Acupuncture for Acupuncture for Neurological DisordersNeurological Disorders

It matters not whether It matters not whether medicine is new or old, it medicine is new or old, it only matters that it is only matters that it is applied for the benefit of applied for the benefit of the patient.the patient.

Neurologic AssessmentNeurologic Assessment

• Is it a neurologic Is it a neurologic disease?disease?– SeizuresSeizures– Intention tremorIntention tremor– CN deficitsCN deficits

• Head tiltHead tilt• NystagmusNystagmus

– CP deficitsCP deficits– DysmetriaDysmetria– ParalysisParalysis

Minimum DatabaseMinimum Database

• CBCCBC• ChemistryChemistry

– Bile acidsBile acids– CholinesteraseCholinesterase

• UrinalysisUrinalysis• Chest and Chest and

abdominal abdominal radiographsradiographs

• Abdominal Abdominal ultrasoundultrasound

• Heartworm testHeartworm test• FecalFecal

Ancillary Neurologic Ancillary Neurologic TestsTests

• ElectrodiagnosticsElectrodiagnostics– EEGEEG– EMGEMG– BAERBAER

• CSF tap & analysisCSF tap & analysis– Cells & proteinCells & protein– PressurePressure– CholinesteraseCholinesterase– TitersTiters

• RadiographsRadiographs– Skull & spinal filmsSkull & spinal films– MyelographyMyelography– CT scanCT scan– MRIMRI

• Muscle AnalysisMuscle Analysis– EnzymesEnzymes– 2M antibody2M antibody– Anti-ACH receptor Anti-ACH receptor

antibodyantibody– BiopsyBiopsy

When all else fails…When all else fails…

Look at the patient!!!Look at the patient!!!

Outcome of Neurologic Outcome of Neurologic AssessmentAssessment

• Localization of LesionLocalization of Lesion• DD• AA• MM• NN• NN• II• II• II• TT• TT• VV

OO

• DefDef (Qi, Yin, Blood) (Qi, Yin, Blood)

• Jing DefJing Def• Def Def (Qi, Yin, Blood, Yang)(Qi, Yin, Blood, Yang)

• Def Def (Qi, Yin, Blood)(Qi, Yin, Blood)

• Stagnation Stagnation (Blood)(Blood)

• Jing Def/Excess or DefJing Def/Excess or Def• Phlegm FirePhlegm Fire• Phlegm FirePhlegm Fire• TraumaTrauma• Excess or DefExcess or Def• Wind PhlegmWind Phlegm

PlanPlan

PP

• Problem ListProblem List– ??

• Differential DxDifferential Dx– ??

• Diagnostic Diagnostic ApproachApproach– ??

• TreatmentTreatment– ??

Seizures in Small Seizures in Small AnimalsAnimals

• It is estimated that the It is estimated that the overall incidence of seizure overall incidence of seizure disorders in dogs and cats disorders in dogs and cats is around 1%is around 1%

• In pure breed dogs, this In pure breed dogs, this incidence may increase to incidence may increase to 15-20%, due to the 15-20%, due to the presence of inherited, presence of inherited, primary epilepsy in those primary epilepsy in those breedsbreeds

Lesion Localization in Lesion Localization in SeizuresSeizures

• Cerebral CortexCerebral Cortex• DiencephalonDiencephalon

– ThalamusThalamus– HypothalamusHypothalamus

• MesencephalonMesencephalon

Seizure DiagnosesSeizure Diagnoses

SEIZURES

Primary Epilepsy Secondary Epilepsy Reactive Epilepsy

Inactive Active

Probably Probably Symptomatic Symptomatic

EpilepsyEpilepsy

Symptomatic Symptomatic EpilepsyEpilepsy

Seizure DiagnosisSeizure Diagnosis

• Minimum Minimum DatabaseDatabase– Abnormal in Abnormal in

Reactive EpilepsyReactive Epilepsy

• CSF tap & analysisCSF tap & analysis– Abnormal in Active Abnormal in Active

Secondary EpilepsySecondary Epilepsy

• CT or MRI ScanCT or MRI Scan– Abnormal in Abnormal in

Active Active Secondary Secondary EpilepsyEpilepsy

• EEGEEG– Abnormal in Abnormal in

Secondary Secondary EpilepsyEpilepsy

• All test are normal All test are normal in Primary Epilepsyin Primary Epilepsy

Asymmetrical SeizuresAsymmetrical Seizures

Licking SeizureLicking Seizure

Fly-Biting SeizureFly-Biting Seizure

Seizures and Seizures and SignalmentSignalment

• Primary Epilepsy- Primary Epilepsy- purebred dogs 1-3 purebred dogs 1-3 years of ageyears of age

• Secondary Epilepsy- Secondary Epilepsy- any age but any age but especially under 6 especially under 6 months and over 3 months and over 3 yearsyears

Seizures- -TCMSeizures- -TCM

• Represent various Represent various aspects of the aspects of the Liver (Wood) Liver (Wood) systemsystem

• Excess (3 types)Excess (3 types)• Deficiency (3 Deficiency (3

types)types)

Seizures- -TCMSeizures- -TCM

• ExcessExcess– Wind-PhlegmWind-Phlegm

• Tongue pale & Tongue pale & greasygreasy

• Pulse wiry & Pulse wiry & slipperyslippery

– Phlegm-FirePhlegm-Fire• Tongue red & greasyTongue red & greasy• Pulse rapid, wiry & Pulse rapid, wiry &

slipperyslippery

– Blood StagnationBlood Stagnation• Tongue & Pulse like Tongue & Pulse like

Wind-PhlegmWind-Phlegm• History of head History of head

traumatrauma

• DeficiencyDeficiency– Liver Blood Def.Liver Blood Def.

• Tongue pale & dryTongue pale & dry• Pulse weak & threadyPulse weak & thready

– Liver & Kidney Yin Liver & Kidney Yin Def.Def.

• Tongue red & dryTongue red & dry• Pulse weak & threadyPulse weak & thready

– Kidney Jing Def.Kidney Jing Def.• Tongue pale or red & Tongue pale or red &

drydry• Pulse weak & threadyPulse weak & thready• < 1 year of age< 1 year of age

Seizures- -TCMSeizures- -TCM• ExcessExcess

– Wind-PhlegmWind-Phlegm• expel phlegm, extinguish expel phlegm, extinguish

the wind, open the the wind, open the orifice and stabilize the orifice and stabilize the seizuresseizures

• Ding Xian WanDing Xian Wan– Phlegm-FirePhlegm-Fire

• clear the liver, drain the clear the liver, drain the heat, transform phlegm heat, transform phlegm and open the orificesand open the orifices

• Di Tan Tang Di Tan Tang and and Long Long Dan Xie Gan TangDan Xie Gan Tang

– Blood StagnationBlood Stagnation• expel phlegm, extinguish expel phlegm, extinguish

the wind, open the the wind, open the orifice, stabilize the orifice, stabilize the seizures and invigorate seizures and invigorate bloodblood

• Ding Xian WanDing Xian Wan and and Tao Tao Hong Si Wu SanHong Si Wu San

• DeficiencyDeficiency– Liver Blood Def.Liver Blood Def.

• tonify Qi and Blood and tonify Qi and Blood and quiet the windquiet the wind

• Bu Xue Xi Feng San Bu Xue Xi Feng San oror Di Di Tan Tang plus Tan Tang plus Rehmannia 8Rehmannia 8

– Liver & Kidney Yin Def.Liver & Kidney Yin Def.• nourish Yin and nourish Yin and

extinguish windextinguish wind• Yang Yin Xi Feng SanYang Yin Xi Feng San or or

Di Tan Tang and Left Di Tan Tang and Left Side Replenished (Zuo Side Replenished (Zuo Gui Wan) Gui Wan) or or Tian Ma Gou Tian Ma Gou Teng plusTeng plus

– Kidney Jing Def.Kidney Jing Def.• extinguish the wind and extinguish the wind and

astringe or nourish the astringe or nourish the kidney jingkidney jing

• Di Tan Tang Di Tan Tang andand Epimedium PowderEpimedium Powder

Epilepsy -- TCMEpilepsy -- TCM

• Internal heat leading to generation of windInternal heat leading to generation of wind• Clear wind & heat and calm the ShenClear wind & heat and calm the Shen• PointsPoints

– Constitutional pointsConstitutional points– Clear wind & heatClear wind & heat

• GB20, LI4, LI11, GV14, LIV3GB20, LI4, LI11, GV14, LIV3– Calm the shenCalm the shen

• PC6, HT7PC6, HT7– Local pointsLocal points

• GV17, GV20, GV21, Long hui, GB9, GB13, BL5, GV1, GV17, GV20, GV21, Long hui, GB9, GB13, BL5, GV1, ST40ST40

• TCM HerbalsTCM Herbals– Di Tan Tang (TCM phenobarbital)Di Tan Tang (TCM phenobarbital)– Specific herbs for excesses or deficiencies presentSpecific herbs for excesses or deficiencies present

Ear StapleEar Staple

• Shen MenShen Men

– Center of the earCenter of the ear

– Staple or point AP Staple or point AP can help control can help control 50% of refractor 50% of refractor epilepsy casesepilepsy cases

– Fold ear over & Fold ear over & find center on find center on insideinside

Acepromazine in An Acepromazine in An ShenShen

• An ShenAn Shen

– Half way around the Half way around the back of the earback of the ear

– Aim toward the Aim toward the opposite base of opposite base of lipslips

– Inject 0.1-1 mg Inject 0.1-1 mg diluted with saline diluted with saline to 0.5-6mlto 0.5-6ml

Basic AntioxidantsBasic Antioxidants

• Vitamin E 10 IU/lb Vitamin E 10 IU/lb dailydaily

• Vitamin C 5-10 Vitamin C 5-10 mg/lb twice a daymg/lb twice a day

• Selenium 2 µg/lb Selenium 2 µg/lb dailydaily

• Beta carotene 250 Beta carotene 250 IU/lb dailyIU/lb daily

• B Complex 2mg/kg B Complex 2mg/kg twice a daytwice a day

• Vitamin E 100-400 Vitamin E 100-400 IU dailyIU daily

• Vitamin C 100-250 Vitamin C 100-250 mg twice a daymg twice a day

• Selenium 50 µg Selenium 50 µg dailydaily

• Vitamin A 1000-Vitamin A 1000-5000 IU daily5000 IU daily

• B Complex 10 mg B Complex 10 mg twice a daytwice a day

DogsDogs CatsCats

Additional Additional ConsiderationsConsiderations

• Probably safe Probably safe parasite controlparasite control

– InterceptorInterceptor– Frontline Top Frontline Top

SpotSpot– RevolutionRevolution

• Should avoidShould avoid

– HeartgardHeartgard– Proheart 6Proheart 6– ProgramProgram– SentinelSentinel– Frontline SprayFrontline Spray– AdvantageAdvantage– AdvantixAdvantix

Additional Additional ConsiderationsConsiderations

• DietDiet

– Low-Low-carbohydrate carbohydrate foodfood

• SupplementsSupplements

– Ginkgo bilobaGinkgo biloba• 2-4 mg/kg q8-12h2-4 mg/kg q8-12h• Ginkoba or Publix Ginkoba or Publix

brandbrand

– Tofu or LecithinTofu or Lecithin• 20 mg/kg daily20 mg/kg daily

– AcetylcysteineAcetylcysteine• 25 mg/kg q8h 25 mg/kg q8h

qodqod

MeningoencephalomyelMeningoencephalomyelitisitis

• Infectious DiseasesInfectious Diseases– Species SpecificSpecies Specific

• Steroid Response ME Steroid Response ME (SRME)(SRME)

• Necrotizing Vasculitis Necrotizing Vasculitis (SRMA)(SRMA)

• Necrotizing ME (NME)Necrotizing ME (NME)• Granulomatous ME Granulomatous ME

(GME)(GME)

MeningoencephalomyelMeningoencephalomyelitisitis

• Pain to paresis Pain to paresis to plegiato plegia

• Dx with CSF tapDx with CSF tap• Spinal Spinal

radiographs radiographs normalnormal

• Myelography Myelography normal normal (might be (might be contraindicated)contraindicated)

MeningoencephalomyelMeningoencephalomyelitisitis

CSF TapCSF Tap

• Collection site for Collection site for seizures is at the seizures is at the cisterna magnum.cisterna magnum.

• Allows analysis for Allows analysis for cells, protein and cells, protein and pressure.pressure.

• Cytology and titers Cytology and titers for infectious for infectious organisms can be organisms can be obtained.obtained.

MeningoencephalomyelMeningoencephalomyelitisitis

• CSF AnalysisCSF Analysis– may be normal or may be normal or

show increased show increased pressure, protein pressure, protein and/or cells.and/or cells.

• CSF TitersCSF Titers– species specific species specific

teststests– many must be many must be

paired with serum paired with serum titers.titers.

CSF cytology form a dog exhibiting

a mixed reaction with neutrophils,

lymphocytes and macrophages.

MeningoencephalomyelMeningoencephalomyelitisitis

• InfectionInfection– virusvirus– rickettsiarickettsia– protozoaprotozoa– fungusfungus– bacteriabacteria

• InflammationInflammation– GMEGME– NMENME– SRMESRME– SRMASRMA

GMEGME

• Can be:Can be:– peracuteperacute– acute & progressiveacute & progressive– chronicchronic

• In brainstem, tends to In brainstem, tends to be a multifocal be a multifocal inflammatory disorderinflammatory disorder

• Responds temporarily Responds temporarily to steroids.to steroids.

Patient with GME presenting withvertical nystagmus, long tract signs,and circling with incoordination.

GMEGME

GME histologically causes multifocal meningoencephalitis due to proliferation

of reticulohistiocytic cells. Lesions also show multinucleated giant cells.

Treatment of METreatment of ME

• Depends upon Depends upon whether infectious whether infectious or inflammatoryor inflammatory

• PrednisolonePrednisolone– Find minimum Find minimum

daily dose and daily dose and then used 2 times then used 2 times MDD QODMDD QOD

• Primor (activated Primor (activated sulfadimethoxine)sulfadimethoxine)– 15 mg/kg BID15 mg/kg BID

• DoxycyclineDoxycycline– 5-10 mg/kg QD5-10 mg/kg QD

• Herbal SupportHerbal Support– Bromelain/Bromelain/

CurcuminCurcumin• 2.5/5 mg/kg TID2.5/5 mg/kg TID

MenigoencephalomyelitMenigoencephalomyelitisis

– Wind-PhlegmWind-Phlegm• expel phlegm, extinguish the wind, open expel phlegm, extinguish the wind, open

the orifice and stabilize the seizuresthe orifice and stabilize the seizures• Ding Xian WanDing Xian Wan

– Phlegm-FirePhlegm-Fire• clear the liver, drain the heat, transform clear the liver, drain the heat, transform

phlegm and open the orificesphlegm and open the orifices• Di Tan Tang Di Tan Tang and and Long Dan Xie Gan TanLong Dan Xie Gan Tan

Brain Abscess in a FoalBrain Abscess in a Foal

Brain Abscess in a FoalBrain Abscess in a Foal

Vestibular DiseaseVestibular Disease

• Cardinal SignsCardinal Signs– Head TiltHead Tilt– NystagmusNystagmus

• HorizontalHorizontal• RotatoryRotatory• VerticalVertical• PositionalPositional

– Circling (tight)Circling (tight)– Imbalance & Imbalance &

IncoordinationIncoordination

Vestibular DiseaseVestibular Disease

Vestibular DiseaseVestibular Disease

Idiopathic V.D.Idiopathic V.D. Inner Ear Inner Ear DiseaseDisease

Central V.D.Central V.D.

8th Nerve only

8th Nerve,7th Nerve &

Horner’s Syndrome Anything Else

Brainstem V.D.Brainstem V.D. Cerebellar DiseaseCerebellar Disease

Idiopathic Vestibular Idiopathic Vestibular DiseaseDisease

• Acute Onset of Acute Onset of Vestibular SignsVestibular Signs– Head tiltHead tilt– Horizontal or Horizontal or

Rotatory nystagmus Rotatory nystagmus with fast-phase with fast-phase away from head tiltaway from head tilt

– Nothing elseNothing else

• Can Be Very SevereCan Be Very Severe• Acute, regressive Acute, regressive

diseasedisease

Idiopathic Vestibular Idiopathic Vestibular Disease -- TCMDisease -- TCM

• Wind (heat) invasionWind (heat) invasion• Clear wind & heat and Clear wind & heat and

calm the Shencalm the Shen• PointsPoints

– Constitutional pointsConstitutional points– Clear wind & heatClear wind & heat

• GB20, LI4, LI11, GV14GB20, LI4, LI11, GV14– Calm ShenCalm Shen

• PC6, HT7, GV17, GV20, PC6, HT7, GV17, GV20, GV21GV21

– Local pointsLocal points• TH17, TH18, TH21, SI19, TH17, TH18, TH21, SI19,

GB2, Er jian, An shenGB2, Er jian, An shen

Inner Ear DiseaseInner Ear Disease

• 8th Nerve Signs8th Nerve Signs• 7th Nerve Signs7th Nerve Signs

– ear & lip droopear & lip droop– lack of palpebral lack of palpebral

reflexreflex– nose turnnose turn– nostril flaringnostril flaring

• Horner’s Horner’s SyndromeSyndrome

Horner’s SyndromeHorner’s Syndrome

• Small AnimalsSmall Animals– PtosisPtosis– MyosisMyosis– EnophthalmosEnophthalmos

• Large AnimalsLarge Animals– Facial sweating Facial sweating

(horse)(horse)– Lack of muzzle Lack of muzzle

sweating (cow)sweating (cow)

Inner Ear DiseaseInner Ear Disease

• Most cases are Most cases are secondary to secondary to bacterial infection bacterial infection (otitis media & (otitis media & interna)interna)– extension from extension from

otitis externaotitis externa– pharyngitis with pharyngitis with

extension up the extension up the Eustachian tubeEustachian tube

– hematogenous hematogenous spreadspread

Ear Polyps in CatsEar Polyps in Cats

• Benign growth in Benign growth in the external ear the external ear canal which canal which causes signs by causes signs by extension.extension.

• Can also be Can also be pharyngeal mass pharyngeal mass which grows into which grows into middle ear via the middle ear via the Eustachian tube.Eustachian tube.

Ear Polyps in CatsEar Polyps in Cats

• Treatment is Treatment is surgical removal.surgical removal.

• Damage can be Damage can be permanent, if permanent, if pressure pressure necrosis has necrosis has destroyed the destroyed the inner ear inner ear structure.structure.

Inner Ear Disease -- Inner Ear Disease -- TCMTCM

• Invasion of external Invasion of external pathogen leading to pathogen leading to wind, heat, damp.wind, heat, damp.

• Heat boils the fluids Heat boils the fluids leading to the leading to the accumulation of accumulation of phlegm.phlegm.

• Quiet the wind, reduce Quiet the wind, reduce heat, disperse damp heat, disperse damp and activate the blood and activate the blood to dissolve stagnation.to dissolve stagnation.

Inner Ear Disease -- Inner Ear Disease -- TCMTCM

• PointsPoints– Constitutional pointsConstitutional points– Clear wind & heatClear wind & heat

• GB20, LI4, LI11, GV14GB20, LI4, LI11, GV14– Calm the shenCalm the shen

• PC6, HT7, GV17, GV20, PC6, HT7, GV17, GV20, GV21GV21

– Eliminate dampEliminate damp• SP9SP9

– Activate Qi & bloodActivate Qi & blood• ST36, ST40, Xin shuST36, ST40, Xin shu

– Local pointsLocal points• TH17, TH18, TH21, SI19, TH17, TH18, TH21, SI19,

GB2, Er jian, An shenGB2, Er jian, An shen

Central Vestibular Central Vestibular DiseaseDisease

• Postural Postural ChangesChanges– CP DeficitCP Deficit– DysmetriaDysmetria

• Reflex ChangesReflex Changes– hyperactive hyperactive

reflexesreflexes– crossed-extensor crossed-extensor

reflexesreflexes– Babinski’s signBabinski’s sign

Conscious proprioceptive deficitConscious proprioceptive deficit

may be on the same or opposite sidemay be on the same or opposite side

of the lesionof the lesion..

Central Vestibular Central Vestibular DiseaseDisease

• CSF AnalysisCSF Analysis– may be normal or may be normal or

show increased show increased pressure, protein pressure, protein and/or cells.and/or cells.

• CSF TitersCSF Titers– species specific species specific

teststests– many must be many must be

paired with paired with serum titers.serum titers.

CSF cytology form a dog exhibitingCSF cytology form a dog exhibiting

a mixed reaction witha mixed reaction with neutrophils,neutrophils,

lymphocyteslymphocytes and macrophagesand macrophages.

Central Vestibular Central Vestibular DiseaseDisease

• Inflammatory or Inflammatory or Infectious Infectious DiseasesDiseases– canine distempercanine distemper– toxoplasmosis and toxoplasmosis and

neosporiosisneosporiosis– fungalfungal– rickettsialrickettsial– GMEGME– SRMESRME

Central Vestibular Central Vestibular DiseaseDisease

• Trauma or VascularTrauma or Vascular– remember dogs don’t remember dogs don’t

get atherosclerosis !get atherosclerosis !

• NeoplasiaNeoplasia– meningiomasmeningiomas– choroid plexus choroid plexus

papillomaspapillomas– oligodendrogliomasoligodendrogliomas– astrocytomasastrocytomas– metastatic neoplasiametastatic neoplasia

Central Vestibular Central Vestibular DiseaseDisease

MRI of Cerebellar MeningiomaMRI of Cerebellar Meningioma

Central Vestibular Central Vestibular DiseaseDisease

• Infectious DiseasesInfectious Diseases– FIPFIP– FeLVFeLV– toxoplasmosistoxoplasmosis– cryptococcosiscryptococcosis

• TraumaTrauma• MetabolicMetabolic

– thiamine deficiencythiamine deficiency

• ToxicityToxicity– organophosphatesorganophosphates

• NeoplasiaNeoplasia– meningiomasmeningiomas

Central Vestibular Central Vestibular Disease -- TCMDisease -- TCM

• Can be wind, heat-Can be wind, heat-damp or wind cold damp or wind cold based upon the based upon the causative factor causative factor involved.involved.

• PointsPoints– ConstitutionalConstitutional– 8 Principle8 Principle– Zang-FuZang-Fu

IVD- -TCM DiagnosisIVD- -TCM Diagnosis

• Represents a “bi” Represents a “bi” syndrome often syndrome often accompanied by accompanied by “wei” syndrome“wei” syndrome

• Under domain of Under domain of KID (bones) & LIV KID (bones) & LIV (joints & free flow (joints & free flow of qi & blood)of qi & blood)

IVD- - TCM PatternsIVD- - TCM Patterns

• Excess typesExcess types

– Wind-Cold-DampWind-Cold-Damp

– Blood Blood stagnationstagnation

• Deficient typesDeficient types

– Yang deficiencyYang deficiency

– Yin deficiencyYin deficiency

– Yin & Yyang Yin & Yyang deficiencydeficiency

Fibrocartilagenous Fibrocartilagenous EmboliEmboli

• Vascular occlusion Vascular occlusion from IVD materialfrom IVD material– IVD herniates into IVD herniates into

the venous sinus or the venous sinus or the vertebral bodythe vertebral body

– the venous sinuses the venous sinuses have no valveshave no valves

– increased pressure increased pressure forces material into forces material into spinal cordspinal cord

FCEFCE

• Generally affects Generally affects a radicular a radicular penetrating penetrating branch which branch which leads to a leads to a quadrant (wedge) quadrant (wedge) of infarctionof infarction

• Many will improve Many will improve with timewith time

SchatzieSchatzie

IVD- -Wind-Cold-DampIVD- -Wind-Cold-Damp

• Acute invasion of Acute invasion of external pathogen external pathogen leading to leading to stagnation (cold stagnation (cold slows blood flow slows blood flow which is worsened which is worsened by accumulation of by accumulation of damp)damp)

• TongueTongue– GreasyGreasy

• PulsePulse– Slow & softSlow & soft

• Rx principleRx principle– Dispel W-C-D, Dispel W-C-D,

activate blood & activate blood & relieve stagnationrelieve stagnation

• TCM herbalTCM herbal– Xiao Huo Luo DanXiao Huo Luo Dan

• AcupunctureAcupuncture– Hua-tuo-jia-ji, BL23, Hua-tuo-jia-ji, BL23,

BL67, GB39, GV1, & BL67, GB39, GV1, & GV14GV14

Acute Spinal Cord Acute Spinal Cord InjuryInjury

• Damage affects Damage affects the vascular the vascular supply leading to supply leading to ischemiaischemia

• The ischemia leads The ischemia leads to lactic acidosis to lactic acidosis and lipid and lipid peroxidation which peroxidation which furthers the injuryfurthers the injury

Pathology of Spinal Pathology of Spinal InjuryInjury

• Within 5 minutes Within 5 minutes there are there are petechiations in petechiations in the grey matterthe grey matter

• Progresses to Progresses to complete complete hemorrhagic hemorrhagic necrosis of the necrosis of the grey matter by 4 grey matter by 4 hourshours

Pathology of Spinal Pathology of Spinal InjuryInjury

• From 4-24 hours From 4-24 hours there is there is progressive local progressive local extension to extension to involve the involve the white matter.white matter.

• If force is great If force is great enough, then enough, then progresses up & progresses up & down spinal corddown spinal cord

Treatment of Acute SPITreatment of Acute SPI

• Antioxidant Antioxidant steroids (Solu steroids (Solu Medral or Solu Medral or Solu Delta Cortef)Delta Cortef)– 30mg/kg30mg/kg– 15mg/kg every 8 15mg/kg every 8

hours for 24-48 hours for 24-48 hourshours

• Surgical correctionSurgical correction

Acupuncture needle inAcupuncture needle inwei jian (tip of tail)wei jian (tip of tail)

Intervertebral Disc Intervertebral Disc Disease:Disease:chondrodystrophic dogschondrodystrophic dogs

• Collagen fibers of Collagen fibers of the nucleus the nucleus pulposus pulposus metamorphs into metamorphs into hyalin cartilagehyalin cartilage

• IVD looses IVD looses elasticity and elasticity and leads to damage leads to damage of annulus of annulus fibrosusfibrosus

IVD- -chondrodystrophyIVD- -chondrodystrophy

• Annulus ruptures Annulus ruptures extruding extruding degenerate degenerate nuclear material nuclear material into the neural into the neural canalcanal

• This leads to This leads to pain, paresis or pain, paresis or paralysisparalysis

IVD- -Pain OnlyIVD- -Pain Only

• Cage Rest for 30 Cage Rest for 30 days or 3 weeks days or 3 weeks after patient after patient becomes becomes clinically normal.clinically normal.

• AcupunctureAcupuncture• Oral steroids and Oral steroids and

diazepam only diazepam only under under supervisionsupervision

IVD- -ParesisIVD- -Paresis

• HospitalizeHospitalize– Prednisolone (2 Prednisolone (2

mg/kg divided mg/kg divided 2-3 times a day)2-3 times a day)

– Misoprostol 3-4 Misoprostol 3-4 µg/kg twice a µg/kg twice a dayday

– Diazepam 0.25-Diazepam 0.25-0.5 mg/kg TID0.5 mg/kg TID

• Should improve Should improve in first 5-7 daysin first 5-7 days

IVD- -Paralysis with IVD- -Paralysis with Deep PainDeep Pain

• EmergencyEmergency– Give Solu Medral or Give Solu Medral or

Solu Delta Cortef 30 Solu Delta Cortef 30 mg/kgmg/kg

– ReferRefer

• May observe for 24 May observe for 24 hours to see if hours to see if dramatic dramatic improvementimprovement– If none, EmergencyIf none, Emergency

IVD- -Paralysis No Deep IVD- -Paralysis No Deep PainPain

• EmergencyEmergency– Give 30 mg/kg Give 30 mg/kg

Solu Medral or Solu Medral or Solu Delta CortefSolu Delta Cortef

– ReferRefer

• 75% respond in 75% respond in first 24 hoursfirst 24 hours

• 50% in first 72 50% in first 72 hourshours

• 25% after that25% after that

Integrative Therapy of Integrative Therapy of IVD DiseaseIVD Disease

• Acute IVD Acute IVD Disease is a Disease is a surgical surgical emergencyemergency– Even with no deep Even with no deep

pain there is a pain there is a 75% chance of 75% chance of success within the success within the 11stst 24 hours & 24 hours & 50% chance in the 50% chance in the 11stst 72 hours 72 hours

– After 72 hours After 72 hours with no deep with no deep pain, the pain, the chances are no chances are no differentdifferent

• Chronic IVD Chronic IVD Disease may Disease may respond poorly respond poorly to surgeryto surgery

HemilaminectomyHemilaminectomy

• The thinned The thinned lamina is further lamina is further removed and the removed and the laminectomy laminectomy expanded with expanded with rongeurs exposing rongeurs exposing the spinal cordthe spinal cord

• The area is probed The area is probed for the problemfor the problem

IVD materialIVD material

IVDIVD

• After surgery, After surgery, healing is neededhealing is needed

• Physical therapyPhysical therapy– Passive Passive

movementsmovements– MassageMassage– Standing exercisesStanding exercises– HydrotherapyHydrotherapy– WalkingWalking

• AcupunctureAcupuncture– Control painControl pain– Stimulate nervesStimulate nerves

• Magnet therapyMagnet therapy– North pole North pole

magnet magnet stimulates nerve stimulates nerve regenerationregeneration

• Healing touchHealing touch

IVD- -DietIVD- -Diet

• Basic antioxidantsBasic antioxidants– Vitamin E, vitamin C, Vitamin E, vitamin C,

vitamin B complex, vitamin B complex, selenium, beta selenium, beta carotenecarotene

• Anti-inflammatory Anti-inflammatory membrane membrane stabilizersstabilizers– Omega-3-fatty acids, Omega-3-fatty acids,

gamma linolenic acid, gamma linolenic acid, coenzyme Q-10coenzyme Q-10

• Lecithin to help Lecithin to help support myelinationsupport myelination

• Herbal medications Herbal medications to help immune to help immune systemsystem– Astragalus, cordyceps Astragalus, cordyceps

mushroom, garlicmushroom, garlic

• Dietary cartilageDietary cartilage

IVD- -PreventionIVD- -Prevention

• Diet & weight Diet & weight controlcontrol– Low carbohydrate Low carbohydrate

dietdiet– Basic antioxidantsBasic antioxidants

• Chiropractic careChiropractic care• MassageMassage• ExerciseExercise

HansHans

HansHans

• Routine Routine radiographs radiographs showed a showed a narrowed IVD narrowed IVD space at T11-12 space at T11-12 with a cloudy IV with a cloudy IV foramenforamen

• Incidentally there Incidentally there was calcification was calcification of T13-L1of T13-L1

HansHans

IVD- -Blood StagnationIVD- -Blood Stagnation

• Most common type Most common type in in chondrodystrophic chondrodystrophic dogsdogs– KID Jing deficiency KID Jing deficiency

leads to failure to leads to failure to nourish LIV leads to nourish LIV leads to joint problems & joint problems & stagnationstagnation

• TongueTongue– PurplePurple

• PulsePulse– Wiry or FastWiry or Fast

• Rx PrincipleRx Principle– Activate blood, Activate blood,

dissipate stagnation dissipate stagnation and resolve stasisand resolve stasis

• TCM herbalTCM herbal– Da huo luo dan Da huo luo dan

(Double P formula (Double P formula #2)#2)

• AcupunctureAcupuncture– Hua-tuo-jia-ji, BL23, Hua-tuo-jia-ji, BL23,

BL11, GB39, GV14, BL11, GB39, GV14, Wei jian, GV6, GV1, Wei jian, GV6, GV1, & LIV3& LIV3

Cervical Cervical SpondylomyelopathySpondylomyelopathy

• Young Great Danes Young Great Danes and older and older Doberman PinchersDoberman Pinchers– Young dogs is due to Young dogs is due to

misarticulation and misarticulation and spondylolithesisspondylolithesis

– Older dogs is due to Older dogs is due to IVD disease and IVD disease and ligamentous ligamentous hypertrophyhypertrophy

LS Stenosis- -Cardinal LS Stenosis- -Cardinal SignsSigns

• LS Back PainLS Back Pain– pain on palpation at pain on palpation at

LS junctionLS junction– pain on raising the pain on raising the

tail headtail head

• Diminished tail Diminished tail movementmovement

• Urinary and Fecal Urinary and Fecal continency problemscontinency problems

LS StenosisLS Stenosis

LS Stenosis- -DiagnosisLS Stenosis- -Diagnosis

• EMGEMG– fibrillation potentials fibrillation potentials

and positive sharp and positive sharp waves caudal to LS waves caudal to LS junction, distal limb junction, distal limb and tailand tail

• Imaging techniquesImaging techniques– CT ScanCT Scan– MRI ScanMRI Scan

IVD- -Yang DeficientIVD- -Yang Deficient

• Old age leads to Old age leads to KID deficiencyKID deficiency– General weakness General weakness

& cold back& cold back

• TongueTongue– Pale & wet Pale & wet

(swollen with (swollen with teeth marks)teeth marks)

• PulsePulse– Deep & weakDeep & weak

• Rx principleRx principle– Nourish Yang & Nourish Yang &

warm KIDwarm KID

• TCM herbalTCM herbal– Sang ji sheng Sang ji sheng

san (lorathus san (lorathus powder)powder)

• Chronic IVDChronic IVD

IVD- -Yin DeficiencyIVD- -Yin Deficiency

• Chronic illness or Chronic illness or old age consumes old age consumes KID YinKID Yin– Weakness in back Weakness in back

worse at nightworse at night

• TongueTongue– Red & dryRed & dry

• PulsePulse– Deep, thready & Deep, thready &

weakweak

• Rx principleRx principle– Nourish Yin & Nourish Yin &

tonify KIDtonify KID

• TCM herbalTCM herbal– Di gu pi sanDi gu pi san

• Chronic IVDChronic IVD

DiscospondylitisDiscospondylitis

• Infection of the Infection of the intervertebral spaceintervertebral space

• Common causesCommon causes– Staph. aureusStaph. aureus– Strep. sp.Strep. sp.– CorynebactriumCorynebactrium

• SignsSigns– Pain (can be Pain (can be

extreme)extreme)– Ataxia to plegiaAtaxia to plegia

DiscospondylitisDiscospondylitis

• Diagnosis can be Diagnosis can be made on plain made on plain radiographsradiographs– May initially be May initially be

normal, until 2-3 normal, until 2-3 weeks of weeks of incubationincubation

• Find organism Find organism viavia– Blood cultureBlood culture– Urine cultureUrine culture

DiscospondylitisDiscospondylitis

• Also considerAlso consider– NocardiaNocardia or other or other

fungal cause fungal cause (aspergillosis)(aspergillosis)

– Brucella canisBrucella canis– Spirocerca lupiSpirocerca lupi

• Treatment Treatment (6-8 (6-8 wk)wk)– CephalosporinsCephalosporins– Sulfa drugsSulfa drugs

MooseMoose

• 9 year old M/C 9 year old M/C LabradorLabrador

• HBC 4 months agoHBC 4 months ago– RecoveredRecovered

• Chronic, Chronic, progressive progressive paresis over 2 paresis over 2 weeksweeks

Moose- -MyelogramMoose- -Myelogram

Moose- -Surgical Moose- -Surgical ObservationObservation

Abnormal articular process at T12

Epidural mass

Moose- -CytologyMoose- -Cytology

• Impression Impression smears from both smears from both the articular the articular process and the process and the epidural mass epidural mass revealed PMN revealed PMN with intracellular with intracellular bacteriabacteria

Moose- -CT scanMoose- -CT scan

Moose- -Post OPMoose- -Post OP

• AntibioticsAntibiotics

– SulfadimethoxinSulfadimethoxine (Primor) 15 e (Primor) 15 mg/kg q12hmg/kg q12h

– Cephalexin 22 Cephalexin 22 mg/kg every 8 mg/kg every 8 hourshours

– Use for 6-8 Use for 6-8 weeksweeks

IVD- -Yin & Yang Def.IVD- -Yin & Yang Def.

• Aging leads to Aging leads to KID Yang & Yin KID Yang & Yin deficiencydeficiency– decreases decreases

resistance & resistance & allows low grade allows low grade infection to startinfection to start

• TongueTongue– Pink or palePink or pale

• PulsePulse– Deep & weakDeep & weak

• Rx PrincipleRx Principle– Nourish Yin & Nourish Yin &

tonify KIDtonify KID

• TCM herbalTCM herbal– Double P #1 Double P #1

(hindquarter (hindquarter formula)formula)

• Very chronicVery chronic

ConclusionsConclusions

• Acupuncture can help treat or Acupuncture can help treat or control a number of neurologic control a number of neurologic diseasesdiseases

• Point selection depends upon Point selection depends upon the constitution of the animal the constitution of the animal and the nature and location of and the nature and location of the diseasethe disease

• Patience is still a virtue with Patience is still a virtue with neurologic conditionsneurologic conditions