@article{mondino_nettifee_muñana_2025, title={An Exploratory Study on the Relationship Between Idiopathic Epilepsy and Sleep in Dogs}, url={https://doi.org/10.1111/jvim.70026}, DOI={10.1111/jvim.70026}, journal={Journal of Veterinary Internal Medicine}, author={Mondino, Alejandra and Nettifee, Julie and Muñana, Karen R.}, year={2025}, month={Mar} }
 @article{nagendran_nettifee_carter_munana_2025, title={Characterization of post-ictal clinical signs in dogs with idiopathic epilepsy: A questionnaire-based study}, volume={39}, ISSN={["1939-1676"]}, DOI={10.1111/jvim.17302}, abstractNote={Abstract Background Post‐ictal (PI) clinical signs are a key defining stage of seizure manifestation in dogs. However, this phase remains poorly understood. Objectives To further characterize PI signs and their relation to other parts of a seizure, and understand the owner's perception of how PI signs affect the quality of life (QOL) of the dog. Animals Eight‐seven dogs with a diagnosis of idiopathic epilepsy from a single institution. Methods The prospective questionnaire‐based study surveying owners of dogs previously and newly diagnosed with idiopathic epilepsy. Results Post‐ictal signs were identified in 79/87 dogs, 5/5 of dogs with focal seizures and 74/82 of dogs with generalized seizures. Median duration of PI signs was 30 minutes (range, 5‐4320 minutes). The most common PI signs reported were disorientation (50/79) and wobbliness or clumsiness (49/79). Within a year, a change in PI signs was seen in 18/79 dogs. The administration of benzodiazepines was significantly associated with an increase in duration of PI signs ( P = .04). Post‐ictal signs had more impact on dogs' quality of life compared with ictal signs ( P < .01). Groupings of co‐existing PI signs identified included disorientation, blindness and deafness. Conclusion Post‐ictal signs are a commonly reported aspect of seizures in dogs with idiopathic epilepsy, both in focal as well as generalized seizures. Co‐existence of signs could provide some valuable insight into the relevance of this particular phase of a seizure. Owner‐reported signs and documentation emphasize the need for a better understanding of PI signs in dogs with idiopathic epilepsy.}, number={1}, journal={JOURNAL OF VETERINARY INTERNAL MEDICINE}, author={Nagendran, Aran and Nettifee, Julie A. and Carter, Dani and Munana, Karen R.}, year={2025}, month={Jan} }
 @article{schachar_bocage_nelson_early_mariani_olby_munana_2024, title={Clinical and imaging findings in dogs with nerve root signature associated with cervical intervertebral disc herniation}, volume={1}, ISSN={["1939-1676"]}, url={https://doi.org/10.1111/jvim.16982}, DOI={10.1111/jvim.16982}, abstractNote={Abstract Background Intervertebral disc herniation (IVDH) is the most common spinal cord disease in dogs. Little information is available regarding the clinical presentation of nerve root signature (NRS) associated with cervical IVDH. Hypothesis/Objective To detail the clinical and magnetic resonance imaging (MRI) findings in dogs with NRS associated with cervical IVDH. Animals Forty‐seven client‐owned dogs presenting with thoracic limb NRS and MRI confirmed IVDH. Methods Medical records from 2010 to 2020 were retrospectively reviewed for dogs that met inclusion criteria. Imaging studies were evaluated by 2 individuals to characterize location and severity of neural tissue compression. Results Chondrodystrophoid dogs comprised the majority of the study cohort, with dachshund the most common breed (n = 10). Three‐quarters of dogs were ≥7 years of age. Interobserver agreement was moderate or good for all of the imaging variables evaluated. The C6‐C7 intervertebral disc space was significantly overrepresented ( P = .01), comprising 32% (15/47) of the affected discs. However, 42% (20/47) of cases involved C2‐C3 though C4‐C5 disc sites. Disc material was more frequently located laterally compared to medially within the vertebral canal ( P = .0005), and to be associated with compression of the nerve root at the level of the intervertebral foramen ( P = .012). Conclusion/Clinical Importance NRS is most commonly associated with lateralized or foraminal cervical disc herniations. It is most prevalent with C6‐C7 intervertebral disc involvement, suggesting that there might be unique anatomic factors that contribute to development of NRS at this site, but can be a clinical manifestation of IVDH occurring anywhere along the cervical spine.}, journal={JOURNAL OF VETERINARY INTERNAL MEDICINE}, author={Schachar, Jordan and Bocage, Alan and Nelson, Nathan C. and Early, Peter J. and Mariani, Christopher L. and Olby, Natasha J. and Munana, Karen R.}, year={2024}, month={Jan} }
 @article{colon_early_munana_olby_mariani_mancini_fefer_li_briley_bailey_et al._2024, title={Pharmacokinetics of subcutaneous ketamine administration via the Omnipod® system in dogs}, volume={3}, ISSN={["1365-2885"]}, DOI={10.1111/jvp.13440}, abstractNote={Abstract Ketamine is an injectable anesthetic agent with analgesic and antidepressant effects that can prevent maladaptive pain. Ketamine is metabolized by the liver into norketamine, an active metabolite. Prior rodent studies have suggested that norketamine is thought to contribute up to 30% of ketamine's analgesic effect. Ketamine is usually administered as an intravenous (IV) bolus injection or continuous rate infusion (CRI) but can be administered subcutaneously (SC) and intramuscularly (IM). The Omnipod® is a wireless, subcutaneous insulin delivery device that adheres to the skin and delivers insulin as an SC CRI. The Omnipod® was used in dogs for postoperative administration of ketamine as a 1 mg/kg infusion bolus (IB) over 1 hour (h). Pharmacokinetics (PK) showed plasma ketamine concentrations between 42 and 326.1 ng/mL. The median peak plasma concentration was 79.5 (41.9–326.1) ng/mL with a Tmax of 60 (30–75) min. After the same infusion bolus, the corresponding norketamine PK showed plasma drug concentrations between 22.0 and 64.8 ng/mL. The median peak plasma concentration was 43.0 (26.1–71.8) ng/mL with a median Tmax of 75 min. The median peak ketamine plasma concentration exceeded 100 ng/mL in dogs for less than 1 h post infusion. The Omnipod® system successfully delivered subcutaneous ketamine to dogs in the postoperatively.}, journal={JOURNAL OF VETERINARY PHARMACOLOGY AND THERAPEUTICS}, author={Colon, Claudia and Early, Peter and Munana, Karen and Olby, Natasha and Mariani, Christopher and Mancini, Shelby and Fefer, Gilad and Li, Zhong and Briley, Jessica and Bailey, Kate and et al.}, year={2024}, month={Mar} }
 @article{charalambous_munana_patterson_platt_volk_2023, title={ACVIM Consensus Statement on the management of status epilepticus and cluster seizures in dogs and cats}, volume={11}, ISSN={["1939-1676"]}, url={https://doi.org/10.1111/jvim.16928}, DOI={10.1111/jvim.16928}, abstractNote={Abstract Background Seizure emergencies (ie, status epilepticus [SE] and cluster seizures [CS]), are common challenging disorders with complex pathophysiology, rapidly progressive drug‐resistant and self‐sustaining character, and high morbidity and mortality. Current treatment approaches are characterized by considerable variations, but official guidelines are lacking. Objectives To establish evidence‐based guidelines and an agreement among board‐certified specialists for the appropriate management of SE and CS in dogs and cats. Animals None. Materials and Methods A panel of 5 specialists was formed to assess and summarize evidence in the peer‐reviewed literature with the aim to establish consensus clinical recommendations. Evidence from veterinary pharmacokinetic studies, basic research, and human medicine also was used to support the panel's recommendations, especially for the interventions where veterinary clinical evidence was lacking. Results The majority of the evidence was on the first‐line management (ie, benzodiazepines and their various administration routes) in both species. Overall, there was less evidence available on the management of emergency seizure disorders in cats in contrast to dogs. Most recommendations made by the panel were supported by a combination of a moderate level of veterinary clinical evidence and pharmacokinetic data as well as studies in humans and basic research studies. Conclusions and Clinical Relevance Successful management of seizure emergencies should include an early, rapid, and stage‐based treatment approach consisting of interventions with moderate to preferably high ACVIM recommendations; management of complications and underlying causes related to seizure emergencies should accompany antiseizure medications.}, journal={JOURNAL OF VETERINARY INTERNAL MEDICINE}, author={Charalambous, Marios and Munana, Karen and Patterson, Edward E. and Platt, Simon R. and Volk, Holger A.}, year={2023}, month={Nov} }
 @article{gristina_waldron_nettifee_munana_2023, title={Comparison of caregivers' assessments of clinical outcome in dogs with idiopathic epilepsy administered levetiracetam, zonisamide, or phenobarbital monotherapy}, volume={261}, ISSN={["1943-569X"]}, DOI={10.2460/javma.22.10.0469}, abstractNote={Abstract OBJECTIVE To investigate caregivers’ assessments of outcome in dogs with idiopathic epilepsy (IE) administered levetiracetam (LEV), zonisamide (ZNS), or phenobarbital (PB) monotherapy. ANIMALS 100 dogs with IE administered LEV (n = 34), ZNS (31), or PB (35) monotherapy between January 1, 2003, and February 6, 2019, and survey responses from their caregivers. PROCEDURES Information on duration of therapy, adverse effects (AEs), and outcome was obtained from medical record review and caregiver questionnaire. RESULTS A significant improvement in mean quality of life score was reported during monotherapy (7.7; SD, 2.14) compared to before treatment (6.25; SD, 2.63; P < .0001), with no difference identified between monotherapy groups. Compared to ZNS monotherapy, dogs prescribed PB monotherapy had a significantly younger median age at seizure onset (2.6 vs 4.3 years; P = .024). A significant relationship was identified between the occurrence of reported AEs and monotherapy group, with a higher prevalence in the PB group (77% [27/35]) and a lower prevalence in the ZNS group (39% [12/31]; P = .0066). Treatment failure rates for PB, LEV, and ZNS monotherapy were 51%, 35%, and 45%, respectively, with failure attributed most commonly to inadequate seizure control. No significant difference was identified between groups with respect to rate of or time to failure. CLINICAL RELEVANCE Most caregivers reported a favorable outcome with administration of LEV, ZNS, or PB monotherapy to dogs with IE. Phenobarbital is associated with the highest prevalence of AEs but no difference in quality of life score. Prospective controlled studies are needed to further compare the efficacy and safety of these monotherapies in dogs with IE.}, number={7}, journal={JAVMA-JOURNAL OF THE AMERICAN VETERINARY MEDICAL ASSOCIATION}, author={Gristina, Bryanna R. and Waldron, Rennie J. and Nettifee, Julie A. and Munana, Karen R.}, year={2023}, month={Jul}, pages={1020–1027} }
 @article{bini_bailey_voyvodic_chiavaccini_munana_keenihan_2023, title={Effects of alfaxalone, propofol and isoflurane on cerebral blood flow and cerebrovascular reactivity to carbon dioxide in dogs: A pilot study}, volume={291}, ISSN={["1532-2971"]}, DOI={10.1016/j.tvjl.2022.105939}, abstractNote={Propofol total intravenous anesthesia is a common choice to anesthetize patients with increased intracranial pressure, reducing cerebral blood flow while maintaining cerebrovascular reactivity to CO2. Propofol and alfaxalone are commonly used for total intravenous anesthesia in dogs, but the effects of alfaxalone on cerebral blood flow and cerebrovascular reactivity to CO2 are unknown. Our hypothesis was that alfaxalone would not be significantly different to propofol, while isoflurane would increase cerebral blood flow and decrease cerebrovascular reactivity to CO2. Six healthy hound dogs were evaluated in this randomized crossover trial. Dogs were anesthetized with 7.5 mg/kg propofol, 3 mg/kg alfaxalone or 8 % sevoflurane, mechanically ventilated and maintained with propofol (400 µg/kg/min), alfaxalone (150 µg/kg/min) or 1.7 % end-tidal isoflurane, respectively, with one week washout between treatments. Cerebral blood flow and cerebrovascular reactivity to CO2 during hypercapnic and hypocapnic challenges were measured using arterial spin labelling and blood oxygen level-dependent magnetic resonance imaging sequences, respectively. Median (interquartile range, IQR) normocapnic cerebral blood flow was significantly lower (P = 0.016) with alfaxalone compared to isoflurane, in the whole brain 15.39 mL/min/100 g (14.90–19.90 mL/min/100 g) vs. 34.10 mL/min/100 g (33.35–43.17 mL/min/100 g), the grey matter 14.57 mL/min/100 g (13.66–18.72 mL/min/100 g) vs. 32.37 mL/min/100 g (31.03–42.99 mL/min/100 g), the caudal brain 15.47 mL/min/100 g (13.37–21.45 mL/min/100 g) vs. 36.85 mL/min/100 g (32.50–47.18 mL/min/100 g) and the temporal lobe grey matter 18.80 mL/min/100 g (15.89–20.84 mL/min/100 g) vs. 43.32 (36.07–43.58 mL/min/100 g). Median (IQR) hypocapnic cerebrovascular reactivity to CO2 was significantly higher (P = 0.016) for alfaxalone compared to isoflurane 8.85 %S/mm Hg (6.92–10.44 %S/mm Hg) vs. 3.90 %S/mm Hg (3.80–4.33 %S/mm Hg). Alfaxalone maintained lower cerebral blood flow and higher hypocapnic cerebrovascular reactivity to CO2 than isoflurane.}, journal={VETERINARY JOURNAL}, author={Bini, G. and Bailey, K. M. and Voyvodic, J. T. and Chiavaccini, L. and Munana, K. R. and Keenihan, E. K.}, year={2023}, month={Jan} }
 @article{bray_platt_kent_olby_early_mariani_munana_holmes_2023, title={Magnetic resonance imaging characteristics of atlanto-axial subluxation in 42 dogs: Analysis of joint cavity size, subluxation distance, and craniocervical junction anomalies}, volume={13}, ISSN={["2218-6050"]}, DOI={10.5455/OVJ.2023.v13.i9.4}, abstractNote={Atlanto-axial (AA) subluxation can be a complex syndrome in dogs. Accurate identification and assessment of this condition are key to providing treatment and resolution.The purpose of this retrospective study was to describe the magnetic resonance imaging (MRI) characteristics of AA subluxation and associated neurologic deficits.A multicenter review of dogs with a diagnosis of AA subluxation was conducted, evaluating signalment, neurologic grade, duration of signs, and MRI characteristics. MRI characteristics included degree of spinal cord compression and joint subluxation, integrity of odontoid ligaments, presence of a dens, spinal cord signal intensity, and presence of syringohydromyelia, hydrocephalus, and Chiari-like malformation. A control population with normal AA joints was also evaluated. MR images of 42 dogs with AA subluxation were compared to 26 age and breed-matched control dogs.Affected dogs had a median age of 27 months and a median weight of 2.7 kg, and the most commonly affected breed was the Yorkshire terrier (47.5%). Spinal cord signal hyperintensity, increased AA joint size, and cross-sectional cord compression at the level of the dens and mid-body C2 were associated with AA subluxation. No associations were found between cord compression, the appearance of the dens, or cord signal intensity and neurologic grade. Affected dogs did not have a higher incidence of Chiari-like malformation, syringohydromyelia, or hydrocephalus than control dogs, and their neurologic grade was not associated with MRI findings. Lack of dens and/or odontoid ligaments was associated with larger subluxations.Dogs with clinical signs of AA subluxation were significantly more likely to have intramedullary hyperintensity at the level of compression ( p = 0.0004), an increased AA joint cavity size ( p = 0.0005), and increased spinal cord compression at the level of dens and mid-body C2 (p ≤ 0.05). The authors suggest an AA joint cavity size >1.4 mm and a subluxation distance >2.5 mm as cutoffs for MRI diagnosis of AA subluxation in dogs. No differences were noted between dogs with AA subluxation and control dogs regarding syringohydromyelia, hydrocephalus, and Chiari-like malformation.}, number={9}, journal={OPEN VETERINARY JOURNAL}, author={Bray, Kathryn Y. and Platt, Simon R. and Kent, Marc and Olby, Natasha J. and Early, Peter J. and Mariani, Christopher L. and Munana, Karen R. and Holmes, Shannon P.}, year={2023}, pages={1091–1098} }
 @article{woelfel_mariani_nolan_keenihan_topulos_early_muñana_musulin_olby_2023, title={Presumed pituitary apoplexy in 26 dogs: Clinical findings, treatments, and outcomes}, volume={37}, ISSN={0891-6640 1939-1676}, url={http://dx.doi.org/10.1111/jvim.16703}, DOI={10.1111/jvim.16703}, abstractNote={Abstract Background Pituitary apoplexy refers to hemorrhage or infarction within the pituitary gland resulting in acute neurological abnormalities. This condition is poorly described in dogs. Objectives To document presenting complaints, examination findings, endocrinopathies, magnetic resonance imaging (MRI), treatments, and outcomes of dogs with pituitary apoplexy. Animals Twenty‐six client‐owned dogs with acute onset of neurological dysfunction. Methods Retrospective case series. Dogs were diagnosed with pituitary apoplexy if MRI or histopathology documented an intrasellar or suprasellar mass with evidence of hemorrhage or infarction in conjunction with acute neurological dysfunction. Clinical information was obtained from medical records and imaging reports. Results Common presenting complaints included altered mentation (16/26, 62%) and gastrointestinal dysfunction (14/26, 54%). Gait or posture changes (22/26, 85%), mentation changes (18/26, 69%), cranial neuropathies (17/26, 65%), cervical or head hyperpathia (12/26, 46%), and hyperthermia (8/26, 31%) were the most frequent exam findings. Ten dogs (38%) lacked evidence of an endocrinopathy before presentation. Common MRI findings included T1‐weighted hypo‐ to isointensity of the hemorrhagic lesion (21/25, 84%), peripheral enhancement of the pituitary mass lesion (15/25, 60%), brain herniation (14/25, 56%), and obstructive hydrocephalus (13/25, 52%). Fifteen dogs (58%) survived to hospital discharge. Seven of these dogs received medical management alone (median survival 143 days; range, 7‐641 days) and 8 received medications and radiation therapy (median survival 973 days; range, 41‐1719 days). Conclusions and Clinical Importance Dogs with pituitary apoplexy present with a variety of acute signs of neurological disease and inconsistent endocrine dysfunction. Dogs that survive to discharge can have a favorable outcome.}, number={3}, journal={Journal of Veterinary Internal Medicine}, publisher={Wiley}, author={Woelfel, Christian W. and Mariani, Christopher L. and Nolan, Michael W. and Keenihan, Erin K. and Topulos, Sophia P. and Early, Peter J. and Muñana, Karen R. and Musulin, Sarah E. and Olby, Natasha J.}, year={2023}, month={Apr}, pages={1119–1128} }
 @article{mancini_early_slater_olby_mariani_munana_woelfel_schacher_zhong_messenger_2022, title={Novel subcutaneous cytarabine infusion with the Omnipod system in dogs with meningoencephalomyelitis of unknown etiology}, volume={83}, ISSN={["1943-5681"]}, DOI={10.2460/ajvr.22.03.0046}, abstractNote={Abstract OBJECTIVE To investigate the feasibility and pharmacokinetics of cytarabine delivery as a subcutaneous continuous-rate infusion with the Omnipod system. ANIMALS 6 client-owned dogs diagnosed with meningoencephalomyelitis of unknown etiology were enrolled through the North Carolina State University Veterinary Hospital. PROCEDURES Cytarabine was delivered at a rate of 50 mg/m 2 /hour as an SC continuous-rate infusion over 8 hours using the Omnipod system. Plasma samples were collected at 0, 4, 6, 8, 10, 12, and 14 hours after initiation of the infusion. Plasma cytarabine concentrations were measured by high-pressure liquid chromatography. A nonlinear mixed-effects approach generated population pharmacokinetic parameter estimates. RESULTS The mean peak plasma concentration (Cmax) was 7,510 ng/mL (range, 5,040 to 9,690 ng/mL; SD, 1,912.41 ng/mL), average time to Cmax was 7 hours (range, 4 to 8 hours; SD, 1.67 hours), terminal half-life was 1.13 hours (SD, 0.29 hour), and the mean area under the curve was 52,996.82 hours X μg/mL (range, 35,963.67 to 71,848.37 hours X μg/mL; SD, 12,960.90 hours X μg/mL). Cmax concentrations for all dogs were more than 1,000 ng/mL (1.0 μg/mL) at the 4-, 6-, 8-, and 10-hour time points. CLINICAL RELEVANCE An SC continuous-rate infusion of cytarabine via the Omnipod system is feasible in dogs and was able to achieve a steady-state concentration of more than 1 μg/mL 4 to 10 hours postinitiation of cytarabine and a Cmax of 7,510 ng/mL (range, 5,040 to 9,690 ng/mL; SD, 1,912.41 ng/mL). These are comparable to values reported previously with IV continuous-rate infusion administration in healthy research Beagles and dogs with meningoencephalomyelitis of unknown etiology.}, number={9}, journal={AMERICAN JOURNAL OF VETERINARY RESEARCH}, author={Mancini, Shelby L. and Early, Peter J. and Slater, Bailey M. and Olby, Natasha J. and Mariani, Christopher L. and Munana, Karen R. and Woelfel, Christian W. and Schacher, Jordan A. and Zhong, Li and Messenger, Kristen M.}, year={2022}, month={Sep} }
 @article{bray_mariani_early_muñana_olby_2021, title={Continuous rate infusion of midazolam as emergent treatment for seizures in dogs}, url={https://doi.org/10.1111/jvim.15993}, DOI={10.1111/jvim.15993}, abstractNote={Midazolam delivered by continuous rate infusion (CRI) might be effective in dogs with cluster seizures (CS) or status epilepticus (SE).To describe the use and safety of midazolam CRI in dogs with CS or SE.One-hundred six client-owned dogs presenting to a veterinary teaching hospital with CS or SE.Retrospective review of medical records for dogs with CS or SE treated with a midazolam CRI.Seventy-nine dogs presented with CS and 27 dogs had SE. Seizure control was achieved in 82/106 dogs (77.4%) receiving a midazolam CRI. The median dose associated with seizure control was 0.3 mg/kg/h (range, 0.1-2.5 mg/kg/h). The median duration of CRI was 25 hours (range, 2-96 hours). Seizures were controlled in 34/40 dogs (85%) with idiopathic epilepsy, 32/43 dogs (74%) with structural epilepsy, 12/16 dogs (75%) with unknown epilepsy, and 4/7 dogs (57%) with reactive seizures (P = .20). Seizure control was achieved in 81% of dogs with CS and 67% in dogs with SE (P = .18). Dogs with idiopathic/unknown epilepsy were more likely to survive than those with structural epilepsy (87% vs 63%, P = .009). Adverse effects were reported in 24 dogs (22.6%) and were mild in all cases.Midazolam CRI is apparently safe and might be an effective treatment in dogs with CS or SE.}, journal={Journal of Veterinary Internal Medicine}, author={Bray, Kathryn Y. and Mariani, Christopher L. and Early, Peter J. and Muñana, Karen R. and Olby, Natasha J.}, year={2021}, month={Jan} }
 @article{woelfel_robertson_mariani_munana_early_olby_2021, title={Outcomes and prognostic indicators in 59 paraplegic medium to large breed dogs with extensive epidural hemorrhage secondary to thoracolumbar disc extrusion}, volume={50}, ISSN={["1532-950X"]}, DOI={10.1111/vsu.13592}, abstractNote={Abstract Objective To evaluate outcomes and prognostic factors after decompressive hemilaminectomy in paraplegic medium to large breed dogs with extensive epidural hemorrhage (DEEH) and thoracolumbar intervertebral disc extrusion (TL‐IVDE). Study design Retrospective, cohort, descriptive study. Animals Fifty‐nine client‐owned dogs. Methods Medical records and advanced imaging were reviewed for paraplegic dogs with DEEH. Ambulatory status 6 months after surgery and postoperative complications were recorded. Multiple logistic regression models were constructed to explore prognostic factors. Results Records of 22 dogs with and 37 dogs without pelvic limb pain perception at presentation were included. Median age of dogs was 5 years (interquartile range, 4‐7), and mean weight was 26.9 kg (SD, ±9.71). Labradors and Labrador mixes were most common (17/59 [28.8%]). Recovery of ambulation occurred in 17 of 22 (77.3%) dogs with and in 14 of 37 (37.8%) dogs without pain perception prior to surgery. Progressive myelomalacia was recorded in three of 59 (5.1%) dogs, one with pain perception and two without pain perception at presentation. Postoperative complications (14/59 [23.7%]) were common. Factors independently associated with outcome included clinical severity (odds ratio [OR] 0.179, P = .005), number of vertebrae with signal interruption in half Fourier single‐shot turbo spin‐echo sequences (HASTEi; OR, 0.738; P = .035), and ratio of vertebral sites decompressed to HASTEi (OR, 53.79; P = .03). Conclusion Paraplegic medium to large breed dogs with DEEH have a less favorable outcome after surgical decompression than paraplegic dogs with TL‐IVDE. Clinical significance Dogs with DEEH can have severe postoperative complications. Loss of pain perception and increased HASTEi are associated with a poor outcome, while more extensive decompression improves outcome.}, number={3}, journal={VETERINARY SURGERY}, author={Woelfel, Christian W. and Robertson, James B. and Mariani, Chris L. and Munana, Karen R. and Early, Peter J. and Olby, Natasha J.}, year={2021}, month={Apr}, pages={527–536} }
 @article{henning_nielson_nettifee_munana_hazel_2021, title={Understanding the impacts of feline epilepsy on cats and their owners}, volume={8}, ISSN={["2042-7670"]}, DOI={10.1002/vetr.836}, abstractNote={Epilepsy is the most common neurological condition reported in cats. Characterised by recurrent seizures, treatment involves the administration of anti-epileptic drugs up to multiple times a day. Epilepsy and its associated treatments may impact both cats and their owners. The present study aimed to assess factors associated with quality of life (QOL) in cats with epilepsy and the burden of care in their owners.An online survey was developed using demographic information and the following validated measures: cat QOL, Zarit burden interview (ZBI) and the cat owner relationship scale (CORS). Regression analysis was conducted using SPSS 26.Responses were completed by 141 owners from 22 countries. QOL was significantly higher in cats with controlled seizures, no adverse effects from medication and epilepsy onset before 5 years of age. ZBI was significantly lower in owners who felt supported by their veterinarian, who were over 55 and had cats with controlled seizures. Higher CORS was significantly correlated with both higher cat QOL and lower owner ZBI.Adequate seizure control and close cat-owner relationships may play an important role in mitigating the impact of epilepsy on cats and their owners. Further research into understanding cat-owner relationships and successfully controlling epilepsy in cats is needed.}, journal={VETERINARY RECORD}, author={Henning, Julia and Nielson, Torben and Nettifee, Julie and Munana, Karen and Hazel, Susan}, year={2021}, month={Aug} }
 @article{mariani_niman_boozer_ruterbories_early_munana_olby_2021, title={Vascular endothelial growth factor concentrations in the cerebrospinal fluid of dogs with neoplastic or inflammatory central nervous system disorders}, volume={6}, ISSN={["1939-1676"]}, url={https://doi.org/10.1111/jvim.16181}, DOI={10.1111/jvim.16181}, abstractNote={Abstract Background Vascular endothelial growth factor (VEGF) is a key molecular driver of angiogenesis and vascular permeability and is expressed by a wide variety of neoplasms. Although blood VEGF concentrations have been quantified in intracranial tumors of dogs, cerebrospinal fluid (CSF) VEGF concentration might be a more sensitive biomarker of disease. Objective Concentrations of VEGF in CSF are higher in dogs with central nervous system (CNS) neoplasia compared to those with meningoencephalomyelitis and other neurologic disorders. Animals One hundred and twenty‐six client‐owned dogs presented to a veterinary teaching hospital. Methods Case‐control study. Cerebrospinal fluid was archived from dogs diagnosed with CNS neoplasia and meningoencephalomyelitis. Control dogs had other neurological disorders or diseases outside of the CNS. A commercially available kit was used to determine VEGF concentrations. Results Detectable CSF VEGF concentrations were present in 49/63 (77.8%) neoplastic samples, 22/24 (91.7%) inflammatory samples, and 8/39 (20.5%) control samples. The VEGF concentrations were significantly different between groups ( P < .0001), and multiple comparison testing showed that both neoplastic and inflammatory groups had significantly higher concentrations than did controls ( P < .05), but did not differ from each other. Gliomas and choroid plexus tumors had significantly higher VEGF concentrations than did the control group ( P < .05). Conclusions and Clinical Importance Cerebrospinal fluid VEGF concentrations may serve as a marker of neoplastic and inflammatory CNS disorders relative to other conditions.}, journal={JOURNAL OF VETERINARY INTERNAL MEDICINE}, publisher={Wiley}, author={Mariani, Christopher L. and Niman, Zachary E. and Boozer, Lindsay B. and Ruterbories, Laura K. and Early, Peter J. and Munana, Karen R. and Olby, Natasha J.}, year={2021}, month={Jun} }
 @article{fenn_ru_jeffery_moore_tipold_soebbeler_wang‐leandro_mariani_early_muñana_et al._2020, title={Association between anesthesia duration and outcome in dogs with surgically treated acute severe spinal cord injury caused by thoracolumbar intervertebral disk herniation}, ISSN={0891-6640 1939-1676}, url={http://dx.doi.org/10.1111/jvim.15796}, DOI={10.1111/jvim.15796}, abstractNote={Abstract Background Retrospective research recently identified a possible relationship between duration of surgery and outcome in severely affected dogs treated surgically for acute thoracolumbar intervertebral disk herniation (TL‐IVDH). Hypothesis That increased duration of surgery is associated with poorer outcome in dogs with absent pain perception treated surgically for TL‐IVDH. Animals Two hundred ninety‐seven paraplegic dogs with absent pain perception surgically treated for acute TL‐IVDH. Methods Retrospective cohort study. Medical records of 5 institutions were reviewed. Inclusion criteria were paraplegia with absence of pain perception, surgical treatment of TL‐IVDH, and 1‐year postoperative outcome (ambulatory: yes or no). Canine data, outcome, and surgery and total anesthesia duration were retrieved. Results In this study, 183/297 (61.6%) dogs were ambulatory within 1 year, 114 (38.4%) dogs failed to recover, including 74 dogs (24.9%) euthanized because of progressive myelomalacia. Median anesthesia duration in dogs that regained ambulation within 1 year of surgery (4.0 hours, interquartile range [IQR] 3.2‐5.1) was significantly shorter than those that did not (4.5 hours, IQR 3.7‐5.6, P = .01). Multivariable logistic regression demonstrated a significant negative association between both duration of surgery and total anesthesia time and ambulation at 1 year when controlling for body weight and number of disk spaces operated on. Conclusions and Clinical Importance Findings support a negative association between increased duration of anesthesia and outcome in this group of dogs. However, the retrospective nature of the data does not imply a causal relationship.}, journal={Journal of Veterinary Internal Medicine}, publisher={Wiley}, author={Fenn, Joe and Ru, Hongyu and Jeffery, Nick D. and Moore, Sarah and Tipold, Andrea and Soebbeler, Franz J. and Wang‐Leandro, Adriano and Mariani, Christopher L. and Early, Peter J. and Muñana, Karen R. and et al.}, year={2020}, month={May} }
 @article{mariani_nye_ruterbories_tokarz_green_lau_zidan_early_muñana_olby_et al._2020, title={Cerebrospinal fluid lactate concentrations in dogs with seizure disorders}, url={https://doi.org/10.1111/jvim.15953}, DOI={10.1111/jvim.15953}, abstractNote={Abstract Background Cerebrospinal fluid (CSF) lactate concentrations increase after seizure activity in many human patients independent of the underlying disease process. The effect of seizure activity on CSF lactate concentration in dogs is unknown. Hypothesis/Objectives Cerebrospinal fluid lactate concentration is unaffected by seizure activity in dogs and is more dependent on the underlying disease process causing the seizures. Animals One‐hundred eighteen client‐owned dogs with seizure disorders. Methods Case series. Cerebrospinal fluid lactate concentration was determined using a commercially available lactate monitor. Seizure semiology, time from last seizure to CSF collection, number of seizures within the 72 hours preceding CSF collection, and clinical diagnosis were recorded. Results Dogs with focal seizures had higher CSF lactate concentrations than did those with generalized seizures ( P = .03). No differences in lactate concentrations were found among dogs with single seizures, cluster seizures or status epilepticus ( P = .12), among dogs with CSF collection at different time points after the last seizure activity ( P = .39) or among dogs having different numbers of seizures within the 72 hours preceding CSF collection ( P = .42). A significant difference ( P = .001) was found in CSF lactate concentrations among diagnostic groups, and dogs with inflammatory and neoplastic disease had higher concentrations than did dogs with idiopathic or unknown epilepsy. Conclusions and Clinical Importance Cerebrospinal fluid lactate concentration is minimally affected by seizure activity in dogs and increased concentrations are more likely associated with the underlying disease process.}, journal={Journal of Veterinary Internal Medicine}, author={Mariani, Christopher L. and Nye, Carolyn J. and Ruterbories, Laura and Tokarz, Debra A. and Green, Lauren and Lau, Jeanie and Zidan, Natalia and Early, Peter J. and Muñana, Karen R. and Olby, Natasha J. and et al.}, year={2020}, month={Nov} }
 @article{muñana_nettifee_griffith_early_yoder_2020, title={Evaluation of a collar‐mounted accelerometer for detecting seizure activity in dogs}, volume={34}, url={https://doi.org/10.1111/jvim.15760}, DOI={10.1111/jvim.15760}, abstractNote={The majority of dogs with idiopathic epilepsy continue to have seizures despite appropriate treatment.To assess the use of a commercially available, collar-mounted accelerometer to detect generalized seizures in dogs.Twenty two client-owned dogs with idiopathic epilepsy.Six-month prospective clinical study during which dogs wore a collar-mounted accelerometer. Seizure documentation was based on owner observations and video recordings. The accelerometer used a predefined algorithm to detect seizures in the first study phase, and an individualized algorithm in the second study phase. Caregivers completed a quality of life (QoL) questionnaire at the initial and final study visit.Using the predefined algorithm, the accelerometer detected seizures with a sensitivity of 18.6% (95% CI [13.4%, 23.8%]) and mean false detection rate of 0.096/day. Values did not change significantly with use of an individualized algorithm (sensitivity 22.1%, 95% CI [15.1%, 29.0%]; false detection rate 0.054/day). Mean composite QoL score was significantly improved at study completion (50.42) compared to study initiation (39.53; P = .005), and this change was moderately correlated with a change in weekly exercise (r = 0.46, P = .05).Generalized seizures in dogs can be detected with a collar-mounted accelerometer, but the overall sensitivity is low.}, number={3}, journal={Journal of Veterinary Internal Medicine}, publisher={Wiley}, author={Muñana, Karen R. and Nettifee, Julie A. and Griffith, Emily H. and Early, Peter J. and Yoder, Nathanael C.}, year={2020}, month={May}, pages={1239–1247} }
 @article{muñana_jacob_callahan_2020, title={Evaluation of fecal Lactobacillus populations in dogs with idiopathic epilepsy: a pilot study}, volume={2}, url={https://doi.org/10.1186/s42523-020-00036-6}, DOI={10.1186/s42523-020-00036-6}, abstractNote={Idiopathic epilepsy is a common neurological disorder of dogs characterized by recurrent seizures for which no underlying basis is identified other than a presumed genetic predisposition. The pathogenesis of the disorder remains poorly understood, but environmental factors are presumed to influence the course of disease. Within the growing body of research into the microbiota-gut-brain axis, considerable attention has focused on the protective role of Lactobacilli in the development and progression of neurological disease. Investigations into the association between the gut microbiome and epilepsy are in their infancy, but some preliminary findings support a role for Lactobacilli in drug resistant epilepsy. To date, there are no published studies evaluating the gut microbiome in dogs with epilepsy. This pilot study was undertaken to evaluate fecal Lactobacillus populations in dogs with idiopathic epilepsy compared to healthy dogs. Fecal samples were obtained from 13 pairs of dogs, consisting of a drug-naïve epileptic dog and a healthy dog from the same household and maintained on the same diet. Evaluation of large-scale microbial patterns based on 16S rRNA gene amplicon sequencing identified a household effect in the study population. Differential prevalence testing at the 16S rRNA gene sequence variant and genus levels did not identify any statistically significant differences between epileptic and control dogs. Quantitative PCR of Lactobacillus species isolated through culture revealed no statistically significant difference between the epileptic and control dogs (median concentration, 3.8 log10 CFU/g feces and 4.6 log10 CFU/g feces, respectively). Lactobacillus in culture was not killed by exposure to phenobarbital, potassium bromide, zonisamide, or levetiracetam. This pilot study did not identify any difference in large-scale microbial patterns or relative or absolute abundance of Lactobacillus species in drug-naïve epileptic dogs compared to healthy dogs. Further studies are warranted to evaluate the role of the gut microbiome in disease progression and treatment response in dogs with epilepsy. Lactobacilli in culture were not killed or inhibited from growing when exposed to phenobarbital, potassium bromide, zonisamide or levetiracetam, suggesting that antiepileptic drug administration is less likely to be a confounding factor in future studies evaluating the role of Lactobacillus in epilepsy.}, number={1}, journal={Animal Microbiome}, publisher={Springer Science and Business Media LLC}, author={Muñana, Karen R. and Jacob, Megan E. and Callahan, Benjamin J.}, year={2020}, month={Dec} }
 @article{lewis_early_mariani_munana_olby_2020, title={Influence of Duration of Injury on Diffusion Tensor Imaging in Acute Canine Spinal Cord Injury}, volume={37}, ISSN={["1557-9042"]}, DOI={10.1089/neu.2019.6786}, abstractNote={Diffusion tensor imaging (DTI) quantifies microstructural lesion characteristics, but impact of the interval between spinal cord injury (SCI) and examination on imaging characteristics is unclear. Our objective was to investigate the impact of duration of injury on DTI indices in dogs with acute, spontaneous SCI from thoracolumbar intervertebral disc herniation (IVDH) and explore associations with clinical severity. Twenty-six dogs with acute thoracolumbar IVDH of variable severity who underwent DTI were included. Neurological severity was graded using the modified Frankel Score (0-V). Fractional anisotropy (FA) and mean diffusivity (MD) were calculated on regions of interest within and adjacent to the lesion epicenter. Relationships between FA or MD and duration (injury to imaging interval) or neurological severity were determined using regression analysis and Wilcoxon rank sum. Median age was 6.8 years (1-13), median duration was 1.5 days (1-9), and neurological signs ranged from ambulatory paraparesis (MFS II) to paraplegia with absent pain perception (MFS V). Mean FA was 0.61 ± 0.09 cranial to the lesion, 0.57 ± 0.12 at the epicenter and 0.55 ± 0.10 caudally. Mean MD was 1.18 × 10-3 ± 0.0002 cranially, 1.09 × 10-3 ± 0.0002 at the epicenter, and 1.14 × 10-3 ± 0.0002 caudally. Accounting for neurological severity and age, FA caudal to the epicenter decreased with increasing duration of injury (p = 0.02). Lower MD within the lesion epicenter was associated with worse neurological severity (p = 0.01). Duration of injury should be considered when interpreting DTI results in dogs with acute thoracolumbar IVDH. The MD might differentiate injury severity in the acute setting and be worthy of development as an imaging biomarker.}, number={21}, journal={JOURNAL OF NEUROTRAUMA}, author={Lewis, Melissa J. and Early, Peter J. and Mariani, Christopher L. and Munana, Karen R. and Olby, Natasha J.}, year={2020}, month={Nov}, pages={2261–2267} }
 @article{amengual-batle_jose-lopez_durand_czopowicz_beltran_guevar_lazzerini_de decker_munana_early_et al._2020, title={Traumatic skull fractures in dogs and cats: A comparative analysis of neurological and computed tomographic features}, volume={34}, ISSN={["1939-1676"]}, DOI={10.1111/jvim.15838}, abstractNote={Abstract Background Traumatic skull fractures (TSF) are relatively frequent in dogs and cats, but little information is available regarding their clinical and imaging features. Hypothesis/Objectives To describe the neurological and computed tomographic (CT) features of a large cohort of dogs and cats with TSF. Animals Ninety‐one dogs and 95 cats with TSF identified on CT. Methods Multicenter retrospective comparative study. Signalment, cause of trauma, fracture locations and characteristics, presence of neurological deficits, and 1‐week survival were recorded. Fractures were classified according to the extent of fragmentation and displacement. Results The cranial vault was affected more frequently in dogs ( P = .003), whereas the face and base of the cranium more often was affected in cats ( P < .001). Cats presented with multiple fractures more frequently ( P < .001). All animals with TSF in the cranial vault were more likely to develop neurological signs ( P = .02), especially when depressed fractures were present (95% confidence interval [CI], 1.7‐8.2; P = .001). Animals with TSF located only in the facial region were less likely to have neurological signs (odds ratio with Mantel‐Haenszel's method [OR MH ], 0.2; 95% CI, 0.1‐0.6; P = .004). Most affected animals (84.9%) survived the first week post‐trauma. Death was more likely with fractures of the cranial vault ( P = .003), especially when fragmented ( P = .007) and displaced ( P = .004). Conclusions and Clinical Importance Traumatic skull fracture distribution and patterns are different between dogs and cats. Cranial vault fractures were associated with neurological deficits and worse survival. The presence of TSF alone should not be considered a negative prognostic factor because most affected animals survived the first week.}, number={5}, journal={JOURNAL OF VETERINARY INTERNAL MEDICINE}, author={Amengual-Batle, Pablo and Jose-Lopez, Roberto and Durand, Alexane and Czopowicz, Michal and Beltran, Elsa and Guevar, Julien and Lazzerini, Kali and De Decker, Steven and Munana, Karen and Early, Peter and et al.}, year={2020}, month={Sep}, pages={1975–1985} }
 @article{mariani_nye_tokarz_green_lau_zidan_early_guevar_muñana_olby_et al._2019, title={Cerebrospinal fluid lactate in dogs with inflammatory central nervous system disorders}, volume={33}, ISSN={0891-6640 1939-1676}, url={http://dx.doi.org/10.1111/jvim.15606}, DOI={10.1111/jvim.15606}, abstractNote={Abstract Background Cerebrospinal fluid (CSF) lactate is frequently used as a biomarker in humans with inflammatory central nervous system (CNS) disorders including bacterial meningitis and autoimmune disorders such as multiple sclerosis. Hypothesis Cerebrospinal fluid lactate concentrations are increased in a subset of dogs with inflammatory CNS disorders. Animals One hundred two client‐owned dogs diagnosed with inflammatory CNS disease. Methods Case series. Cases were identified both prospectively at the time of diagnosis and retrospectively by review of a CSF biorepository. Cerebrospinal fluid lactate was analyzed with a commercially available, handheld lactate monitor. Subcategories of inflammatory disease were created for comparison (eg, steroid‐responsive meningitis arteritis, meningoencephalitis of unknown etiology). Results Cerebrospinal fluid lactate concentrations were above reference range in 47% of dogs (median, 2.5 mmol/L; range, 1.0‐11.7 mmol/L). There was no significant difference in lactate concentrations between disease subcategories ( P = .48). Significant but weak correlations were noted between CSF lactate concentration and nucleated cell count ( r = .33, P < .001), absolute large mononuclear cell count ( r = .44, P < .001), absolute small mononuclear cell count ( r = .39, P < .001), absolute neutrophil cell count ( r = .24, P = .01), and protein ( r = .44, P < .001). No correlation was found between CSF lactate concentration and CSF red blood cell count ( P = .58). There was no significant association of CSF lactate concentration with survival ( P = .27). Conclusions and Clinical Importance Cerebrospinal fluid lactate concentrations could serve as a rapid biomarker of inflammatory CNS disease in dogs.}, number={6}, journal={Journal of Veterinary Internal Medicine}, publisher={Wiley}, author={Mariani, Christopher L. and Nye, Carolyn J. and Tokarz, Debra A. and Green, Lauren and Lau, Jeanie and Zidan, Natalia and Early, Peter J. and Guevar, Julien and Muñana, Karen R. and Olby, Natasha J. and et al.}, year={2019}, month={Sep}, pages={2701–2708} }
 @article{lau_nettifee_early_mariani_olby_muñana_2019, title={Clinical characteristics, breed differences, and quality of life in North American dogs with acute steroid‐responsive meningitis‐arteritis}, volume={33}, ISSN={0891-6640 1939-1676}, url={http://dx.doi.org/10.1111/jvim.15543}, DOI={10.1111/jvim.15543}, abstractNote={Abstract Background Steroid‐responsive meningitis‐arteritis (SRMA) is a common inflammatory neurologic disorder of dogs for which certain breeds are predisposed. Objectives To determine whether breed differences exist in clinical features, treatment response, and relapse in a population of North American dogs with SRMA, and to evaluate the effect of disease on dogs' quality of life (QoL). Animals Sixty‐one client‐owned dogs with SRMA: 29 dogs identified through an American Kennel Club‐Canine Health Foundation survey and 32 dogs from North Carolina (NC) State Veterinary Hospital. Methods Retrospective case series. Caregivers completed an online survey to assess QoL. Results Breeds represented most often included the Golden Retriever (n = 12), Bernese Mountain Dog (10), Wirehaired Pointing Griffon (9), Boxer (9), and Beagle (6). No breed differences were identified with respect to clinical severity, diagnostic findings, or outcome. Twenty‐nine dogs (48%) had ≥1 disease relapse. There was a significant effect of cerebrospinal fluid nucleated cell count on the frequency of disease relapse ( P = .003), but no relationship was identified between treatment protocol and relapse. Dogs' QoL was associated with the severity of corticosteroid‐related adverse effects ( P = .03), which were dose‐related ( r = .24, P = .02) and more prevalent in Wirehaired Pointing Griffons than in other breeds ( P = .04). Conclusion and Clinical Importance Golden Retrievers and Wirehaired Pointing Griffons should be considered among the breeds recognized to develop SRMA. Treatment with higher corticosteroid dosages is correlated with more severe adverse effects and worse QoL, but it may not improve clinical outcome.}, number={4}, journal={Journal of Veterinary Internal Medicine}, publisher={Wiley}, author={Lau, Jeanie and Nettifee, Julie A. and Early, Peter J. and Mariani, Christopher L. and Olby, Natasha J. and Muñana, Karen R.}, year={2019}, month={Jun}, pages={1719–1727} }
 @article{early_muñana_olby_mariani_2019, title={Comparison of cerebrospinal fluid parameters from the cerebellomedullary and lumbar cisterns in 54 dogs}, volume={60}, journal={Canadian Veterinary Journal}, author={Early, P.J. and Muñana, K.R. and Olby, N.J. and Mariani, C.L.}, year={2019}, pages={885–888} }
 @article{muñana_2019, title={Nutritional management of idiopathic epilepsy in dogs}, journal={Today’s Veterinary Practice}, author={Muñana, K.R.}, year={2019}, month={May} }
 @article{stafford_kortum_castel_green_lau_early_muñana_mariani_yoder_olby_2019, title={Presence of cerebrospinal fluid antibodies associated with autoimmune encephalitis of humans in dogs with neurologic disease}, volume={33}, ISSN={0891-6640 1939-1676}, url={http://dx.doi.org/10.1111/jvim.15616}, DOI={10.1111/jvim.15616}, abstractNote={Presumed autoimmune diseases affecting the central nervous system (CNS) of dogs are common. In people, antibodies against neuronal cell surface antigens that are associated with a wide variety of neurological syndromes have been identified. The presence of cerebrospinal fluid (CSF) autoantibodies that target neuronal cell surface proteins has not been reported in dogs with neurologic disorders.}, number={5}, journal={Journal of Veterinary Internal Medicine}, publisher={Wiley}, author={Stafford, Emma G. and Kortum, Amanda and Castel, Aude and Green, Lauren and Lau, Jeanie and Early, Peter J. and Muñana, Karen R. and Mariani, Christopher L. and Yoder, Jeffrey A. and Olby, Natasha J.}, year={2019}, month={Sep}, pages={2175–2182} }
 @article{castel_olby_ru_mariani_muñana_early_2019, title={Risk factors associated with progressive myelomalacia in dogs with complete sensorimotor loss following intervertebral disc extrusion: a retrospective case-control study}, volume={15}, ISSN={1746-6148}, url={http://dx.doi.org/10.1186/s12917-019-2186-0}, DOI={10.1186/s12917-019-2186-0}, abstractNote={Progressive myelomalacia (PMM) is a usually fatal complication of acute intervertebral disc extrusion (IVDE) in dogs but its risk factors are poorly understood. The objective of this retrospective case-control study was to identify risk factors for PMM by comparing dogs with complete sensorimotor loss following IVDE that did and did not develop the disease after surgery. We also investigated whether any risk factors for PMM influenced return of ambulation. Medical records of client-owned dogs with paraplegia and loss of pain perception that underwent surgery for IVDE from 1998 to 2016, were reviewed. Dogs were categorized as PMM yes or no based on clinical progression or histopathology. Walking outcome at 6 months was established. Signalment, onset and duration of signs (categorized), steroids, non-steroidal anti-inflammatory drugs (yes or no), site of IVDE (lumbar intumescence or thoracolumbar) and longitudinal extent of IVDE were retrieved and their associations with PMM and walking outcome were examined using logistic regression.One hundred and ninety seven dogs were included, 45 with and 152 without PMM. A 6-month-outcome was available in 178 dogs (all 45 PMM dogs and 133 control dogs); 86 recovered walking (all in the control group). Disc extrusions at the lumbar intumescence were associated with PMM (p = 0.01, OR: 3.02, CI: 1.3-7.2). Surgery performed more than 12 h after loss of ambulation was associated with PMM (OR = 3.4; CI = 1.1-10.5, p = 0.03 for 12-24 h and OR = 4.6; CI = 1.3-16.6, p = 0.02 for the > 24 h categories when compared with the ≤12 h category). Treatment with corticosteroids was negatively associated with PMM (OR: 3.1; CI: 1.3-7.6, p = 0.01). The only variable to affect walking outcome was longitudinal extent of IVDE (OR = 2.6; CI = 1.3-5.3, p = 0.006).Dogs with lumbar intumescence IVDE are at increased risk of PMM. Timing of surgery and corticosteroid use warrant further investigations. PMM and recovery of walking are influenced by different factors.}, number={1}, journal={BMC Veterinary Research}, publisher={Springer Science and Business Media LLC}, author={Castel, Aude and Olby, Natasha J. and Ru, Hongyu and Mariani, Christopher L. and Muñana, Karen R. and Early, Peter J.}, year={2019}, month={Dec} }
 @article{olby_lim_wagner_zidan_early_mariani_muñana_laber_2019, title={Time course and prognostic value of serum GFAP, pNFH, and S100β concentrations in dogs with complete spinal cord injury because of intervertebral disc extrusion}, volume={33}, ISSN={0891-6640 1939-1676}, url={http://dx.doi.org/10.1111/jvim.15439}, DOI={10.1111/jvim.15439}, abstractNote={Background A noninvasive biomarker is needed to predict recovery from severe spinal cord injury (SCI) because of thoracolumbar intervertebral disc extrusion (TL‐IVDE). Proteins released from neural and glial cells can be detected in the blood and show promise as prognostic tools, but their concentration is influenced by time after injury. Hypothesis/Objectives Serum concentrations of glial fibrillary acidic protein (GFAP), phosphorylated neurofilament heavy chain (pNFH), and S100β will follow different time courses; measurement of combinations of these proteins will predict outcome. Animals Thirty‐one dogs with TL‐IVDE causing paralysis with no pain perception. Methods Prospective study. Serum samples were taken at presentation and intervals over 56 days and banked at −80°C. Glial fibrillary acidic protein, pNFH, and S100β concentrations were measured using ELISA tests and plotted against time from onset of nonambulatory status. Outcome was established at 6 months. The association between biomarker concentration and outcome was examined using logistic regression, receiver operator characteristics curve analysis, and model development. Results Thirty‐one dogs participated, 3/31 (10%) developed progressive myelomalacia and 19/31 (62%) recovered ambulation. Glial fibrillary acidic protein and S100β concentrations rose for the first 1 to 3 days, and were undetectable by 14 and 28 days, respectively. Phosphorylated neurofilament heavy chain concentrations peaked at 14 days and were detectable at 56 days. Glial fibrillary acidic protein concentrations in the first 72 hours after onset of nonambulatory status predicted recovery with an accuracy of 76.7%‐89% depending on sample timing. Conclusions and Clinical Importance Serum GFAP concentrations can be used to predict outcome in clinically complete SCI. A rapid inexpensive bedside test is needed.}, number={2}, journal={Journal of Veterinary Internal Medicine}, publisher={Wiley}, author={Olby, Natasha J. and Lim, Ji‐Hey and Wagner, Nikki and Zidan, Natalia and Early, Peter J. and Mariani, Christopher L. and Muñana, Karen R. and Laber, Eric}, year={2019}, month={Feb}, pages={726–734} }
 @article{zidan_sims_fenn_williams_griffith_early_mariani_munana_guevar_olby_et al._2018, title={A randomized, blinded, prospective clinical trial of postoperative rehabilitation in dogs after surgical decompression of acute thoracolumbar intervertebral disc herniation}, volume={32}, ISSN={0891-6640}, url={http://dx.doi.org/10.1111/jvim.15086}, DOI={10.1111/jvim.15086}, abstractNote={Background Experimental evidence shows benefit of rehabilitation after spinal cord injury (SCI) but there are limited objective data on the effect of rehabilitation on recovery of dogs after surgery for acute thoracolumbar intervertebral disc herniations (TL‐IVDH). Objective Compare the effect of basic and intensive post‐operative rehabilitation programs on recovery of locomotion in dogs with acute TL‐IVDH in a randomized, blinded, prospective clinical trial. Animals Thirty non‐ambulatory paraparetic or paraplegic (with pain perception) dogs after decompressive surgery for TL‐IVDH. Methods Blinded, prospective clinical trial. Dogs were randomized (1:1) to a basic or intensive 14‐day in‐house rehabilitation protocol. Fourteen‐day open field gait score (OFS) and coordination (regulatory index, RI) were primary outcomes. Secondary measures of gait, post‐operative pain, and weight were compared at 14 and 42 days. Results Of 50 dogs assessed, 32 met inclusion criteria and 30 completed the protocol. There were no adverse events associated with rehabilitation. Median time to walking was 7.5 (2 – 37) days. Mean change in OFS by day 14 was 6.13 (confidence intervals: 4.88, 7.39, basic) versus 5.73 (4.94, 6.53, intensive) representing a treatment effect of −0.4 (−1.82, 1.02) which was not significant, P =.57. RI on day 14 was 55.13 (36.88, 73.38, basic) versus 51.65 (30.98, 72.33, intensive), a non‐significant treatment effect of −3.47 (−29.81, 22.87), P = .79. There were no differences in secondary outcomes between groups. Conclusions Early postoperative rehabilitation after surgery for TL‐IVDH is safe but doesn't improve rate or level of recovery in dogs with incomplete SCI.}, number={3}, journal={Journal of Veterinary Internal Medicine}, publisher={Wiley}, author={Zidan, Natalia and Sims, Cory and Fenn, Joe and Williams, Kim and Griffith, Emily and Early, Peter J. and Mariani, Chris L. and Munana, Karen and Guevar, Julien and Olby, Natasha J. and et al.}, year={2018}, month={Apr}, pages={1133–1144} }
 @article{muñana_otamendi_nettifee_papich_2018, title={Population pharmacokinetics of extended-release levetiracetam in epileptic dogs when administered alone, with phenobarbital or zonisamide}, volume={32}, ISSN={0891-6640}, url={http://dx.doi.org/10.1111/jvim.15298}, DOI={10.1111/jvim.15298}, abstractNote={Extended-release levetiracetam (LEV-XR) has gained acceptance as an antiepileptic drug in dogs. No studies have evaluated its disposition in dogs with epilepsy.To evaluate the pharmacokinetics of LEV-XR in epileptic dogs when administered alone or with phenobarbital or zonisamide.Eighteen client-owned dogs on steady-state maintenance treatment with LEV-XR (Group L, n = 6), LEV-XR and phenobarbital (Group LP, n = 6), or LEV-XR and zonisamide (Group LZ, n = 6).Pharmacokinetic study. Blood samples were collected at 0, 2, 4, 8, and 12 hours after LEV-XR was administered with food. Plasma LEV concentrations were determined by high-pressure liquid chromatography. A population pharmacokinetic approach and nonlinear mixed effects modeling were used to analyze the data.Treatment group accounted for most of the interindividual variation. The LP group had lower CMAX (13.38 μg/mL) compared to the L group (33.01 μg/mL) and LZ group (34.13 μg/mL), lower AUC (134.86 versus 352.95 and 452.76 hours·μg/mL, respectively), and higher CL/F (0.17 versus 0.08 and 0.07 L/kg/hr, respectively). The half-life that defined the terminal slope of the plasma concentration versus time curve (~5 hours) was similar to values previously reported for healthy dogs.Considerable variation exists in the pharmacokinetics of LEV-XR in dogs with epilepsy being treated with a common dose regimen. Concurrent administration of phenobarbital contributed significantly to the variation. Other factors evaluated, including co-administration of zonisamide, were not shown to contribute to the variability. Drug monitoring may be beneficial to determine the most appropriate dose of LEV-XR in individual dogs.}, number={5}, journal={Journal of Veterinary Internal Medicine}, publisher={Wiley}, author={Muñana, Karen R. and Otamendi, Arturo J. and Nettifee, Julie A. and Papich, Mark G.}, year={2018}, month={Sep}, pages={1677–1683} }
 @article{zidan_fenn_griffith_early_mariani_muñana_guevar_olby_2018, title={The Effect of Electromagnetic Fields on Post-Operative Pain and Locomotor Recovery in Dogs with Acute, Severe Thoracolumbar Intervertebral Disc Extrusion: A Randomized Placebo-Controlled, Prospective Clinical Trial}, volume={35}, ISSN={0897-7151 1557-9042}, url={http://dx.doi.org/10.1089/neu.2017.5485}, DOI={10.1089/neu.2017.5485}, abstractNote={Spinal cord injury (SCI) attributed to acute intervertebral disc extrusions (IVDEs) is common in dogs and is treated by surgical decompression. Dogs with sensorimotor complete injuries have an incomplete recovery. Pulsed electromagnetic fields (PEMFs) reduce post-operative pain through anti-inflammatory effects and there is growing evidence for neuroprotective effects. This randomized, controlled clinical trial evaluated the effect of PEMF on post-operative pain and neurological recovery in dogs with surgically treated sensorimotor complete SCI attributed to acute IVDE. Sixteen dogs with surgically treated complete thoracolumbar SCI were randomized to receive PEMF (15 min every 2 h for 2 weeks then twice-daily for 4 weeks) or placebo starting immediately after diagnosis. The primary outcome was gait score at 2 weeks. Secondary measures of gait, pain perception, and proprioceptive function were evaluated at 2 and 6 weeks. Plasma glial fibrillary acidic protein (GFAP) concentration was measured as an SCI biomarker. Post-operative pain was quantified by measuring mechanical sensory thresholds (MSTs) at control and surgical sites. There was no significant difference in demographics or GFAP concentration between the two groups at trial entry. There was no difference in primary outcome or in secondary measures of gait, but proprioceptive placing was significantly better at 6 weeks and GFAP concentrations were significantly lower at 2 weeks in the PEMF group. MSTs were significantly higher in the PEMF-treated group. We conclude that PEMF reduced incision-associated pain in dogs post-surgery for IVDE and may reduce extent of SCI and enhance proprioceptive placing. Larger clinical trials are warranted.}, number={15}, journal={Journal of Neurotrauma}, publisher={Mary Ann Liebert Inc}, author={Zidan, Natalia and Fenn, Joe and Griffith, Emily and Early, Peter J. and Mariani, Chris L. and Muñana, Karen R. and Guevar, Julien and Olby, Natasha J.}, year={2018}, month={Aug}, pages={1726–1736} }
 @article{pastina_early_bergman_nettifee_maller_bray_waldron_castel_munana_papich_et al._2018, title={The pharmacokinetics of cytarabine administered subcutaneously, combined with prednisone, in dogs with meningoencephalomyelitis of unknown etiology}, volume={41}, ISSN={["1365-2885"]}, url={https://doi.org/10.1111/jvp.12667}, DOI={10.1111/jvp.12667}, abstractNote={Abstract The objective of this study was to describe the pharmacokinetics (PK) of cytarabine (CA) after subcutaneous (SC) administration to dogs with meningoencephalomyelitis of unknown etiology (MUE). Twelve dogs received a single SC dose of CA at 50 mg/m 2 as part of treatment of MUE. A sparse sampling technique was used to collect four blood samples from each dog from 0 to 360 min after administration. All dogs were concurrently receiving prednisone (0.5–2 mg kg −1 day −1 ). Plasma CA concentrations were measured by HPLC, and pharmacokinetic parameters were estimated using nonlinear mixed‐effects modeling (NLME). Plasma drug concentrations ranged from 0.05 to 2.8 μg/ml. The population estimate (CV%) for elimination half‐life and Tmax of cytarabine in dogs was 1.09 (21.93) hr and 0.55 (51.03) hr, respectively. The volume of distribution per fraction absorbed was 976.31 (10.85%) ml/kg. Mean plasma concentration of CA for all dogs was above 1.0 μg/ml at the 30‐, 60‐, 90‐, and 120‐min time points. In this study, the pharmacokinetics of CA in dogs with MUE after a single 50 mg/m 2 SC injection in dogs was similar to what has been previously reported in healthy beagles; there was moderate variability in the population estimates in this clinical population of dogs.}, number={5}, journal={Journal of Veterinary Pharmacology & Therapeutics}, publisher={Wiley}, author={Pastina, B. and Early, P.J. and Bergman, R.L. and Nettifee, J. and Maller, A. and Bray, K.Y. and Waldron, R.J. and Castel, A.M. and Munana, K.R. and Papich, M.G. and et al.}, year={2018}, month={Oct}, pages={638–643} }
 @article{royal_neel_munana_flammer_2018, title={Using a modified bookmark procedure to help identify reasonable consequences for academic integrity violations}, volume={45}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-85043509585&partnerID=MN8TOARS}, DOI={10.3138/jvme.0816-126r2}, abstractNote={It is recommended that institutions develop academic conduct policies to help preserve academic integrity, enforce compliance, and aid in legal defensibility. These policies should also articulate reasonable consequences for persons found in violation. The problem, however, is that all academic misconduct offenses are not created equal, and determining reasonable consequences for these violations can be particularly challenging due to their subjective nature. Thus, the purpose of this study was to introduce a novel method for more objectively determining reasonable sanctions for several academic misconduct offenses of varying degrees of severity. We utilized a variation of the Bookmark procedure, a popular standard-setting technique used primarily by psychometricians in high-stakes testing environments, to investigate empirical survey data and develop policy recommendations. We encourage others to use this procedure, where appropriate, to identify appropriate cut scores and ranges to aid in policy development across a variety of contexts.}, number={1}, journal={Journal of Veterinary Medical Education}, publisher={University of Toronto Press Inc. (UTPress)}, author={Royal, Kenneth D. and Neel, Jennifer A. and Munana, Karen R. and Flammer, Keven}, year={2018}, pages={43–50} }
 @article{fenn_laber_williams_rousse_early_mariani_munana_decker_volk_olby_et al._2017, title={Associations Between Anesthetic Variables and Functional Outcome in Dogs With Thoracolumbar Intervertebral Disk Extrusion Undergoing Decompressive Hemilaminectomy}, volume={31}, ISSN={0891-6640}, url={http://dx.doi.org/10.1111/jvim.14677}, DOI={10.1111/jvim.14677}, abstractNote={Background Outcome of acute experimental spinal cord injury is strongly associated with tissue perfusion and oxygenation. Cardiopulmonary depression could affect outcome in dogs undergoing general anesthesia for surgical treatment of thoracolumbar intervertebral disk extrusion (IVDE). Hypothesis/Objectives To evaluate the effects of general anesthesia on functional outcome in dogs undergoing surgery to treat thoracolumbar IVDE. Animals Eighty‐four client‐owned dogs with acute thoracolumbar IVDE treated by decompressive hemilaminectomy. Methods Exploratory, retrospective observational study. Medical records were reviewed for clinical presentation and anesthetic monitoring variables, including duration of anesthesia and surgery, hypotension, bradycardia, temperature, and respiratory parameters. Multivariable regression tree analysis was performed to explore associations between anesthetic variables and functional outcome scores after 6 weeks, as well as return to ambulatory status. Results Episodes of bradycardia (69%) and hypotension (57%) were frequent. Across all outcome measures, regression tree analysis highlighted functional grade at presentation as the primary determining factor, and among pain perception negative dogs, there was a possible association between increased duration of surgery and poorer outcome. In dogs with intact pain perception, duration of bradycardia, mean body temperature, and mean end‐tidal carbon dioxide were highlighted. Conclusions and Clinical Importance Exploratory statistical methods can facilitate hypothesis‐generating studies to inform prospective investigations in veterinary medicine. Although the mechanism is uncertain, increased duration of surgery might be associated with poorer outcome in pain perception negative dogs with thoracolumbar IVDE.}, number={3}, journal={Journal of Veterinary Internal Medicine}, publisher={Wiley}, author={Fenn, J. and Laber, E. and Williams, K. and Rousse, C. A. and Early, P. J. and Mariani, C. L. and Munana, Karen and Decker, S. De and Volk, H. A. and Olby, N. J. and et al.}, year={2017}, month={Mar}, pages={814–824} }
 @article{castel_olby_mariani_muñana_early_2017, title={Clinical Characteristics of Dogs with Progressive Myelomalacia Following Acute Intervertebral Disc Extrusion}, volume={31}, ISSN={0891-6640}, url={http://dx.doi.org/10.1111/jvim.14829}, DOI={10.1111/jvim.14829}, abstractNote={Background Progressive myelomalacia ( PMM ) is a catastrophic disease associated with acute intervertebral disc extrusion ( IVDE ). Published data on the clinical characteristics of this disease are limited. Objective To describe the onset and progression of clinical signs of PMM in a large case cohort. Animals Fifty‐one dogs , 18 with histopathologically confirmed PMM , 33 presumptively diagnosed based on clinical signs and diagnostic imaging. Methods Retrospective study. Dogs with confirmed IVDE and either a histopathologic diagnosis of PMM or a high clinical suspicion were identified by medical record search. Data on nature and progression of signs were extracted. Results Twenty‐four of 51 dogs were Dachshunds. T12–T13 was the most common site of disc extrusion (12 of 56), and 18 of 55 of mid‐to‐caudal lumbar discs (between L3 and L6) were affected. Onset of PMM signs ranged from present at first evaluation (17/51) to 5 days after presentation, with 25 of 51 cases developing signs within 48 hours. Progression of signs from onset of PMM to euthanasia or death, excluding 7 cases euthanized at presentation, ranged from 1 to 13 days with 23 being euthanized within 3 days. Nonspecific systemic signs were documented in 30 of 51 dogs. Conclusion and Clinical Importance The majority of dogs developed PMM within 2 days of presentation and was euthanized within another 3 days. However, onset can be delayed up to 5 days after presentation with progression to euthanasia taking as long as 2 weeks. Mid‐to‐caudal lumbar discs might be associated with an increased risk of PMM .}, number={6}, journal={Journal of Veterinary Internal Medicine}, publisher={Wiley}, author={Castel, A. and Olby, N.J. and Mariani, C.L. and Muñana, K.R. and Early, P.J.}, year={2017}, month={Sep}, pages={1782–1789} }
 @article{nettifee_munana_griffith_2017, title={Evaluation of the Impacts of Epilepsy in Dogs on Their Caregivers}, volume={53}, ISSN={["1547-3317"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-85019011505&partnerID=MN8TOARS}, DOI={10.5326/jaaha-ms-6537}, abstractNote={Epilepsy is a common problem in dogs, and management of this chronic disorder requires a substantial commitment on the part of the pet owner. The aim of this study was to evaluate the impact of epilepsy in dogs on their owners, utilizing an online survey tool. A questionnaire was developed to explore a variety of factors, including seizure history, treatment, outcome, quality of life, costs associated with therapy, and sources of support. A total of 225 responses were obtained. The majority of respondents reported positive scores for overall quality of life, although scores were significantly lower for dogs with poorly controlled epilepsy and medication-related adverse effects. The median monthly expenditure for antiepileptic medication was $51-75. Despite the considerable financial burden placed on the dog owner, monthly medication cost was not associated with quality of life score. Few published reports follow dogs with epilepsy after diagnosis, and there is a growing need to understand the issues associated with long-term management of this population. The results of this study provide useful information that can help veterinary professionals educate owners and set expectations regarding treatment of seizures and quality of life for dogs with epilepsy.}, number={3}, journal={JOURNAL OF THE AMERICAN ANIMAL HOSPITAL ASSOCIATION}, author={Nettifee, Julie A. and Munana, Karen R. and Griffith, Emily H.}, year={2017}, pages={143–149} }
 @article{early_crook_williams_davis_munana_papich_messenger_2017, title={Plasma and serum concentrations of cytarabine administered via continuous intravenous infusion to dogs with meningoencephalomyelitis of unknown etiology}, volume={40}, ISSN={["1365-2885"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-84988369300&partnerID=MN8TOARS}, DOI={10.1111/jvp.12360}, abstractNote={The objective of this study was to evaluate the plasma and serum concentrations of cytarabine (CA) administered via constant rate infusion (CRI) in dogs with meningoencephalomyelitis of unknown etiology (MUE). Nineteen client-owned dogs received a CRI of CA at a dose of 25 mg/m2 /h for 8 h as treatment for MUE. Dogs were divided into four groups, those receiving CA alone and those receiving CA in conjunction with other drugs. Blood samples were collected at 0, 1, 8, and 12 h after initiating the CRI. Plasma (n = 13) and serum (n = 11) cytarabine concentrations were measured by high-pressure liquid chromatography. The mean peak concentration (CMAX ) and area under the curve (AUC) after CRI administration were 1.70 ± 0.66 μg/mL and 11.39 ± 3.37 h·μg/mL, respectively, for dogs receiving cytarabine alone, 2.36 ± 0.35 μg/mL and 16.91 + 3.60 h·μg/mL for dogs administered cytarabine and concurrently on other drugs. Mean concentrations for all dogs were above 1.0 μg/mL at both the 1- and 8-h time points. The steady-state achieved with cytarabine CRI produces a consistent and prolonged exposure in plasma and serum, which is likely to produce equilibrium between blood and the central nervous system in dogs with a clinical diagnosis of MUE. Other medications commonly used to treat MUE do not appear to alter CA concentrations in serum and plasma.}, number={4}, journal={JOURNAL OF VETERINARY PHARMACOLOGY AND THERAPEUTICS}, author={Early, P. J. and Crook, K. I. and Williams, L. M. and Davis, E. G. and Munana, K. R. and Papich, M. G. and Messenger, K. M.}, year={2017}, month={Aug}, pages={411–414} }
 @article{royal_munana_neel_2017, title={Prohibiting students from asking questions during exams: A guideline for promoting fairness and preserving score validity}, volume={44}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-85024494960&partnerID=MN8TOARS}, DOI={10.3138/jvme.0316-054R}, abstractNote={Many medical and professional programs implement policies that prohibit students from asking questions during examinations. The reasoning behind these policies remains unclear to some, as there is a lack of literature addressing this topic. The purpose of this article is to present the rationale behind such policies and to discuss why these policies may help promote fairness and preserve score validity.}, number={2}, journal={Journal of Veterinary Medical Education}, publisher={University of Toronto Press Inc. (UTPress)}, author={Royal, Kenneth D. and Munana, Karen R. and Neel, Jennifer A.}, year={2017}, pages={343–345} }
 @inbook{muñana_2017, edition={8th}, title={Seizures}, booktitle={Textbook of Veterinary Internal Medicine}, publisher={Elsevier}, author={Muñana, K.R.}, editor={Ettinger, S.J. and Feldman, E.C. and Cote, E.Editors}, year={2017}, pages={142–145} }
 @article{podell_volk_berendt_löscher_munana_patterson_platt_2016, title={2015 ACVIM Small Animal Consensus Statement on Seizure Management in Dogs}, volume={30}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-84961214898&partnerID=MN8TOARS}, DOI={10.1111/jvim.13841}, abstractNote={This report represents a scientific and working clinical consensus statement on seizure management in dogs based on current literature and clinical expertise. The goal was to establish guidelines for a predetermined, concise, and logical sequential approach to chronic seizure management starting with seizure identification and diagnosis (not included in this report), reviewing decision‐making, treatment strategies, focusing on issues related to chronic antiepileptic drug treatment response and monitoring, and guidelines to enhance patient response and quality of life. Ultimately, we hope to provide a foundation for ongoing and future clinical epilepsy research in veterinary medicine.}, number={2}, journal={Journal of Veterinary Internal Medicine}, author={Podell, M. and Volk, H.A. and Berendt, M. and Löscher, W. and Munana, Karen and Patterson, E.E. and Platt, S.R.}, year={2016}, pages={477–490} }
 @article{olby_muguet-chanoit_lim_davidian_mariani_freeman_platt_humphrey_kent_giovanella_et al._2016, title={A Placebo-Controlled, Prospective, Randomized Clinical Trial of Polyethylene Glycol and Methylprednisolone Sodium Succinate in Dogs with Intervertebral Disk Herniation}, volume={30}, ISSN={["1939-1676"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-84956678975&partnerID=MN8TOARS}, DOI={10.1111/jvim.13657}, abstractNote={Background Acute intervertebral disk herniation ( IVDH ) is a common cause of spinal cord injury in dogs and currently there is no proven medical treatment to counter secondary injury effects. Use of methylprednisolone sodium succinate ( MPSS ) or polyethylene glycol ( PEG ) as neuroprotectants is advocated but controversial because neither treatment has been tested in placebo‐controlled, randomized, blinded trials in dogs. Hypothesis Polyethylene glycol will improve the outcome of severe spinal cord injury caused by IVDH compared to MPSS or placebo. Animals Client‐owned dogs with acute onset of thoracolumbar IVDH causing paralysis and loss of nociception for <24 hours. Methods Dogs were randomized to receive MPSS , PEG , or placebo; drugs appeared identical and group allocation was masked. Drug administration was initiated once the diagnosis of IVDH was confirmed and all dogs underwent hemilaminectomy. Neurologic function was assessed 2, 4, 8, and 12 weeks postoperatively using an open field gait score ( OFS ) as the primary outcome measure. Outcomes were compared by the Wilcoxon rank sum test. Results Sixty‐three dogs were recruited and 47.6% recovered ambulation. 17.5% developed progressive myelomalacia but there was no association with group. There was no difference in OFS among groups. Although full study power was not reached, conditional power analyses indicated the futility of continued case recruitment. Conclusions This clinical trial did not show a benefit of either MPSS or PEG in the treatment of acute, severe thoracolumbar IVDH when used as adjunctive medical treatment administered to dogs presenting within 24 hours of onset of paralysis.}, number={1}, journal={JOURNAL OF VETERINARY INTERNAL MEDICINE}, author={Olby, N. J. and Muguet-Chanoit, A. C. and Lim, J. -H. and Davidian, M. and Mariani, C. L. and Freeman, A. C. and Platt, S. R. and Humphrey, J. and Kent, M. and Giovanella, C. and et al.}, year={2016}, pages={206–214} }
 @article{lewis_olby_early_mariani_muñana_seiler_griffith_2016, title={Clinical and Diagnostic Imaging Features of Brain Herniation in Dogs and Cats}, volume={30}, ISSN={0891-6640}, url={http://dx.doi.org/10.1111/jvim.14526}, DOI={10.1111/jvim.14526}, abstractNote={Quantification of brain herniation on MRI and its immediate clinical implications are poorly described.Define the normal position of caudal fossa structures on brain MRIs in dogs and cats utilizing morphometry, compare this to dogs and cats with caudal transtentorial herniation (CTH), foramen magnum herniation (FMH) or both identified on MRI, and investigate associations between herniation severity, clinical signs, and 24-hour outcome.Ninety-two controls (66 dogs, 26 cats), 119 cases with herniation (88 dogs, 31 cats).Retrospective case series. The MRI database was searched for controls with normal brain anatomy and cases with brain herniation. Morphometry in controls established TTX (transtentorial to rostroventral cerebellum) to quantify CTH and FMX (caudoventral cerebellum to foramen magnum) to quantify FMH. Measurements were compared between cases and controls. Correlations with specific clinical variables and outcome were investigated.Measurements in medium/large control dogs versus small dog and cat controls were significantly different (P < .001, TTX: -0.46, -0.305, -0.3, FMX: 0.695, 0.27, 0.25, respectively). 119/1564 (7.6%) cases that underwent brain imaging had brain herniation. TTX and FMX were significantly different between controls and cases with CTH or FMH (P < .001). 67/89 (75%) cases with supratentorial lesions had no signs directly attributable to herniation. 71/119 (60%) had a normal anesthetic recovery. TTX was significantly associated with 24-hour survival (P < .001).Brain herniation can be quantified on MRI. Clinical signs directly attributable to brain herniation commonly are absent, and more severe CTH based on TTX is associated with a worse short-term outcome.}, number={5}, journal={Journal of Veterinary Internal Medicine}, publisher={Wiley}, author={Lewis, M.J. and Olby, N.J. and Early, P.J. and Mariani, C.L. and Muñana, K.R. and Seiler, G.S. and Griffith, E.H.}, year={2016}, month={Sep}, pages={1672–1680} }
 @article{olby_vaden_williams_griffith_harris_mariani_muñana_early_platt_boozer_et al._2016, title={Effect of Cranberry Extract on the Frequency of Bacteriuria in Dogs with Acute Thoracolumbar Disk Herniation: A Randomized Controlled Clinical Trial}, volume={31}, ISSN={0891-6640}, url={http://dx.doi.org/10.1111/jvim.14613}, DOI={10.1111/jvim.14613}, abstractNote={Background Dogs with spinal cord injury are at increased risk of developing bacteriuria due to increased residual urine volume. Cranberry extract inhibits binding of E. coli to uroepithelial cells, potentially reducing risk of bacteriuria. Hypothesis Cranberry extract reduces risk of bacteriuria in dogs after acute TL ‐ IVDH . Animals Client‐owned dogs with acute onset TL ‐ IVDH causing nonambulatory status. Methods Randomized, placebo‐controlled, blinded, prospective clinical trial. Dogs with acute TL ‐ IVDH were recruited 48 hours postoperatively and randomized to receive cranberry extract or placebo in a masked fashion. Urine cultures and neurological examinations were performed 2, 4, and 6 weeks postoperatively. The number of dogs with bacteriuria (all bacterial species) and bacteriuria ( E. coli) were primary and secondary outcome measures and were evaluated using chi‐squared test. Urine antiadhesion activity ( AAA ) was measured in a subset (N = 47) and examined in a secondary analysis evaluating additional risk factors for bacteriuria. Results Bacteriuria was detected 17 times in 94 dogs (6 placebo, 11 cranberry, P = .12). There were 7 E. coli . positive cultures (1 placebo, 6 cranberry, P = .09). Dogs in both groups had positive urine AAA (14/21: placebo, 16/26: cranberry), and dogs with urine AAA had significantly fewer E. coli positive cultures (n = 1) than dogs without it (n = 4) ( P = .047). Conclusions and Clinical Importance This clinical trial did not show a benefit of oral cranberry extract but had low power. Cranberry extract supplementation did not impact urine AAA , but a possible association between urine AAA and lower risk of E. coli bacteriuria was identified. Other doses could be investigated.}, number={1}, journal={Journal of Veterinary Internal Medicine}, publisher={Wiley}, author={Olby, N.J. and Vaden, S.L. and Williams, K. and Griffith, E.H. and Harris, T. and Mariani, C.L. and Muñana, K.R. and Early, P.J. and Platt, S.R. and Boozer, L. and et al.}, year={2016}, month={Dec}, pages={60–68} }
 @article{bray_munana_meichner_white_seiler_2016, title={Eosinophilic meningomyelitis associated with T-cell lymphoma in a cat}, volume={45}, ISSN={["1939-165X"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-85005995766&partnerID=MN8TOARS}, DOI={10.1111/vcp.12406}, abstractNote={A 12-year-old cat was presented for evaluation of progressive tetraparesis. Magnetic resonance imaging of the cervical spine demonstrated T2-hyperintensity, and contrast enhancement within the C4-C7 spinal cord, with marked meningeal contrast enhancement and segmental nerve root thickening. Lumbar cerebrospinal fluid contained 407 total nucleated cells/μL, with 99% eosinophils. The cat transiently improved with prednisolone, clindamycin, and ivermectin therapy, but subsequently worsened and was euthanized. Necropsy revealed an asymmetric infiltration predominantly of the white matter, meninges, and nerve roots of the C4-C6 spinal cord segments by an unencapsulated, poorly demarcated neoplasm composed of atypical lymphocytes admixed with eosinophils, causing perivascular hemorrhage and lytic necrosis. The neoplastic cells were immunoreactive for CD3, ultimately confirming T-cell lymphoma.}, number={4}, journal={VETERINARY CLINICAL PATHOLOGY}, author={Bray, Kathryn Y. and Munana, Karen R. and Meichner, Kristina and White, Laura A. and Seiler, Gabriela}, year={2016}, month={Dec}, pages={698–702} }
 @article{berendt_hulsmeyer_bhatti_de risio_farquhar_fischer_mandigers_long_matiasek_munana_et al._2016, title={Epilepsy today - Summary of the consensus statements for definition, classification and terminology of epilepsy in companion animals as well as genetic origin in purebred dogs}, volume={61}, number={8}, journal={Kleintier-Praxis}, author={Berendt, M. and Hulsmeyer, V. I. and Bhatti, S. F. M. and De Risio, L. and Farquhar, R. G. and Fischer, A. and Mandigers, P. J. J. and Long, S. and Matiasek, K. and Munana, K. and et al.}, year={2016}, pages={425–435} }
 @article{bhatti_de risio_munana_penderis_stein_tipold_berendt_farquhar_fischer_long_et al._2016, title={Epilepsy today: Summary of the IVETF "Consensus Proposal: Medical treatment of canine epilepsy in Europe"}, volume={61}, number={10}, journal={Kleintier-Praxis}, author={Bhatti, S. F. M. and De Risio, L. and Munana, K. and Penderis, J. and Stein, V. M. and Tipold, A. and Berendt, M. and Farquhar, R. G. and Fischer, A. and Long, S. and et al.}, year={2016}, pages={529-} }
 @article{de risio_bhatti_munana_penderis_steins_tipolds_berendt_farqhuar_fischer_long_et al._2016, title={Epilepsy today: Summary of the IVETF "Consensus proposal: Diagnostic Approach to Epilepsy in Dogs"}, volume={61}, number={9}, journal={Kleintier-Praxis}, author={De Risio, L. and Bhatti, S. and Munana, K. and Penderis, J. and Steins, V. and Tipolds, A. and Berendt, M. and Farqhuar, R. and Fischer, A. and Long, S. and et al.}, year={2016}, pages={477–487} }
 @article{rousse_olby_williams_harris_griffith_mariani_muñana_early_2016, title={Recovery of stepping and coordination in dogs following acute thoracolumbar intervertebral disc herniations}, volume={213}, ISSN={1090-0233}, url={http://dx.doi.org/10.1016/J.TVJL.2016.04.002}, DOI={10.1016/J.TVJL.2016.04.002}, abstractNote={Prospective data on the recovery of coordination in dogs suffering acute thoracolumbar intervertebral disc herniations (TL-IVDH) are limited. The purpose of this study was to use treadmill based and open field scores (OFS) to quantify recovery of stepping ability and forelimb, hindlimb coordination in the 6 weeks following surgical decompression of dogs with TL-IVDH. Sixty-three dogs were grouped at presentation as grades 3 (non-ambulatory paraparetic), 4 (paraplegic) or 5 (paraplegic without pain sensation) and were evaluated 2, 4, and 6 weeks post-operatively. Stepping scores and Regularity Index (RI), a measure of coordination, were calculated from treadmill walking, and an OFS incorporating supported and unsupported walking was assigned. Outcomes for the three measures were compared between groups and correlation between scoring methods was assessed. Grade 3 and 4 dogs recovered ambulation by 2 weeks, reaching median stepping scores of 96 and 90% by 6 weeks, respectively. Recovery of coordination differed between groups 3 and 4 with median RI scores of 93.9% and 63%, respectively, by 6 weeks. Eight grade 5 dogs failed to recover independent ambulation by 6 weeks. Nine dogs recovered with scores that were significantly worse than the grade 3 and 4 dogs at 6 weeks for stepping score (P < 0.001) and RI (P < 0.001). OFS correlated closely with stepping and RI scores and each group was significantly different using this ordinal scale. In conclusion, recovery of coordination was incomplete in dogs that showed good recovery of stepping. The data generated could be used for clinical trial design.}, journal={The Veterinary Journal}, publisher={Elsevier BV}, author={Rousse, C.A. and Olby, N.J. and Williams, K. and Harris, T.L. and Griffith, E.H. and Mariani, C.L. and Muñana, K.R. and Early, P.J.}, year={2016}, month={Jul}, pages={59–63} }
 @misc{muñana_2015, title={Book review: Seizures in Dogs and Cats}, volume={247}, journal={Journal of the American Veterinary Medical Association}, author={Muñana, K.R.}, year={2015}, pages={619–620} }
 @article{munana_nettifee-osborne_papich_2015, title={Effect of Chronic Administration of Phenobarbital, or Bromide, on Pharmacokinetics of Levetiracetam in Dogs with Epilepsy}, volume={29}, ISSN={["1939-1676"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-84925714278&partnerID=MN8TOARS}, DOI={10.1111/jvim.12548}, abstractNote={Background Levetiracetam ( LEV ) is a common add‐on antiepileptic drug ( AED ) in dogs with refractory seizures. Concurrent phenobarbital administration alters the disposition of LEV in healthy dogs. Hypothesis/Objectives To evaluate the pharmacokinetics of LEV in dogs with epilepsy when administered concurrently with conventional AED s. Animals Eighteen client‐owned dogs on maintenance treatment with LEV and phenobarbital ( PB group, n = 6), LEV and bromide ( BR group, n = 6) or LEV , phenobarbital and bromide ( PB – BR group, n = 6). Methods Prospective pharmacokinetic study. Blood samples were collected at 0, 1, 2, 4, and 6 hours after LEV administration. Plasma LEV concentrations were determined by high‐pressure liquid chromatography. To account for dose differences among dogs, LEV concentrations were normalized to the mean study dose (26.4 mg/kg). Pharmacokinetic analysis was performed on adjusted concentrations, using a noncompartmental method, and area‐under‐the‐curve ( AUC ) calculated to the last measured time point. Results Compared to the PB and PB – BR groups, the BR group had significantly higher peak concentration ( C max ) (73.4 ± 24.0 versus 37.5 ± 13.7 and 26.5 ± 8.96 μg/mL, respectively, P < .001) and AUC (329 ± 114 versus 140 ± 64.7 and 98.7 ± 42.2 h*μg/mL, respectively, P < .001), and significantly lower clearance (CL/F) (71.8 ± 22.1 versus 187 ± 81.9 and 269 ± 127 mL/h/kg, respectively, P = .028). Conclusions and Clinical Importance Concurrent administration of PB alone or in combination with bromide increases LEV clearance in epileptic dogs compared to concurrent administration of bromide alone. Dosage increases might be indicated when utilizing LEV as add‐on treatment with phenobarbital in dogs.}, number={2}, journal={JOURNAL OF VETERINARY INTERNAL MEDICINE}, author={Munana, K. R. and Nettifee-Osborne, J. A. and Papich, M. G.}, year={2015}, pages={614–619} }
 @inbook{muñana_2015, edition={6th}, title={Feline Hyperesthesia Syndrome}, booktitle={Blackwell's 5-Minute Veterinary Consult, Canine and Feline}, publisher={Wiley-Blackwell}, author={Muñana, K.R.}, editor={Tilley, L. P. and Smith, F. W. K.Editors}, year={2015}, pages={497} }
 @article{bhatti_de risio_muñana_penderis_stein_tipold_berendt_farquhar_fischer_long_et al._2015, title={International Veterinary Epilepsy Task Force consensus proposal: medical treatment of canine epilepsy in Europe}, volume={11}, ISSN={1746-6148}, url={http://dx.doi.org/10.1186/s12917-015-0464-z}, DOI={10.1186/s12917-015-0464-z}, abstractNote={In Europe, the number of antiepileptic drugs (AEDs) licensed for dogs has grown considerably over the last years. Nevertheless, the same questions remain, which include, 1) when to start treatment, 2) which drug is best used initially, 3) which adjunctive AED can be advised if treatment with the initial drug is unsatisfactory, and 4) when treatment changes should be considered. In this consensus proposal, an overview is given on the aim of AED treatment, when to start long-term treatment in canine epilepsy and which veterinary AEDs are currently in use for dogs. The consensus proposal for drug treatment protocols, 1) is based on current published evidence-based literature, 2) considers the current legal framework of the cascade regulation for the prescription of veterinary drugs in Europe, and 3) reflects the authors' experience. With this paper it is aimed to provide a consensus for the management of canine idiopathic epilepsy. Furthermore, for the management of structural epilepsy AEDs are inevitable in addition to treating the underlying cause, if possible.}, number={1}, journal={BMC Veterinary Research}, publisher={Springer Nature}, author={Bhatti, Sofie F.M. and De Risio, Luisa and Muñana, Karen and Penderis, Jacques and Stein, Veronika M. and Tipold, Andrea and Berendt, Mette and Farquhar, Robyn G. and Fischer, Andrea and Long, Sam and et al.}, year={2015}, month={Aug} }
 @article{rusbridge_long_jovanovik_milne_berendt_bhatti_de risio_farqhuar_fischer_matiasek_et al._2015, title={International Veterinary Epilepsy Task Force recommendations for a veterinary epilepsy-specific MRI protocol}, volume={11}, ISSN={1746-6148}, url={http://dx.doi.org/10.1186/s12917-015-0466-x}, DOI={10.1186/s12917-015-0466-x}, abstractNote={Epilepsy is one of the most common chronic neurological diseases in veterinary practice. Magnetic resonance imaging (MRI) is regarded as an important diagnostic test to reach the diagnosis of idiopathic epilepsy. However, given that the diagnosis requires the exclusion of other differentials for seizures, the parameters for MRI examination should allow the detection of subtle lesions which may not be obvious with existing techniques. In addition, there are several differentials for idiopathic epilepsy in humans, for example some focal cortical dysplasias, which may only apparent with special sequences, imaging planes and/or particular techniques used in performing the MRI scan. As a result, there is a need to standardize MRI examination in veterinary patients with techniques that reliably diagnose subtle lesions, identify post-seizure changes, and which will allow for future identification of underlying causes of seizures not yet apparent in the veterinary literature.There is a need for a standardized veterinary epilepsy-specific MRI protocol which will facilitate more detailed examination of areas susceptible to generating and perpetuating seizures, is cost efficient, simple to perform and can be adapted for both low and high field scanners. Standardisation of imaging will improve clinical communication and uniformity of case definition between research studies. A 6-7 sequence epilepsy-specific MRI protocol for veterinary patients is proposed and further advanced MR and functional imaging is reviewed.}, number={1}, journal={BMC Veterinary Research}, publisher={Springer Nature}, author={Rusbridge, Clare and Long, Sam and Jovanovik, Jelena and Milne, Marjorie and Berendt, Mette and Bhatti, Sofie F. M. and De Risio, Luisa and Farqhuar, Robyn G. and Fischer, Andrea and Matiasek, Kaspar and et al.}, year={2015}, month={Aug} }
 @article{de risio_bhatti_munana_penderis_stein_tipold_berendt_farqhuar_fischer_long_et al._2015, title={International veterinary epilepsy task force consensus proposal: diagnostic approach to epilepsy in dogs}, volume={11}, ISSN={["1746-6148"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-84940021273&partnerID=MN8TOARS}, DOI={10.1186/s12917-015-0462-1}, abstractNote={This article outlines the consensus proposal on diagnosis of epilepsy in dogs by the International Veterinary Epilepsy Task Force. The aim of this consensus proposal is to improve consistency in the diagnosis of epilepsy in the clinical and research settings. The diagnostic approach to the patient presenting with a history of suspected epileptic seizures incorporates two fundamental steps: to establish if the events the animal is demonstrating truly represent epileptic seizures and if so, to identify their underlying cause. Differentiation of epileptic seizures from other non-epileptic episodic paroxysmal events can be challenging. Criteria that can be used to make this differentiation are presented in detail and discussed. Criteria for the diagnosis of idiopathic epilepsy (IE) are described in a three-tier system. Tier I confidence level for the diagnosis of IE is based on a history of two or more unprovoked epileptic seizures occurring at least 24 h apart, age at epileptic seizure onset of between six months and six years, unremarkable inter-ictal physical and neurological examination, and no significant abnormalities on minimum data base blood tests and urinalysis. Tier II confidence level for the diagnosis of IE is based on the factors listed in tier I and unremarkable fasting and post-prandial bile acids, magnetic resonance imaging (MRI) of the brain (based on an epilepsy-specific brain MRI protocol) and cerebrospinal fluid (CSF) analysis. Tier III confidence level for the diagnosis of IE is based on the factors listed in tier I and II and identification of electroencephalographic abnormalities characteristic for seizure disorders. The authors recommend performing MRI of the brain and routine CSF analysis, after exclusion of reactive seizures, in dogs with age at epileptic seizure onset <6 months or >6 years, inter-ictal neurological abnormalities consistent with intracranial neurolocalisation, status epilepticus or cluster seizure at epileptic seizure onset, or a previous presumptive diagnosis of IE and drug-resistance with a single antiepileptic drug titrated to the highest tolerable dose. This consensus article represents the basis for a more standardised diagnostic approach to the seizure patient. These recommendations will evolve over time with advances in neuroimaging, electroencephalography, and molecular genetics of canine epilepsy.}, number={1}, journal={BMC VETERINARY RESEARCH}, author={De Risio, Luisa and Bhatti, Sofie and Munana, Karen and Penderis, Jacques and Stein, Veronika and Tipold, Andrea and Berendt, Mette and Farqhuar, Robyn and Fischer, Andrea and Long, Sam and et al.}, year={2015}, month={Aug} }
 @article{potschka_fischer_löscher_patterson_bhatti_berendt_de risio_farquhar_long_mandigers_et al._2015, title={International veterinary epilepsy task force consensus proposal: outcome of therapeutic interventions in canine and feline epilepsy}, volume={11}, ISSN={1746-6148}, url={http://dx.doi.org/10.1186/s12917-015-0465-y}, DOI={10.1186/s12917-015-0465-y}, abstractNote={Common criteria for the diagnosis of drug resistance and the assessment of outcome are needed urgently as a prerequisite for standardized evaluation and reporting of individual therapeutic responses in canine epilepsy. Thus, we provide a proposal for the definition of drug resistance and partial therapeutic success in canine patients with epilepsy. This consensus statement also suggests a list of factors and aspects of outcome, which should be considered in addition to the impact on seizures. Moreover, these expert recommendations discuss criteria which determine the validity and informative value of a therapeutic trial in an individual patient and also suggest the application of individual outcome criteria. Agreement on common guidelines does not only render a basis for future optimization of individual patient management, but is also a presupposition for the design and implementation of clinical studies with highly standardized inclusion and exclusion criteria. Respective standardization will improve the comparability of findings from different studies and renders an improved basis for multicenter studies. Therefore, this proposal provides an in-depth discussion of the implications of outcome criteria for clinical studies. In particular ethical aspects and the different options for study design and application of individual patient-centered outcome criteria are considered.}, number={1}, journal={BMC Veterinary Research}, publisher={Springer Nature}, author={Potschka, Heidrun and Fischer, Andrea and Löscher, Wolfgang and Patterson, Ned and Bhatti, Sofie and Berendt, Mette and De Risio, Luisa and Farquhar, Robyn and Long, Sam and Mandigers, Paul and et al.}, year={2015}, month={Aug} }
 @article{berendt_farquhar_mandigers_pakozdy_bhatti_de risio_fischer_long_matiasek_muñana_et al._2015, title={International veterinary epilepsy task force consensus report on epilepsy definition, classification and terminology in companion animals}, volume={11}, ISSN={1746-6148}, url={http://dx.doi.org/10.1186/s12917-015-0461-2}, DOI={10.1186/s12917-015-0461-2}, abstractNote={Dogs with epilepsy are among the commonest neurological patients in veterinary practice and therefore have historically attracted much attention with regard to definitions, clinical approach and management. A number of classification proposals for canine epilepsy have been published during the years reflecting always in parts the current proposals coming from the human epilepsy organisation the International League Against Epilepsy (ILAE). It has however not been possible to gain agreed consensus, "a common language", for the classification and terminology used between veterinary and human neurologists and neuroscientists, practitioners, neuropharmacologists and neuropathologists. This has led to an unfortunate situation where different veterinary publications and textbook chapters on epilepsy merely reflect individual author preferences with respect to terminology, which can be confusing to the readers and influence the definition and diagnosis of epilepsy in first line practice and research studies.In this document the International Veterinary Epilepsy Task Force (IVETF) discusses current understanding of canine epilepsy and presents our 2015 proposal for terminology and classification of epilepsy and epileptic seizures. We propose a classification system which reflects new thoughts from the human ILAE but also roots in former well accepted terminology. We think that this classification system can be used by all stakeholders.}, number={1}, journal={BMC Veterinary Research}, publisher={Springer Nature}, author={Berendt, Mette and Farquhar, Robyn G. and Mandigers, Paul J. J. and Pakozdy, Akos and Bhatti, Sofie F. M. and De Risio, Luisa and Fischer, Andrea and Long, Sam and Matiasek, Kaspar and Muñana, Karen and et al.}, year={2015}, month={Aug} }
 @article{matiasek_pumarola i batlle_rosati_fernández-flores_fischer_wagner_berendt_bhatti_de risio_farquhar_et al._2015, title={International veterinary epilepsy task force recommendations for systematic sampling and processing of brains from epileptic dogs and cats}, volume={11}, ISSN={1746-6148}, url={http://dx.doi.org/10.1186/s12917-015-0467-9}, DOI={10.1186/s12917-015-0467-9}, abstractNote={Traditionally, histological investigations of the epileptic brain are required to identify epileptogenic brain lesions, to evaluate the impact of seizure activity, to search for mechanisms of drug-resistance and to look for comorbidities. For many instances, however, neuropathological studies fail to add substantial data on patients with complete clinical work-up. This may be due to sparse training in epilepsy pathology and or due to lack of neuropathological guidelines for companion animals.The protocols introduced herein shall facilitate systematic sampling and processing of epileptic brains and therefore increase the efficacy, reliability and reproducibility of morphological studies in animals suffering from seizures.Brain dissection protocols of two neuropathological centres with research focus in epilepsy have been optimised with regards to their diagnostic yield and accuracy, their practicability and their feasibility concerning clinical research requirements.The recommended guidelines allow for easy, standardised and ubiquitous collection of brain regions, relevant for seizure generation. Tissues harvested the prescribed way will increase the diagnostic efficacy and provide reliable material for scientific investigations.}, number={1}, journal={BMC Veterinary Research}, publisher={Springer Nature}, author={Matiasek, Kaspar and Pumarola i Batlle, Martí and Rosati, Marco and Fernández-Flores, Francisco and Fischer, Andrea and Wagner, Eva and Berendt, Mette and Bhatti, Sofie F. M. and De Risio, Luisa and Farquhar, Robyn G. and et al.}, year={2015}, month={Aug} }
 @inbook{muñana_2015, edition={6th}, title={Nystagmus}, booktitle={Blackwell's 5-Minute Veterinary Consult, Canine and Feline}, publisher={Wiley-Blackwell}, author={Muñana, K.R.}, editor={Tilley, L.P. and Smith, F.W.K.Editors}, year={2015}, pages={957–958} }
 @article{schwartz_munana_nettifee-osborne_2013, title={Assessment of the prevalence and clinical features of cryptogenic epilepsy in dogs: 45 cases (2003-2011)}, volume={242}, ISSN={["1943-569X"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-84873910001&partnerID=MN8TOARS}, DOI={10.2460/javma.242.5.651}, abstractNote={To determine the prevalence and clinical features of cryptogenic epilepsy among dogs.Retrospective case series.214 client-owned dogs with onset of epileptic seizures at ≥ 7 years of age.A diagnostic imaging database was searched for dogs with symptomatic or cryptogenic epilepsy. Signalment, seizure history, and diagnostic information were recorded. Information regarding seizure frequency, administration of antiepileptic drugs (AEDs), owners' perceptions regarding quality of life, survival times, and causes of death for dogs with cryptogenic epilepsy was obtained via questionnaire. Variables were compared among dogs grouped according to diagnosis and age.45 (21%) dogs had a diagnosis of cryptogenic epilepsy, and 169 (79%) had symptomatic epilepsy. In dogs 7 to 9 years and ≥ 10 years of age at the time of seizure onset, 31 of 106 (29%) and 14 of 108 (13%), respectively, had a diagnosis of cryptogenic epilepsy. At last follow-up, most (40 [89%]) dogs with cryptogenic epilepsy were receiving ≥ 1 AED. Thirty-one of 37 (84%) dogs typically had ≤ 1 seizure/mo following hospital discharge. Death was confirmed in 20 (44%) dogs with cryptogenic epilepsy and was related to seizures or AEDs in 7 Median survival time from onset of seizures was 52 months for all dogs with cryptogenic epilepsy. Median quality-of-life score (scale, 1 [poor] to 10 [excellent]) indicated by 34 owners of dogs with cryptogenic epilepsy was 10 before diagnosis and initiation of AED treatment and 8 afterward.Cryptogenic epilepsy was diagnosed in a substantial proportion of dogs with an onset of epileptic seizures at ≥ 7 years of age. Seizure control was considered acceptable in most dogs.}, number={5}, journal={JAVMA-JOURNAL OF THE AMERICAN VETERINARY MEDICAL ASSOCIATION}, author={Schwartz, Malte and Munana, Karen R. and Nettifee-Osborne, Julie}, year={2013}, month={Mar}, pages={651–657} }
 @inbook{muñana_2013, title={Head tilt and nystagmus}, ISBN={9781905319343 9781910443125}, url={http://dx.doi.org/10.22233/9781910443125.11}, DOI={10.22233/9781910443125.11}, abstractNote={Head tilt and nystagmus are relatively common presentations in veterinary practice. These signs are typically associated with vestibular disease, although an intermittent head tilt alone may be due to otitis externa or other aural irritation. This chapter looks at clinical signs, lesion localization, pathophysiology, differential diagnosis, neurodiagnostic investigation, peripheral vestibular diseases, central vestibular diseases.}, booktitle={BSAVA Manual of Canine and Feline Neurology}, publisher={British Small Animal Veterinary Association}, author={Muñana, Karen R.}, year={2013}, month={Jan}, pages={195–212} }
 @misc{munana_2013, title={Management of Refractory Epilepsy}, volume={28}, ISSN={["1946-9837"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-84884400682&partnerID=MN8TOARS}, DOI={10.1053/j.tcam.2013.06.007}, abstractNote={The term refractory epilepsy is utilized in veterinary medicine to describe a condition in which an animal with epilepsy fails to attain satisfactory seizure control or suffers intolerable side effects despite appropriate therapy with conventional antiepileptic drugs. Refractory epilepsy is an important problem in small animal practice as it occurs in approximately one-third of dogs with epilepsy. Consequently, there is much interest in identifying ways to more effectively treat this population of animals. More than a dozen new antiepileptic drugs have been approved for humans over the last 2 decades, and several of these drugs, including gabapentin, zonisamide, levetiracetam, and pregabalin, have been evaluated for the treatment of refractory seizures in veterinary patients. Nonmedical methods to treat poorly controlled epilepsy are also being explored. The 2 alternative forms of therapy that have shown the most promise in humans with epilepsy are electrical stimulation of the brain and dietary modification, both of which have also been evaluated in dogs. This overview summarizes the available data on pharmacologic as well as nonmedical treatment options for dogs and cats with refractory epilepsy. Although many forms of therapy are currently being utilized in clinical practice, our knowledge of the safety and efficacy of these treatments is limited. Additional randomized controlled trials are needed to better evaluate these novel therapies for refractory epilepsy in dogs and cats.}, number={2}, journal={TOPICS IN COMPANION ANIMAL MEDICINE}, author={Munana, Karen R.}, year={2013}, month={May}, pages={67–71} }
 @article{crook_early_messenger_munana_gallagher_papich_2013, title={The pharmacokinetics of cytarabine in dogs when administered via subcutaneous and continuous intravenous infusion routes}, volume={36}, ISSN={["1365-2885"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-84880035701&partnerID=MN8TOARS}, DOI={10.1111/jvp.12008}, abstractNote={This crossover study compared the pharmacokinetics of cytarabine in six healthy dogs following intravenous constant rate infusion (CRI) and subcutaneous (SC) administrations, as these are two routes of administration commonly employed in the treatment of meningoencephalitis of unknown etiology. Each dog received a SC cytarabine injection of 50 mg/m(2) or an 8 h CRI of 25 mg/m(2) per hour, with a 7-day washout before receiving the alternative treatment. Blood samples were collected for 16 h after CRI initiation and for 8 h after SC injection. Plasma concentrations were measured by high-pressure liquid chromatography (HPLC). Pharmacokinetic parameters were estimated using the best-fit compartmental analysis for both CRI and SC routes. Terminal half-life (T(1/2) ) of cytarabine was 1.35 ± 0.3 and 1.15 ± 0.13 h after SC administration and CRI, respectively. Mean peak concentration (Cmax ) was 2.88 and 2.80 μg/mL for SC and CRI administration, respectively. Volume of distribution was 0.66 ± 0.07 l/kg. The 8-h CRI produced steady-state plasma concentrations as determined by consecutive measurement that did not decline until the end of the infusion. The SC administration did not achieve steady-state concentrations because cytarabine administered by this route was rapidly absorbed and eliminated quickly. The steady state achieved with the cytarabine CRI may produce a more prolonged exposure of cytarabine at cytotoxic levels in plasma compared to the concentrations after SC administration.}, number={4}, journal={JOURNAL OF VETERINARY PHARMACOLOGY AND THERAPEUTICS}, author={Crook, K. I. and Early, P. J. and Messenger, K. M. and Munana, K. R. and Gallagher, R. and Papich, M. G.}, year={2013}, month={Aug}, pages={408–411} }
 @article{schwartz_munana_nettifee-osborne_messenger_papich_2013, title={The pharmacokinetics of midazolam after intravenous, intramuscular, and rectal administration in healthy dogs}, volume={36}, ISSN={["0140-7783"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-84883647308&partnerID=MN8TOARS}, DOI={10.1111/jvp.12032}, abstractNote={Intravenous benzodiazepines are utilized as first‐line drugs to treat prolonged epileptic seizures in dogs and alternative routes of administration are required when venous access is limited. This study compared the pharmacokinetics of midazolam after intravenous (IV), intramuscular (IM), and rectal (PR) administration. Six healthy dogs were administered 0.2 mg/kg midazolam IV, IM, or PR in a randomized, 3‐way crossover design with a 3‐day washout between study periods. Blood samples were collected at baseline and at predetermined intervals until 480 min after administration. Plasma midazolam concentrations were measured by high‐pressure liquid chromatography with UV detection. Rectal administration resulted in erratic systemic availability with undetectable to low plasma concentrations. Arithmetic mean values ± SD for midazolam peak plasma concentrations were 0.86 ± 0.36 μg/mL ( C 0 ) and 0.20 ± 0.06 μg/mL ( C max ), following IV and IM administration, respectively. Time to peak concentration ( T max ) after IM administration was 7.8 ± 2.4 min with a bioavailability of 50 ± 16%. Findings suggest that IM midazolam might be useful in treating seizures in dogs when venous access is unavailable, but higher doses may be needed to account for intermediate bioavailability. Rectal administration is likely of limited efficacy for treating seizures in dogs.}, number={5}, journal={JOURNAL OF VETERINARY PHARMACOLOGY AND THERAPEUTICS}, author={Schwartz, M. and Munana, K. R. and Nettifee-Osborne, J. A. and Messenger, K. M. and Papich, M. G.}, year={2013}, month={Oct}, pages={471–477} }
 @article{munana_2013, title={Update Seizure Management in Small Animal Practice}, volume={43}, ISSN={["1878-1306"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-84880936777&partnerID=MN8TOARS}, DOI={10.1016/j.cvsm.2013.04.008}, abstractNote={Seizures are the most common neurologic condition encountered in small animal practice and arise from an imbalance of excitatory and inhibitory mechanisms in the brain. Epilepsy refers to recurrent seizures of any cause. Successful management of epilepsy requires knowledge of the pharmacologic properties of available antiepileptic medications, regular patient evaluations to assess response to therapy and monitor for adverse effects, and thorough client education to ensure that goals and expectations of therapy are understood. Recommendations for emergency care of seizures at home should be provided for patients with seizures that are not controlled with maintenance antiepileptic therapy.}, number={5}, journal={VETERINARY CLINICS OF NORTH AMERICA-SMALL ANIMAL PRACTICE}, author={Munana, Karen R.}, year={2013}, month={Sep}, pages={1127-+} }
 @article{muñana_nettifee-osborne_bergman_mealey_2012, title={Association between ABCB1 Genotype and Seizure Outcome in Collies with Epilepsy}, volume={26}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-84869889645&partnerID=MN8TOARS}, DOI={10.1111/j.1939-1676.2012.01006.x}, abstractNote={Medically refractory seizures are an important problem in both humans and dogs with epilepsy. Altered expression of ABCB1, the gene encoding for p-glycoprotein (PGP), has been proposed to play a role in drug-resistant epilepsy.Heterogeneity of the ABCB1 gene is associated with seizure outcome in dogs with epilepsy.Twenty-nine Collies with epilepsy being treated with antiepileptic drugs (AEDs).Prospective and retrospective cohort study. Dogs were classified as having a good outcome (≤ 1 seizure/month, no cluster seizures) or a poor outcome (>1 seizure/month, with or without cluster seizures) based on owner-completed questionnaire. Serum AED concentrations were measured, and ABCB1 genotyping was performed on buccal tissue samples. Association analyses were performed for genotype and seizure outcome, number of AEDs administered, serum AED concentrations, and incidence of adverse effects.Fourteen dogs of 29 (48%) were homozygous for the ABCB1-1∆ mutation (M/M), 11 dogs (38%) were heterozygous (M/N), and 4 dogs (14%) had the wild-type genotype (N/N). Dogs with the M/M genotype were significantly more likely to have fewer seizures and have less AED-related sedation than M/N or N/N dogs (P = .003 and P = .001, respectively). Serum phenobarbital and bromide concentrations did not differ between groups, but the M/N and N/N groups received a larger number of AEDs than the M/M group (P = .014).ABCB1 genotype is associated with seizure outcome in Collies with epilepsy. This cannot be attributed to differences in PGP function, but might be because of intrinsic variations in seizure severity among phenotypes.}, number={6}, journal={Journal of Veterinary Internal Medicine}, author={Muñana, K.R. and Nettifee-Osborne, J.A. and Bergman, R.L. and Mealey, K.L.}, year={2012}, pages={1358–1364} }
 @article{munana_thomas_inzana_nettifee-osborne_mclucas_olby_mariani_early_2012, title={Evaluation of Levetiracetam as Adjunctive Treatment for Refractory Canine Epilepsy: A Randomized, Placebo-Controlled, Crossover Trial}, volume={26}, ISSN={["1939-1676"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-84858746170&partnerID=MN8TOARS}, DOI={10.1111/j.1939-1676.2011.00866.x}, abstractNote={Background There is little evidence‐based information available to guide treatment of refractory epilepsy in dogs. The antiepileptic drug levetiracetam (LEV) is administered to dogs, although its safety and efficacy are unknown. Objective To evaluate the safety and efficacy of LEV as adjunctive therapy for refractory epilepsy in dogs. Animals Thirty‐four client‐owned dogs with idiopathic epilepsy. Methods Randomized, blinded trial involving dogs resistant to phenobarbital and bromide. Dogs received LEV (20 mg/kg PO q8h) or placebo for 16 weeks, and after a 4‐week washout were crossed over to the alternate treatment for 16 weeks. Owners kept records on seizure frequency and adverse events. Hemogram, chemistry profile, urinalysis, and serum antiepileptic drug concentrations were evaluated at established intervals. Results Twenty‐two (65%) dogs completed the study. Weekly seizure frequency during the 1st treatment period decreased significantly during LEV administration relative to baseline (1.9 ± 1.9 to 1.1 ± 1.3, P = .015). The reduction in seizures with LEV was not significant when compared to placebo (1.1 ± 1.3 versus 1.5 ± 1.7, P = .310). The most common adverse event was ataxia, with no difference in incidence between LEV and placebo (45 versus 18%, P = .090). No changes in laboratory parameters were identified and owners reported an improved quality of life (QOL) with LEV compared to placebo (QOL score 32.7 ± 4.3 versus 29.4 ± 4.5, P = .028). Conclusions and Clinical Importance Adjunctive treatment with LEV appears safe in epileptic dogs. Efficacy of LEV over placebo was not demonstrated, although the power of the study was limited. Further evaluation of LEV as treatment for epilepsy in dogs is warranted.}, number={2}, journal={JOURNAL OF VETERINARY INTERNAL MEDICINE}, author={Munana, K. R. and Thomas, W. B. and Inzana, K. D. and Nettifee-Osborne, J. A. and McLucas, K. J. and Olby, N. J. and Mariani, C. J. and Early, P. J.}, year={2012}, pages={341–348} }
 @inbook{muñana_2011, edition={5th}, title={Feline Hyperesthesia Syndrome}, booktitle={Blackwell's 5-Minute Veterinary Consult, Canine and Feline}, publisher={Wiley-Blackwell}, author={Muñana, K.R.}, editor={Tilley, L.P. and Smith, F.W.KEditors}, year={2011}, pages={463} }
 @inbook{muñana_2011, edition={5th}, title={Nystagmus}, booktitle={Blackwell's 5-Minute Veterinary Consult, Canine and Feline}, publisher={Wiley-Blackwell}, author={Muñana, K.R.}, editor={Tilley, L.P. and Smith, F.W.K.Editors}, year={2011}, pages={897–898,} }
 @article{schwartz_munana_olby_2011, title={Possible Drug-Induced Hepatopathy in a Dog Receiving Zonisamide Monotherapy for Treatment of Cryptogenic Epilepsy}, volume={73}, ISSN={["0916-7250"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-82955171529&partnerID=MN8TOARS}, DOI={10.1292/jvms.11-0164}, abstractNote={A 9-year old female spayed Rottweiler was diagnosed with cryptogenic epilepsy and started on zonisamide monotherapy (8.3 mg/kg, PO, q 12 hr). Three weeks after the 1st dose of zonisamide the dog presented for vomiting, inappetence and icterus. Serum biochemistry showed marked elevation of liver enzymes, consistent with hepatocellular damage and cholestasis. No underlying cause for liver disease was identified and a drug-induced hepatopathy was suspected. Zonisamide was discontinued and replaced by potassium bromide. Supportive therapy consisted of intravenous fluids, antiemetics, antibiotics and hepatoprotectants. The dog made a complete recovery and serial serum biochemical examinations showed complete normalisation of liver parameters 8 weeks after discontinuation of zonisamide. Based on a human Drug-induced Liver Injury Diagnostic Scale, the likelihood for zonisamide-induced hepatopathy was classified as "possible". Veterinary practitioners and owners should be educated about the potential for an idiosyncratic drug reaction to zonisamide. If signs of hepatotoxicity are recognised early and zonisamide is discontinued, complete recovery is possible.}, number={11}, journal={JOURNAL OF VETERINARY MEDICAL SCIENCE}, author={Schwartz, Malte and Munana, Karen R. and Olby, Natasha J.}, year={2011}, month={Nov}, pages={1505–1508} }
 @article{muguet-chanoit_olby_lim_gallagher_niman_dillard_campbell_early_mariani_muñana_et al._2011, title={The Cutaneous Trunci Muscle Reflex: A Predictor of Recovery in Dogs with Acute Thoracolumbar Myelopathies Caused by Intervertebral Disc Extrusions}, volume={41}, ISSN={0161-3499}, url={http://dx.doi.org/10.1111/j.1532-950X.2011.00921.x}, DOI={10.1111/j.1532-950x.2011.00921.x}, abstractNote={Objective To determine whether changes in the cutaneous trunci muscle ( CTM ) reflex are an early predictor of outcome in dogs with severe acute thoracolumbar intervertebral disc extrusion ( IVDE ). Study Design Multicenter prospective cohort study. Animals Dogs ( n = 36) with acute IVDE causing paraplegia, loss of nociception in pelvic limbs and tail, and an abnormal CTM reflex postoperatively. Methods The caudal border of the CTM reflex was established 24 hours after surgery and at discharge, and was reported as moving cranially, caudally, or staying static. Dogs were re‐evaluated at 12–20 weeks and at 7–36 months postoperatively. Outcome was classified as improved or unimproved, successful or unsuccessful, and ascending myelomalacia or not, and compared with early movement of the CTM reflex by construction of contingency tables and performing a F isher's exact test. Results By discharge (mean, 4.7 days; SD = 2.10), CTM reflex progression was caudal in 19 dogs, static in 11, and cranial in 6. Five of 6 dogs with cranial movement developed ascending myelomalacia ( P < .0001). Seventeen of 19 dogs with caudal movement showed an improvement by 12–20 weeks ( P = .0046) and none developed ascending myelomalacia ( P = .0013). Conclusions Postoperative changes of the caudal border of the CTM reflex are an early indicator of outcome in dogs with severe acute IVDE . Cranial movement of the CTM reflex is significantly associated with the development of ascending myelomalacia. Caudal movement is significantly associated with improvement, but not associated with a long‐term successful outcome.}, number={2}, journal={Veterinary Surgery}, publisher={Wiley}, author={Muguet-Chanoit, Audrey C. and Olby, Natasha J. and Lim, Ji-Hey and Gallagher, Ryan and Niman, Zachary and Dillard, Stacy and Campbell, James and Early, Peter and Mariani, Christopher L. and Muñana, Karen R. and et al.}, year={2011}, month={Dec}, pages={200–206} }
 @article{moore_muñana_papich_nettifee osborne_2011, title={The pharmacokinetics of levetiracetam in healthy dogs concurrently receiving phenobarbital}, volume={34}, ISSN={0140-7783}, url={http://dx.doi.org/10.1111/j.1365-2885.2010.01188.x}, DOI={10.1111/j.1365-2885.2010.01188.x}, abstractNote={Levetiracetam (LEV) is a commonly used add-on medication in dogs with refractory epilepsy. The objective of this study was to determine if the pharmacokinetics of LEV are altered by concurrent administration of phenobarbital (PB). Six healthy dogs received a single oral dose of LEV (16.7-27.8 mg/kg). Blood samples were collected at baseline and intermittently for 24 h. The study was repeated after the dogs received oral PB (2.0-3.3 mg/kg) twice daily for 21 days. Plasma LEV levels were evaluated by high pressure liquid chromatography, and data analyzed using a compartmental model. Compared with values determined when LEV was administered alone, concurrent administration of PB resulted in a decrease in LEV peak concentration (C(max) ) from 32.39 ± 6.76 to 18.22 ± 8.97 (P = 0.0071), a decrease in elimination half-life (T(1/2) ) from 3.43 ± 0.47 to 1.73 ± 0.22 (P = 0.0005), and an increase in oral clearance from 124.93 ± 26.93 to 252.99 ± 135.43 ml/h/kg (P < 0.0001). Concurrent PB administration significantly alters the pharmacokinetics of LEV in the dog, indicating that dosage adjustments might be necessary when the drug is administered with PB.}, number={1}, journal={Journal of Veterinary Pharmacology and Therapeutics}, publisher={Wiley}, author={Moore, S.A. and Muñana, K.R. and Papich, M.G. and Nettifee Osborne, J.A.}, year={2011}, month={Jan}, pages={31–34} }
 @article{moore_munana_papich_nettifee-osborne_2010, title={Levetiracetam pharmacokinetics in healthy dogs following oral administration of single and multiple doses}, volume={71}, ISSN={["1943-5681"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-77950965044&partnerID=MN8TOARS}, DOI={10.2460/ajvr.71.3.337}, abstractNote={To measure pharmacokinetics of levetiracetam (LEV) after single-dose oral administration in healthy dogs and determine whether pharmacokinetics changed after repeated oral dosing.6 healthy adult dogs.Pharmacokinetics were calculated following administration of a single dose (mean, 21.7 mg/kg, PO; day 1) and after administration of the last dose following administration for 6 days (20.8 to 22.7 mg/kg, PO, q 8 h; days 2 to 7). Plasma LEV concentrations were determined by use of high-pressure liquid chromatography. Pharmacokinetic data were analyzed by use of a 1-compartment model with first-order absorption.Peak concentration occurred 0.6 hours after administration of the first dose, with an absorption half-life of 0.06 hours. Minimal accumulation occurred over the 7 days, with only a slight increase in total area under the concentration-versus-time curve from 268.52 +/- 56.33 h x microg/mL (mean +/- SD) to 289.31 +/- 51.68 h x microg/mL after 7 days. Terminal half-life was 2.87 +/- 0.21 hours after the first dose and 3.59 +/- 0.82 hours after the last dose on day 7. Trough plasma concentrations were variable, depending on the time of day they were measured (morning trough concentration, 18.42 +/- 5.16 microg/mL; midday trough concentration, 12.57 +/- 4.34 microg/mL), suggesting a diurnal variation in drug excretion.Results indicated that the pharmacokinetics of LEV did not change appreciably after administration of multiple doses over 7 days. Administration of LEV at a dosage of 20 mg/kg, PO, every 8 hours to healthy dogs yielded plasma drug concentrations consistently within the therapeutic range established for LEV in humans.}, number={3}, journal={AMERICAN JOURNAL OF VETERINARY RESEARCH}, author={Moore, Sarah A. and Munana, Karen R. and Papich, Mark G. and Nettifee-Osborne, Julie}, year={2010}, month={Mar}, pages={337–341} }
 @article{munana_zhang_patterson_2010, title={Placebo Effect in Canine Epilepsy Trials}, volume={24}, ISSN={["0891-6640"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-73349107805&partnerID=MN8TOARS}, DOI={10.1111/j.1939-1676.2009.0407.x}, abstractNote={Background: The placebo effect is a well‐recognized phenomenon in human medicine; in contrast, little information exists on the effect of placebo administration in veterinary patients. Hypothesis: Nonpharmacologic therapeutic effects play a role in response rates identified in canine epilepsy trials. Animals: Thirty‐four dogs with epilepsy. Methods: Meta‐analysis of the 3 known prospective, placebo‐controlled canine epilepsy trials. The number of seizures per week was compiled for each dog throughout their participation in the trial. Log‐linear models were developed to evaluate seizure frequency during treatment and placebo relative to baseline. Results: Twenty‐two of 28 (79%) dogs in the study that received placebo demonstrated a decrease in seizure frequency compared with baseline, and 8 (29%) could be considered responders, with a 50% or greater reduction in seizures. For the 3 trials evaluated, the average reduction in seizures during placebo administration relative to baseline was 26% ( P = .0018), 29% ( P = .17), and 46% ( P = .01). Conclusions and Clinical Importance: A positive response to placebo administration, manifesting as a decrease in seizure frequency, can be observed in epileptic dogs. This is of importance when evaluating open label studies in dogs that aim to assess efficacy of antiepileptic drugs, as the reported results might be overstated. Findings from this study highlight the need for more placebo‐controlled trials in veterinary medicine.}, number={1}, journal={JOURNAL OF VETERINARY INTERNAL MEDICINE}, author={Munana, K. R. and Zhang, D. and Patterson, E. E.}, year={2010}, pages={166–170} }
 @article{olby_mackillop_cerda-gonzalez_moore_munana_graffinger_osborne_vaden_2010, title={Prevalence of urinary tract infection in dogs after surgery for thoracolumbar intervertebral disc extrusion}, volume={24}, ISSN={["1939-1676"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-77957900958&partnerID=MN8TOARS}, DOI={10.1111/j.1939-1676.2010.0567.x}, abstractNote={Background: Urinary tract infection (UTI) is a common complication in people with spinal cord injury (SCI). Dogs with acute intervertebral disc extrusion (IVDE) have similar risk factors for UTI when compared with human SCI patients and have a high perioperative prevalence of UTI. Objectives: Determine the prevalence of UTI in dogs for 3 months after surgery for thoracolumbar IVDE and identify risk factors for development of UTI. Animals: Twenty-five dogs treated surgically for 26 acute disc extrusions. Methods: Prospective study. Urinalysis and urine culture were performed perioperatively. At home, owners monitored urine with dipsticks every 48 hours for 1 month then once a week until 3 months. Dogs returned for assessment of motor function, urinalysis, and urine culture at 1 and 3 months after surgery. Presence of UTI over the 3-month period was correlated to potential risk factors. Results: Ten dogs (38%) developed 12 UTIs over the 3-month period, with the majority occurring between weeks 1 and 6; 60% of the UTIs were occult. Hematuria in the absence of pyuria or UTI was a common finding in the perioperative period. Sex, breed, and ambulatory status influenced the risk of developing a UTI. Conclusions and Clinical Importance: There is a high prevalence of UTIs, many of which are occult, in the 3 months after surgery for thoracolumbar IVDE. These dogs should be routinely monitored for UTI with urine culture regardless of urinalysis results.}, number={5}, journal={Journal of Veterinary Internal Medicine}, author={Olby, N.J. and MacKillop, E. and Cerda-Gonzalez, S. and Moore, S. and Munana, K.R. and Graffinger, M. and Osborne, J.A. and Vaden, S.L.}, year={2010}, month={Sep}, pages={1106–1111} }
 @inbook{muñana_2009, title={Brainstem Auditory Evoked Response}, booktitle={Blackwell's Five-Minute Veterinary Consult: Laboratory Tests and Diagnostic Procedures: Canine and Feline}, publisher={Blackwell Publishing}, author={Muñana, K.R.}, editor={Vaden, S. and Knoll, J and Tilley, L.P. and Smith, F.W.K, Jr.Editors}, year={2009}, pages={129–131} }
 @inbook{muñana_2009, title={Cerebrospinal Fluid Tap}, booktitle={Blackwell's Five-Minute Veterinary Consult: Laboratory Tests and Diagnostic Procedures: Canine and Feline}, publisher={Blackwell Publishing}, author={Muñana, K.R.}, editor={Vaden, S. and Knoll, J. and Tilley, L.P. and Smith, F.W.K, Jr.Editors}, year={2009}, pages={168–171} }
 @inbook{muñana_2009, place={New York}, edition={4th}, title={Feline Hyperesthesia Syndrome}, booktitle={Blackwell's Five-Minute Veterinary Consult: Laboratory Tests and Diagnostic Procedures: Canine and Feline}, publisher={Wiley}, author={Muñana, K.R.}, editor={Tilley, L.P. and Smith, F.W.K. and Vaden, S.L. and Knoll, J.S.Editors}, year={2009}, pages={480–481} }
 @misc{muñana_2009, edition={2nd}, title={Large Animal Neurology}, volume={235}, journal={Journal of the American Veterinary Medical Association}, author={Muñana, K.R.}, year={2009}, pages={700} }
 @article{muñana_2009, title={Medical Management of Refractory Canine Epilepsy}, volume={104}, journal={Veterinary Medicine}, author={Muñana, K.R.}, year={2009}, pages={342–347} }
 @article{muñana_2009, title={Newer options for medically managing refractory canine epilepsy}, volume={104}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-77249153182&partnerID=MN8TOARS}, number={7}, journal={Veterinary Medicine}, author={Muñana, K.R.}, year={2009}, pages={342–347} }
 @inbook{muñana_2009, place={New York}, edition={4th}, title={Nystagmus}, booktitle={Blackwell's Five-Minute Veterinary Consult: Laboratory Tests and Diagnostic Procedures: Canine and Feline}, publisher={Wiley}, author={Muñana, K.R.}, editor={Tilley, L.P. and Smith, F.W.K and Vaden, S.L. and Knoll, J.S.Editors}, year={2009}, pages={980–981} }
 @article{kennerly_idaghdour_olby_munana_gibson_2009, title={Pharmacogenetic association study of 30 genes with phenobarbital drug response in epileptic dogs}, volume={19}, ISSN={1744-6872}, url={http://dx.doi.org/10.1097/fpc.0b013e3283307cba}, DOI={10.1097/FPC.0b013e3283307cba}, abstractNote={Epilepsy, with a prevalence as high as 6%, is the most common neurological disorder in dogs. Although several antiepileptic drugs are in common use, in one-third of all epileptic dogs, adequate seizure control is not achieved with a single medication, and hence a combinatorial drug treatment must be adopted. Exploration of the genetic mechanisms involved in drug response may provide better treatment options for epileptic patients.A custom Illumina BeadChip was designed for high throughput genotyping of 384 single nucleotide polymorphisms in 30 genes involved in drug metabolism, drug targeting, and drug transport. A case-control association study of 125 epileptic dogs identified five genes with suggestive association to phenobarbital drug response: KCNQ3, P=0.0003; SNC2A2, P=0.0008; EPOX HYD, P=0.0005; ABCC4, P=0.0091; and GABRA2, P=0.0130. These associations are not significant after adjustment for multiple comparisons, but on functional grounds may tag strong candidate genes. The study was powered to detect alleles with at least 3.5-fold additive increases in responsiveness. A combined area under the curve value of 0.74 from receiver operating curve analysis also provides suggestive support for their consideration as canine pharmacogenetic markers.Further replication and assessment of breed specificity is required before these markers can be considered as predictive of responsiveness to phenobarbital in dogs.}, number={12}, journal={Pharmacogenetics and Genomics}, publisher={Ovid Technologies (Wolters Kluwer Health)}, author={Kennerly, Erin M. and Idaghdour, Youssef and Olby, Natasha J. and Munana, Karen R. and Gibson, Greg}, year={2009}, month={Dec}, pages={911–922} }
 @article{munana_saito_hoshi_2007, title={Beta-2-microglobulin levels in the cerebrospinal fluid of normal dogs and dogs with neurological disease}, volume={36}, ISSN={["0275-6382"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-34250377355&partnerID=MN8TOARS}, DOI={10.1111/j.1939-165X.2007.tb00204.x}, abstractNote={Background: Cerebrospinal fluid (CSF) analysis is the basis for establishing a diagnosis of central nervous system (CNS) inflammation. However, the information provided by routine CSF analysis is limited. Determination of CSF beta‐2‐microglobulin (β 2 m) concentration has been used diagnostically in humans to identify inflammatory CNS disease; we hypothesized that it may have similar value in dogs. Objectives: The objective of this study was to measure β 2 m concentration in the CSF of clinically healthy dogs and compare the values to those observed in dogs with inflammatory CNS disease and intervertebral disc disease (IVDD). Methods: CSF was collected from 10 clinically healthy laboratory dogs and 11 dogs each with inflammatory CNS disease and IVDD. Routine CSF analysis was performed, and β 2 m concentration was measured by ELISA. CSF β 2 m concentration and CSF:serum β 2 m ratio were compared between groups by ANOVA. Linear relationships between CSF total nucleated cell count (TNCC), RBC count, total protein concentration, and β 2 m concentration were assessed by regression analysis. Results: The mean (± SD) CSF β 2 m concentration in clinically healthy dogs was 0.36 ± 0.05 μg/mL (cisternal) and 0.40 ± 0.07 μg/mL (lumbar). Median CSF β 2 m concentration in dogs with IVDD (0.46 μg/mL) and inflammatory CNS disease (0.85 μg/mL) differed from that of controls (0.36 μg/mL; P = .002). The concentration also differed between the 2 disease groups ( P = .01). Five dogs with inflammatory CNS disease had CSF:serum β 2 m ratios >1. A correlation was identified between TNCC and β 2 m concentration ( r = 0.69, P = .0003). Conclusions: CSF β 2 m concentration is higher in dogs with IVDD and inflammatory CNS disease, with highest values seen with inflammatory disease. This may be attributed in part to the correlation between CSF β 2 m concentration and TNCC, but also may reflect intrathecal immune activation.}, number={2}, journal={VETERINARY CLINICAL PATHOLOGY}, author={Munana, Karen R. and Saito, Miyoko and Hoshi, Fumio}, year={2007}, month={Jun}, pages={173–178} }
 @inbook{munana_2007, title={Brain, spinal cord, and nerve disorders}, ISBN={9780911910223}, booktitle={Merck/Merial manual for pet health}, publisher={Whitehouse Station, NJ : Merck & Co}, author={Munana, K. R.}, year={2007} }
 @article{mackillop_thrall_ranck_linder_munana_2007, title={Imaging diagnosis-synchronous primary brain tumors in a dog}, volume={48}, ISSN={["1058-8183"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-35448932842&partnerID=MN8TOARS}, DOI={10.1111/j.1740-8261.2007.00294.x}, abstractNote={Four-year-old, neutered male, Bassett Hound. The dog was referred for progressive neurologic dysfunction of approximately 1 month. He would occasionally circle to the right and had developed behavior changes. Two weeks before evaluation the dog began drifting to the left when ambulating and would fall over after shaking his head. Signs of vestibular disequilibrium progressed to falling and rolling to the left. There was mild dehydration (<5%), markedly depressed mentation, and moderate vestibular ataxia with a tendency to stumble to the left. When supported, the dog would circle aimlessly to the right. Menace response was absent in the left eye. Vertical and occasional beats of horizontal nystagmus with a fast-phase to the right were noted in both eyes upon neck extension. Postural reactions were decreased in the left thoracic and pelvic limbs and dysmetric in the right thoracic and pelvic limbs. Neuroanantomic localization was multifocal: right forebrain and caudal fossa. A solitary caudal fossa mass with secondary obstructive hydrocephalus was also considered. Vestibular signs were thought to be consistent with a right-sided paradoxical central vestibular lesion although multifocal cerebellovestibular disease could not be excluded. The differential diagnosis included meningoencephalitis, neoplasia, brain abscess or congenital anomaly. Magnetic resonance (MR) imaging of the brain was performed using a 1.5 T magnet. Two anatomically distant brain masses with disparate features were identified (1, 3). T2-weighted transverse spin echo magnetic resonance image (4000/91) of a cerebellar primitive neuroectodermal tumor. The tumor is mildly T2 hyperintense with a large cystic region in the right dorsolateral aspect. That the hyperintense region is cystic is based on its hypointense appearance in fluid-attenuated inversion recovery images (not shown). T2-weighted transverse spin echo magnetic resonance image (4000/91) of the pilocytic astrocytoma in the right thalamus. Note the ill-defined mass effect, moderate T2-intensity, and peritumoral edema tracking along cerebral white matter (arrow). The first was an approximately 1.5–2.0 cm, mildly T2-hyperintense, ill defined, partially cystic, mass in the right cerebellar hemisphere that was causing mild compression of the brainstem (Fig. 1). In a T2*-weighted gradient echo sequence there were multiple susceptibility artifacts consistent with intralesional hemorrhage (Fig. 2). There was faint, wispy contrast enhancement of this mass. The mass caused overcrowding of the caudal fossa, and faint T2-hyperintensity was present in the cervical spinal cord at the C2 level, consistent with syringohydromyelia. T2*-weighted transverse gradient echo magnetic resonance image (875/26/20°), of the cerebellar primitive neuroectodermal tumor. This image was acquired 5 mm rostral to the image in Fig. 1. There are multiple signal voids (arrow head) representing susceptibility artifact from intratumoral hemorrhage. There was a second similarly sized mass located in the right, ventral aspect of the thalamus at the level of the sella turcica with extension into the right frontal lobe. The imaging characteristics of this mass were different from the cerebellar mass as it had greater T2 intensity, marked adjacent T2 hyperintensity consistent with vasogenic edema, and no evidence of intralesional hemorrahge (Fig. 3). Following contrast medium administration there was faint enhancement of the forebrain mass itself, as well as wispy peripheral enhancement suggestive of peripheral neovascularization. The different imaging characteristics of these masses suggested disparate etiologies. The characteristics of the cerebellar mass suggested it might be associated with a vascular event with resultant necrosis and hemorrhage while the features of the forebrain mass were more consistent with a glial tumor. However, the imaging features were not specific and other etiologies for these lesions included metastatic neoplasia, inflammatory disease or multifocal primary brain tumors. Following MR imaging mannitol was administered intravenously and CSF was collected from the cerebellomedullary cistern. CSF analysis was within the normal reference range. Progressive neurological signs prompted a CT-guided brain biopsy. In CT images, the forebrain mass did not contrast enhance and there was a subtle hypoattenuating focus within the mass, consistent with edema. The cerebellar mass was hyperattenuating relative to adjacent neuropil and contained a central hypoattenuating focus consistent with cystic fluid, necrosis, or chronic hemorrhage. Samples of the forebrain mass were obtained with a core biopsy needle using CT guidance and submitted for stat frozen section histologic assessment. Despite sampling from the apparent epicenter of the mass, the biopsy was interpreted as mild gliosis without evidence of inflammation or neoplasia. The dog failed to adequately ventilate following anesthesia and was euthanized based on the poor prognosis for recovery. The right cerebral hemisphere was swollen with moderate subdural hemorrhage. The caudal aspect of the cerebellum was herniated into the fourth ventricle and compressed the associated segment of brain stem, which had moderate patchy hemorrhage. There was no evidence of transtentorial brain herniation. Following transverse sectioning of the brain, a poorly defined, slightly expansile pale mass, with fine stippling was centered in the right thalamus. There was a more discrete, spheroid mass in the cerebellum that was mottled dark brown-red and effaced approximately 70% of the right hemisphere. Microscopically, the forebrain mass was composed of elongated fascicles of slender spindle cells with a fibrillary cytoplasm and thin oval nuclei (Fig. 4A). This mass had diffuse, strong immunoreactivity for glial fibrillary acidic protein (GFAP) and mild to moderate regional immunoreactivity for vimentin but staining was negative for cytokeratin, neuron-specific enolase (NSE), neurofilament, and synaptophysin. The histological diagnosis was astrocytoma with pilocytic features. Photomicrographs of two primary brain tumors in a dog. (A) Thalamus, astrocytoma with pilocytic features composed of discrete fascicles of long slender spindle cells with hyperchromatic elongated nuclei and pale abundant fibrillary cytoplasm. (B) Cerebellum, primitive neuroectodermal tumor, consistent with medullobastoma, formed by sheets of densely packed round to angular small cells with scant cytoplasm and round nuclei. Hematoxylin and eosin, 200 × . The cerebellar mass was distinctly different from the forebrain mass, being composed of dense sheets of small, round to angular cells, with hyperchromatic round nuclei (Fig. 4B). Scattered tumor cells had increased amounts of eosinophilic cytoplasm. Occasionally small cells arranged in rosette-like aggregates. Pyknotic debris was scattered throughout the mass, and there were multiple foci of hemorrhage. Small patchy areas of neoplastic cells exhibited mild immunoreactivity for vimentin but cells lacked specific staining for cytokeratin, GFAP, NSE, neurofilament, synaptophysin, CD3 or CD79a. Individual cells distributed throughout the mass stained for GFAP and were consistent with reactive astrocytes. Morphology supported a primitive neuroectodermal tumor (PNET) in the cerebellum, consistent with a medulloblastoma. We conclude that our patient developed two independent synchronous brain tumors. Multifocal brain lesions may occur from inflammatory, neoplastic, vascular, metabolic, or degenerative etiologies. Cerebrospinal fluid analysis is often used to distinguish inflammatory disease from tumors, although some tumors may be associated with pleocytosis. A multifocal distribution of intracranial masses is suggestive of metastatic neoplasia; however, multiple primary brain tumors or a combination of primary and secondary brain tumors should be considered when brain masses have disparate MR imaging characteristics, as seen here. Multiple intracranial tumors are found in humans with brain metastasis but may also be found with certain heritable neurocutaneous syndromes (syn. phakomatoses) such as neurofibromatosis types 1 and 2 (NF1 and NF2).1,2 For example, people with NF1 are prone to optic nerve gliomas and/or juvenile pilocytic astrocytomas whereas NF2 is associated with either bilateral vestibulocochlear nerve (acoustic) schwannomas or an acoustic schwannoma and another primary brain tumor.2 In one study in dogs, 39/170 (23%) of dogs with a primary brain tumor had at least one other unrelated tumor.3 Interestingly, six of 170 (3.5%) had a second unrelated intracranial neoplasm. In most of these animals (4/6) the second tumor was a pituitary adenoma, although one dog had a meningioma and an astrocytoma. In contrast, multiple menginiomas may be found in as many as 17% of cats with meningioma.4 We found two reports of multiple histologically distinct brain tumors in dogs; one dog had an oligodendroglioma and a meningioma while the other had an oligodendroglioma and metastatic mammary carcinoma.1,5 Both patients were Boxer dogs, a breed predisposed to glioma.1 Multiple histologically distinct brain tumors are a rare occurrence in people without phakomatosis or exposure to ionizing radiation.6,7 Anatomically distant brain tumors, such as in our dog, may reflect coincidental tumorigenesis; alternatively, a genetic abnormality or exposure to a carcinogen may predispose to multifocal neoplasia. It has been speculated that adjacent or collision tumors may result from neoplastic transformation of peritumoral tissue because of chronic inflammation.6 In many instances of multifocal primary intracranial neoplasia, the second tumor is an incidental finding. Therapy is initially directed at the symptomatic tumor unless both tumors can be removed through the same surgical approach.7 Primary brain tumors usually occur in older dogs.8 There are, however, a number of reports of astrocytomas in young dogs such as this animal and gliomas are one of the most common malignancies in children.9 On MR imaging, canine astrocytomas are usually ill-defined intraparenchymal space-occupying masses that are hyperintense on T2-weighted images and hypointense on T1-weighted images.10 Astrocytomas may be associated with mild to marked peritumoral edema and as in this dog extensive peritumoral edema may obscure tumor boundaries. Astrocytomas have variable enhancement patterns but are often heterogenous.10 In our dog, faint contrast enhancement and extensive peritumoral edema made biopsy of the mass difficult and samples were mostly composed of rarefied neuropil with reactive gliosis. Primitive neuroectodermal tumors are rare and thought to arise from neoplastic transformation of embryonal neuroectoderm. The World Health Organization (WHO) for classification of nervous system tumors in domestic animals defines PNET as a generic term for brain tumors that are histologically indistinguishable from medulloblastoma—which is the common term used for this tumor type in the cerebellum.11 MR imaging and CT characteristics of the cerebellar tumor in this dog support the diagnosis of medulloblastoma. PNETs are primarily found in adult dogs (range 3–10 years old) but there are reports of medulloblastoma in dogs ≤2 years of age.12 In our dog, lack of association with the ventricular system argues against another primitive neoplasm, such as an anaplastic ependymal tumor. Medulloblastoma and pilocytic astrocytoma are the two most common brain tumors in children and the simultaneous occurrence of both tumors in this relatively young dog is extremely unusual.2,13 Medulloblastoma is a malignant embryonal tumor that is thought to be derived from either the external germinal layer of the cerebellum or subependymal matrix cells.14 On MR imaging, human medulloblastomas are predominantly isointense to grey matter on T2-weighted and fluid-attenuated inversion recovery (FLAIR) sequences and hypointense or isointense to grey matter on T1-weighted sequences. Though in our dog the cerebellar tumor was not T2-isointense to brain, its T2-intensity was lower than the forebrain astrocytoma. In people, it is not uncommon for there to be regions of heterogeneity in medulloblastomas because of tumor hemorrhage, necrosis, or cavitation.2,15 Contrast enhancement is usually mild to moderate. One reported canine medulloblastoma had similar MR imaging characteristics to the cerebellar tumor in our dog.12 Complete neuraxial MR imaging has been recommended in the presurgical evaluation of people with suspected medulloblastoma because intrathecal or drop metastasis may be found in approximately 40% of patients.15 Diffusion-weighted imaging (DWI) is used in people to help distinguish PNETs from other brain tumors. DWI has historically been used in the diagnosis of stroke because of its capacity to identify the restricted movement of water protons, a characteristic feature of acute stroke. Of 12 human PNETs, including nine medulloblastomas, tumors were characterized as having restricted water diffusion.15 Medulloblastomas are densely cellular and have a high nuclear:cytoplasmic ratio which may restrict the motion of both extra- and intracellular water protons.15 These same tumor characteristics are thought to be the reason that medulloblastomas are hyperattenuating on CT images and predominantly isointense on T2-weighted and FLAIR sequences.2 In our dog, the combination of a densely cellular neoplasm along with intratumoral hemorrhage may explain the hyperattenuation on CT images. Although uncommon, multiple histologically distinct intracranial tumors should be considered in dogs that have multifocal brain masses with disparate MR imaging characteristics. A heterogeneous, slightly T2 hyperintense cerebellar mass lesion should raise the index of suspicion for a medulloblastoma. The authors would like to thank Drs. Talmage Brown, Brian Summers, Tom Van Winkle, Jim Cooley, and Jon Patterson for their histopathologic review of tissue from this dog.}, number={6}, journal={VETERINARY RADIOLOGY & ULTRASOUND}, author={MacKillop, Edward and Thrall, Donald E. and Ranck, Rose S. and Linder, Keith E. and Munana, Karen R.}, year={2007}, pages={550–553} }
 @inbook{muñana_2007, title={Meningitis and encephalitis in dogs, cats and horses}, booktitle={The Merck-Merial Manual of Pet Health}, author={Muñana, K.R.}, year={2007}, pages={210–211, 466–467, 722–723,} }
 @article{aikawa_kanazono_yoshigae_sharp_munana_2007, title={Vertebral stabilization using positively threaded profile pins and polymethylmethacrylate, with or without laminectomy, for spinal canal stenosis and vertebral instability caused by congenital thoracic vertebral anomalies}, volume={36}, ISSN={["0161-3499"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-34547321877&partnerID=MN8TOARS}, DOI={10.1111/j.1532-950X.2007.00289.x}, abstractNote={To describe diagnostic findings, surgical technique, and outcome in dogs with thoracic spinal canal stenosis and vertebral instability secondary to congenital vertebral anomalies.Retrospective clinical study.Dogs (n=9) with thoracic spinal canal stenosis.Medical records (1995-1996; 2000-2006) of 9 dogs with a myelographic diagnosis of spinal canal stenosis and/or vertebral instability secondary to congenital vertebral anomaly that were surgically managed by vertebral stabilization with or without laminectomy were reviewed. Data on pre- and postoperative neurologic status, diagnostic findings, surgical techniques, and outcomes were retrieved. Follow-up evaluations were performed at 1, 2, and 6 months. Long-term outcome was assessed by means of clinical examination or owner telephone interviews.Spinal cord compression was confirmed by myelography, and in 2 dogs, dynamic compression by stress myelography. Eight dogs regained the ability to ambulate postoperatively. One dog with a partial recovery regained voluntary movement but did not become ambulatory.Spinal cord injury secondary to congenital vertebral anomaly may have a good outcome when treated by vertebral stabilization with or without laminectomy. Adequate stabilization of the vertebrae and improved neurologic outcome were achieved in most dogs.Vertebral stabilization using positively threaded profile pins and polymethylmethacrylate with or without laminectomy is an effective treatment for spinal canal stenosis and vertebral instability secondary to congenital thoracic vertebral anomalies.}, number={5}, journal={VETERINARY SURGERY}, author={Aikawa, Takeshi and Kanazono, Shinichi and Yoshigae, Yuki and Sharp, Nicholas J. H. and Munana, Karen R.}, year={2007}, month={Jul}, pages={432–441} }
 @article{muñana_2006, title={Leading Edge - Management of refractory canine epilepsy}, volume={23}, journal={Veterinary Forum}, author={Muñana, K.R.}, year={2006}, pages={42–46} }
 @inbook{munana_2005, title={Meningitis and Encephalitis}, ISBN={0911910506}, booktitle={Merck veterinary manual}, publisher={Whitehouse Station, N.J. : Merck}, author={Munana, K. R.}, editor={Kahn, C.M. and Line, S.Editors}, year={2005} }
 @misc{muñana_2004, title={Book review: Neurology for the Small Animal Practitioner}, volume={224}, number={6}, journal={Journal of the American Veterinary Medical Association}, author={Muñana, K.R.}, year={2004}, month={Mar}, pages={856} }
 @article{breitschwerdt_blann_stebbins_munana_davidson_jackson_willard_2004, title={Clinicopathological abnormalities and treatment response in 24 dogs seroreactive to Bartonella vinsonii (berkhoffii) antigens}, volume={40}, ISSN={["0587-2871"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-1842839032&partnerID=MN8TOARS}, DOI={10.5326/0400092}, abstractNote={Bartonella vinsonii (B. vinsonii) subspecies berkhoffii is a recently recognized cause of endocarditis, myocarditis, and granulomatous disease in dogs. In an effort to elucidate other potential disease manifestations, the case records of 24 dogs that were seroreactive to B. vinsonii (berkhoffii) antigens were studied retrospectively. Diagnoses included immune-mediated hemolytic anemia, neutrophilic or granulomatous meningoencephalitis, neutrophilic polyarthritis, cutaneous vasculitis, and uveitis. Repeated B. vinsonii (berkhoffii) antibody titers became negative after treatment. This study indicates that a diverse spectrum of disease manifestations and clinicopathological abnormalities can be detected in dogs that are seroreactive to B. vinsonii (berkhoffii) antigens.}, number={2}, journal={JOURNAL OF THE AMERICAN ANIMAL HOSPITAL ASSOCIATION}, author={Breitschwerdt, EB and Blann, KR and Stebbins, ME and Munana, KR and Davidson, MG and Jackson, HA and Willard, MD}, year={2004}, pages={92–101} }
 @inbook{muñana_2004, place={Baltimore, MD}, edition={3rd}, title={Feline Hyperesthesia Syndrome}, ISBN={9780781740388}, booktitle={The 5-minute veterinary consult : canine and feline}, publisher={Lippincott Williams & Wilkins}, author={Muñana, K.R.}, editor={Tilley, L.P. and Smith, F.W.K.Editors}, year={2004}, pages={454–455} }
 @inbook{muñana_2004, edition={3rd}, title={Head tilt and nystagmus}, booktitle={BSAVA Manual of Canine and Feline Neurology}, publisher={British Small Animal Veterinary Association}, author={Muñana, K.R.}, editor={Platt, S.R. and Olby, N.J.Editors}, year={2004}, pages={155–171} }
 @article{jaeger_early_munana_hardie_2004, title={Lumbosacral disc disease in a cat}, volume={17}, DOI={10.1055/s-0038-1636482}, abstractNote={Summary An eight-year-old male castrated domestic shorthair admitted with a two-day history of acute back pain, flaccid tail, and urinary and faecal incontinence. Diagnostic tests, including myelogram, epidurogram, and CT scan revealed an extradural lesion at the L7-S1 disc space. Exploratory surgery and histopathology confirmed a Type II lumbosacral intervertebral disc protrusion. The cat regained neurological function by six weeks after surgery. This is the first case report of a cat with documented lumbosacral disc disease. Lumbosacral disease should be considered as a differential diagnosis in cats with caudal lumbar pain or neurological signs localizable to the S1-S3 spinal cord segments or peripheral nerves.}, number={2}, journal={Veterinary and Comparative Orthopaedics and Traumatology}, author={Jaeger, G. H. and Early, P. J. and Munana, K. R. and Hardie, E. M.}, year={2004}, pages={104–106} }
 @inbook{muñana_2004, place={Baltimore, MD}, edition={3rd}, title={Nystagmus}, ISBN={9780781740388}, booktitle={The 5-minute veterinary consult: canine and feline}, publisher={Lippincott Williams & Wilkins}, author={Muñana, K.R.}, editor={Tilley, L.P. and Smith, F.W.K.Editors}, year={2004}, pages={924–925} }
 @article{olby_harris_burr_munana_sharp_keene_2004, title={Recovery of pelvic limb function in dogs following acute intervertebral disc herniations}, volume={21}, ISSN={["1557-9042"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-0942290535&partnerID=MN8TOARS}, DOI={10.1089/089771504772695940}, abstractNote={Chondrodystrophoid breeds of dog are prone to explosive herniation of mineralized disc material into the thoracolumbar spinal canal. The resulting acute spinal cord injury may represent an excellent spontaneous model of acute traumatic spinal cord injury. The aims of this study were to quantify the recovery of dogs following acute disc herniations, to evaluate external factors that influence recovery, and to identify a group of dogs suitable for use in clinical trials on neuroprotective drugs. The gait of 88 dogs with thoracolumbar disc herniations was scored at the time of injury and 2, 4, and 12 weeks after surgical decompression. Dogs were placed into four groups dependent on the severity of presenting signs; dogs in group 1 had the most severe injury severity. Group 1 dogs showed a variable but incomplete recovery by 12 weeks. Dogs in groups 2 and 3 recovered uniformly but more completely, while dogs in group 4 made a rapid and excellent recovery and were deemed unsuitable for clinical trials. Combining dogs in groups 1, 2 and 3 produced a population of dogs with incomplete recovery by 12 weeks. Power analysis revealed that 87 such dogs would be needed per treatment group to detect a 20% change in function with a power of 95%. The number needed reduced drastically to 19 by eliminating dogs in group 1, but this produced less room for functional improvement. External factors did not appear to influence outcome. We conclude that dogs with spontaneous disc herniations provide a useful model of acute spinal cord injury for clinical trials.}, number={1}, journal={JOURNAL OF NEUROTRAUMA}, author={Olby, N and Harris, T and Burr, J and Munana, K and Sharp, N and Keene, B}, year={2004}, month={Jan}, pages={49–59} }
 @article{muñana_2004, title={Taking a practical approach to the management of seizures in dogs}, journal={DVM In Focus: A supplement to DVM Newsmagazine}, author={Muñana, K.R.}, year={2004}, pages={21–24} }
 @inbook{muñana_2003, place={Philadelphia}, edition={4th}, title={Disorders of the Brain}, booktitle={Handbook of Small Animal Practice}, publisher={WB Saunders}, author={Muñana, K.R.}, editor={Morgan, R.Editor}, year={2003}, pages={233–255} }
 @article{olby_levine_harris_muñana_skeen_sharp_2003, title={Long-term functional outcome of dogs with severe injuries of the thoracolumbar spinal cord: 87 cases (1996–2001)}, volume={222}, ISSN={0003-1488}, url={http://dx.doi.org/10.2460/javma.2003.222.762}, DOI={10.2460/javma.2003.222.762}, abstractNote={To determine long-term (> 6 months) outcome of dogs with paraplegia and loss of hind limb deep pain perception (DPP) resulting from intervertebral disk herniation or trauma.Retrospective study.87 dogs.Outcome was determined as successful or unsuccessful. The association of neuroanatomic localization, breed, age, weight, sex, and (for dogs with intervertebral disk herniation) speed of onset of signs and duration of paraplegia prior to surgery with outcome was evaluated. Owners were contacted by telephone to identify long-term health problems.Nine of 17 dogs with traumatic injuries were treated, and 2 regained the ability to walk; none of the 17 dogs regained DPP. Sixty-four of 70 dogs with intervertebral disk herniation underwent surgery; 9 (14%) were euthanatized within 3 weeks after surgery (7 because of ascending myelomalacia), 37 (58%) regained DPP and the ability to walk, 7 (11%) regained the ability to walk without regaining DPP, and 11 (17%) remained paraplegic without DPP. Outcome was not associated with any of the factors evaluated, but speed of recovery of ambulation was significantly associated with body weight and age. Fifteen (41%) and 12 (32%) dogs that regained DPP had intermittent fecal and urinary incontinence, respectively.Results suggested that the prognosis for paraplegic dogs without DPP because of trauma was guarded, while dogs with disk herniation had a better chance of recovering motor function. A third of the dogs that recovered motor function had intermittent incontinence. Persistent loss of DPP did not preclude recovery of motor function, but such dogs remained incontinent.}, number={6}, journal={Journal of the American Veterinary Medical Association}, publisher={American Veterinary Medical Association (AVMA)}, author={Olby, Natasha and Levine, Jay and Harris, Tonya and Muñana, Karen and Skeen, Todd and Sharp, Nick}, year={2003}, month={Mar}, pages={762–769} }
 @article{saito_olby_spaulding_munana_sharp_2003, title={Relationship among basilar artery resistance index, degree of ventriculomegaly, and clinical signs in hydrocephalic dogs}, volume={44}, ISSN={["1740-8261"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-1342290248&partnerID=MN8TOARS}, DOI={10.1111/j.1740-8261.2003.tb00532.x}, abstractNote={Forty‐four transcranial Doppler ultrasound studies were performed in 36 dogs. The ratio of the height of the ventricle to the height of the brain (VB ratio) was calculated to determ‐ine the severity of ventriculomegaly. Resis‐tance index (RI) was calculated from Doppler measurements of the blood flow velocity in the basilar artery and neurologic signs were scored on a scale of 0 to 3. Based on clinical and ultrasonographic findings, dogs were divided into four groups (normal controls, asymptomatic hydrocephalus, symptomatic hydrocephalus, and other intracranial disease). RI and VB ratio were compared between the groups of dogs and compared with neurologic signs in hydrocephalic dogs. RI ranged from 0.50 to 0.81 (mean, 0.68). Resistance index was significantly higher in dogs with symptomatic hydrocephalus and other intracranial disease when compared with the other two groups. The degree of ventriculomegaly was significantly higher in dogs with symptomatic hydrocephalus than the other groups, but there was substantial overlap between asymptomatic and symptomatic hydrocephalus groups. Combining measurements of VB ratio and RI allowed detection of symptomatic hydrocephalus with a sensitivity of 77% and a specificity of 94%. The severity of neurological signs was significantly correlated with RI and with VB ratio in hydrocephalic dogs, and in dogs evaluated on more than one occasion, changes in neurologic status were accompanied by changes in RI but not in VB ratio. All asymptomatic hydrocephalic dogs with a VB ratio of greater than 60% eventually developed neurologic signs. Our results suggest that ultrasonographic measurement of VB ratio and basilar artery RI may allow identification of dogs with symptomatic hydrocephalus or dogs that are at risk of developing symptomatic hydrocephalus. Repeated RI measurements are a useful means of monitoring dogs with a variety of intracranial diseases.}, number={6}, journal={VETERINARY RADIOLOGY & ULTRASOUND}, author={Saito, M and Olby, NT and Spaulding, K and Munana, K and Sharp, NJH}, year={2003}, pages={687–694} }
 @article{skeen_olby_munana_sharp_2003, title={Spinal arachnoid cysts in 17 dogs}, volume={39}, ISSN={["1547-3317"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-0038289206&partnerID=MN8TOARS}, DOI={10.5326/0390271}, abstractNote={The medical records of 17 dogs diagnosed with spinal arachnoid cysts at North Carolina State University Veterinary Teaching Hospital were retrospectively examined to identify trends in signalment, history, neurological status, treatment, and short- and long-term prognosis. The typical case was that of a nonpainful, progressive ataxia frequently characterized by hypermetria and incontinence. Cysts typically occurred in the dorsal subarachnoid space at the first to third cervical vertebrae of young, large-breed dogs or the caudal thoracic vertebrae of older, small-breed dogs. Although 14 of 15 dogs treated surgically did well in the short term, long-term successful outcomes were achieved in only eight of the 12 dogs that were followed for >1 year. Significant predictors of good, long-term outcome were not identified; however, factors associated with a trend toward a good outcome included <3 years of age, <4 months’ duration of clinical signs, and marsupialization as the surgical technique.}, number={3}, journal={JOURNAL OF THE AMERICAN ANIMAL HOSPITAL ASSOCIATION}, author={Skeen, TM and Olby, NJ and Munana, KR and Sharp, NJ}, year={2003}, pages={271–282} }
 @article{schatzberg_haley_barr_delahunta_olby_munana_sharp_2003, title={Use of a multiplex polymerase chain reaction assay in the antemortem diagnosis of toxoplasmosis and neosporosis in the central nervous system of cats and dogs}, volume={64}, ISSN={["1943-5681"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-0346900736&partnerID=MN8TOARS}, DOI={10.2460/ajvr.2003.64.1507}, abstractNote={Abstract Objective —To develop a multiplex polymerase chain reaction (PCR) assay for the detection of Toxoplasma gondii and Neospora caninum DNA in canine and feline biological samples. Sample Population —Biological samples from 7 cats with systemic (n = 4) or CNS (3) toxoplasmosis, 6 dogs with neospora- or toxoplasma-associated encephalitis, and 11 animals with nonprotozoal disease. Procedure —Primers for T gondii, N caninum , and the canine ferritin gene (dogs) or feline histone 3.3 gene (cats) were combined in a single PCR assay. The DNA was extracted from paraffin-embedded brain tissue, CSF, or skeletal muscle. The PCR products with positive results were cloned, and sequence identity was confirmed. Results —Of 7 cats and 4 dogs with immunohistochemical or serologic evidence of toxoplasmosis, PCR results were positive for all cats and 3 dogs for T gondii , and positive for T gondii and N caninum for 1 dog. Another dog had negative PCR results for both parasites. Of 2 dogs with immunohistochemical or serologic evidence of neosporosis, PCR results were positive for 1 for N caninum and positive for the other for T gondii . All negative-control samples yielded negative results for T gondii and N caninum on the PCR assay. Conclusions and Clinical Relevance —Standard tests for toxoplasmosis or neosporosis associated with the CNS rely on serologic, histologic, or immunohistochemical analysis and can be difficult to interpret. The multiplex PCR assay with built-in control reactions could be a complementary clinical tool for the antemortem diagnosis of toxoplasmosis or neosporosis associated with the CNS. ( Am J Vet Res 2003;64:1507–1513)}, number={12}, journal={AMERICAN JOURNAL OF VETERINARY RESEARCH}, author={Schatzberg, SJ and Haley, NJ and Barr, SC and deLahunta, A and Olby, N and Munana, K and Sharp, NJH}, year={2003}, month={Dec}, pages={1507–1513} }
 @article{saito_sharp_munana_troan_tokuriki_thrall_2002, title={CT findings of intracranial blastomycosis in a dog}, volume={43}, ISSN={["1058-8183"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-0036369393&partnerID=MN8TOARS}, DOI={10.1111/j.1740-8261.2002.tb00436.x}, abstractNote={Computed tomography (CT) findings in a dog with intracranial blastomycosis were marked periventricular contrast enhancement of the lateral ventricles, the 3rd ventricle, and the mesencephalic aqueduct. The CT appearance correlated with the histopathologic findings, where severe ependymitis was present throughout the ventricular system and there was stenosis of the mesencephalic aqueduct due to an inflammatory infiltrate. CT is therefore recommended as a screening test for intracranial blastomycosis in dogs and also as an imaging modality for follow-up evaluation after treatment. This is particularly true in dogs with systemic or ocular blastomycosis, which appear to be at higher risk of developing CNS involvement.}, number={1}, journal={VETERINARY RADIOLOGY & ULTRASOUND}, author={Saito, M and Sharp, NJH and Munana, K and Troan, BV and Tokuriki, M and Thrall, DE}, year={2002}, pages={16–21} }
 @article{olby_munana_de risio_sebestyen_hansen_2002, title={Cervical injury following a horse kick to the head in two dogs}, volume={38}, ISSN={["0587-2871"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-0036069170&partnerID=MN8TOARS}, DOI={10.5326/0380321}, abstractNote={Two dogs were presented to North Carolina State University Veterinary Teaching Hospital following blunt trauma to the head delivered by a horse kick. On presentation, both dogs had resolving clinical signs directly related to the head trauma, but both also had compromise to their upper airway as a result of indirect injury to the soft tissues of the neck, visible on plain radiographs. One dog made a full recovery following a period of assisted ventilation. The other dog was euthanized at the request of the owner. These injuries illustrate the importance of evaluating the cervical spine and soft tissues of the neck following blunt trauma to the head.}, number={4}, journal={JOURNAL OF THE AMERICAN ANIMAL HOSPITAL ASSOCIATION}, author={Olby, N and Munana, K and De Risio, L and Sebestyen, P and Hansen, B}, year={2002}, pages={321–326} }
 @article{risio_munana_murray_olby_sharp_cuddon_2002, title={Dorsal laminectomy for caudal cervical spondylomyelopathy: Postoperative recovery and long-term follow-up in 20 dogs}, volume={31}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-0036715660&partnerID=MN8TOARS}, DOI={10.1053/jvet.2002.34673}, abstractNote={To evaluate the postoperative morbidity and long-term outcome of dogs after dorsal laminectomy for caudal cervical spondylomyelopathy (CCSM).Retrospective study.Twenty dogs with CCSM.Medical records of dogs treated by dorsal laminectomy for CCSM at North Carolina State University and Colorado State University between 1989 and 1999 were reviewed. Information on signalment, onset, progression and duration of clinical signs, diagnostic testing, sites of dorsal laminectomy, postoperative complications, length of hospitalization, and the ambulatory status on discharge was recorded. A minimum follow-up of 7 months was required for inclusion in the study. Neurologic status was graded (0 to 5) preoperatively, 2 days after surgery, and at the time of the study (final score). Improvement or worsening of the neurologic status was assessed by comparison of different scores for each dog. Additional follow-up information was obtained by means of a detailed telephone questionnaire directed at both the owner and referring veterinarian.Mean duration of clinical signs before surgery was 4.9 months. At admission, 15 dogs were ambulatory and 5 were nonambulatory. Neurologic status worsened in 70% of dogs 2 days after surgery but improved in all but 1 dog over the long term. Mean time to optimal recovery was 3.6 months. Long-term follow-up ranged from 7 months to 9 years (mean +/- SD, 3.2 +/- 2.4 years). Four dogs had confirmed recurrence; 2 other dogs may have had recurrence.Dorsal cervical laminectomy is an effective treatment for CCSM in those dogs with dorsal compression or multiple sites of involvement.Although most dogs' neurologic status transiently worsened after surgery, long-term outcome and recurrence rates were comparable to those seen with other surgical techniques for CCSM.}, number={5}, journal={Veterinary Surgery}, author={Risio, L. De and Munana, Karen and Murray, M. and Olby, N. and Sharp, N.J.H. and Cuddon, P.}, year={2002}, pages={418–427} }
 @article{munana_vitek_tarver_saito_skeen_sharp_olby_haglund_2002, title={Use of vagal nerve stimulation as a treatment for refractory epilepsy in dogs}, volume={221}, ISSN={["0003-1488"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-0036777150&partnerID=MN8TOARS}, DOI={10.2460/javma.2002.221.977}, abstractNote={To evaluate safety and efficacy of vagal nerve stimulation in dogs with refractory epilepsy.Placebo-controlled, double-masked, crossover study.10 dogs with poorly controlled seizures.A programmable pacemaker-like device designed to deliver intermittent stimulation to the left cervical trunk of the vagus was surgically implanted in each dog. Dogs were assigned randomly to two 13-week test periods, 1 with nerve stimulation and 1 without nerve stimulation. Owners recorded data on seizure frequency, duration, and intensity, as well as adverse effects.No significant difference in seizure frequency, duration, or severity was detected between overall 13-week treatment and control periods. During the final 4 weeks of the treatment period, a significant decrease in mean seizure frequency (34.4%) was detected, compared with the control period. Complications included transient bradycardia, asystole, and apnea during intraoperative device testing, and seroma formation, subcutaneous migration of the generator, and transient Horner's syndrome during the 14-day period between surgery and suture removal. No adverse effects of stimulation were detected, and most owners were satisfied with the treatment.Vagal nerve stimulation is a potentially safe approach to seizure control that appears to be efficacious in certain dogs and should be considered a possible treatment option when antiepileptic medications are ineffective.}, number={7}, journal={JOURNAL OF THE AMERICAN VETERINARY MEDICAL ASSOCIATION}, author={Munana, KR and Vitek, SM and Tarver, WB and Saito, M and Skeen, TM and Sharp, NJH and Olby, NJ and Haglund, MM}, year={2002}, month={Oct}, pages={977–983} }
 @article{olby_de risio_munana_wosar_skeen_sharp_keene_2001, title={Development of a functional scoring system in dogs with acute spinal cord injuries}, volume={62}, ISSN={["1943-5681"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-0035487722&partnerID=MN8TOARS}, DOI={10.2460/ajvr.2001.62.1624}, abstractNote={Abstract Objective —To develop and compare the reliability of 2 methods of scoring pelvic limb gait in dogs recovering from thoracolumbar spinal cord injuries and to use this scoring system to determine the rate and level of functional recovery of dogs with acute thoracolumbar intervertebral disk herniations. Animals —46 dogs with spinal cord injuries resulting from intervertebral disk herniations. Procedure —Dogs' gaits were videotaped at different time intervals after injury. In phase 1 of the study, the stages of recovery of pelvic limb function were identified, and a numeric scoring system was devised to reflect that recovery. In phase 2, pelvic limb gait was scored by different observers, using a numeric and a visual analog scale. Intra- and interobserver coefficients of variability of both methods were compared. In phase 3, pelvic limb function was scored, using the numeric scale at various intervals after acute thoracolumbar disk herniations. Results —The numeric scale was significantly more reliable than the visual analog scale when both intraand interobserver coefficients of variability were evaluated. Dogs that were paraplegic with no deep pain sensation recovered at different rates during the first 3 months, whereas dogs that were paraplegic with deep pain sensation typically recovered within 1 month of injury. Conclusion and Clinical Relevance —Pelvic limb gait of dogs recovering from thoracolumbar spinal cord injuries can be reliably quantified, using a numeric scale. This scale will facilitate the performance of clinical trials aimed at improving the outcome of acute spinal cord injuries. ( Am J Vet Res 2001;62:1624–1628)}, number={10}, journal={AMERICAN JOURNAL OF VETERINARY RESEARCH}, author={Olby, NJ and De Risio, L and Munana, KR and Wosar, MA and Skeen, TM and Sharp, NJH and Keene, BW}, year={2001}, month={Oct}, pages={1624–1628} }
 @article{munana_vitek_hegarty_kordick_breitschwerdt_2001, title={Infection of Fetal Feline Brain Cells in Culture with Bartonella henselae}, volume={69}, ISSN={0019-9567}, url={http://dx.doi.org/10.1128/IAI.69.1.564-569.2001}, DOI={10.1128/IAI.69.1.564-569.2001}, abstractNote={Bartonella henselae is known to cause central nervous system (CNS) disease in humans, and neurological signs have been observed in experimentally infected cats. However, the pathogenesis of CNS disease remains unclear. This study was undertaken to determine whether B. henselae infects feline fetal brain cells in vitro. Microglial-cell- and astrocyte-enriched cultures were inoculated with B. henselae. Giménez staining identified bacterial organisms within microglial cells by day 7 postinoculation. The viability of the intracellular bacteria was demonstrated by incubating cultures with gentamicin and plating cell lysate on agar. Electron microscopy identified intracellular organisms with characteristic Bartonella morphology but identified no ultrastructural abnormalities within infected microglial cells. No evidence of infection was seen in Bartonella-inoculated astrocyte cultures. These findings suggest a role for microglia in the pathogenesis of B. henselae-associated neurological disease.}, number={1}, journal={Infection and Immunity}, publisher={American Society for Microbiology}, author={Munana, K. R. and Vitek, S. M. and Hegarty, B. C. and Kordick, D. L. and Breitschwerdt, E. B.}, year={2001}, month={Jan}, pages={564–569} }
 @inbook{muñana_2001, place={Philadelphia}, edition={4th}, title={Inflammatory Disorders of the Central Nervous System}, booktitle={Consultations in Feline Internal Medicine}, publisher={WB Saunders}, author={Muñana, K.R.}, editor={August, J.R.Editor}, year={2001}, pages={425–433} }
 @article{munana_olby_sharp_skeen_2001, title={Intervertebral disk disease in 10 cats}, volume={37}, ISSN={["0587-2871"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-0034766968&partnerID=MN8TOARS}, DOI={10.5326/15473317-37-4-384}, abstractNote={The medical records of 10 cats diagnosed with intervertebral disk disease were reviewed. No apparent sex or breed predilection was found. The mean age of cats in the study was 9.8 years. Clinical signs included back pain, difficulty ambulating, and incontinence. Radiographs revealed narrowed disk spaces, mineralized intervertebral disks, and evidence of extradural compression on myelography or computed tomography. All intervertebral disk herniations occurred in the thoracolumbar spine, with a peak incidence at the fourth to fifth lumbar (L4-L5) intervertebral disk space. Eight cats had Hansen's type I intervertebral disk herniation. Surgery was performed in seven cats. All cats judged to have an excellent outcome had undergone surgical decompression.}, number={4}, journal={JOURNAL OF THE AMERICAN ANIMAL HOSPITAL ASSOCIATION}, author={Munana, KR and Olby, NJ and Sharp, NJH and Skeen, TM}, year={2001}, pages={384–389} }
 @article{de risio_sharp_olby_munana_thomas_2001, title={Predictors of outcome after dorsal decompressive laminectomy for degenerative lumbosacral stenosis in dogs: 69 cases (1987-1997)}, volume={219}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-0035462838&partnerID=MN8TOARS}, DOI={10.2460/javma.2001.219.624}, abstractNote={Abstract Objective —To identify predictive factors of long-term outcome after dorsal decompressive laminectomy for the treatment of degenerative lumbosacral stenosis (DLSS) in dogs. Design —Retrospective study. Sample Population —69 client-owned dogs. Procedure —Medical records of dogs that had undergone dorsal laminectomy at North Carolina State University and the University of Tennessee between 1987 and 1997 were reviewed. Dogs with diskospondylitis, traumatic lesions, or neoplasia of the lumbosacral region were excluded. All dogs had evidence of cauda equina compression on myelography, epidurography, computed tomography, or magnetic resonance imaging, along with subsequent confirmation of the lesion at surgery. Follow-up was performed by telephone inquiries to the referring veterinarian, the owner, or both, using a detailed questionnaire. Results —The outcome was excellent or good in 54 of 69 (78%) dogs over a mean follow-up period of 38 ± 22 months. Five of these 54 dogs had been incontinent for a median of 2 weeks prior to surgery. Six of the 15 dogs with a poor outcome had been incontinent for a median of 8 weeks before surgery. A significant correlation was detected between the presence of urinary and fecal incontinence prior to surgery and outcome. When duration of signs was considered, urinary incontinence was the only variable that significantly affected outcome. Conclusions and Clinical Relevance —Decompressive laminectomy is an effective treatment for DLSS, although dogs with urinary or fecal incontinence have a worse prognosis than dogs that are continent before surgery. Chronic urinary incontinence is a predictor of poor outcome for dogs with DLSS. ( J Am Vet Med Assoc 2001;219:624–628)}, number={5}, journal={JOURNAL OF THE AMERICAN VETERINARY MEDICAL ASSOCIATION}, author={De Risio, L and Sharp, NJH and Olby, NJ and Munana, KR and Thomas, WB}, year={2001}, month={Sep}, pages={624–628} }
 @article{saito_munana_sharp_olby_2001, title={Risk factors for development of status epilepticus in dogs with idiopathic epilepsy and effects of status epilepticus on outcome and survival time: 32 cases (1990-1996)}, volume={219}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-0342902123&partnerID=MN8TOARS}, DOI={10.2460/javma.2001.219.618}, abstractNote={To identify risk factors for episodes of status epilepticus (SE) in dogs with idiopathic epilepsy and determine how SE affects long-term outcome and survival time.Retrospective study.32 dogs with idiopathic epilepsy.Information on signalment, seizure onset, initiation of treatment, anticonvulsants administered, number of episodes of SE, overall seizure control, and long-term outcome was obtained from medical records and through telephone interviews. Differences between dogs that did and did not have episodes of SE were evaluated statistically.19 (59%) dogs had 1 or more episodes of SE. Body weight was the only variable significantly different between dogs that did and did not have episodes of SE. Thirteen dogs (9 that did not have episodes of SE and 4 that did) were still alive at the time of the study and were > or = 10 years old. Six of the 19 (32%) dogs that had episodes of SE died of causes directly attributed to the seizure disorder. Mean life spans of dogs that did and did not have episodes of SE were 8.3 and 11.3 years, respectively. Survival time was significantly different between groups.Results suggest that a substantial percentage of dogs with idiopathic epilepsy will have episodes of SE. Dogs with greater body weights were more likely to have episodes of SE, and early appropriate seizure treatment did not appear to decrease the risk that dogs would have episodes. Most dogs with idiopathic epilepsy had an expected life span, but survival time was shorter for dogs that had episodes of SE.}, number={5}, journal={JOURNAL OF THE AMERICAN VETERINARY MEDICAL ASSOCIATION}, author={Saito, M and Munana, KR and Sharp, NJH and Olby, NJ}, year={2001}, month={Sep}, pages={618–623} }
 @article{spugnini_thrall_price_sharp_munana_page_2000, title={Primary irradiation of canine intracranial masses}, volume={41}, ISSN={["1740-8261"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-0034220024&partnerID=MN8TOARS}, DOI={10.1111/j.1740-8261.2000.tb02091.x}, abstractNote={Twenty‐nine dogs received primary radiation therapy for intracranial lesions and clinical signs suggestive of neoplasia. Presumptive diagnosis and tumor categorization was based on computed toniographic or magnetic resonance images. Meningioma was the most likely tumor type in 22 dogs and glioma or choroid plexus tumors were tentatively identified in 4 and 3 dogs, respectively. Cobalt‐60 radiation was delivered in 3 Gy fractions on a daily, Monday‐through‐Friday basis for a total dose of 48 Gy (16 fractions) in 28 dogs; one dog received 54 Gy. Two of 29 dogs died during treatment of signs suggestive of progressive tumor growth but were included in the overall evaluation of response to treatment. Median overall survival was 250 days (range 21–804). Mild acute radiation effects on normal tissue developed and did not influence outcome in any dog. Late radiation effects could not be evaluated in this study. No significant predictive indicators were identified from the clinical or imaging data. Radiation therapy is superior to medical treatment of brain tumors in dogs with steroids, is useful for tumors that are not currently operable and may be preferable to surgical resection in dogs if the mass appears infiltrative. However, 22/29 (76%) dogs died of recurrent progressive neuropathy suggestive of tumor regrowth or progression. Thus, alternative methods for delivery of radiation to dogs with brain tumors or novel combinations of therapy should continue to undergo evaluation.}, number={4}, journal={VETERINARY RADIOLOGY & ULTRASOUND}, author={Spugnini, EP and Thrall, DE and Price, GS and Sharp, NJ and Munana, K and Page, RL}, year={2000}, pages={377–380} }
 @article{flegel_kagan_munana_2000, title={Spinal cord compression due to synovial cysts in a Great Dane}, volume={45}, number={10}, journal={Kleintier-Praxis}, author={Flegel, T. and Kagan, K. and Munana, K.}, year={2000}, pages={787–792} }
 @article{flegel_kagan_muñana_2000, title={Spinal cord compression due to synovial cysts in a Great Dane,Rückenmarskompression durch Synoviazysten bei einer Deutschen Dogge}, volume={45}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-0346385033&partnerID=MN8TOARS}, number={10}, journal={Kleintierpraxis}, author={Flegel, T. and Kagan, K. and Muñana, K.}, year={2000}, pages={787–792} }
 @article{olby_muntana_sharp_thrall_2000, title={The computed tomographic appearance of acute thoracolumbar intervertebral disk herniations in dogs.}, volume={41}, ISSN={1058-8183 1740-8261}, url={http://dx.doi.org/10.1111/j.1740-8261.2000.tb01860.x}, DOI={10.1111/j.1740-8261.2000.tb01860.x}, abstractNote={The appearance of herniated intervertebral disc material in the thoracolumbar vertebral canal was evaluated in 23 dogs using computed tomography (CT). The images were then compared with the myelographic and surgical findings. The normal spinal cord, outlined by epidural fat over intervertebral disc spaces, was of intermediate attenuation on transverse CT images. Herniated disc material was identified in all animals as a heterogeneous hyperattenuating extradural mass. The attenuation of the disc material increased with the degree of mineralization. In seven dogs, the herniated material was only slightly more attenuating than the spinal cord. In these dogs, small fragments of mineralized disc material and significant hemorrhage were found in the epidural space at surgery. In dogs with a long standing history of disc herniations, disc material identified in the vertebral canal had a more hyperattenuating and homogeneous appearance than recently herniated disc material. We conclude that mineralized, herniated disc material and hemorrhage can be identified quickly and safely in dogs using CT.}, number={5}, journal={Veterinary Radiology Ultrasound}, publisher={Wiley}, author={Olby, Natasha J. and Muntana, Karen R. and Sharp, Nicholas J.H. and Thrall, Donald E.}, year={2000}, month={Sep}, pages={396–402} }
 @article{muñana_1999, title={Acute-Onset Vestibular Disease}, volume={1}, number={8}, journal={Compendium’s Standards of Care}, author={Muñana, K.R.}, year={1999}, pages={1–5} }
 @article{olby_sharp_muñana_papich_1999, title={Chronic and Acute Compressive Spinal Cord Lesions in Dogs due to Intervertebral Disc Herniation Are Associated With Elevation in Lumbar Cerebrospinal Fluid Glutamate Concentration}, volume={16}, ISSN={0897-7151 1557-9042}, url={http://dx.doi.org/10.1089/neu.1999.16.1215}, DOI={10.1089/neu.1999.16.1215}, abstractNote={Acute injury to the central nervous system initiates a series of biochemical events that cause secondary tissue damage. The accumulation of excessive concentrations of glutamate in the extracellular space causes excitotoxic damage, and is incriminated as a mediator of this secondary tissue damage. The aim of this study was to measure the concentration of glutamate in cerebrospinal fluid (CSF) obtained from the cerebellomedullary cistern and lumbar subarachnoid space in dogs with acute and chronic compressive injuries of the cervical and thoracolumbar spinal cord, and to correlate the glutamate concentration with injury severity. The results demonstrate that focal injuries of the spinal cord do not affect the glutamate concentration in CSF taken from the cerebellomedullary cistern. However, dogs with severe, acute thoracolumbar disc herniations have two- to 10-fold increases in glutamate concentration in their lumbar CSF at intervals of >12 h after injury. Moreover, the severity of their clinical signs is directly related to the glutamate concentration. Dogs with chronic compressive thoracolumbar lesions have a two-fold elevation of CSF glutamate concentration, suggesting that excitotoxicity may also be a component of chronic spinal cord compression.}, number={12}, journal={Journal of Neurotrauma}, publisher={Mary Ann Liebert Inc}, author={Olby, Natasha J. and Sharp, Nick J.H. and Muñana, Karen R. and Papich, Mark G.}, year={1999}, month={Dec}, pages={1215–1224} }
 @article{muñana_luttgen_1998, title={Evaluation of prognostic factors for canine granulomatous meningoencephalomyelitis: 42 cases (1982–1996)}, volume={212}, journal={Journal of the American Veterinary Medical Association}, author={Muñana, K.R. and Luttgen, P.J.}, year={1998}, pages={1902–1906} }
 @article{muñana_luttgen_1998, title={Prognostic factors for dogs with granulomatous meningoencephalomyelitis: 42 Cases (1982-1996)}, volume={212}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-0032525387&partnerID=MN8TOARS}, number={12}, journal={Journal of the American Veterinary Medical Association}, author={Muñana, K.R. and Luttgen, P.J.}, year={1998}, pages={1902–1906} }
 @inbook{muñana_1997, place={Philadelphia}, edition={3rd}, title={Disorders of the Brain}, booktitle={Handbook of Small Animal Practice}, publisher={WB Saunders}, author={Muñana, K.R.}, editor={Morgan, R.Editor}, year={1997}, pages={230–251} }
 @article{gookin_brooks_catalfamo_bunch_munana_1997, title={Factor X deficiency in a cat}, volume={211}, number={5}, journal={Journal of the American Veterinary Medical Association}, author={Gookin, J. L. and Brooks, M. B. and Catalfamo, J. L. and Bunch, S. E. and Munana, K. R.}, year={1997}, pages={576–579} }
 @article{factor x deficiency in a cat_1997, volume={211}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-0031226017&partnerID=MN8TOARS}, number={5}, journal={Journal of the American Veterinary Medical Association}, year={1997}, pages={576–579} }
 @article{munana_1996, title={Encephalitis and meningitis}, volume={26}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-0030018463&partnerID=MN8TOARS}, number={4}, journal={Veterinary Clinics of North America - Small Animal Practice}, author={Munana, K.R.}, year={1996}, pages={857–874} }
 @article{lappin_chavkin_munana_cooper_1996, title={Feline ocular and cerebrospinal fluid Toxoplasma gondii-specific humoral immune responses following specific and nonspecific immune stimulation}, volume={55}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-0030470247&partnerID=MN8TOARS}, DOI={10.1016/S0165-2427(96)05633-4}, abstractNote={Toxoplasma gondii-naive cats and cats previously infected orally with T. gondii tissue cysts were inoculated with soluble tachyzoite antigens plus adjuvant or adjuvant alone. Toxoplasma gondii-specific IgM and IgG were measured in serum, aqueous humor, and cerebrospinal fluid (CSF). The Goldman-Witmer coefficient (C value) for ocular or central nervous system (CNS) antibody production was calculated for aqueous humor or CSF samples positive for T. gondii-specific antibodies. Following inoculation with adjuvant plus soluble tachyzoite antigens, ocular and CNS T. gondii-specific IgG C values increased in the three previously infected cats. Following inoculation with adjuvant, the two previously infected cats had increases in ocular and CNS T. gondii-specific IgG C values. Ocular (2/3 cats) or CNS (1/3 cats) T. gondii-specific IgG C values of over 1 were detected in some T. gondii-naive cats following inoculation with adjuvant plus soluble tachyzoite antigens. The results of this study suggest that T. gondii-specific IgG C values of over 1 in aqueous humor or CSF do not prove active ocular or CNS infection in all cats.}, number={1-3}, journal={Veterinary Immunology and Immunopathology}, author={Lappin, M.R. and Chavkin, M.J. and Munana, K.R. and Cooper, C.M.}, year={1996}, pages={23–31} }
 @article{munana_1995, title={LONG-TERM COMPLICATIONS OF DIABETES-MELLITUS .1. RETINOPATHY, NEPHROPATHY, NEUROPATHY}, volume={25}, ISSN={["1878-1306"]}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-0029302395&partnerID=MN8TOARS}, DOI={10.1016/S0195-5616(95)50064-6}, abstractNote={Diabetic retinopathy, nephropathy, and neuropathy occur infrequently in small animals, but are capable of causing significant disease. The clinical and histopathologic findings seen with these late complications of diabetes are discussed. The pathogenesis of these disorders is most likely multifactorial; metabolic alterations secondary to the hyperglycemic state, and microvascular changes seen with diabetes have both been implicated. Current treatment consists of aggressive control of the hyperglycemia, as research continues into the pathology of the late complications in attempts to find a definitive therapy.}, number={3}, journal={VETERINARY CLINICS OF NORTH AMERICA-SMALL ANIMAL PRACTICE}, author={MUNANA, KR}, year={1995}, month={May}, pages={715–730} }
 @article{lappin_chavkin_muñana_cooper_1995, title={Sequential measurement of Toxoplasma gondii-specific antibodies in the cerebrospinal fluid of cats with experimentally induced toxoplasmosis}, volume={6}, journal={Progress in Veterinary Neurology}, author={Lappin, M.R. and Chavkin, M.J. and Muñana, K.R. and Cooper, C.M.}, year={1995}, pages={27–31} }
 @article{bergman_bruyette_coyne_shelton_ogilvie_muñana_richter_1994, title={Canine clinical peripheral neuropathy associated with pancreatic islet cell carcinoma}, volume={5}, journal={Progress in Veterinary Neurology}, author={Bergman, P.J. and Bruyette, D.S. and Coyne, B.S. and Shelton, G.D. and Ogilvie, G.K. and Muñana, K.R. and Richter, K.P.}, year={1994}, pages={57–62} }
 @article{muñana_luttgen_thrall_mitchell_wenger_1994, title={Neurological Manifestations of Niemann‐Pick Disease Type C in Cats}, volume={8}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-0028398035&partnerID=MN8TOARS}, DOI={10.1111/j.1939-1676.1994.tb03208.x}, abstractNote={Seven Domestic shorthair cats with a lysosomal storage disorder analogous to human Niemann‐Pick disease type C, from a breeding colony were studied to characterize the neurological manifestations of this disorder. Affected cats were identified by means of liver biopsies at 4 to 6 weeks of age. Neurological examinations were performed at 2 week intervals from the onset of clinical signs. All cats displayed signs referrable to the cerebellum, with a subtle intention tremor noticed initially at 8 to 12 weeks of age; the disease was rapidly progressive. The tremor became more pronounced, menace response was lost, and severe dysmetria and ataxia developed. Three cats also had signs referrable to other areas of the central nervous system. Cats died or were euthanized between 12 and 43 weeks of age. Pathological findings included accumulation of substrate within neurons throughout the central nervous system, and axonal spheroid formation. The clinical and pathological findings in these cats are comparable to those in the human form of the disease.}, number={2}, journal={Journal of Veterinary Internal Medicine}, author={Muñana, K.R. and Luttgen, P.J. and Thrall, M.A. and Mitchell, T.W. and Wenger, D.A.}, year={1994}, pages={117–121} }
 @article{toxoplasma gondii-specific antibodies in the aqueous humor of cats with toxoplasmosis._1994, volume={55}, url={http://www.scopus.com/inward/record.url?eid=2-s2.0-0028507886&partnerID=MN8TOARS}, number={9}, journal={American Journal of Veterinary Research}, year={1994}, pages={1244–1249} }
 @article{bradley_carpenter_muñana_douglass_1991, title={Clinical Challenge: Case 2}, volume={22}, journal={Journal of Zoo and Wildlife Medicine}, author={Bradley, T.A. and Carpenter, J.W. and Muñana, K.R. and Douglass, J.}, year={1991}, pages={505–506} }
 @article{muñana_1991, title={What is your diagnosis?}, volume={2}, journal={Progress in Veterinary Neurology}, author={Muñana, K.R.}, year={1991}, pages={213–214} }