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.

Roberts, VLH
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Bailey, M
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Patel, NK

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.

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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.

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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