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Thread: New SM research results published

  1. #1
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    Default New SM research results published

    http://www3.interscience.wiley.com/j...TRY=1&SRETRY=0

    Abstract:

    ABSTRACT
    Syringomyelia is an important morbidity source in Cavalier King Charles Spaniels. Although abnormal cerebrospinal fluid (CSF) flow secondary to Chiari malformations is thought to cause syringomyelia in humans, this relationship is unknown in dogs. We used phase-contrast magnetic resonance (MR) imaging to evaluate CSF flow in dogs. Fifty-nine Cavalier King Charles Spaniels were assigned a neurologic grade reflecting their neurologic status. Five normal control dogs of other breeding were imaged for comparison. The presence of syringomyelia was noted from sagittal MR images. The pattern and velocity of CSF flow were assessed using phase-contrast cine MRI at the foramen magnum, C2–C3 disc space, and within syrinxes. Flow was measured most easily with the neck flexed to mimic standing. CSF flow velocity in the dorsal aspect of the subarachnoid space at the foramen magnum was significantly higher in control dogs than Cavalier King Charles Spaniels (P=0.035). Flow was obstructed at the foramen magnum in 41 of 59 Cavalier King Charles Spaniels. Turbulent flow and jets were associated with syringomyelia presence and severity, and CSF flow velocity at C2/3 dorsally was inversely related to the presence of syringomyelia (P=0.0197). Peak dorsal subarachnoid space CSF flow velocity at the foramen magnum and C2–C3 were together highly predictive of syringomyelia. CSF flow can be assessed in dogs using phase-contrast cine MRI. Obstruction to flow at the foramen magnum is common in Cavalier King Charles Spaniels and CSF flow pattern and velocity are related to the presence of syringomyelia.
    So as has been surmised, the malformation/syrinxes that impede CSF flow may well cause the development/further development of syrinxes, and poor CSF flow is directly associated with SM.

    This study was funded by the ACKCSC -- I wonder if they will highlight it to members, as this did not happen with other published results from this research?
    Karlin
    Cavaliers: Tansy : Mindy Connie Roxy Neasa Gus
    In memory: My beautiful Jaspar Lucy Leo Lily Libby

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    Default New SM Research Results Published.

    Karlin,

    Thanks for this.
    Bet (Hargreaves)

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    Very interesting study. My Dottie started showing disturbing behavior, (ear and neck scratching sessions, yelping for no apparent reason, acting frantic,then calming, jumping around to bite back side, and paw licking,) at about 7 months. Our vet then referred her to a vet neurologist who gave her an MRI. She showed a mild Chiari malformation with no herniation or syrinxes, and PSOM. She had the myringotomy (ear flush) and then went on antibiotic and steroid drops for the weeks following the procedure.

    She seemed okay for some time after, but the scratching eventually returned and the next check of her ears showed no overt evidence of more PSOM. When we re-visited our neurologist, Dottie had had several yelping issues, scratching and occasional signs of discomfort. He could not find any evidence of limb weakness and did not observe a pain response to the manipulation tests that he performed.

    It has been over a year and a half since the MRI, and without another scan, we have no idea if she is forming syrinxes now. Her neurologist has decided to hold off on pain meds for now, and instead put Dottie on a 5mg cap of Omeprazole, once each morning to see if that would relieve any cerebral fluid/flow issues she might be having. He also said that there are some promising reports of this therapy even slowing or maybe preventing formation or growth of syrinxes.

    Well, in our case, so far anyway, we are thrilled with the results. Dottie rarely scratches now, has not yelped once or acted like she is having discomfort. She is running around like a puppy again, playing with her toys, jumping up and off the couch and enjoying long walks. (She has never exhibited air scratching on lead.)....

    We are praying that this medication will continue to work for her and prevent problems in the future. Only time will tell, but we are thrilled for now.
    Marianne
    Mom to Dottie, and our precious rescue, Claire-Bear

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    Marianne, be sure to read the section on Clare Rusbridge's website on Chiarilike Malformation alone (CM without SM). This can cause the symptoms you describe and Clare says the best treatment is something like frusemide of omeprazole or cimetidine (eg CSF inhibitors). Generally a painkiller like gabapentin doesn't help, is my understanding. I've posted a few times here and on the SM support lists on some anecdotal evidence (including from Clare) that sometimes CSF inhibitors can limit or halt development of syrinxes caught very early on.
    Karlin
    Cavaliers: Tansy : Mindy Connie Roxy Neasa Gus
    In memory: My beautiful Jaspar Lucy Leo Lily Libby

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    Thanks Karlin, I will read that section. I can't see doing another MRI because honestly, I am not sure that even if she had SM I would put her through that surgery.

    My biggest fear is that she may someday deteriorate, but if the omeprazole is working for now, I am extremely thankful for that. Dottie is only a little over 2 yrs now, and given the early onset of the symptoms, due to what I have read here on the boards I was terrified. Hopefully this treatment will be all she needs for a long time to come.
    Marianne
    Mom to Dottie, and our precious rescue, Claire-Bear

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    I'd not worry about doing another MRI. Just follow the treatment protocol. Hopefully this will be CM alone, and that is a much better option, according to Clare. If it evolves to SM, then the treatment protocol is there.

    She doesn't seem to have the info on CM on her site -- guess it is from her thesis.

    See:

    http://www.veterinary-neurologist.co.uk/part2.htm#21

    This is what she says on treatment -- she has said in her thesis that using CSF drugs can help with a CM diagnosis. She has said to me in the past that gabapentin alone is not likely to help with CM but CSF drugs often do.

    There are three main drugs used for treatment of CM/SM: drugs that reduce CSF production; analgesics; and corticosteroids (Fig 3). If the dog’s history suggests postural pain or discomfort relating to obstruction of CSF flow then a trial of a drug which reducing CSF pressure, e.g. furosemide, cimetidine or omeprazole, is appropriate. This can also be very useful if it is difficult to determine if the cause of discomfort is CM versus, for example, ear disease. CSF pressure reducing drugs may be sufficient to control signs in some dogs, but additional analgesics are likely to be necessary for an individual with a wide syrinx. In this circumstance we suggest that non steroidal anti-inflammatory drugs are the medication of first choice partly because there are several licensed products. However, for dogs with signs of neuropathic pain, i.e. allodynia and scratching behaviour (suspected dysesthesia); a drug which is active in the spinal cord dorsal horn is more likely to be effective. Because gabapentin has established use in veterinary medicine we suggest that this is the drug of first choice but amitriptyline or pregabalin may also be suitable. Corticosteroids are an option if pain persists or where available finances prohibit the use of other drugs
    Karlin
    Cavaliers: Tansy : Mindy Connie Roxy Neasa Gus
    In memory: My beautiful Jaspar Lucy Leo Lily Libby

  7. #7
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    Default New SM Research Results Published.

    Can I mention this again.

    The Cavalier Breed is now known to have the most cases of SM.

    I dont think any other TOY Breed originated Like the Cavaliers have , when to get the Flat Type of Head required for Cavaliers , the Dome Type of Head of the King Charles Spaniel was used.

    This alteration was started in the 1930's.

    It has been well documented that Cavalier Breeders through out the years have successfully Bred away the well Domed Skull of the King Charles Spaniel

    Did this alteration have any-thing to do with the Foramen Magnum in Cavaliers also altering?

    The Foramen Magnum seems to be involved with the Flow of the Cerebro Spinal Fluid(CSF)

    It also can't be denied that the Cavaliers' Heads have altered once again from being Larger ,but in the late 80's the Smaller Pretty Look of Cavaliers was appearing, even to some Cavaliers having shorter legs.

    Have all these Breeding alterations in Cavaliers be being involved with their SM Problem to-day.?

    Has any-body got thoughts about this?

    All these Breeding Alterations ,you would think must have had some consequences for Cavaliers not to be causing problems.
    Bet (Hargreaves)

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    I think we also need to remember that this has all happened in such a short space of time.
    Dogs have been mucked around with sooo much in the last century or two that its no wonder they are developing weakness.
    Surely if we think about this logically:

    Dogs that are sick in the wild - ie have a disease prop up in the lines- dont survive. They die out. It is a weakness in the genes and those genes will not spread. Whole lion prides and wolf packs have been known to die out very quickly through spread of illness and disease.
    The cavalier breed has developed a weakness, diseases that if left alone surely would wipe out the breed and the most distressing thought is that it is through no fault of there own.
    I know that clocks cant be turned back and time past cannot be changed but... oh IF ONLY!!!
    Dogs would be dogs and not 'specimens of beauty'- surely the most beautiful thing in the whole world is to see a dog live a healthy life to the full and die of old age and not suffer in the meantime.

    Karen

    Karen

    Ruby - my stunning soul mate who defies the odds every day
    Charlie- my angel at heart and devil at play


  9. #9
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    Default New SM Research Results Published

    Karen,

    What a lot of sense you've Posted, .

    If the Changing of the Cavaliers Heads has a Link with the SM Problem in Cavaliers in the 1930's,and the further Change of Cavalier Heads by Cavalier Breeders wanting to be winning in the Show Ring ,what a Legacy those Breeders have left in the Cavalier Breed.

    I just don't know what the answer will be, those Genes will now be spread every-where in Cavaliers.

    Even if Dr Blott 's EBV Scheme has an answer ,but it's for Larger Types of Heads of Cavaliers, will to-day's Cavalier Breeders want this Type of Head if there is no chance of winning in the Show Ring with it.
    Bet (Hargreaves)

  10. #10
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    To be completely realistic Bet, when it comes to addressing the SM problem, we need to accept that everyone is still pretty much at the data gathering phase, mainly Mri scanning and submitting the results to various researchers.Some breeders are trying to incorporate the cavaliers with the best scans into their breeding programmes which is great,but the EBV programme will only be the very first step on the way and may take many many years to pay dividends.
    Also Bet, if you think inbreeding got the cavaliers into this situation then we may also need to accept that there may be some close inbreeding needed to dig them out as well....
    Research takes time, and every new publication may contain a piece of the jigsaw.
    I was under the impression that head size has been discounted as being of any real significance.
    Patience is a virtue and we have no other choice to to try to support the breeders who are making a real effort and even if it means people pushing the boundaries of the protocols to the very limit if they feel they can breed a healthier cavalier.
    I know you've been through so much anguish as an owner Bet,and want only the best for our little dogs.Hopefully if I can survive another 40 years I hope to always have two or three cavaliers on my couch.Sometimes you can feel a bit deflated and discouraged but there are enough breeders out there who may have shifted the balance very much in favour of a better future for the breed.
    Chin up Bet.
    Sins

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