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      Electroencephalographic evaluation under standing sedation using sublingual detomidine hydrochloride in Egyptian Arabian foals for investigation of epilepsy

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          Abstract

          Background

          A standardized protocol for electroencephalography (EEG) under standing sedation for the investigation of epilepsy in foals is needed.

          Hypothesis/Objectives

          To evaluate a modified standardized EEG protocol under standing sedation using sublingual detomidine hydrochloride in Egyptian Arabian foals.

          Animals

          Nineteen foals (controls, 9; juvenile idiopathic epilepsy [JIE], 10).

          Methods

          Descriptive clinical study. Foals were classified as controls or epileptic based on history or witnessed seizures and neurological examination. Foals were sedated using sublingual detomidine hydrochloride at a dosage of 0.08 mg/kg to avoid stress associated with injectable sedation. Once foals appeared sedated with their heads low to the ground and with wide base stance (30 minutes), topical lidocaine hydrochloride was applied at the determined locations of EEG electrodes. Fifteen minutes were allowed for absorption and electrodes were placed, protected, and EEG recording performed.

          Results

          Level of sedation was considered excellent with no need of redosing. The EEG recording lasted from 27 to 51 minutes and provided interpretable data. Epileptic discharges (ED) were noted predominantly in the central‐parietal region in 9 of 10 epileptic foals. Photic stimulation triggered ED in 7 of 10 epileptic foals and in none of the controls. Foals were not oversedated and recovered uneventfully.

          Conclusions and Clinical Importance

          Sublingual detomidine hydrochloride is a safe, painless, simple, and effective method of sedation for EEG recording in foals. Sublingual sedation allowed the investigation of cerebral electrical activity during states of sleep and arousal, and during photic stimulation for the investigation of epilepsy in foals.

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          Most cited references26

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          ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology

          The International League Against Epilepsy (ILAE) Classification of the Epilepsies has been updated to reflect our gain in understanding of the epilepsies and their underlying mechanisms following the major scientific advances that have taken place since the last ratified classification in 1989. As a critical tool for the practicing clinician, epilepsy classification must be relevant and dynamic to changes in thinking, yet robust and translatable to all areas of the globe. Its primary purpose is for diagnosis of patients, but it is also critical for epilepsy research, development of antiepileptic therapies, and communication around the world. The new classification originates from a draft document submitted for public comments in 2013, which was revised to incorporate extensive feedback from the international epilepsy community over several rounds of consultation. It presents three levels, starting with seizure type, where it assumes that the patient is having epileptic seizures as defined by the new 2017 ILAE Seizure Classification. After diagnosis of the seizure type, the next step is diagnosis of epilepsy type, including focal epilepsy, generalized epilepsy, combined generalized, and focal epilepsy, and also an unknown epilepsy group. The third level is that of epilepsy syndrome, where a specific syndromic diagnosis can be made. The new classification incorporates etiology along each stage, emphasizing the need to consider etiology at each step of diagnosis, as it often carries significant treatment implications. Etiology is broken into six subgroups, selected because of their potential therapeutic consequences. New terminology is introduced such as developmental and epileptic encephalopathy. The term benign is replaced by the terms self-limited and pharmacoresponsive, to be used where appropriate. It is hoped that this new framework will assist in improving epilepsy care and research in the 21st century.
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            The ten-twenty electrode system of the International Federation. The International Federation of Clinical Neurophysiology.

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              International League Against Epilepsy classification and definition of epilepsy syndromes with onset in childhood: Position paper by the ILAE Task Force on Nosology and Definitions.

              The 2017 International League Against Epilepsy classification has defined a three-tier system with epilepsy syndrome identification at the third level. Although a syndrome cannot be determined in all children with epilepsy, identification of a specific syndrome provides guidance on management and prognosis. In this paper, we describe the childhood onset epilepsy syndromes, most of which have both mandatory seizure type(s) and interictal electroencephalographic (EEG) features. Based on the 2017 Classification of Seizures and Epilepsies, some syndrome names have been updated using terms directly describing the seizure semiology. Epilepsy syndromes beginning in childhood have been divided into three categories: (1) self-limited focal epilepsies, comprising four syndromes: self-limited epilepsy with centrotemporal spikes, self-limited epilepsy with autonomic seizures, childhood occipital visual epilepsy, and photosensitive occipital lobe epilepsy; (2) generalized epilepsies, comprising three syndromes: childhood absence epilepsy, epilepsy with myoclonic absence, and epilepsy with eyelid myoclonia; and (3) developmental and/or epileptic encephalopathies, comprising five syndromes: epilepsy with myoclonic-atonic seizures, Lennox-Gastaut syndrome, developmental and/or epileptic encephalopathy with spike-and-wave activation in sleep, hemiconvulsion-hemiplegia-epilepsy syndrome, and febrile infection-related epilepsy syndrome. We define each, highlighting the mandatory seizure(s), EEG features, phenotypic variations, and findings from key investigations.
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                Author and article information

                Contributors
                mraleman@ucdavis.edu
                Journal
                J Vet Intern Med
                J Vet Intern Med
                10.1111/(ISSN)1939-1676
                JVIM
                Journal of Veterinary Internal Medicine
                John Wiley & Sons, Inc. (Hoboken, USA )
                0891-6640
                1939-1676
                07 April 2023
                May-Jun 2023
                : 37
                : 3 ( doiID: 10.1111/jvim.v37.3 )
                : 1209-1215
                Affiliations
                [ 1 ] Equine Veterinary Medical Center Member of Qatar Foundation Doha Qatar
                [ 2 ] Division of Pediatric Neurology Sidra Medicine Doha Qatar
                [ 3 ] College of Veterinary Medicine Purdue University West Lafayette Indiana USA
                [ 4 ] Department of Medicine and Epidemiology School of Veterinary Medicine, University of California Davis California USA
                [ 5 ]Present address: Precision Therapy Mazy Belgium
                Author notes
                [*] [* ] Correspondence

                Monica Aleman, School of Veterinary Medicine, University of California, Tupper Hall 2108, One Shields Avenue, Davis, California, USA.

                Email: mraleman@ 123456ucdavis.edu

                Author information
                https://orcid.org/0000-0002-4902-6725
                https://orcid.org/0000-0001-5811-9520
                Article
                JVIM16695
                10.1111/jvim.16695
                10229339
                37029498
                2e09f6ba-1f57-41a6-bb6a-f65933072fae
                © 2023 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC. on behalf of the American College of Veterinary Internal Medicine.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 31 January 2023
                : 24 March 2023
                Page count
                Figures: 5, Tables: 0, Pages: 7, Words: 4860
                Funding
                Funded by: Equine Veterinary Medical Center‐Member of Qatar Foundation
                Award ID: RG22_TV1
                Funded by: University of California, Department of Medicine and Epidemiology , doi 10.13039/100005595;
                Award ID: V435AM2
                Funded by: Sidra Medicine , doi 10.13039/100019475;
                Categories
                Standard Article
                EQUINE
                Standard Articles
                Neurology
                Custom metadata
                2.0
                May/June 2023
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.2.8 mode:remove_FC converted:30.05.2023

                Veterinary medicine
                electroencephalogram,epilepsy,paroxysmal,photic,sedation,seizures
                Veterinary medicine
                electroencephalogram, epilepsy, paroxysmal, photic, sedation, seizures

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