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

Abstract

Background: Early results from the use of neuromodulation by percutaneous electrical nerve stimulation for the management of trigeminal-mediated headshaking in horses were promising but lacked sufficient case numbers and long-term follow-up. The neuromodulatory procedure has since been established as EquiPENS™.

Objectives: The aim of this study was to report long-term results from a larger number of cases and to investigate for predictors of outcome.

Study design: Prospective case series using international, multi-centre data.

Methods: Eligible cases were horses with a veterinary diagnosis of trigeminal-mediated headshaking, which received EquiPENS™ neuromodulation at trained centres between August 2013 and November 2017. The standard protocol was an initial three-procedure course, with additional procedures should a horse go into remission but then relapse. Data collected included signalment, history, diagnostic tests performed, details of any complications, whether horses had gone into remission and the length of remission.

Results: Results were obtained from 168 horses, with 530 procedures. The complication rate was 8.8% of procedures. In all but one case, complications were mild and transient, without self-trauma. Remission of headshaking following the initial course occurred in 53% (72/136) of horses. Median length of time recorded in remission was 9.5 weeks (range 2 days to 156 weeks ongoing). Where signs recurred, most horses went back into remission following additional procedures, usually for longer than from the previous procedure. No predictors for outcome were determined.

Main limitations: No placebo or control group, owner-assessed results.

Conclusions: EquiPENS™ neuromodulation can be an effective and safe treatment for the management of trigeminal-mediated headshaking in some horses. An increased understanding of neuromodulation could help optimise the technique. Advances in treatment for trigeminal-mediated headshaking will remain limited until there is a greater understanding of the aetiopathogenesis of the condition.

Keywords: headshaking; horse; neuromodulation; percutaneous electrical nerve stimulation; trigeminal-mediated.

Figure 1

Kaplan‐Meier survival plot demonstrating the proportion of horses entering remission at the end of the initial three‐procedure course and the maintenance of remission over time. The dotted lines are 95% confidence intervals.

Figure 2

Kaplan‐Meier survival plot demonstrating the proportion of horses entering remission after their last procedure and the maintenance of remission over time. The dotted lines are 95% confidence intervals.