The Tick Paralysis Consensus Guidelines

In Australia, total grazing pressure is an important consideration in livestock production. This is the combined grazing pressure exerted by all stock, domestic and wild, native and feral, on the vegetation, soil and water resources of rangeland areas. Improved veterinarians struggle with managing tick paralysis cases, not only ecause it is a severe and unpredictable disease, but also because there is significant variation in its management across different veterinary practices and scant practical literature for reference.

This situation leads to uncertainty among veterinarians treating patients with tick paralysis about whether they are offering clients appropriate treatment. This situation also appears to exacerbate professional complaints, because clients may receive conflicting advice from second opinions and referral practices. The effect on individual veterinarians, and our collective professional reputation, is significant.

The Australian Paralysis Tick Advisory Panel first met in Sydney in April 2016, with the aim of developing evidence-based guidelines for the management and prevention of tick paralysis in dogs and cats. The 16 veterinarians on the panel are from diverse professional backgrounds representing industry, academia, private practice, and emergency and specialist practice.

The panel used a modified consensus-oriented decision-making model to examine a series of questions regarding the prevention and management of tick paralysis and to evaluate the evidence for and against various clinical procedures involved in the management of cases of tick paralysis. Dr Chris Holland collated the bibliography of papers on tick paralysis, which was used as a database, and each question was debated until consensus could be reached.

For many questions, the panel could not find any research publications, which meant that the highest level of evidence was expert opinion. Therefore, the experience of the panel members and transparent process led to the development of guidelines that reflect the current state of tick paralysis management in Australia.

The guidelines consist of suggested protocols for management of non-clinical and clinical cases of tick paralysis in dogs and cats, and an algorithm for escalation of supportive care for the deteriorating patient.
The most appropriate management of tick paralysis remains unknown because of unanswered questions about the pathophysiology of the toxicity and the use of various treatment modalities in its management. For example, the mode of action of holocyclotoxin was only elucidated in 2016. There is a huge requirement for ongoing research, most of which will never be conducted for financial and ethical reasons.

In the absence of definitive answers, continued research, adoption of consensus guidelines, and inclusive debate and refinement of the guidelines will lead to incremental improvements in the management of tick paralysis, and hopefully lessen the burden of this disease on Australian pets. I look forward to the next meeting of the panel to refine the 2016 guidelines in light of new research to be published over the next 12 months.

Copies of the consensus guidelines can be obtained by contacting your local BI representative or Boehringer Ingelheim Business Support on 1800 808 691 or businesssupport.australia@merial.com

I would like to thank BI for supporting this initiative.

Rob Webster
Springwood, QLD

Dr Webster is a member of the 2016 Australian Paralysis Tick Advisory Panel and co-author of Australian tick paralysis of dogs and cats: A guide to diagnosis, management, treatment and prevention, which was funded and coordinated by Boehringer Ingelheim.
 

This article appeared in the January/February 2018 issue of the Australian Veterinary Journal

 

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