Postattenuation neurologic signs after surgical attenuation of congenital portosystemic shunts in dogs: A review.

Autor: Mullins RA; Section of Small Animal Clinical Sciences, University College Dublin, Dublin, Ireland., Escribano Carrera A; Section of Small Animal Clinical Sciences, University College Dublin, Dublin, Ireland., Anderson DM; Anderson Moores Veterinary Specialists, Winchester, UK., Billet JP; Centre Hospitalier Vétérinaire Atlantia, Nantes, France., Brissot H; Azurvet, Saint-Laurent-du-Var, France., Broome C; Veterinary Referral Hospital, Melbourne, Victoria, Australia., de Rooster H; Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium., Kirby BM; Section of Small Animal Clinical Sciences, University College Dublin, Dublin, Ireland., Pratschke KM; Veterinary Clinical Services, The Royal (Dick) School of Veterinary Studies and The Roslin Institute, Easter Bush Campus, Midlothian EH25 9RG, UK., Tivers MS; Paragon Veterinary Referrals, Paragon Business Village, Red Hall Crescent, Wakefield, UK., White RN; School of Veterinary Medicine & Science, University of Nottingham, Sutton Bonington Campus, Loughborough, UK., Yool DA; University of Glasgow, School of Veterinary Medicine, Glasgow, UK., Youmans KR; The Small Animal Surgeon Ltd, Auckland, New Zealand.
Jazyk: angličtina
Zdroj: Veterinary surgery : VS [Vet Surg] 2022 Jan; Vol. 51 (1), pp. 23-33. Date of Electronic Publication: 2021 Sep 29.
DOI: 10.1111/vsu.13729
Abstrakt: The development of postattenuation neurologic signs (PANS) is a poorly understood and potentially devastating complication after surgical attenuation of congenital portosystemic shunts in dogs. Postattenuation neurologic signs include seizures but also more subtle neurologic signs such as depression, behavioral changes, tremors, and twitching. They most commonly occur within 7 days postoperatively and are typically unrelated to hyperammonemia, hypoglycemia, or electrolyte disturbances. This narrative review summarizes the findings of 50 publications from 1988-2020 that report occurrence of PANS. While most published reports included only dogs affected by postattenuation seizures (PAS), others included dogs with any form of PANS. Overall, PANS (including PAS) affected 1.6%-27.3% of dogs, whereas incidence of PAS ranged from 0%-18.2%. The etiology of PANS remains unknown; however, several theories have been proposed. Risk factors include preoperative hepatic encephalopathy, increasing age, and possibly certain breeds and extrahepatic shunt morphology. There is increasing evidence that prophylactic antiepileptic drugs do not prevent PANS. Treatment is centered around controlling neurologic signs with antiepileptic drugs and providing supportive intensive care. The 30-day survival rate in studies that included a minimum of four dogs affected by PANS was 0%-100% (median, 50.0%) and 0%-75.0% (median, 37.5%) for those with PAS. Mortality associated with PANS was typically related to occurrence of generalized seizure activity. Prognostic factors positively associated with short-term survival included having a history of preoperative seizures and development of focal seizures only. If affected dogs survived to discharge, survival for several years was possible, and the majority of neurologic signs manifested as part of the phenomenon of PANS appeared to resolve.
(© 2021 The Authors. Veterinary Surgery published by Wiley Periodicals LLC on behalf of American College of Veterinary Surgeons.)
Databáze: MEDLINE
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