DIAGNOSIS AND PROGNOSIS •Differential diagnosis - There are other diseases and disorders that can cause weakness and ataxia of the rear limbs. These include: ◦Hip dysplasia ◦Spinal neoplasia ◦Diskospondylitis ◦Myelitis ◦Spinal cord compression due to Hansen type II intervertebral disk protrusion. ◦Trauma with chronic instability or scarring ◦Syringo- and hydromyelia ◦Lumbosacral disease Of the common diseases causing pelvic limb dysfunction in German Shepherds, degenerative myelopathy, type II intervertebral disk disease, hip dysplasia, and lumbosacral disease are most commonly confused. Clinical signs, however, are useful in separating these diseases. Degenerative myelopathy is usually a T3 to L3 UMN clinical presentation. The mild exception to this is the approximately 10 percent of dogs with DM that have decreased to absent patellar reflexes (LMN sign). Hip dysplasia is an orthopedic condition. Therefore, conscious proprioceptive deficits should not be present in these dogs. Occasionally, the degree of degenerative joint disease around the coxofemoral joints will be so exuberant that the process will entrap the sciatic nerve along its course. This may result in paresis and decreases in the withdrawal reflex (LMN sign). Dog with lumbosacral (LS) disease usually start as being painful only in the LS area. The tail may become dysfunctional, the varying degrees of urinary and fecal incontinence may occur. Urinary and fecal incontinence, comparatively, is not present with DM. When the sciatic nerves become affected, the dog may become paretic, with significant muscle atrophy of the pelvic limb muscles innervated by the sciatic nerve and the limbs may be paretic. The muscle atrophy is often easily seen in the cranial tibial muscles. This LMN sciatic presentation is significantly different from the UMN clinical presentation associated with DM. Intervertebral disk disease can result in both an UMN and a LMN clinical presentation, depending upon which disks are affected. It is not uncommon, however, that multiple diseases exist in one dog and contribute to the clinical signs seen. This has probably resulted in some historical confusion as to the clinical spectrum of signs associated with DM. •Recommended tests - Neurologic examination, vertebral radiographs and advanced imaging such as MR studies •Summary of diagnostic criteria - Middle-aged German shepherds with progressive neurologic dysfunction in the pelvic legs of an UMN character are suspicious for degenerative myelopathy. Radiographs and myelography are often normal. Magnetic resonance imaging studies are also normal but are important to exclude subtle spinal cord diseases not detected with myelography. Diagnosis is usually based on the age, breed and clinical signs of progressive neurologic dysfunction of the pelvic limbs. Caveat: Many dogs with suspected DM have concurrent diseases, such as Type II intervertebral disk disease, that may complicate the clinical diagnosis. DM may be present is association with these diseases and should be considered when discussing treatment options and prognosis. •Prognosis - Most dogs deteriorate over the course of 6 to 12 months and are eventually euthanized because of paraplegia. TREATMENT OF DEGENERATIVE MYELOPATHY TREATMENT PRINCIPLES There is no scientifically validated treatment for degenerative myelopathy. A few treatments have been recommended, but no controlled studies have been performed to show any proven benefit. INITIAL/HOSPITAL THERAPY There is no consistently effective treatment for degenerative myelopathy, and affected dogs usually progress to severe weakness and lack of coordination within a year of onset of disease. Most dogs are treated on an outpatient basis LONG TERM/HOME THERAPY Although no controlled studies have been performed to test their efficacy, some researchers have recommended the following experimental treatments: •Vitamin and herbal supplements - High levels of vitamin E (2000 IU/day orally), vitamin B-complex (1 high potency B vitamin complex tablet twice daily), vitamin C (1000 mg twice daily), and 200 micrograms of selenium daily have been recommended. Gingko leaves, a natural tonic herb, is recommended twice daily. •Aminocaproic acid may reduce the spinal cord damage that occurs during the disease process and may slow the progression of the disease. The drug is most successful if given early in the course of disease. The dosage recommended is 500 mg/dog 3 times daily. As this drug is reasonably expensive, owners should be informed of the costs prior to prescribing. •N-acetylcysteine, a potent anti-oxidant, when given along with aminocaproic acid, has been suggested as part of a therapeutic regimen. •Exercise appears to be helpful in delaying the progression of the disease. Dogs should be placed on an increasing, alternate-day exercise program including walking and swimming, if possible. A day of rest between each session is equally as important. FOLLOW-UP CARE Periodic exams are recommended to assess the progression of disease and vary in individual cases. Unfortunately, most dogs continue to progress and are eventually euthanized within a year of diagnosis. A homemade diet has been recommended as part of the overall therapy for degenerative myelopathy. One recommended recipe is: 2 oz. boneless pork center loin chop (boiled, baked or fried in olive oil) 4 oz. Tofu 8 oz. Long grain brown rice (3 oz. cooked in 6 oz. water) 2 tsp extra virgin olive oil ¼ cup molasses 2 whole carrots (boiled, then cut up) 1 cup spinach 4 tbs green bell pepper (chopped and steamed) 4 broccoli spears (boiled, then cut up)
Posted on: Wed, 19 Jun 2013 02:15:24 +0000
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