetic resonance imaging (MRI) became a commonplace in veterinary neurology, our best guesswork at a seizuring geriatric patient was neoplasia. Once the presumptive diagnosis of neoplasia is reached, the survival time of patients generally decline dramatically, as owners choose to euthanize based on expectations of a grave prognosis, which may or may not be related to clinician bias. As veterinarians, we play a major role in bridging the gap between owner and pet. When faced with such a task, the more information we operate with, the more accurately we may advise our owners.

 

Information gathered from the increasing number of advanced neurodiagnostics performed over the past decade has shifted our bias away from the existing paradigm when faced with a seizuring geriatric, middle-aged, or juvenile patient. While neoplasia remains an important differential, onset of seizures at an older age certainly does not preclude the geriatric patient from a laundry list of other differentials, such as meningoencephalitidies and vasculitidies that may be immune-mediated or infectious in origin; endocrinopathies, metabolic derangement; and even cryptogenic etiologies. The same needs to be said of young patients with seizures. How sure are we that these etiologies are idiopathic epilepsy and not immune-mediated, structural abnormalities, metabolic, Rickettsial disease, or even neoplasia?

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Although infectious etiologies (bacterial, viral, fungal, protozoal) for seizures do not often receive much attention in discussions, they certainly should not be overlooked. For example, Rickettsial diseases causing vasculitis can result in hemorrhage or thrombosis within the central nervous system and may represent a cause for seizures. 

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Granulomatous meningoencephalitis (GME), necrotizing leukoencephalitis (NLE), and necrotizing meningoencephalitis (NME) are currently known to most neurologists under an umbrella terminology called meningoencephalitis of unknown origin (MUO). These are immune-mediated entities that are classified by histopathologic appearance. Regardless of the classification, the mainstay treatment is with lifelong immunosuppressive drugs. Generally, a focal rather than disseminated form of disease carries a better prognosis, and GME has a more favorable outcome than the necrotizing encephalitidies. Patients that respond favorably to treatment can have long survival times ranging from 1 to 1215 days.

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Hypothyroidism may result in cerebrovascular atherosclerosis and has been documented to cause seizures in dogs (4). Metabolic derangements such as hypocalcemia, hypertriglyceridemia (especially notable in the miniature schnauzer breed) are also known causes for seizures.

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A diagnosis of cryptogenic epilepsy is reached when a hereditary cause is unlikely and an underlying pathological change in the central nervous system is suspected but cannot be identified after complete neurologic workup. A retrospective study of 214 client owned dogs with onset of seizures at or above 7 years of age revealed 21% of dogs had the diagnosis of cryptogenic epilepsy.

 

CONCLUSION

 

A full neurologic workup is highly recommended for any patient presenting with seizures. This presentation highlights the importance of early detection of underlying etiology of seizures to provide the best treatment, prognosis, and to guide adjustment of antiseizure medications. A brief and yet non-exhaustive review of the top potential causes for seizures has been provided above. Based on these examples, the reader can glean that depending on the underlying etiology, the prognoses and treatment modalities vary. Thus, there is neither a blanket treatment nor diagnosis for seizures in patients. The overarching theme in this presentation is that we need to appropriately educate our pet owners that seizures does not equate to idiopathic epilepsy and seizures in a geriatric patient, even with proven intracranial pathology does not equate to an immediately grave prognosis. Ultimately, a diagnosis cannot be reached without an MRI and cerebrospinal fluid (CSF) analysis. Moreover, even if a pet has been diagnosed with intracranial neoplasia, the type of neoplasm and its location can have good treatment options that may be able to provide the patient with a good quality of life with varying survival times.

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Spinal Cord Disease

 

Philip Jull, MVetMed, DECVN (Neurology)

Neurology and Neurosurgery

The VSCAN

 

 Spinal Cord Disease I. Diagnostics in Spinal Cord in Small Animals

 

Choosing a cost effective work up for spinal cord disease can be challenging. A review of when to apply each of the following spinal imaging modalities from radiographs, computer tomography, magnetic resonance imaging, and electrodiagnostics will be discussed along with adjunctive tests for suspected spinal cord disease. The importance of localization is stressed in relation to these tests. Case examples will be given to clarify when to use each diagnostic modality.

 

Spinal Cord Disease II. Management of Spinal Cord Disease: Medical Versus Surgical

 

Medical and surgical treatment options will be discussed for main differential diagnoses for spinal cord disease. The advantages and disadvantages of each will be reviewed, along with a presentation of the literature to support each treatment modality. Case examples will be presented.

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Anesthesia and Analgesia

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Stefania Grasso, DVM, MS, DACVAA (Anesthesia)

Guest Speaker

 

Anesthetic morbidity and mortality

 

Complications during general anesthesia arise from several factors such as malfunctioning equipment, lack of monitoring equipment, human error, patient variability, or procedural related complications. Anesthetic safety can be improved by being able to anticipate complications and to trouble-shoot problems; performing close and attentive patient monitoring; and using state-of-the-art equipment. Specific considerations and tailoring of anesthetic protocol and procedures should also be done for patients with a higher anesthetic risk, such as brachycephalics or patients affected by cardiac disease. The choice of anesthetic drugs tailored to the patient, the right monitoring equipment and the careful peri-anesthetic management are all factors that will improve the anesthetic and post-operative outcome.

 

Improving pain management in small animals

 

Acute and chronic pain management is of paramount importance and new therapeutic options are under constant research and development. Whenever possible, multimodal analgesics and locoregional techniques should be used in order to increase the comfort of the patient.

 

With increased interest in veterinary pain management, several new practices such as the use of a nerve stimulator and ultrasound to perform peripheral blocks is becoming commonplace. There are indeed several advantages to performing neurostimulation and using ultrasound-guided techniques, as the safety and the success of peripheral nerve blocks are increased, along with reduction of risk and adverse effects.