Out-of-hospital rescue medication in dogs with emergency seizure disorders: an owner perspective.

Background: Emergency seizure disorders such as status epilepticus and cluster seizures are unlikely to cease spontaneously while prolonged seizure activity become progressively more resistant to treatment. Early administration of rescue medication in canine epileptic patients, in particular benzodiazepines, at seizure onset by the owners can be life-saving and brain protecting. Clinical studies in dogs evaluating the use of rescue medication in hospital environment exist, however, the owner perspective has not been assessed to date. Hypothesis or objectives: To evaluate the use of rescue medication in dogs with seizure emergencies by the owner at home. Method: Observational study based on online surveys of owners of dogs with emergency seizure disorders. Results: The questionnaire was answered by 1,563 dog owners, of which 761 provided complete and accurate answers suitable for analysis. Of these, 71% administered diazepam, 19% midazolam, 6% levetiracetam, 3% lorazepam, and 4% more than one rescue or other medication. Overall, the success rates based on owners' perspective for intranasal midazolam and rectal diazepam were 97 and 63%, respectively. Owners reported a compliance level of 95 and 66% for intranasal midazolam and rectal diazepam administration, respectively. Conclusions and clinical importance: Even though rectal diazepam was the most used rescue medication in this survey population, intranasal midazolam was perceived by the owners as a better option regarding effectiveness, time to seizure cessation and owner compliance.

The Postictal Phase in Canine Idiopathic Epilepsy: Semiology, Management, and Impact on the Quality of Life from the Owners' Perspective.

BACKGROUND: Dogs with idiopathic epilepsy experience not only the preictal and ictal seizure phases but also the postictal phase. To date, research has primarily focused on the preictal and ictal semiology and therapeutic control of ictal events. Research into the postictal phase's pathophysiology, as a therapeutic target and how it impacts the quality of life, is sparse across different species. Interestingly, even if anecdotally, owners report the postictal period being an impactful negative factor on their quality of life as well as their dog's quality of life. HYPOTHESIS/OBJECTIVES: We aimed to assess the semiology and the impact of postictal signs on the quality of life of owners and dogs. METHOD: This observational study was carried out using surveys of owners of dogs with seizure disorders. RESULTS: The questionnaire was filled out by 432 dog owners, 292 of whom provided complete responses that could be analysed. More than nine out of ten owners (97%) reported the presence of various postictal clinical signs. The dog's and the owner's quality of life was mainly affected by specific postictal signs, i.e., disorientation (dog: 31%; owner: 20%), compulsive walking (dog: 17%; owner: 22%), ataxia (dog: 12%; owner: 6%), and blindness (dog: 17%; owner: 10%). Nearly 61% of the owners felt that the severity of postictal signs was moderate or severe. Rescue antiseizure medications did not have an effect on controlling the postictal signs based on 71% of the responders. In contrast, 77% of the respondents reported that other measures such as rest, physical closeness, and a quiet and dark environment had a positive impact on the postictal phase. CONCLUSIONS AND CLINICAL IMPORTANCE: Overall, this survey shows that specific postictal signs are common and have a notable impact on the perceived quality of life of both dogs and their owners. According to the respondents, antiseizure medication might have no influence on the postictal phase in most cases, in contrast to other nonpharmacological measures. Further research on the management of the postictal phase is vital for improving the quality of life of dogs with seizure disorders and their owners.

A Brief Introduction to Mass Migration: Then and Now.

To provide a context, this introduction presents a bird's-eye view of migration history, of some differences between voluntary and forced motivation for leaving home territories, and the significance of large group relocations.(mass migrations). The challenges of adjustment and acculturation as well as the interactional effects on migrants and host populations, including mental health issues and facilities, are considered.

Aspects of narcissism and symbiosis, or, essential neurosis of twins.

Following a brief introduction I address the relationships of twins from five different perspectives: the Intimate Connection, the Mirror Image and Complementarity, Object- and Self-Representation, Self and Object or Rivalry, and Intersubjective Communication. This approach attempts to understand twin relationships and the individual development of twins in terms of their intense mutual dependence, akin to infantile symbiosis, and in terms of narcissism. In their similarity to each other, twins may choose each other as love objects even as they see themselves in the other. That is, a twin may "love what he himself is" or "someone who was once part of himself." This "type of object-choice … must be termed 'narcissistic'" (Freud, 1914, pp. 90, 88). Such "cathexis of an undifferentiated self-object" is considered to be "primary narcissism" (Burstein, 1977, p. 103). Hoffer (1952) describes primary narcissism as "the lack of all qualities discriminating between self and not-self, inside and outside" (p. 33).