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Home / Equine Research Bank / Equine Vet J / The safety and efficacy of neuromodulation using percutaneou...
Equine veterinary journal2019; 52(2); 238-243; doi: 10.1111/evj.13174

The safety and efficacy of neuromodulation using percutaneous electrical nerve stimulation for the management of trigeminal-mediated headshaking in 168 horses.

Abstract: Early results from the use of neuromodulation by percutaneous electrical nerve stimulation for the management of trigeminal-mediated headshaking in horses were promising but lacked sufficient case numbers and long-term follow-up. The neuromodulatory procedure has since been established as EquiPENS™. Objective: The aim of this study was to report long-term results from a larger number of cases and to investigate for predictors of outcome. Methods: Prospective case series using international, multi-centre data. Methods: Eligible cases were horses with a veterinary diagnosis of trigeminal-mediated headshaking, which received EquiPENS™ neuromodulation at trained centres between August 2013 and November 2017. The standard protocol was an initial three-procedure course, with additional procedures should a horse go into remission but then relapse. Data collected included signalment, history, diagnostic tests performed, details of any complications, whether horses had gone into remission and the length of remission. Results: Results were obtained from 168 horses, with 530 procedures. The complication rate was 8.8% of procedures. In all but one case, complications were mild and transient, without self-trauma. Remission of headshaking following the initial course occurred in 53% (72/136) of horses. Median length of time recorded in remission was 9.5 weeks (range 2 days to 156 weeks ongoing). Where signs recurred, most horses went back into remission following additional procedures, usually for longer than from the previous procedure. No predictors for outcome were determined. Conclusions: No placebo or control group, owner-assessed results. Conclusions: EquiPENS™ neuromodulation can be an effective and safe treatment for the management of trigeminal-mediated headshaking in some horses. An increased understanding of neuromodulation could help optimise the technique. Advances in treatment for trigeminal-mediated headshaking will remain limited until there is a greater understanding of the aetiopathogenesis of the condition.
© 2019 The Authors. Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.
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Publication Date: 2019-09-23 PubMed ID: 31461784PubMed Central: PMC7317358DOI: 10.1111/evj.13174Google Scholar: Lookup
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Summary

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The research investigates the impact of using neuromodulation through percutaneous electrical nerve stimulation (EquiPENS™) in managing trigeminal-mediated headshaking in horses. It looks at long-term results from several case studies and attempts to identify predictors of outcome.

About the Study

  • This study is a prospective case series that used international, multi-centre data.
  • It focused on horses that received a veterinary diagnosis of trigeminal-mediated headshaking, and had undergone EquiPENS™ neuromodulation treatment at various trained centers between August 2013 and November 2017.
  • The standard protocol of treatment included an initial course of three procedures, followed by additional procedures, only if the horse initially went into remission but later relapsed.
  • Data collected from the study included information about the horse’s signalment (physiological/clinical profile), history, the diagnostic tests performed, details of any complications that occurred, and whether the horse had gone into remission, and if so, for how long.

Results

  • The study collected results from 168 horses, which amounted to 530 procedures.
  • The complication rate noted was 8.8% of the procedures.
  • Excluding one instance, all complications were mild, temporary, and did not result in self-trauma.
  • 53% (72/136) of the horses experienced remission of headshaking following the initial course of treatment.
  • The median period of remission recorded was 9.5 weeks, ranging between 2 days to 156 weeks (and ongoing).
  • In cases where signs recurred, most horses revisited remission upon subsequent procedures, often for longer durations than the initial remission period.

Conclusions

  • The study did not include a placebo or control group and received owner-assessed results.
  • It concluded that EquiPENS™ neuromodulation can be an effective and safe treatment for managing trigeminal-mediated headshaking in some horses.
  • It also highlighted the need for a greater understanding of neuromodulation to optimize the technique.
  • The study indicated a need for deepening our understanding of the aetiopathogenesis (cause and development) of trigeminal-mediated headshaking before any significant advancements in the treatment can be achieved.

Cite This Article

APA
Roberts VLH, Bailey M, Patel NK. (2019). The safety and efficacy of neuromodulation using percutaneous electrical nerve stimulation for the management of trigeminal-mediated headshaking in 168 horses. Equine Vet J, 52(2), 238-243. https://doi.org/10.1111/evj.13174

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English
Volume: 52
Issue: 2
Pages: 238-243

Researcher Affiliations

Roberts, V L H
  • Bristol Veterinary School, University of Bristol, Somerset, UK.
Bailey, M
  • Bristol Veterinary School, University of Bristol, Somerset, UK.
Patel, N K
  • Institute of Neurosciences, Southmead Hospital Bristol, Westbury-on-Trym, Bristol, UK.

MeSH Terms

  • Animals
  • Horse Diseases
  • Horses
  • Prospective Studies
  • Transcutaneous Electric Nerve Stimulation / veterinary
  • Trigeminal Nerve

Grant Funding

  • Academy of Medical Sciences
  • Wellcome Trust's Inspire Research Studentship

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Citations

This article has been cited 7 times.
  1. 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).
    doi: 10.3390/ani13010064pubmed: 36611674google scholar: lookup
  2. Aleman M, Sheldon SA, Jospin G, Coil D, Stratton-Phelps M, Eisen J. Caecal microbiota in horses with trigeminal-mediated headshaking. Vet Med Sci 2022 May;8(3):1049-1055.
    doi: 10.1002/vms3.735pubmed: 35060350google scholar: lookup
  3. Rodríguez-Palma EJ, Allen HN, Nelson TS, Khanna R. Innovating pain research: bridging gaps and shaping the future. Pain 2025 Nov 1;166(11S):S15-S18.
    doi: 10.1097/j.pain.0000000000003661pubmed: 41086321google scholar: lookup
  4. Heun F, Delarocque J, Feige K, Hellige M. Trigeminal Nerve Asymmetry in Horses With Idiopathic Trigeminal-Mediated Headshaking: A Retrospective Case-Control Magnetic Resonance Imaging Study. J Vet Intern Med 2025 Sep-Oct;39(5):e70196.
    doi: 10.1111/jvim.70196pubmed: 40739903google scholar: lookup
  5. Franzen V, Gruber NA, Klußmann S, Schoster A, May A. Effect of repetitive transcranial magnetic stimulation on trigeminal-mediated headshaking in 17 horses. J Vet Intern Med 2024 Sep-Oct;38(5):2758-2765.
    doi: 10.1111/jvim.17194pubmed: 39264234google scholar: lookup
  6. Pickles KJ, Marlin DJ, Williams JM, Roberts VLH. Use of a poll-mounted accelerometer for quantification and characterisation of equine trigeminal-mediated headshaking. Equine Vet J 2025 May;57(3):645-653.
    doi: 10.1111/evj.14132pubmed: 39020521google scholar: lookup
  7. Nessler JN, Delarocque J, Kloock T, Twele L, Neudeck S, Meyerhoff N, Riese F, Cavalleri JV, Tipold A, Feige K, Niebuhr T. Sensory nerve conduction stimulus threshold measurements of the infraorbital nerve and its applicability as a diagnostic tool in horses with trigeminal-mediated headshaking. BMC Vet Res 2024 May 16;20(1):201.
    doi: 10.1186/s12917-024-04068-xpubmed: 38750534google scholar: lookup
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