8Seizures in Small Animals It is estimated that the overall incidence of seizure disorders in dogs and cats is around 1%In pure breed dogs, this incidence may increase to 15-20%, due to the presence of inherited, primary epilepsy in those breeds
9Lesion Localization in Seizures Cerebral CortexDiencephalonThalamusHypothalamusMesencephalon
11Seizure Diagnosis Minimum Database CSF tap & analysis CT or MRI Scan Abnormal in Reactive EpilepsyCSF tap & analysisAbnormal in Active Secondary EpilepsyCT or MRI ScanAbnormal in Active Secondary EpilepsyEEGAbnormal in Secondary EpilepsyAll test are normal in Primary Epilepsy
15Seizures and Signalment Primary Epilepsy- purebred dogs 1-3 years of ageSecondary Epilepsy- any age but especially under 6 months and over 3 years
16Seizures- -TCM Represent various aspects of the Liver (Wood) system Excess (3 types)Deficiency (3 types)
17Seizures- -TCM Excess Deficiency Wind-Phlegm Phlegm-Fire Tongue pale & greasyPulse wiry & slipperyPhlegm-FireTongue red & greasyPulse rapid, wiry & slipperyBlood StagnationTongue & Pulse like Wind-PhlegmHistory of head traumaDeficiencyLiver Blood Def.Tongue pale & dryPulse weak & threadyLiver & Kidney Yin Def.Tongue red & dryKidney Jing Def.Tongue pale or red & dry< 1 year of age
18Seizures- -TCM Excess Deficiency Wind-Phlegm Phlegm-Fire expel phlegm, extinguish the wind, open the orifice and stabilize the seizuresDing Xian WanPhlegm-Fireclear the liver, drain the heat, transform phlegm and open the orificesDi Tan Tang and Long Dan Xie Gan TangBlood Stagnationexpel phlegm, extinguish the wind, open the orifice, stabilize the seizures and invigorate bloodDing Xian Wan and Tao Hong Si Wu SanDeficiencyLiver Blood Def.tonify Qi and Blood and quiet the windBu Xue Xi Feng San or Di Tan Tang plus Rehmannia 8Liver & Kidney Yin Def.nourish Yin and extinguish windYang Yin Xi Feng San or Di Tan Tang and Left Side Replenished (Zuo Gui Wan) or Tian Ma Gou Teng plusKidney Jing Def.extinguish the wind and astringe or nourish the kidney jingDi Tan Tang and Epimedium Powder
19Epilepsy -- TCM Internal heat leading to generation of wind Clear wind & heat and calm the ShenPointsConstitutional pointsClear wind & heatGB20, LI4, LI11, GV14, LIV3Calm the shenPC6, HT7Local pointsGV17, GV20, GV21, Long hui, GB9, GB13, BL5, GV1, ST40TCM HerbalsDi Tan Tang (TCM phenobarbital)Specific herbs for excesses or deficiencies present
20Ear Staple Shen Men Center of the ear Staple or point AP can help control 50% of refractor epilepsy casesFold ear over & find center on inside
21Acepromazine in An Shen Half way around the back of the earAim toward the opposite base of lipsInject mg diluted with saline to 0.5-6ml
22Basic Antioxidants Dogs Cats Vitamin E 10 IU/lb daily Vitamin C 5-10 mg/lb twice a daySelenium 2 µg/lb dailyBeta carotene 250 IU/lb dailyB Complex 2mg/kg twice a dayVitamin E IU dailyVitamin C mg twice a daySelenium 50 µg dailyVitamin A IU dailyB Complex 10 mg twice a day
28CSF Tap Collection site for seizures is at the cisterna magnum. Allows analysis for cells, protein and pressure.Cytology and titers for infectious organisms can be obtained.
29Meningoencephalomyelitis CSF Analysismay be normal or show increased pressure, protein and/or cells.CSF Titersspecies specific testsmany must be paired with serum titers.CSF cytology form a dog exhibitinga mixed reaction with neutrophils,lymphocytes and macrophages.
31GMECan be:peracuteacute & progressivechronicIn brainstem, tends to be a multifocal inflammatory disorderResponds temporarily to steroids.Patient with GME presenting withvertical nystagmus, long tract signs,and circling with incoordination.
32GMEGME histologically causes multifocal meningoencephalitis due to proliferationof reticulohistiocytic cells. Lesions also show multinucleated giant cells.
33Treatment of ME Primor (activated sulfadimethoxine) Depends upon whether infectious or inflammatoryPrednisoloneFind minimum daily dose and then used 2 times MDD QODPrimor (activated sulfadimethoxine)15 mg/kg BIDDoxycycline5-10 mg/kg QDHerbal SupportBromelain/Curcumin2.5/5 mg/kg TID
34Menigoencephalomyelitis Wind-Phlegmexpel phlegm, extinguish the wind, open the orifice and stabilize the seizuresDing Xian WanPhlegm-Fireclear the liver, drain the heat, transform phlegm and open the orificesDi Tan Tang and Long Dan Xie Gan Tan
42Horner’s Syndrome Small Animals Large Animals Ptosis Myosis EnophthalmosLarge AnimalsFacial sweating (horse)Lack of muzzle sweating (cow)
43Inner Ear DiseaseMost cases are secondary to bacterial infection (otitis media & interna)extension from otitis externapharyngitis with extension up the Eustachian tubehematogenous spread
44Ear Polyps in CatsBenign growth in the external ear canal which causes signs by extension.Can also be pharyngeal mass which grows into middle ear via the Eustachian tube.
45Ear Polyps in Cats Treatment is surgical removal. Damage can be permanent, if pressure necrosis has destroyed the inner ear structure.
46Inner Ear Disease -- TCM Invasion of external pathogen leading to wind, heat, damp.Heat boils the fluids leading to the accumulation of phlegm.Quiet the wind, reduce heat, disperse damp and activate the blood to dissolve stagnation.
48Central Vestibular Disease Postural ChangesCP DeficitDysmetriaReflex Changeshyperactive reflexescrossed-extensor reflexesBabinski’s signConscious proprioceptive deficitmay be on the same or opposite sideof the lesion.
49Central Vestibular Disease CSF Analysismay be normal or show increased pressure, protein and/or cells.CSF Titersspecies specific testsmany must be paired with serum titers.CSF cytology form a dog exhibitinga mixed reaction with neutrophils,lymphocytes and macrophages.
50Central Vestibular Disease Inflammatory or Infectious Diseasescanine distempertoxoplasmosis and neosporiosisfungalrickettsialGMESRME
51Central Vestibular Disease Trauma or Vascularremember dogs don’t get atherosclerosis !Neoplasiameningiomaschoroid plexus papillomasoligodendrogliomasastrocytomasmetastatic neoplasia
52Central Vestibular Disease MRI of Cerebellar Meningioma
57Fibrocartilagenous Emboli Vascular occlusion from IVD materialIVD herniates into the venous sinus or the vertebral bodythe venous sinuses have no valvesincreased pressure forces material into spinal cord
58FCEGenerally affects a radicular penetrating branch which leads to a quadrant (wedge) of infarctionMany will improve with time
60IVD- -Wind-Cold-DampAcute invasion of external pathogen leading to stagnation (cold slows blood flow which is worsened by accumulation of damp)TongueGreasyPulseSlow & softRx principleDispel W-C-D, activate blood & relieve stagnationTCM herbalXiao Huo Luo DanAcupunctureHua-tuo-jia-ji, BL23, BL67, GB39, GV1, & GV14
61Acute Spinal Cord Injury Damage affects the vascular supply leading to ischemiaThe ischemia leads to lactic acidosis and lipid peroxidation which furthers the injury
62Pathology of Spinal Injury Within 5 minutes there are petechiations in the grey matterProgresses to complete hemorrhagic necrosis of the grey matter by 4 hours
63Pathology of Spinal Injury From 4-24 hours there is progressive local extension to involve the white matter.If force is great enough, then progresses up & down spinal cord
64Treatment of Acute SPIAntioxidant steroids (Solu Medral or Solu Delta Cortef)30mg/kg15mg/kg every 8 hours for hoursSurgical correctionAcupuncture needle inwei jian (tip of tail)
65Intervertebral Disc Disease: chondrodystrophic dogs Collagen fibers of the nucleus pulposus metamorphs into hyalin cartilageIVD looses elasticity and leads to damage of annulus fibrosus
66IVD- -chondrodystrophy Annulus ruptures extruding degenerate nuclear material into the neural canalThis leads to pain, paresis or paralysis
67IVD- -Pain OnlyCage Rest for 30 days or 3 weeks after patient becomes clinically normal.AcupunctureOral steroids and diazepam only under supervision
68IVD- -Paresis Hospitalize Should improve in first 5-7 days Prednisolone (2 mg/kg divided 2-3 times a day)Misoprostol 3-4 µg/kg twice a dayDiazepam mg/kg TIDShould improve in first 5-7 days
69IVD- -Paralysis with Deep Pain EmergencyGive Solu Medral or Solu Delta Cortef 30 mg/kgReferMay observe for 24 hours to see if dramatic improvementIf none, Emergency
70IVD- -Paralysis No Deep Pain EmergencyGive 30 mg/kg Solu Medral or Solu Delta CortefRefer75% respond in first 24 hours50% in first 72 hours25% after that
71Integrative Therapy of IVD Disease Acute IVD Disease is a surgical emergencyEven with no deep pain there is a 75% chance of success within the 1st 24 hours & 50% chance in the 1st 72 hoursAfter 72 hours with no deep pain, the chances are no differentChronic IVD Disease may respond poorly to surgery
72HemilaminectomyThe thinned lamina is further removed and the laminectomy expanded with rongeurs exposing the spinal cordThe area is probed for the problemIVD material
73IVD After surgery, healing is needed Physical therapy Acupuncture Passive movementsMassageStanding exercisesHydrotherapyWalkingAcupunctureControl painStimulate nervesMagnet therapyNorth pole magnet stimulates nerve regenerationHealing touch
74IVD- -Diet Basic antioxidants Anti-inflammatory membrane stabilizers Vitamin E, vitamin C, vitamin B complex, selenium, beta caroteneAnti-inflammatory membrane stabilizersOmega-3-fatty acids, gamma linolenic acid, coenzyme Q-10Lecithin to help support myelinationHerbal medications to help immune systemAstragalus, cordyceps mushroom, garlicDietary cartilage
75IVD- -Prevention Diet & weight control Chiropractic care Massage Low carbohydrate dietBasic antioxidantsChiropractic careMassageExercise
79IVD- -Blood Stagnation Most common type in chondrodystrophic dogsKID Jing deficiency leads to failure to nourish LIV leads to joint problems & stagnationTonguePurplePulseWiry or FastRx PrincipleActivate blood, dissipate stagnation and resolve stasisTCM herbalDa huo luo dan (Double P formula #2)AcupunctureHua-tuo-jia-ji, BL23, BL11, GB39, GV14, Wei jian, GV6, GV1, & LIV3
80Cervical Spondylomyelopathy Young Great Danes and older Doberman PinchersYoung dogs is due to misarticulation and spondylolithesisOlder dogs is due to IVD disease and ligamentous hypertrophy
81LS Stenosis- -Cardinal Signs LS Back Painpain on palpation at LS junctionpain on raising the tail headDiminished tail movementUrinary and Fecal continency problems
83LS Stenosis- -Diagnosis EMGfibrillation potentials and positive sharp waves caudal to LS junction, distal limb and tailImaging techniquesCT ScanMRI Scan
84IVD- -Yang Deficient Old age leads to KID deficiency Tongue Pulse General weakness & cold backTonguePale & wet (swollen with teeth marks)PulseDeep & weakRx principleNourish Yang & warm KIDTCM herbalSang ji sheng san (lorathus powder)Chronic IVD
85IVD- -Yin Deficiency Chronic illness or old age consumes KID Yin Weakness in back worse at nightTongueRed & dryPulseDeep, thready & weakRx principleNourish Yin & tonify KIDTCM herbalDi gu pi sanChronic IVD
86Discospondylitis Infection of the intervertebral space Common causes Staph. aureusStrep. sp.CorynebactriumSignsPain (can be extreme)Ataxia to plegia
87Discospondylitis Diagnosis can be made on plain radiographs May initially be normal, until 2-3 weeks of incubationFind organism viaBlood cultureUrine culture
88Discospondylitis Also consider Treatment (6-8 wk) Nocardia or other fungal cause (aspergillosis)Brucella canisSpirocerca lupiTreatment (6-8 wk)CephalosporinsSulfa drugs
89Moose 9 year old M/C Labrador HBC 4 months ago RecoveredChronic, progressive paresis over 2 weeks
97ConclusionsAcupuncture can help treat or control a number of neurologic diseasesPoint selection depends upon the constitution of the animal and the nature and location of the diseasePatience is still a virtue with neurologic conditions