Terapia medica dell'epilessia idiopatica nel cane: stato dell'arte e nuove prospettive

Abstract

Epilepsy is a disease of the brain characterized by a persistent predisposition to generate epileptic seizures. The diagnosis of idiopathic epilepsy in dogs is a diagnosis of exclusion, which is made based on the age at seizure onset, insignificant interictal physical and neurological examinations and the exclusion of brain disorders of metabolic, toxic and structural origin by diagnostic investigations. To date, the therapy of idiopathic epilepsy in dogs is symptomatic treatment, as it is limited to seizure control, commonly through the chronic administration of antiepileptic drugs (AEDs). The AEDs primarily used in dogs are phenobarbital, potassium bromide and imepitoin, but more recently discovered drugs that are approved for use in humans and appear to be relatively safe in dogs are also used as adjunctive treatment. However, despite adequately managed polypharmacy, 20-30% of dogs with idiopathic epilepsy continue to experience seizures that are difficult to control. Furthermore, AED-related side effects contribute to the reduction of the quality of life not only of the dog, but also of the owner, sometimes leading to the premature death of the animal following euthanasia. This underlines the importance of new treatment strategies, which should be alternative or supportive to pharmacological therapy, to improve the well-being of dogs with epilepsy. In this regard, studies conducted in recent years indicate that the use of low doses of CBD isolates or CBD-rich formulations associated with antiepileptic therapy may be safe and effective in improving seizure control. Recent reports have also demonstrated the importance of specialized nutrition as a treatment strategy for canine epilepsy. In particular, a promising diet in dogs is one that includes medium-chain triglycerides (MCTs): this has not only improved seizure control in most studies, but has also demonstrated potentially beneficial effects on the behavioral comorbidities of canine epilepsy. Finally, promising results in human clinical practice have triggered an interest in neurostimulation as an additional therapeutic option for seizure control in drug-resistant subjects also in Veterinary Medicine, especially vagus nerve stimulation, deep brain stimulation and transcranial magnetic stimulation. In relation to these potential new therapeutic approaches, although the results of some studies appear to be promising, larger, randomized controlled clinical trials are needed to draw conclusions regarding the efficacy and safety of these treatments.