Wobbler Syndrome

What is Wobbler Syndrome?

The term “wobbler” originated from a spinal disease of horses that causes lack of co-ordination while walking. The canine version is more appropriately known as Cervical Spondylomyelopathy. It results in a wobbly gait when walking or running due to pressure on the spinal cord in the lower part of the neck. Many of these dogs stumble when walking, and the rear legs may be affected first.

How does it happen?

This disease begins because there is an instability between two or more vertebrae in the lower part of the neck. When instability exists, the body attempts to correct the problem. This results in a thickening of the ligaments that are within the joint; one is above the spinal cord and two are below it. As these ligaments thicken, they put pressure on the spinal cord.

The spinal cord is much like a large telephone cable that contains thousands of wires, each carrying important messages. When the telephone cable is crushed, the tiny wires within are broken so they cannot transmit information. A similar event occurs when the spinal cord is compressed by the thickened ligaments. They are unable to carry messages from the brain to the nerves in the legs, so the legs cannot move as they should.

My dog is paralysed in all four legs.  Is this part of this disease?

It might be. The pressure on the spinal cord from the thickened ligaments causes the dog to walk in a very uncoordinated fashion. However, another event often follows. The instability present between the vertebrae also puts unnatural stress on the discs that are located between the bones. After weeks or months of stress, the discs may rupture. When this happens, the pressure on the spinal cord may be so great that paralysis occurs. If the problem is in the neck, this will generally involve all four legs.

Are certain breeds of dogs more commonly affected than others?

Yes. Great Danes, Dobermans and Basset Hounds are commonly affected breeds, but any large breed is at risk for this disorder. Great Danes are usually affected when they are young, about 1-3 years of age. Dobermans and other breeds are typically 6-9 years of age when the symptoms begin.

How is the diagnosis made?

Radiographs (x-rays) of the neck often reveal that the cervical vertebrae are not properly aligned.  If the dog is one of the prone breeds, and the symptoms are correct, this provides strong evidence of wobbler syndrome. However, plain radiographs do not show the spinal cord so the presence of pressure on it cannot be proven in this manner. A myelogram is a radiograph made after a special contrast material (dye) is injected around the spinal cord, and this can provide information to confirm the diagnosis. With advances in diagnostic imaging, CT or MRI scans are now much more often the method utilized to investigate spinal cord disease including suspected cases of wobbler syndrome.

What is the treatment?

Anti-inflammatory drugs and pain relievers are often prescribed in the early stages of this disease.  They may provide some relief from the symptoms, but this improvement is usually only temporary.  As the disease progresses, medication may no longer be helpful. In some dogs, a specially-fashioned neck brace can be helpful in limiting motion in the neck. This can be helpful in some dogs, especially dogs for which surgery is not feasible. However, most dogs have progressive disease and are helped best with prompt surgery.Surgery offers the best chance of significant and ongoing improvement. The aim of surgery is to reduce pressure on the spinal cord. There are several surgical procedures that have been used. The findings on imaging (myelogram, CT, MRI) are used to determine the surgical procedure that is most likely to be helpful.

What is involved with after care?

The degree of after care will depend on the dog’s status at the time it goes home. If it can walk, but is uncoordinated, it will need assistance so that a fall does not occur. If it is still paralysed to some degree at the time of discharge, the nursing and ongoing home care can be challenging because these are generally large and heavy dogs. If you are not able to lift your dog and you do not have someone else who can help you do so, you should discuss this situation further with your veterinarian.

What is the prognosis?

If surgery is performed at the time the dog is uncoordinated, there is a fairly good chance of success. If paralysis of all four legs has occurred, the success rate is less.

Seizures in cats

Seizures and epilepsy are less commonly encountered in cats than dogs. They are, however, the most common sign of disease affecting the front part of the brain in the cat.

Some important terms

Seizure: (convulsion, ictus, fit) – an involuntary disturbance of normal brain control which is usually seen as uncontrollable muscle activity.  Seizures can be single and very occasional, or may occur in clusters followed by long periods (weeks to months) without fitting.

Epilepsy: recurrent seizures (usually without an identifiable structural cause).

Preictal: the change in character that occurs prior to a fit e.g. nervousness, attention seeking, head turning.

Postictal: following a seizure it can take 24-48 hours for a cat to return to normal. This phase is called the postictal period and is characterised by a variety of signs including sleepiness, pacing, depression, excitement, excessive eating and drinking and sometimes blindness.

Generalised seizures: jerking movements, rigid limbs, paddling/running movements, loss of faecal and urinary control. The head is often bent backwards along the spine.

Status epilepticus: continuous fitting for more than 5-10 minutes. Cats in status epilepticus require urgent treatment.

Partial seizures: very rare in cats, a partial seizure may involve only certain muscle groups or be characterised by behavioural changes (e.g. tail chasing, biting at imaginary objects, aggression).

Seizures often occur at times of changing brain activity e.g. during phases of sleep, excitement or feeding. Affected cats can appear completely normal in between fits. Many different diseases can lead to seizures so it is often important that diagnostic tests be performed to try to discover the cause of the fitting, as treatment of the underlying disease is most likely to lead to successful control of the seizures. In cats, idiopathic epilepsy, which occurs commonly in some breeds of dog e.g. German Shepherds, is rare.

How can I help my veterinarian to make a diagnosis?

Carefully observing your cat particularly at the beginning of a fit can provide very valuable information to your veterinarian about the types of disease that may be causing the problem.

  1. At what age did the fits began and are they getting worse?
  2. Are the seizures intermittent or did they develop suddenly?
  3. Frequency and duration of seizures.
  4. Association of seizures i.e. asleep, excitement, feeding.
  5. Other signs of ill health e.g. poor appetite, excessive drinking, reduced exercise.

Information about your cat’s lifestyle may also be important

  1. What medications is your cat taking? (This includes preventative medications like flea, worm and tick treatment).
  2. Diet (food rolls, all fish diet, pet mince)
  3. Access to poisons (particularly lead-based paints)

Both diseases which involve the brain directly (intracranial) and conditions which affect other body systems (metabolic or extracranial conditions) e.g. liver or kidney disease, can cause fitting. With recent developments in treatment many diseases which have previously been untreatable may now be treated though this can require referral to a specialist centre.

How can a diagnosis of the cause of the seizures be made?

A range of tests are often needed before a final diagnosis can be made, initially this is likely to involve blood samples to look for extracranial causes of the fitting. Following this a general anaesthetic may be required to allow x-rays of the skull to be taken and the fluid that surrounds the brain (cerebrospinal fluid) sampled. In order to actually look at the brain, powerful imaging techniques are required e.g. magnetic resonance imaging (MRI) and computer assisted tomography (CT). These tests are only available at a limited number of specialist centres, usually with the co-operation of medical colleagues.

What treatments are available?

It is important that a cat which is having regular seizures (more than one every 6-8 weeks) receives treatment, even if the cause is not as yet clear, as each fit can lead to further brain damage increasing the likelihood of more fits in the future. In some cases where the cause of the fitting is not known or is untreatable then the seizures need to be treated directly. A variety of drugs are available, the treatment chosen will depend on each individual case. Several changes of dose rate, timing and drug may be required before the regime that suits your cat best is found. This can be a frustrating time but the benefits of finding the right treatment are generally realised. Even with treatment it may not be possible to completely prevent fitting, in many cases the aim is to reduce the seizures so your cat can lead a more or less normal life.

Golden rules of treatment

ALWAYS follow the instructions on the label. Both the dose rate, and timing of the medication is important to maintain adequate drug levels in the bloodstream.

NEVER run out of the medication as sudden withdrawal of treatment can lead to serious fitting.

LET your vet know when your supply is running low so a repeat prescription can be arranged. This is particularly important if the treatment needs to be ordered specially for your cat.

KEEP these drugs safe (away from children etc.) as they can be powerful sedatives.

BE CAREFUL about other drugs including herbal remedies that you also give your cat. If in doubt check with the veterinary practice.

 What are the side effects of treatment?

Mild side effects are common particularly at the beginning of treatment or following changes in the regime. The most common side effect is sedation but other signs can also occur. Most disappear quite rapidly as the cat becomes used to the medication. If side effects persist or seem severe then the veterinary practice should be informed.

DO NOT BE TEMPTED TO CHANGE THE DOSE OR TIMING OF MEDICATION WITHOUT CONSULTING YOUR VETERINARIAN FIRST

Why has treatment failed?

Sometimes treatment will appear to have failed, in many cases this is because the dosage and timing of the medication is not yet right. Please check that you are following the instructions on the medication label correctly. In some cases, your veterinary surgeon may want to take a blood sample to ensure that your cat has adequate circulating blood levels of the medication.

Other causes of treatment failure include:

  1. Specific circumstances e.g. stress – increased medication may be required during such periods.
  2. Progression of disease.
  3. Some cases are uncontrollable even with medication.
  4. Failure to identify the underlying problem, e.g. unidentified food intolerance, brain tumour.

Seizures are generally a sign of fairly severe disease, this does not necessarily mean that nothing can be done for your cat, with the correct treatment, the quality of your cat’s life can be dramatically improved.

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