ISSN 2398-2950      

Therapeutics: neurological system

ffelis

Introduction

  • This article gives an overview on some of the products that may be utilized when treating neurological cases.
  • Drug therapy for diseases of the central nervous system (CNS) involves the following complicating factors:
    •  Drug penetration across the blood-brain barrier (BBB).
    • Therapeutic effect on CNS.
    • Potential for adverse effects.
  • Drugs capable of crossing BBB are of either small molecular weight or are highly lipophilic:
    • Ionization - this affects lipophilicity, only neutral (uncharged) drugs enter CNS.
    • Lipophilicity - small lipophilic drugs cross BBB more easily than larger more hydrophilic drugs.
    • Molecular size - molecular mass threshold for crossing BBB is <400-500 Daltons.
    • Carrier-mediated transport - via facilitated diffusion or active transport mechanisms.
    • P-glycoprotein - this is a transmembrane protein coded by the multidrug resistance gene ABCB1 and it pumps drugs out of CNS therefore an integral part of the functional BBB.
Many of these drugs are not licensed in veterinary species, and licensing varies across the world. It is therefore advisable to check with the local authority prior to administration.

Anti-microbial drug therapy

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Anti-inflammatory therapy

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Anti-cancer chemotherapy of the nervous system

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Anti-epiletics

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Stee K, Broeckx B J G, Targett M, Gomes S & Lowrie M (2020) Cytosine arabinoside constant rate infusion without subsequent subcutaneous injections for the treatment of dogs with meningoencephalomyelitis of unknown origin. Vet Rec /dx.doi.org/10.1136/vr.106019.
  • Stabile F, Van Dijk J, Barnett C R, De Risio L (2019) Epileptic seizure frequency and semiology in dogs with idiopathic epilepsy after initiation of imepitoin or phenobarbital monotherapy. The Vet J 249, 53-57 PubMed.
  • Tauro A, Beltran E, Cherubini G B, Coelho A T, Wessmann A, Driver C J, Rusbridge C J (2018) Metronidazole-induced neurotoxicity in 26 dogs. Aust Vet J 96(12), 495-501 doi: 10.1111/avj.12772.
  • Lowrie M, Thomson S, Smith P & Garosi L (2016) Effect of a constant rate infusion of cytosine arabinoside on mortality in dogs with meningoencephalitis of unknown origin. Vet J 213, 1-5 PubMed.
  • De Risio L, Bhatti S, Muñana K, Penderis J, Stein V, Tipold A, Berendt M, Farqhuar R, Fischer A, Long S, Mandigers P J J, Matiasek K, Packer R M A, Pakozdy A, Patterson N, Platt S, Podell M, Potschka H., Batlle P M, Rusbridge C, Volk H A (2015) International veterinary epilepsy task force consensus proposal: diagnostic approach to epilepsy in dogs. BMC Vet Res 11, 148 PubMed.
  • Packer R M, Shihab N K, Torres B B et al (2015) Responses to successive anti-epileptic drugs in canine idiopathic epilepsy. Vet Rec 176 (8), 203 PubMed.
  • Potschka H, Fischer A, Löscher W, Patterson N, Bhatti S, Berendt M, De Risio L, Farquhar R, Long S, Mandigers P, Matiasek K, Muñana K, Pakozdy A, Penderis J, Platt S, Podell M, Rusbridge C, Stein V, Tipold A, Volk H A (2015) International veterinary task force consensus proposal: outcome of therapeutic interventions in canine and feline epilepsy. BMC Vet Res 11, 177 PubMed.
  • Tipold A, Keefe T J, Loscher W, Rundfeldt C, De Vries F (2015) Clinical efficacy and safety of imepitoin in comparison with phenobarbital for the control of idiopathic epilepsy in dogs. J Vet Pharmacol Ther 38 (2), 160-168 PubMed.
  • Peters R K, Schubert T, Clemmons R et al (2014) Levetiracetam rectal administration in healthy dogs. JVIM 28 (2), 504-509 PubMed.
  • Jeffery N D (2014) Corticosteroid use in small animal neurology. Vet Clin North Am Small Anim Pract 44(6), 1059-1074 doi: 10.1016/j.cvsm.2014.07.004
  • Lowrie M, Smith P and Garosi L (2013) Meningoencephalitis of unknown origin: Investigation of prognostic factors and outcome using a standard treatment protocol. Vet Rec 172, 527 PubMed.
  • Boothe D M, Dewey C & Carpenter D M (2012) Comparison of phenobarbital with bromide as a first-choice antiepileptic drug for treatment of epilepsy in dogs. JAVMA 240 (9), 1073-1083 PubMed.
  • Monteiro R, Adams V, Keys D, Platt S R (2012) Canine idiopathic epilepsy: prevalence, risk factors and outcome associated with cluster seizures and status epilepticus. JSAP 53 (9), 526-530 PubMed
  • Dewey C W, Cerda-Gonzalez S, Fletcher D J, Harb-Hauser M F, Levine J M, Badgley B L, Olby N J, Shelton G D (2010) Mycophenolate mofetil treatment in dogs with serologically diagnosed acquired myasthenia gravis: 27 cases (1999-2008). J Am Vet Med Asso236(6), 664-668 doi: 10.2460/javma.236.6.664.
  • Abelson A L, Shelton G D, Whelan M F, Cornejo L, Shaw S, O'Toole T E (2009) Use of mycophenolate mofetil as a rescue agent in the treatment of severe generalized myasthenia gravis in three dogs. J Vet Emerg Crit Care (San Antonio) 19(4), 369-374. doi: 10.1111/j.1476-4431.2009.00433.x
  • Dewey C W, Guiliano R, Boothe D M et al (2004) Zonisamide therapy for refractory idiopathic epilepsy in dogs. JAAHA 40 (4), 285-291 PubMed.
  • Dewey C W, Coates J R, Ducoté J M, Meeks J C, Fradkin J M (1999) Azathioprine therapy for acquired myasthenia gravis in five dogs. J Am Anim Hosp Assoc 35(5), 396-402 doi: 10.5326/15473317-35-5-396.

Other sources of information

  • Papich MG (2013) Drug therapy for diseases if the central nervous system. In: BSAVA Manual of Canine and Feline Neurology. 4th edn. Platt S & Olby N (eds). BSAVA, Gloucester, UK.
  • Lappin M R (2000) Protozoal and miscellaneous infections. In: Textbook of Veterinary Internal Medicine. 5th edn. Ettinger S J & Feldman E C (eds). W B Saunders, Philadelphia. pp 408-417.
  • Plumb D C (1999) Veterinary Drug Handbook. 3rd edn. Iowa State University Press, Ames Iowa.

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