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EQUINE VETERINARY EDUCATION


Equine vet. Educ. (2018) 30 (4) 170-171 doi: 10.1111/eve.12907


Highlights of recent clinically relevant papers


Cranial nuchal bursitis In this retrospective case series Amanda Bergren and colleagues in the USA and the Netherlands analysed medical records of horses diagnosed with cranial nuchal bursitis to further characterise associated diagnostic, management and prognostic factors. Thirty horses met the inclusion criteria, 21 of which were


geldings and nine mares. The most common presenting clinical signs were swelling over the cranial nuchal bursa, pain upon poll palpation, reduced flexion of the neck and abnormal head carriage. Radiographs were obtained in 27/ 30 cases; 22 of which had radiographic abnormalities. All horses underwent ultrasonography, which showed synovial effusion in most cases. Ten horses were treated with medication only (box rest and


nonsteroidal anti-inflammatory drugs or intrabursal injection of corticosteroids), 16 underwent surgery (bursoscopic debridement and lavage) and four underwent surgical treatment following failed medical management. Of the 24 horses that had follow-up information available, 10 had recurrence of clinical signs; the most common of which was residual swelling of the poll region. Horses that underwent surgery after a failed response to medical treatment were more likely to have recurrence of clinical signs, while horses that underwent surgical treatment only were less likely to have recurrence. There was no significant difference between the different treatment groups and the likelihood of return to their previous level of work. These results indicate that horses with cranial nuchal


bursitis have a fair prognosis for return to their previous level of work, but recurrence of clinical signs is common.


Diagnosis of neurological abnormalities


In this study William Saville and colleagues in the USA and Australia investigated interobserver variation when performing neurological examinations in horses. The diagnosis of equine protozoal myeloencephalitis


(EPM) relies heavily on the clinical examination. Accurate identification of neurological signs during a clinical examination is critical to the interpretation of laboratory results. This study investigated the level of agreement between board-certified veterinary internists when performing neurological examinations in 97 horses admitted to a veterinary teaching hospital. A prospective epidemiological research design was used.


Horses enrolled in the study were examined by the internist responsible for care of the horse, and later by an internist who was not aware of the presenting complaint or other case history. Data were analysed by descriptive statistics, and kappa statistics were calculated to assess interobserver agreement. Overall, examiners agreed that 60/97 (61.9%) were


clinically abnormal, 21/97 (21.6%) were clinically normal, and the status of 16/97 (16.5%) of horses was contested. There was complete agreement among the examiners with regard to cranial nerve signs and involuntary movements. Disagreement involving severity of clinical signs occurred in 31 horses, with 25 of those horses (80.6%) considered either


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normal or mildly affected by the primary observer. When examining the results of all paired clinical examinations for 11 different categories, there was wide variability in the results. When examiners rated the presence or absence of any neurological abnormalities, lameness, or ataxia, the agreement among observers was either good or excellent for 80% of horses. When assessing truncal sway, the agreement among observers was good or excellent for 60% of the horses. When examining the horses for asymmetry of deficits, agreement was either good or excellent for 40% of the horses. Agreement among observers was excellent or good for only 20% of the horses when assessing muscle atrophy, spasticity (hypermetria), and overall assessment of the severity of neurological abnormalities. This study underscores the subjectivity of the neurological


examination and demonstrates a reasonable level of agreement that may be achieved when different clinicians examine the same horse.


Levetiracetam pharmacokinetics in foals


In this randomised crossover study Katherine MacDonald and colleagues in the USA aimed to describe the pharmacokinetics of the anticonvulsant levetiracetam in neonatal foals. Six healthy Quarter Horse foals aged <1–3 days were


recruited into the study and administered a single 32 mg/kg bwt dose of levetiracetam either intravenously (IV) or intragastrically (IG); the dose of which was extrapolated from pharmacokinetic data reported for adult horses. In order to determine plasma levetiracetam concentrations all foals were blood sampled at 0, 5, 10, 15, 20, 35, 45, 60 and 90 min and 2, 3, 4, 6, 8, 10, 12, 24, 36 and 48 h after administration. There were no apparent adverse effects associated with administration of the levetiracetam and plasma concentrations remained within the proposed therapeutic range (5–45 mg/L) and above the proposed target concentration (35 mg/L) for at least 12 h for both IV and IG administration. Bioavailability for IG administration was excellent, and there was no significant difference in the pharmacokinetic variables between IV and IG administration. The authors concluded that administering levetiracetam


to neonatal foals at a dose of 32 mg/kg bwt IV or orally twice daily is likely to maintain therapeutic plasma concentrations.


Insulin dysregulation assessment


In this study Tobias Warnken and colleagues in Germany analysed insulin responses to standard dosed oral glucose tests (OGTs) via nasogastric tubing with the aim of defining a clinically useful cut-off value. Insulin dysregulation (ID) with basal or postprandial


hyperinsulinaemia is one of the key findings in horses and ponies suffering from equine metabolic syndrome (EMS). Insulin dysregulation can easily be assessed in clinical settings by performing oral glucose challenge tests. Oral glucose test performed with 1 g/kg bwt glucose administered via nasogastric tube allows the exact administration of a defined glucose dosage in a short time. However, reliable cut-off

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