Proceedings of a Workshop on - The Havemeyer Foundation

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Havemeyer Foundation Monograph Series No. 11 SESSION 7: THE FUTURE Is RLN inherited? Newer techniques to help investigate this question M. Binns and J. Swinburne .............................................................................................................Page 89 Multicentre trials for efficacy <strong>of</strong> treatment N. Ducharme ....................................................................................................................................Page 90 WORKSHOP SUMMARY...................................................................................................................Page 93 LIST OF PARTICIPANTS...................................................................................................................Page 99 AUTHOR INDEX .............................................................................................................................Page 101 v
Equine Recurrent Laryngeal Neuropathy EDITORS’ FOREWORD Equine laryngeal paralysis, most commonly attributed to the syndrome <strong>of</strong> recurrent laryngeal neuropathy (RLN), is long recognised as the most important equine upper airway disease <strong>of</strong> horses. It can cause exercise intolerance and stridor during fast work and in the rare bilateral cases, and severe respiratory distress, even in the resting horse. Despite is, there are still large gaps in our knowledge <strong>of</strong> its aetiology, pathogenesis, methods <strong>of</strong> assessment and the critical evaluation <strong>of</strong> its treatment. Between 20 and 30 years ago, there was significant research into the disease, but there have been few substantive studies since then. To promote further basic and applied research into this disease it seemed worthwhile to review current knowledge about this disease. This was the main purpose <strong>of</strong> the present workshop and we invited eminent neurologists to review knowledge <strong>of</strong> the aetiology <strong>of</strong> RLN and to compare it with other equine peripheral neuropathies. It was also valuable to gain an overview <strong>of</strong> some comparative aspects <strong>of</strong> RLN with laryngeal paralysis in other species. By obtaining consensus on our present knowledge, we went on to suggest areas for productive future research. For example, are sub-clinical neuropathies <strong>of</strong> other long peripheral nerves present in horses with RLN? As well as established research scientists, our delegates included practitioners who undertake upper airway examination <strong>of</strong> young horses at sales. Outlining the difficulties and practical problems encountered by clinicians in Europe, America and Australia, they provided insight into the incidence and possible progression <strong>of</strong> this disease. Currently, endoscopy is the gold standard for assessing laryngeal dysfunction in the horse. For clinicians to communicate effectively with each other on RLN cases, a variety <strong>of</strong> grading systems are in use. One aim <strong>of</strong> the workshop was to reach a consensus as to which endoscopic grading system should be advocated universally. After lengthy discussion, we reached a consensus and time will tell if the international community accepts the suggested system. Some studies have shown that, even with well-defined endoscopic criteria and grading systems, inter-observer variation can occur in the endoscopic grading <strong>of</strong> laryngeal function. The upcoming results <strong>of</strong> an interactive video presentation conducted at the workshop may support or refute this. Even allowing for individual variation in interpretation, it is well established that the endoscopic findings in some horses (and foals) may differ from time to time. Presentations addressed the progressive nature <strong>of</strong> the disease, especially in some older horses. The advent <strong>of</strong> endoscopic examination during exercise on a high-speed treadmill has revealed that assessment <strong>of</strong> laryngeal dysfunction in the resting horse does not always reflect what occurs during high speed exercise. In addition, upper airway obstructions in horses are not always due to laryngeal paralysis. The results <strong>of</strong> large surveys <strong>of</strong> both <strong>of</strong> these topics were presented. Recently, it was found that horses can suffer bilateral laryngeal paralysis in the presence <strong>of</strong> liver disease and following general anaesthesia and comparison <strong>of</strong> these cases with RLN may cast further light on the aetiopathogenesis <strong>of</strong> both disorders. In the last 2 decades there have been many clinical and physiological studies <strong>of</strong> the efficacy <strong>of</strong> treatments for equine laryngeal paralysis. These have addressed both the improvement <strong>of</strong> airway function and elimination <strong>of</strong> abnormal sounds. The various treatments currently in use were reviewed including the promising neuromuscular pedicle graft. Comparisons were made with the treatment <strong>of</strong> laryngeal paralysis in the dog. It was agreed that future areas for research should include investigations into the aetiovi
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