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Abstract

Objective—To evaluate progression of clinical signs and magnetic resonance imaging (MRI) findings in dogs with cervical spondylomyelopathy (wobbler syndrome) treated medically or surgically.

Design—Prospective cohort study.

Animals—12 Doberman Pinschers.

Procedures—Neurologic examinations and MRI were performed before medical (n = 9) or surgical treatment (ventral slot, 3) and a minimum of 12 months later.

Results—Mean follow-up time was 14.5 months. Clinically, 2 dogs improved after surgical treatment and 5 improved after medical treatment. Magnetic resonance imaging of surgically treated dogs revealed adequate spinal cord decompression. Spinal cord signal changes were seen in 2 dogs before surgery, both of which had new signal changes at the same and adjacent sites during follow-up examination. One dog treated surgically developed 3 new areas of spinal cord compression. In the medically treated dogs, the severity of spinal cord compression at the time of follow-up examination was unchanged in 4 dogs, worse in 2 dogs, and improved in 3 dogs, but spinal cord atrophy was observed on transverse images. Four medically treated dogs had changes in spinal cord signal initially, but none developed new signal changes or compressions.

Conclusions and Clinical Relevance—Medical and surgical treatment improved or stabilized the clinical condition of most dogs. Surgical treatment appeared to hasten the development of additional areas of spinal cord compression and lesions in dogs with preoperative cord changes; however, the clinical importance of these changes was not determined. The progression of pathologic MRI abnormalities was notably less in medically treated dogs, compared with surgically treated dogs.

Full access
in Journal of the American Veterinary Medical Association

Objective

To determine outcome of clinical management of cats with seizure disorders.

Design

Case series.

Animals

30 cats referred to the Ontario Veterinary College for recurrent seizures.

Procedures

Treatment was dictated by the cat's seizure frequency and by the underlying cause. Cats that were having cluster seizures or status epilepticus at the time of admission were treated orally with phenobarbital and with constant IV administration of diazepam. The other cats were treated with long-term oral admihistration of phenobarbital if the frequency of their seizures justified it. Follow-up included evaluation of seizure frequency. serum antiepileptic drug concentrations, and hematologic and serum biochemical values. Outcome was documented on the basis of survival and seizure frequency at the end of the followup period, which ranged from 3 to 21 months.

Results

6 cats were euthanatized without any therapeutic attempts at the owners' request. Twenty of the remaining 24 cats were alive at the time of final follow-up. Seventeen had a good outcome; 11 were not having any more seizures and 6 were having a low frequency of seizures. For 3 other cats, seizures were not well controlled. Four cats had been euthanatized (2 because of intractable seizures, 1 because of postcraniotomy complications, and 1 because the owners did not want to pursue treatment).

Clinical Implications

Results suggest that severity of seizure disorder in cats is not a good predictor of outcome and that aggressive treatment is often rewarding, even in the most severe cases. (J Am Vet Med Assoc 1997;210:72–77)

Free access
in Journal of the American Veterinary Medical Association

Objective

To report clinical findings, treatments, and outcomes of dogs admitted to the hospital for status epilepticus or cluster seizures and evaluate factors associated with outcome.

Design

Retrospective study.

Animals

156 dogs admitted for status epilepticus or cluster seizures.

Procedure

Medical records were reviewed for seizure and medication history, diagnostic test results, types of treatment, hospitalization costs, and outcome of hospital visits.

Results

Dogs were admitted for seizures on 194 occasions. Of 194 admissions, 128 (66%), 2 (1%), 32 (16.5%), 2 (1%), and 30 (15.5%) were of dogs with a history of clusters of generalized seizures, clusters of partial complex seizures, convulsive status epilepticus, partial status epilepticus, and > 1 type of seizure, respectively. Underlying causes of seizures were primary epilepsy (26.8%; 52/194), secondary epilepsy (35.1%; 68), reactive epileptic seizures (6.7%; 13), primary or secondary epilepsy with low serum antiepileptic drug concentrations (5.7%; 11), and undetermined (25.8%; 50). One hundred and eighty-six hospital visits resulted in admission to the intensive care unit (ICU). Treatments with continuous IV infusions of diazepam or phenobarbital were initiated during 66.8% (124/186) and 18.7% (35) of ICU hospital stays for 22.3 ± 16.1 hours (mean ± SD) and 21.9 ± 15.4 hours, respectively. Of 194 admissions, 74.7% (145) resulted in discharge from the hospital, 2.1% (4) in death, and 23.2% (45) in euthanasia. A poor outcome (death or euthanasia) was significantly associated with granulomatous meningoencephalitis, loss of seizure control after 6 hours of hospitalization, and the development of partial status epilepticus.

Conclusions and Clinical Relevance

Granulomatous meningoencephalitis, loss of seizure control after 6 hours of hospitalization, or the development of partial status epilepticus may indicate a poor prognosis for dogs with seizures. (J Am Vet Med Assoc 1999;215:1463–1468)

Free access
in Journal of the American Veterinary Medical Association

Abstract

Objectives—To evaluate a population of chondrodystrophic dogs treated for Hansen type I intervertebral disk (IVD) disease by surgical decompression with or without prophylactic fenestration and determine the rate and location of surgically confirmed recurrence of intervertebral disk extrusion.

Animals—265 dogs.

Study Design—Retrospective study.

Procedures—Medical records of dogs that underwent spinal decompression between 1995 and 1999 were reviewed.

Results—13 (4.9%) dogs were euthanatized or died prior to discharge. Fenestration was performed in 252 dogs, including 37 (14.7%) at the site of decompression only, 48 (19%) at 3 to 4 disk spaces, and 167 (66%) at 5 to 7 disk spaces. There were 12 instances of recurrent disk extrusion confirmed by removal of disk at a second surgery 3.5 to 33 months after the first surgery. Recurrence was always at a new disk space, and rates did not significantly differ between dogs that underwent single or multiple fenestrations. Two recurrences were at a previously fenestrated disk space. Seven recurrences were at a site immediately adjacent to a fenestrated disk space, and 5 recurrences were at L4-5.

Conclusions and Clinical Relevance—Prophylactic fenestration is generally successful in preventing future disk extrusions at fenestrated disk spaces. Prospective evaluation is still required to determine whether fenestration decreases the overall rate of recurrence. Prophylactic fenestration could promote disk extrusion at adjacent, nonfenestrated disk spaces. This could have a substantial clinical impact if recurrence develops at L4-5. (J Am Vet Med Assoc 2004;224:1808–1814)

Full access
in Journal of the American Veterinary Medical Association

Abstract

Objective—To establish the incidence of and risk factors for seizures following myelography performed with iohexol in dogs.

Design—Retrospective case series.

Animals—503 dogs.

Procedures—Medical records were searched for dogs that underwent myelography between April 2002 and December 2004. Data extracted included body weight, breed, age, sex, volume and dose of iohexol, site of injections, location of lesion, duration of anesthesia, surgical procedures immediately after myelography, use of acepromazine, and presence or absence of seizures.

Results—15 (3%) dogs had postmyelographic seizures. Risk factors significantly associated with seizures were size of dogs (large dogs were 35.35 times as likely to have seizures as were small dogs), location of contrast medium injection (dogs in which iohexol was injected into the cerebellomedullary cistern were 7.4 times as likely to have seizures as were dogs in which iohexol was injected into the lumbar cistern), location of lesion (dogs with lesions at the level of the cervical portion of the vertebral column were 4.65 times as likely to develop seizures as were dogs with lesions in other regions), and total volume of iohexol. Mean ± SD total volume of iohexol was 11.73 ± 5.52 mL (median, 10.5 mL [range, 3.0 to 21.0 mL]) for dogs that had seizures and 4.57 ± 4.13 mL (median, 3.5 mL [range, 0.75 to 45.0 mL]) for those that did not.

Conclusions and Clinical Relevance—Large-breed dogs with cervical lesions and large volumes of iohexol injected into the cerebellomedullary cistern had the highest risk of seizures. The use of contrast medium volumes > 8 mL in large dogs should be avoided, with preference given to injections into the lumbar cistern.

Full access
in Journal of the American Veterinary Medical Association
in Journal of the American Veterinary Medical Association

Abstract

Objective—To evaluate use of transcranial magnetic motor evoked potentials for assessment of the functional integrity of the cervical spinal cord in largebreed dogs with cervical spinal cord disease.

Design—Randomized, controlled, masked study.

Animals—10 healthy large-breed control dogs and 25 large-breed dogs with cervical spinal cord diseases.

Procedure—Affected dogs were allocated to 3 groups on the basis of neurologic status: signs of neck pain alone, ambulatory with ataxia in all limbs, or nonambulatory. Transcranial magnetic stimulation was performed on each dog with the same standard technique. Motor evoked potentials (MEP) were recorded from electrodes inserted in the tibialis cranialis muscle. Following the procedure, each dog was anesthetized and cervical radiography, CSF analysis, and cervical myelography were performed. The MEP latencies and amplitudes were correlated with neurologic status of the dogs after correction for neuronal path length.

Results—Mean MEP latencies and amplitudes were significantly different between control dogs and dogs in each of the 3 neurologic categories, but were not significantly different among dogs in the 3 neurologic categories. A linear association was evident between MEP latencies and amplitudes and severity of neurologic deficits; the more severe the neurologic deficits, the more prolonged the latencies and the more decreased the amplitudes.

Conclusions and Clinical Relevance—Transcranial magnetic MEP are useful to assess severity of cervical spinal cord disease in large-breed dogs. Impairment of the functional integrity of the cervical spinal cord was found even in dogs with neck pain alone. (J Am Vet Med Assoc 2002;221:60–64)

Full access
in Journal of the American Veterinary Medical Association

Abstract

Objective—To establish the reference ranges for motor evoked potential (MEP) latency and amplitude in clinically normal Doberman Pinschers, compare the MEPs of Doberman Pinschers with and without clinical signs of cervical spondylomyelopathy (CSM; wobbler syndrome), and determine whether MEP data correlate with neurologic or magnetic resonance imaging (MRI) findings.

Animals—16 clinically normal and 16 CSM-affected Doberman Pinschers.

Procedures—Dogs were classified according to their neurologic deficits. After sedation with acepromazine and hydromorphone, transcranial magnetic MEPs were assessed in each dog; latencies and amplitudes were recorded from the extensor carpi radialis and cranial tibial muscles. Magnetic resonance imaging was performed to evaluate the presence and severity of spinal cord compression.

Results—Significant differences in cranial tibial muscle MEP latencies and amplitudes were detected between clinically normal and CSM-affected dogs. No differences in the extensor carpi radialis MEP were detected between groups. There was a significant correlation (r = 0.776) between the cranial tibial muscle MEP latencies and neurologic findings. Significant correlations were also found between MRI findings and the cranial tibial muscle MEP latencies (r = 0.757) and amplitudes (r = −0.453).

Conclusions and Clinical Relevance—Results provided a reference range for MEPs in clinically normal Doberman Pinschers and indicated that cranial tibial muscle MEP latencies correlated well with both MRI and neurologic findings. Because of the high correlation between cranial tibial muscle MEP data and neurologic and MRI findings, MEP assessment could be considered as a screening tool in the management of dogs with spinal cord disease.

Full access
in American Journal of Veterinary Research

Abstract

Objective—To compare morphologic and morphometric features of the cervical vertebral column and spinal cord of Doberman Pinschers with and without clinical signs of cervical spondylomyelopathy (CSM; wobbler syndrome) detected via magnetic resonance imaging (MRI).

Animals—16 clinically normal and 16 CSM-affected Doberman Pinschers.

Procedures—For each dog, MRI of the cervical vertebral column (in neutral and traction positions) was performed. Morphologically, MRI abnormalities were classified according to a spinal cord compression scale. Foraminal stenosis and intervertebral disk degeneration and protrusion were also recorded. Morphometric measurements of the vertebral canal and spinal cord were obtained in sagittal and transverse MRI planes.

Results—4 of 16 clinically normal and 15 of 16 CSM-affected dogs had spinal cord compression. Twelve clinically normal and all CSM-affected dogs had disk degeneration. Foraminal stenosis was detected in 11 clinically normal and 14 CSM-affected dogs. Vertebral canal and spinal cord areas were consistently smaller in CSM-affected dogs, compared with clinically normal dogs. In neutral and traction positions, the intervertebral disks of CSM-affected dogs were wider than those of clinically normal dogs but the amount of disk distraction was similar between groups.

Conclusions and Clinical Relevance—The incidence of intervertebral disk degeneration and foraminal stenosis in clinically normal Doberman Pinschers was high; cervical spinal cord compression may be present without concurrent clinical signs. A combination of static factors (ie, a relatively stenotic vertebral canal and wider intervertebral disks) distinguished CSM-affected dogs from clinically normal dogs and appears to be a key feature in the pathogenesis of CSM.

Full access
in American Journal of Veterinary Research

Abstract

Objective—To compare outcomes and survival times for dogs with cervical spondylomyelopathy (CSM; wobbler syndrome) treated medically or surgically.

Design—Retrospective case series.

Animals—104 dogs.

Procedures—Medical records of dogs were included if the diagnosis of CSM had been made on the basis of results of diagnostic imaging and follow-up information (minimum, 6 months) was available. Ordinal logistic regression was used to compare outcomes and the product-limit method was used to compare survival times between dogs treated surgically and dogs treated medically.

Results—37 dogs were treated surgically, and 67 were treated medically. Owners reported that 30 (81%) dogs treated surgically were improved, 1 (3%) was unchanged, and 6 (16%) were worse and that 36 (54%) dogs treated medically were improved, 18 (27%) were unchanged, and 13 (19%) were worse. Outcome was not significantly different between groups. Information on survival time was available for 33 dogs treated surgically and 43 dogs treated medically. Forty of the 76 (53%) dogs were euthanized because of CSM. Median and mean survival times were 36 and 48 months, respectively, for dogs treated medically and 36 and 46.5 months, respectively, for dogs treated surgically. Survival times did not differ significantly between groups.

Conclusions and Clinical Relevance—In the present study, neither outcome nor survival time was significantly different between dogs with CSM treated medically and dogs treated surgically, suggesting that medical treatment is a viable and valuable option for management of dogs with CSM.

Full access
in Journal of the American Veterinary Medical Association