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Background There are few effective drugs for treatment of seizures in avian species. Objectives To investigate the pharmacokinetics and safety of zonisamide in chickens. Methods Phase 1: chickens (n = 4) received a single oral dose of zonisamide at 20 mg/kg. Blood samples were collected intermittently for 36 hr after dosing. Phase 2: chickens (n = 8) received zonisamide in a dose escalation protocol (20, 30, 60 and 80 mg/kg orally every 12 hr). The dose was increased weekly, and peak and trough blood samples were collected on Days 1, 3, and 7 each week. Two birds were randomly euthanized at the end of each week. Plasma zonisamide concentrations were analysed using a commercial immunoassay. Drug concentration vs. time data were subjected to non‐compartmental pharmacokinetic analysis. Results For Phase 1, peak plasma zonisamide (Cmax) was 15 ± 3 µg/ml at 2 ± 1 hr (Tmax). The disappearance half‐life was 6.5 ± 1 hr. Mean plasma concentrations remained within the (human) therapeutic range (10–40 µg/ml) for 6 hr. For Phase 2 of the study, plasma concentrations of zonisamide remained within or close to the recommended mammalian therapeutic range for birds in the 20 and 30 mg/kg dose. Area under the curve (AUC) and Cmax were dose dependent. Two birds developed immune‐mediated haemolytic anaemia. Conclusions Zonisamide appears to be a viable drug for use in chickens at a dose of 20 mg/kg orally every 12 hr., The pharmacokinetics and safety of zonisamide were investigated in chickens in single and repeated dose trials. Zonisamide appears to be a viable drug for use in chickens at a dose of 20mg/kg orally every 12 hr.

Intracranial gliomas are a common malignancy in dogs, and are associated with a poor prognosis due to their aggressive nature and a lack of clinically effective treatments. The efficacies of various treatment modalities for canine brain tumours have been previously described, though little data exist on the use of cytotoxic chemotherapy. A comparative retrospective study, including 40 cases from 5 northeastern US veterinary hospitals, from 2008 to 2017, was conducted. Variables analysed in this study with relation to overall survival and prognostic significance included: age, sex, clinical signs, clinical sign duration, tumour location and treatment protocol used. Dogs with presumptive intracranial gliomas treated with lomustine chemotherapy lived longer (median, 138 days) than those treated exclusively with symptomatic care (median, 35 days; P = .0026 log-rank, 0.0138 Wilcoxon). Additionally, a duration of clinical signs ≥16 days prior to diagnosis (median, 109 days) was associated with a longer survival than a duration

Objective To report a transnasal, endoscopically guided ventral surgical approach for accessing the cranial and caudal segments of the sphenopalatine sinus for mass removal in a horse. Study Design Case report. Animal Adult horse with acute onset blindness referable to a soft tissue mass within the sphenopalatine sinus. Clinical Report A 7-year-old Warmblood gelding presented with a history of running into a fence and falling. No neurologic signs were identified at initial examination but acute blindness was noted 3 weeks later. On computed tomography (CT) the sphenopalatine sinus was filled with a large homogeneous mass with poor contrast enhancement that extended dorsally with thinning to the dorsal cortex of the sphenoid bone, just rostral to the entrance of the optic canals into the cranial cavity. Surgical access to the sphenopalatine sinus was achieved using a transnasal, endoscopically guided ventral pharyngotomy approach and the mass lesion was removed. A presumptive diagnosis of chondroma was made based on histopathology. The horse recovered well from surgery, and although it has not regained vision as of 6.5 years postoperatively, the disease has not progressed. Conclusion Transnasal, endoscopically-guided ventral surgical access to the sphenopalatine sinus is possible in horses and may improve access in horses with disease extending caudally beyond the palatine portion of the sinus. Use of smaller diameter or specialized instruments, such as various endoscopic bone cutting instruments, and CT image guidance may improve sinus access by this route.

Objective To report clinical features and outcomes of cats undergoing excision of intracranial meningiomas. Study Design Retrospective, multicenter case series. Sample Population One hundred and twenty-one cats. Methods Signalment, clinical signs, duration of clinical signs, preoperative drug therapy, diagnostic imaging reports, surgery, histopathology, and outcome were collected from records of cats undergoing excision of intracranial meningiomas. Survival estimates were made using Kaplan–Meier analysis. Results There were 76/121 neutered males and 83/121 domestic short-hairs. Body weight ranged from 1.5–8.7 kg (median 5.0 kg). Age at diagnosis ranged from 3-18 years (median 12 years). Clinical signs included changes in behavior, ataxia, seizures, visual deficits, circling, and paresis. Duration of neurologic signs ranged from

Objective To report clinical findings including severe hyperthermia and hypernatremia after transethmoidal Cavitron ultrasonic surgical aspirator (CUSA)-assisted diencephalic mass removal. Study Design Retrospective case series. Animals Dogs (n = 4) and 2 cats. Methods Medical records (1997–2003) of dogs and cats that had transethmoidal CUSA-assisted diencephalic mass removal were reviewed. Retrieved data were: history, signalment, blood work, neurologic examination findings, MRI results, histopathology, postoperative complications, pre- and postoperative medical therapy, and outcome. Results Tumor types included: meningioma (n = 3), choroid plexus papilloma (1), astrocytoma (1), and pituitary macroadenoma (1). Median onset of hyperthermia was 3.5 hours (range: 1–6 hours) after extubation; median high temperature at onset was 40.3°C, (range: 39.6–41.7°C). Median onset of hypernatremia (median, 172 mmol/L; range: 168–196 mmol/L) was 4.5 hours (range: 1–9 hours) after extubation. Median time of death after hyperthermia was 10.5 hours (range: 6–13 hours) and after extubation was 13.5 hours (range: 11–15 hours). Conclusions Transethmoidal CUSA-assisted diencephalic mass removal is associated with early postoperative hyperthermia, hypernatremia, and death, and cannot be recommended.

Treatment protocols, treatment planning methods and tumour types in studies evaluating radiotherapy for canine brain tumours have been varied. This case series retrospectively evaluated the outcome of definitive, three-dimensional conformal radiation therapy (3D-CRT) as either a sole modality or as an adjuvant to surgery in 31 dogs diagnosed with meningioma by histopathology (n = 10) or cross-sectional imaging of the head (n = 21, assessed independently by two board certified radiologists). Prescribed dose ranged from 45 to 54 Gy in 2.5 to 3 Gy fractions. Median overall survival was 577 days (interquartile range = 272-829 days; range = 30-1942 days) when all deaths were considered and 906 days (interquartile range = 336-912 days; range = 10 -1942 days) when only dogs dying due to meningioma were considered. No significant difference in survival time was detected for the defined clinical or imaging findings or between treatment with radiotherapy alone versus adjuvant radiotherapy, suggesting that 3D-CRT may be a viable alternative to surgery.

Objective: To report the clinical signs, imaging findings and surgical treatment of a meningoencephalocele in a cat. Study Design: Case report. Animal: Domestic shorthaired cat, 4 months old. Methods: A parietal meningoencephalocele was identified and characterized by magnetic resonance and computed tomography (CT) imaging. The abnormal tissue was excised and submitted for histopathology, and the meningeal and skull defects were reconstructed. Results: The cat made a full recovery and the episodes of aggression, restlessness and apparent discomfort that occurred before surgery ceased after surgical treatment. The cat was clinically normal 1 year postoperatively. Conclusion: Surgical management of meningoencephalocele in cats may be a viable treatment option.

Objective: To determine plasma pharmacokinetics of levetiracetam after a single intravenous dose (60 mg/kg) in normal dogs using a high-performance liquid chromatography assay validated for canine plasma. Design: Pharmacokinetic study. Setting: A university-based canine research facility. Animals: Six healthy adult dogs. Interventions: Intravenous drug administration, multiple blood sample procurement. Measurements and main results: There were no obvious adverse effects associated with the intravenous (IV) bolus administration of levetiracetam in any of the dogs. Plasma levetiracetam concentrations remained above or within the reported therapeutic range for humans (5–45 μg/mL) for all dogs, for all time periods evaluated. Mean and median (in parentheses) values for pharmacokinetic parameters included the following: maximum plasma concentration, 254 μg/mL (254 μg/mL); half-life, 4.0 hours (4.0 hours); volume of distribution at steady state, 0.48 L/kg (0.48 L/kg); clearance, 1.4 mL/kg/min (1.5 mL/kg/min); and median residence time, 6.0 hours (6.0 hours). Conclusions: In normal dogs, a 60 mg/kg IV bolus dose of levetiracetam is well tolerated and achieves plasma drug concentrations within or above the therapeutic range reported for humans for at least 8 hours after administration. Based on the favorable pharmacokinetics and tolerability demonstrated for IV levetiracetam in this study, in addition to previously demonstrated efficacy of oral levetiracetam, IV levetiracetam may be a useful treatment option for emergency management of canine seizure activity.

Objective: Reports of cerebellar infarction in veterinary literature are rare. Documentation and descriptions of cerebellar infarction in human literature have been well described. Brain lesions suspected to be infarcts have been recognized with magnetic resonance imaging (MRI). Series summary: Four dogs presented to the Long Island Veterinary Specialists (LIVS) with the history of acute onset cerebellovestibular dysfunction. All animals were imaged using a 0.5 T super-conducting Magna GE MRI unit. Suspected cerebellar infarction was diagnosed in all dogs based on history, physical examination, and MRI findings. Further diagnostics were performed based on the individual case and owner compliance. Functional recovery was favorable in 3 dogs. One dog was euthanized shortly following the onset of neurological dysfunction. New or unique information provided: Cerebellar infarction appears to have characteristic MRI features. Affected tissue within the cerebellum is typically wedge-shaped with low signal intensity in T1-weighted images, high signal intensity in T2-weighted images, subtle rim enhancement without central contrast enhancement in T1 post-gadolinium, and selectively hyperintense in fluid-attenuated inversion recovery images. Anatomic regions serviced by rostral cerebellar arteries are affected. Vascular risk factors as compared with reports in human literature are also discussed.

Objectives— To describe a cranioplasty procedure used in conjunction with foramen magnum decompression (FMD) for the treatment of canine caudal occipital malformation syndrome (COMS), and to evaluate the clinical outcome. Study Design— Prospective clinical study. Animals— Dogs (n=21) with COMS diagnosed by magnetic resonance imaging (MRI). Methods— After FMD, titanium screws were placed around the perimeter of the foramen magnum defect and a skull plate fashioned from titanium mesh and polymethylmethacrylate was attached to the back of the skull, using the titanium screws as anchor posts. Follow-up was obtained by direct examination by the authors, telephone interviews with owners and referring veterinarians, and a questionnaire sent to owners of surviving dogs designed to assign objective measures of response to surgical intervention. Surgical success was defined as improvement in ≥1 aspects of clinical dysfunction (e.g. scratching, pain) postoperatively. Owner-assigned pre- and postoperative quality-of-life (QOL) scores (1–5) for surviving dogs were compared using a Wilcoxon's signed rank test for paired data (P≤.05). Results— No intraoperative complications occurred and postoperative complications were limited to transient worsening of a pre-existing head tilt and ataxia in 1 dog, and the need for oral pain medication for 1–4 weeks in 3 dogs. Seventeen dogs (81%) had clinical improvement after surgery. Although clinical signs resolved in 1 dog, it died after being hit by a car, 5 months after surgery. One dog had no change in clinical signs; this patient's clinical signs were not severe and the owners had opted for surgery primarily to prevent progression of disease. Two dogs were euthanatized; 1 because of no improvement of severe clinical signs, and 1 because of sustained recurrence of apparent head and neck pain 7 months later. One dog required a dorsal laminectomy at a second site (C1/C2 vertebral level), 2 months later. Four dogs has transient “flare-ups” of apparent head/neck pain 2–13 months later; all resolved with transient re-institution of oral analgesic therapy. Further surgery at the FMD was not needed. Based on the returned questionnaires, there was an overall significant improvement in QOL scores. Conclusions— FMD with cranioplasty was well tolerated, with no intraoperative complications, and minor postoperative complications. Most dogs improved clinically, and none required further surgery at the original FMD site. Clinical Relevance— FMD with cranioplasty may be an effective surgical method of treating dogs with COMS and is well tolerated. Based on prior reports of FMD for this disorder, it appears that cranioplasty may reduce the rate of surgical failure caused by formation of compressive scar tissue at the FMD site in the short term. Results of this preliminary study support further evaluation of the cranioplasty procedure in a larger group of dogs over a more extended follow-up period.

Objective: To describe the clinical findings and magnetic resonance imaging (MRI) characteristics of two animals with suspected global brain ischemia (GBI). Series summary: Two brachycephalic animals (Persian cat and Boston terrier) presented for altered mentation, blindness, ataxia, and seizures after being anesthetized. Common to both anesthetic protocols was ketamine. Clinically, the neurological deficits developed rapidly and did not progress after the initial 24 hours. MRI findings were most consistent with GBI. MRI, including pre- and post-T1 weighted, T2 weighted, and fluid-attenuated inversion recovery (FLAIR) studies, was used to image these animals. Abnormalities were seen post-T1, T2, and FLAIR. Both animals improved neurologically with supportive care over several weeks, but both remained blind. New information: The use of MRI for diagnosing GBI.

Summary A ten-year-old, male castrated Springer Spaniel was presented for dysphagia, ptyalism, and regurgitation. Evidence of megaesophagus and mild aspiration pneumonia were apparent on thoracic radiographs. A diagnosis of focal acquired myasthenia gravis was suspected and subsequently confirmed with a positive serum acetylcholine (ACh) receptor antibody concentration (3.87 nM/L). A gastrostomy tube was placed shortly after presentation; food and drugs (including azathioprine) were administered through the tube. After transient improvement, the dog suddenly deteriorated clinically, experiencing frequent episodes of regurgitation and developing severe aspiration pneumonia. Mycophenolate mofetil (MMF), a novel immunosuppressive drug with relative specificity for lymphocytes, was instituted every twelve hours via the gastrostomy tube. Within four days of beginning MMF therapy, both clinical evidence of pharyngeal/esophageal dysfunction and radiographic evidence of megaesophagus had resolved. Initially, clinical side-effects of combined MMF/AZA administration were not apparent, but the patient experienced several vomiting episodes during the third week of treatment. The vomiting resolved after decreasing the dose of both drugs. The patient made a full recovery, and a one-month follow-up ACh receptor antibody concentration was normal (0.26 nM/L). After one month of combination therapy, the patient was weaned off of AZA and maintained on MMF as the sole immunosuppressive drug. The dog was subsequently weaned off of MMF on two occasions. Mycophenolate mofetil was reinstituted after the first discontinuation due to the development of profound appendicular muscle weakness two days after stopping MMF; the weakness resolved within 24 hours of reinstituting MMF. A positive ACh receptor antibody concentration (0.89 nM/L) after the second MMF weaning prompted the second reinstitution of MMF. Two months following this second MMF reinstitution, the dog was again serologically negative (0.51 nM/L) for myasthenia gravis. At the time of last followup, the dog remained in clinical remission eight months after initial presentation. The use of MMF to treat acquired myasthenia gravis in dogs has not been reported previously. The literature concerning MMF and its potential use in treating patients with autoimmune diseases is discussed.

Summary A 1 year old female Aurstralian Heeler dog was presented for fever and paraplegia of recent onset. Radiography and myelography revealed osteolysis of the first lumber (L1) vertebra and extensive epidural spinal cord compression from the level of the thirteenth thoracic (T13) to the fourth lumbar (L4) vertebra. A decompressive hemilaminectomy was performed; purulent-appearing fluid and inflamed epidural fat were present in the vertebral canal. The neurologic recovery of the dog was satisfactory 6 months following surgery.

Summary The accuracy of an inexpensive, easily implantable, epidural intracranial pressure (ICP) monitoring system was assessed in six normal cats by comparing measurements from this system to those obtained with a fiberoptic intraparenchymal monitoring system. The epidural monitoring system consisted of a three-way stopcock and saline-filled extension tubing, connected to a standard blood pressure transducer. Each cat was placed under halothane anesthesia and mechanically ventilated. Both an epidural and a fiberoptic intraparenchymal monitoring device were placed in the left cranium of each cat; correct placement was verified by computed tomography. Mean ICP values were simultaneously recorded from both monitoring devices. After obtaining baseline ICP measurements, the ICP was manipulated via ventilation, jugular compression, and pharmacologic agents. Arterial blood pressure levels, arterial blood gas values, end-tidal carbon dioxide levels, and end-tidal halothane levels were recorded throughout the study. Cerebral perfusion pressure was calculated for each level of ICP. Repeated measures analysis of variance method was used to compare mean ICP values between the two monitoring systems. No significant differences in ICP values obtained from the two systems were found (p>0.05) at any level of ICP. The results of this study show that the epidural monitoring system is a reliable alternative to the fiberoptic intraparenchymal ICP monitoring system in normal cats. The accuracy of the epidural monitoring system in pathologic states needs to be investigated.

The association of myelographic spinal cord swelling with neurological outcome was examined in 46 dogs with intervertebral disc disease and absence of deep pain perception (DPP). Spinal cord swelling was measured by calculating a ratio of the length of the loss of the myelographic dye column to the length of the second lumbar vertebra (L2). A positive neurological outcome was defined as return of voluntary motor function. A cut-off value for swelling:L2 of 5.0 was established by the creation of a receiver operator characteristic curve. Using a swelling:L2 ratio of 5.0 as a cutoff for indication of neurological recovery yielded a sensitivity of 74% and a specificity of 61%. Overall neurological recovery rate was 43%. Dogs with spinal cord swelling:L2 ratios less than 5.0 had a recovery rate of 61%, whereas dogs with a ratio greater than or equal to 5.0 had a recovery rate of 26%. Evaluation of these data by chi square analysis confirmed that a ratio less than 5.0 was associated with a positive outcome, and a ratio greater than or equal to 5.0 was associated with a negative outcome, (P < .05). Although other factors, such as duration of neurological signs, affect neurological outcome in dogs with no DPP, evaluation of myelographic spinal cord swelling can assist in establishing a prognosis.

Background: Granulomatous meningoencephalomyelitis (GME) is an idiopathic inflammatory disease of the central nervous system. Remission often is short-lived in dogs treated with glucocorticoids. Procarbazine is T cell-specific and crosses the blood-brain barrier. Hypothesis: Dogs with presumptive antemortem diagnosis of GME given procarbazine as adjunctive therapy to prednisone will have improved long-term outcome compared with dogs given no treatment or glucocorticoids alone. Animals: Two groups were studied: (1) Dogs with presumptive antemortem diagnosis of GME treated with procarbazine and prednisone (n = 21); (2) Dogs that had a histologic diagnosis of GME at postmortem examination and received no treatment (n = 11). Methods: Dogs with presumptive GME treated with procarbazine were identified retrospectively from medical records of 2 veterinary referral hospitals. Selection criteria required all dogs have a neurologic examination, blood work, cerebrospinal fluid analysis, and brain imaging (MRI or CT). Results: Median survival time for all dogs studied was 5.0 months. Median survival time for dogs treated with procarbazine was 14.0 months and for untreated dogs, 0.73 months. Treatment with procarbazine was significantly correlated with survival time (P < .001). Procarbazine was the only independent predictor of survival. Prednisone was reduced in dosage or discontinued in 17 dogs. Adverse reactions to procarbazine therapy included myelosuppression in 7 dogs and hemorrhagic gastroenteritis in 3 dogs. Conclusion: These data suggest that procarbazine treatment of presumptive GME may result in greater improved long-term outcome than has been previously reported for glucocorticoid treatment alone and may complement other immunomodulatory therapies. Procarbazine-treated dogs must be monitored for adverse reactions.