Neuromodulation using percutaneous electrical nerve stimulation for the management of trigeminal-mediated headshaking: A safe procedure resulting in medium-term remission in five of seven horses.
Abstract: There are no consistently safe and effective methods for the treatment of trigeminal-mediated headshaking in horses. In affected horses, the trigeminal nerve is sensitised, appearing to result in neuropathic pain. Percutaneous electrical nerve stimulation (PENS) therapy is a minimally invasive neuromodulatory treatment used in people to manage neuropathic pain. Objective: To determine whether PENS therapy is safe, tolerated and effective for the management of trigeminal-mediated headshaking in horses. Methods: Descriptive case series. Methods: Seven horses diagnosed with trigeminal-mediated headshaking and currently showing clinical signs were studied. All procedures were carried out in sedated horses with a needle-prick sized area of skin desensitised with local anaesthetic to facilitate probe insertion. A disposable PENS probe was advanced subcutaneously adjacent to the nerve, rostral to the infraorbital foramen under ultrasonographic guidance. The nerve was stimulated for 25 min following a protocol of alternating frequencies and a perception threshold based on human clinical data. The probe was removed and the procedure repeated on the contralateral side. The protocol used comprised a series of 3 or 4 treatments, with treatments being repeated when signs of headshaking recurred. Results: All horses tolerated the procedure well. Three horses developed a haematoma at the site on one occasion and 2 had increased clinical signs for up to 3 days following first treatment. Six horses demonstrated a positive response to their first treatment, returning to ridden work at the same level as prior to onset of headshaking, with 5 continuing to respond. Median remission time for first treatment was 3.8 days (range 0-8 days, n = 7), second treatment 2.5 weeks (0-8 weeks, n = 7), third treatment 15.5 weeks (0-24 weeks, n = 5) and fourth treatment 20 weeks (12-28 weeks ongoing, n = 2). Conclusions: Percutaneous electrical nerve stimulation therapy is a safe, well tolerated, minimally invasive, repeatable management option for trigeminal-mediated headshaking, with encouraging efficacy for amelioration of clinical signs in the short- to medium term.
© 2015 EVJ Ltd.
Publication Date: 2015-04-08 PubMed ID: 25475743DOI: 10.1111/evj.12394Google Scholar: Lookup
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- Journal Article
- Research Support
- Non-U.S. Gov't
Summary
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The research investigates the use and efficacy of percutaneous electrical nerve stimulation (PENS) for treating trigeminal-mediated headshaking in horses. It found the procedure to be safe and well-tolerated with encouraging results in the short to medium term.
Research Objective
- The objective of this study is to discover if Percutaneous Electrical Nerve Stimulation (PENS) therapy is a safe and effective treatment option for horses that display symptoms of trigeminal-mediated headshaking.
Research Methods
- Study includes a descriptive case series, consisting of seven horses diagnosed with trigeminal-mediated headshaking. Each horse was sedated, and a small area of skin was desensitized with local anesthesia to facilitate PENS probe insertion adjacent to the nerve, this was performed with ultrasonic guidance.
- The nerve was then stimulated for 25 minutes with varying frequencies following a protocol based on human clinical data. The procedure was performed on both sides of the head, with a series of 3 or 4 treatments repeated as and when symptoms recurred.
Results
- All horses in the study tolerated the procedure well. While three horses developed a haematoma at the site of procedure once, and two experienced amplified symptoms for around three days after initial treatment.
- Six out of seven horses showed positive response to the first treatment, returning to their prior levels of activity and behavior. Out of these, five continued to respond positively to the treatment.
- The median time for the first remission was recorded as 3.8 days, for the second 2.5 weeks, for the third 15.5 weeks and for the fourth 20 weeks.
Conclusions
- The results suggest that PENS therapy is a safe, well-tolerated, minimally invasive and repeatable treatment option for trigeminal-mediated headshaking in horses, with promising outcomes for alleviating symptoms in the short- to medium-term.
Cite This Article
APA
Roberts VL, Patel NK, Tremaine WH.
(2015).
Neuromodulation using percutaneous electrical nerve stimulation for the management of trigeminal-mediated headshaking: A safe procedure resulting in medium-term remission in five of seven horses.
Equine Vet J, 48(2), 201-204.
https://doi.org/10.1111/evj.12394 Publication
Researcher Affiliations
- School of Veterinary Sciences, University of Bristol, Somerset, UK.
- Institute of Neurosciences, Southmead Hospital, Bristol, UK.
- School of Veterinary Sciences, University of Bristol, Somerset, UK.
MeSH Terms
- Animals
- Head
- Head Movements / physiology
- Horse Diseases / therapy
- Horses
- Transcutaneous Electric Nerve Stimulation
- Trigeminal Nerve / physiology
Citations
This article has been cited 9 times.- Hyytiäinen HK, Boström A, Asplund K, Bergh A. A Systematic Review of Complementary and Alternative Veterinary Medicine in Sport and Companion Animals: Electrotherapy.. Animals (Basel) 2022 Dec 23;13(1).
- Johnson JP, Vinardell T, David F. Ultrasound-guided injections of the equine head and neck: review and expert opinion.. J Equine Sci 2021 Dec;32(4):103-115.
- Zhang B, Wang W, Wang S, Li S, Liu M, Wang L, Yang C. Clinical Study on Electronic Medical Neuroelectric Stimulation Based on the Internet of Things to Treat Epilepsy Patients with Anxiety and Depression.. J Healthc Eng 2021;2021:6667309.
- Roberts VLH, Bailey M, Patel NK. The safety and efficacy of neuromodulation using percutaneous electrical nerve stimulation for the management of trigeminal-mediated headshaking in 168 horses.. Equine Vet J 2020 Mar;52(2):238-243.
- Sheldon SA, Aleman M, Costa LRR, Weich K, Howey Q, Madigan JE. Effects of magnesium with or without boron on headshaking behavior in horses with trigeminal-mediated headshaking.. J Vet Intern Med 2019 May;33(3):1464-1472.
- Sheldon SA, Aleman M, Costa LRR, Santoyo AC, Howey Q, Madigan JE. Intravenous infusion of magnesium sulfate and its effect on horses with trigeminal-mediated headshaking.. J Vet Intern Med 2019 Mar;33(2):923-932.
- Roberts V. Trigeminal-mediated headshaking in horses: prevalence, impact, and management strategies.. Vet Med (Auckl) 2019;10:1-8.
- Bell C, Hnenny L, Torske K. Internal neurolysis of the maxillary branch of the trigeminal nerve for the treatment of equine trigeminal mediated headshaking syndrome.. Can Vet J 2018 Jul;59(7):763-769.
- Roberts VL, Fews D, McNamara JM, Love S. Trigeminal Nerve Root Demyelination Not Seen in Six Horses Diagnosed with Trigeminal-Mediated Headshaking.. Front Vet Sci 2017;4:72.
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