Treatment of Autoimmune Diseases of the Central Nervous System of Dogs

I recently found an interesting article while researching GME. I wanted to add more GME information to the blog & I stumbled upon a website, which linked me to a newsletter - it was the Veterinary Referral News from Angell Animal Medical Center. This is the animal medical center in Boston where our neurologist works. He even wrote an article for this Summer 2010 edition of the newsletter. I've copied & pasted the entire article, but also included the link to the website.

Veterinary Referral News from Angell Animal Medical Center
http://www.mspca.org/assets/documents/alumni_news_september-2010.pdf

Treatment of Autoimmune Diseases of the Central Nervous System of Dogs

By Allen Sisson, DVM, MS, DACVIM (Neurology)

Several inflammatory, primary central nervous system (CNS) diseases of dogs have been described:

1. Granulomatous Meningoencephalomyelitis (GME)
2. Necrotizing Encephalitis of Pug, Maltese, and Yorkshire terrier dogs
3. Corticosteroid-Responsive or Neutrophilic Meningitis
4. Eosinophilic Meningoencephalomyelitis
5. Idiopathic Tremor Syndrome or Cerebellitis
It is now suspected that these idiopathic diseases are due to abnormal immune system function (an autoimmune disorder).

Depending on where in the CNS these diseases start, they can cause a wide variety of signs such as:
1. Progressively worsening central vestibular signs
2. Progressively worsening seizures and behavior abnormalities
3. Progressively worsening neck and/or back pain
4. Progressively worsening para- or tetraparesis often mimicking a disc herniation
5. Progressively worsening generalized severe-intention tremor
6. Acute onset of blindness

These signs can progress at various rates, but they are often acute (1–2 days) to peracute (8–12 hours) in duration. In the peracute form these CNS diseases are emergencies. If rapid neurologic deterioration is noted, immediate referral to a 24-hour emergency center or aggressive immunosuppressive therapy should be started until a spinal fluid analysis and advanced CNS imaging can be done to confirm the diagnosis. Since abnormal spinal fluid can be normalized within 24 hours of starting prednisone therapy, referral for diagnostic testing as soon as possible after initiating therapy is best. High-dose, low-term immunosuppression is the key to successful therapy for all autoimmune diseases of the CNS. For this reason it is important that infectious causes of CNS inflammation be ruled out by diagnostic testing, since immunosuppressive therapy would worsen these conditions. Corticosteroids, primarily prednisone, are the drugs of choice and are sometimes used as the sole therapy for neutrophilic meningitis. It is important that immunosuppressive doses be used initially, and therapy be sustained at high doses, very gradually tapered over many months, or relapses are likely to occur. Prednisone causes many adverse effects. When these adverse effects are severe, they may require the prednisone dose be reduced or even stopped and another immunosuppressive drug to be used in its place or combined with a reduced prednisone dose. In addition, when immune-mediated encephalitis or myelitis is present, it is unlikely that prednisone therapy alone can lead to permanent remission. For this reason the neurology service at Angell Animal Medical Center now treats all immune-mediated CNS diseases with combination immunosuppressive therapy. Dogs with immune-mediated meningitis are treated with prednisone and with the immunomodulatory drug leflunomide, which is a once-daily oral medication given for one year or in some cases longer. This drug inhibits T and B lymphocyte proliferation and function and is very effective. It is a bone-marrow suppressor and requires monthly CBC monitoring and initial dose adjustment based on leflunomide blood levels. Treated this way it is rare for immune-mediated meningitis cases to relapse, with most cases achieving permanent remission and coming off of all therapy within one year. Most dogs with GME are treated with a combination of prednisone, leflunomide and monthly cytarabine injectable therapy given over a 48-hour period. This three-drug combination leads to long-term remission in over 90% of dogs after one to 1.5 years of therapy. Pug dogs, Maltese and Yorkshire terriers that have necrotizing encephalitis, are given a combination of prednisone, leflunomide, cytarabine lomustine and cyclosporine modified. The cytarabine and lomustine are given monthly 14 days apart, since both drugs cause leukocyte nadirs 6 to 14 days post-treatment so that they cannot be given at the same time. The use of these two chemotherapy drugs in combination requires CBC monitoring twice a month, to be sure that neutrophil and platelet numbers are adequate before each therapy. Cyclosporine modified is given BID orally and requires dose adjustment based on blood level measurement. With this five-drug therapy for 1.5 years, about 80% of dogs with necrotizing encephalitis achieve complete remission.

For more information, please visit angell.org/neurology.

Last Day of Prednisone!!!

It has been 6 months since Coby's GME diagnosis and his LAST dose of prednisone was given this morning!! :-) YAY! Coby's chance of relapsing is now increased without being on the prednisone, so fingers (& paws) crossed we don't encounter any problems!! He is still receiving the chemo meds until May. Keep him in your thoughts & prayers....the chance of relapse is greatest in the first 30 days after stopping the prednisone, but could happen at ANY time!

Picture Time!!!

Just posting some new pictures....enjoy!

Coby & I...showing off his portrait tattoo.

My "Princess" (my husband calls him a princess....lol)

Coby all snug in his new bed.

Coby's new Christmas sweater.

Coby's new winter vest.

Coby's skull sweater.

Coby playing fetch with his ball....such a happy little boy!

What am I thankful for this Thanksgiving?

Tomorrow is Thanksgiving - people everywhere have the day off and are spending it with family & friends. Aside from eating turkey & then passing out in a food coma, the day is about being thankful for what we have. Most people take for granted all of the things they have. It is so easy to get caught up in every day living & sometimes we don't stop to really be thankful for all that we have. This year has been a roller-coaster ride, full of many ups & downs, so this Thanksgiving I am taking the time to stop for a moment & remember the many things I am thankful for. I am thankful for MANY things, but here is just a list of some.....

1. I am thankful for Coby & having him here with us this Thanksgiving!! He is happy & healthy & nothing makes me happier than that!
2. I am thankful for my supportive, wonderful & understanding husband - without him, there's no way (without going into some serious debt) I could be caring for Coby the way I am. He supports our family, while I support Coby & his medical needs/expenses.
3. I am thankful for Coby's neurologist Dr. Sisson. Without him, I don't know if Coby would be here with us right now. Although he works in Boston, he is always available when it comes to Coby's health, answering my many emails, questions/concerns, etc. I believe in his treatment protocol & believe Coby will be one of the many full-remission GME dogs.
4. I am thankful for the many medications available for Coby & treating his GME.
4. I am thankful for our local vet, Dr Wendy, for supporting my decision regarding Coby's GME treatment. Dr. Wendy is wonderful with Coby & is always here to help & support us. All the staff at St. Paul Vet Clinic are great.
5. I am thankful for the New GME Dogs Yahoo Group. This group is full of wonderful, knowledgeable & caring people. Without this group I would not have found Dr. Sisson. I have learned so much from this group. All the advice and support is greatly appreciated.
6. I am thankful for the AKK community. As Coby being the first (known) AKK diagnosed with GME, the support, prayers & donations received from the AKK community alone have been tremendous!
7. I am thankful for my supportive family & friends. This has been a difficult & life changing last 6 months, ever since Coby's GME diagnosis & those closest to me have helped a great deal. Without them, I don't know what I would do.
8. I am thankful for the internet - yes, the internet!! Without the internet, I would not have found the many things, places, people, information, etc. I have for Coby's care. I have been able to connect & network with SO many wonderful people via the yahoo groups & Facebook. Having the ability to network with such supportive, kind people has been incredibly helpful this past year.
9. I am thankful for my job. Without my job, I would not be able to pay the medical bills for Coby. I am thankful for those dog lovers I work with that have been understanding, helpful & supportive of the things I do or must do for Coby.
10. I am thankful for all the support, thoughts, prayers & donations made to Coby & I over these past 6 months!

Happy Thanksgiving!!

Love,
Jaime & Coby

Coby's Christmas Pictures

October Overview

What can I say except October was a stressful & expensive month - about $1,000 spent in just one month! We had issues with titrating his chemo medication - the once a month Lomustine. So, we ended up having to get 3 CBC's done within a 3 week period. Coby has also been very hyper & trying to chew up everything in site. He ended up with a sock of mine, which I thought he had totally ingested (a 2x2 inch piece) - needless to say, 2 days later I finally mentioned it to my vet. We did x-rays & then rushed him to the vet hospital ER in Madison for (what we thought at the time) an endoscope. Good news - no endoscope was done/needed. After an over-reaction to the entire situation, I think Coby just ripped a big hole in the sock & did not end up eating it b/c I have yet to see the sock! And, of course his medications are always being ordered & shipped to us, which costs money!

On a positive note, Coby continues to do well. He's very energetic, happy & appears healthy. We're still working on getting the right dose of chemo - due to last month's mishap with the CBC's, we've now fell behind in getting him to that much needed dose of Lomustine. Hopefully this doesn't affect the outcome of his treatments/health.

Coby's last dose of Prednisone will be November 27th. If he relapses, we will need to restart it, but of course....we hope he never needs it again & never ever relapses. The chemo will continue for another year or so.

Hopefully this will be a successful month of medication administration, dosing, lab work, etc!