Keeping Up from the 2016 AAEP Convention: Managing Trigeminal Nerve-Mediated Headshaking

Editor’s note: Each year, the American Association of Equine Practitioners (AAEP) Convention brings forward cutting-edge scientific topics. This venue provides excellent continuing education for equine practitioners from around the world, giving insights into state-of-the-art medical, surgical and business strategies. At the 2016 Convention in Orlando, Florida, interesting papers were presented at the Kester News Hour. Many of the papers discussed have practical implications for common problems in equine medicine and surgery. In addition, this information can help provide practitioners with material to educate clients in the best health care for their horses. We will cover four of these topics in separate articles on

Credit: Horses with head shaking in a small study were helped to some degree by using PENS treatment.

Management of Trigeminal Nerve-Mediated Headshaking

Managing headshaking horses can be fraught with great frustration for horse owner and veterinarian. Looking at seven horses with trigeminal-mediated headshaking, a study (Roberts, V.L.; Patel, N.K.; Tremaine, W.H. Neuromodulation using percutaneous electrical nerve stimulation for the management of trigeminal-mediated headshaking: A safe procedure resulting in medium-term remission in five of seven horses. Equine Vet J. 2016 Mar;48(2):201-4) evaluated the success rate and horse tolerance of anesthetizing the caudal aspect of the infra-orbital nerve using percutaneous electrical nerve stimulation (PENS). This technique passes an electrical current for 25 minutes through a probe placed under ultrasound guidance adjacent to the nerve. Prior to insertion of the probe, the area is desensitized using local anesthetic. Each horse received 3-4 treatments. The initial nerve stimulation resulted in success in 6 of 7 horses. Five horses continued to respond to 2-4 subsequent treatments. Success was measured as return to activity even if the headshaking was not entirely resolved.

PENS was well tolerated by the horses. Although the technique didn’t achieve complete remission, it did lengthen the remission period. By the third treatment, headshaking horses in the study went into remission for as much as four months. This promising intervention may need to be continued indefinitely with repeat treatments but it shows potential for returning trigeminal-mediated headshaking horses to comfort and performance.

The Take Home

Common medical conditions seen by equine practitioners continue to be researched for better approaches and solutions. Having this knowledge in hand enables veterinarians to keep abreast of cutting-edge advances. Clients benefitting from this information will be better served, hopefully with improved outcomes for their equine partners. Client satisfaction from favorable outcomes is not only gratifying to the practitioner but it also inspires loyalty to your practice.

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