Neurological consequences after portosystemic shunt attenuation in cats: A meta-analysis study

Area of Science:

• Veterinary Neurology
• Surgical Outcomes
• Feline Medicine

Background:

• Portosystemic shunts (PSS) are common congenital or acquired vascular anomalies in cats.
• Treatment of PSS can lead to severe neurological complications, termed post-attenuation neurological signs (PANS).
• Understanding neurological outcomes is crucial for improving feline CPSS management.

Purpose of the Study:

• To systematically analyze neurological outcomes following port-systemic shunt attenuation in cats.
• To provide insights into clinical approaches and treatment strategies for congenital portosystemic shunts (CPSS).
• To investigate the incidence, mortality, and potential contributing factors of PANS.

Main Methods:

• A systematic review and meta-analysis guided by the MOOSE Checklist.
• Searches conducted across major scientific databases (PubMed, Web of Science, Embase, Scopus, etc.).
• Statistical analysis included variance, Cochran Q tests, fixed/random effects models, meta-regression, and bias assessment (Egger's, Begg's tests).

Main Results:

• 12 high-quality studies were included, analyzing data from 664 research papers.
• PANS occurred in 38.9% of feline cases, with a 17% mortality rate.
• Portosystemic shunt (PAS) occurred in 20.2% of cases, with a 37.2% mortality rate. Complete ligation was the most frequent technique.

Conclusions:

• The etiology of PANS in cats remains elusive, with limited evidence supporting prophylactic antiepileptic drug use.
• Current treatment focuses on managing neurological symptoms, and long-term prognosis is variable.
• Further research is needed to elucidate PANS causes and optimize treatment strategies for feline CPSS.