Antibiotic Responsive Neuromuscular (Cerebral) Ataxia

Abstract

Since 1994 numerous cases of neuromuscular ataxia have been observed and documented in various dog breeds across Canada and the USA. The incidence appears to be highest in the spring and summer and seems to be related to contact with cattle. The onset appears to be aggravated by inoculations or other stress inducing episodes e.g.: shipping, dog shows or illness. It occurs in any age with young dogs being more highly represented. Signs are varied and begin with inappetance, anorexia, weight loss, ocular discharge, poor thrift, diarrhea or vomiting, and progresses to compromised mobility.  Sometimes skin disorders have been recorded. The condition progresses in a waxing and waning pattern. Most cases have responded to a variety of antibiotics and antimicrobials noted for the efficacy against protozoal conditions. Some dogs have required larger than normal dosage for longer periods of time to achieve results. Clindamycin has proven to be the most efficacious remedy used to date.

Laboratory testing has to date failed to reveal any etiological diagnosis except for one case of Neospora canninum.

If anyone can add any information or observations to the above scenario, kindly contact Dr. Mark Rubensohn at e-mail: bridle@telus.net

Attachments:

1.      Observations from a dog breeder who has been involved with this problem

Attachment:

I grew up showing Scottish Terriers, my father raised them and I started showing when I was about 10 years old. The Scottish terrier is documented as having an ailment known as “Scottie Cramp”; it has been used as a catchall for any mobility problems afflicting the Scottie. About 10 years ago, I noticed some of these “Scottie Cramp” puppies had an ailment that caused the movement to deteriorate over time. The breed has recently had many dogs diagnosed with “Cerebral Abiotrophy”, which is being differentiated from Scottie Cramp.

I believe that while there certainly are some dogs with an inherited disorder which causes symptoms of Cerebral Ataxia, there are also some dogs with a parasite mitigated form of the disorder and that these dogs will respond to antibiotic therapy specific to protozoan parasites. All tests performed on these dogs have to date come back normal, including those for Neospora, which would suggest another parasite, as yet unnamed. I believe this parasite is causing ataxia symptoms in numerous breeds of dogs in addition to Scotties.

Scottie Cramp affected dogs are normal at rest and exhibit normal ability to walk until they are stressed. Common stimuli are exercise, hunting, fighting, or courtship. As the dog's level of stress increases, his gait begins to change. The forelegs move out to the side and forward rather than straight forward in a movement called winging. The spine in the lumbar area may arch and the rear legs begin to overflex. If the excitement or exercise continues, the dog begins to exhibit a "goose-stepping" gait. If the dog is running, he may somersault and fall. Severely affected dogs may find their ability to walk or run completely inhibited. This is not a seizure. There is no loss of consciousness. As soon as the stimulus abates, the symptoms disappear almost immediately.

The severity of symptoms in affected dogs varies widely as does the amount and type of stimulation necessary to elicit clinical signs. The symptoms appear to be caused by a buildup or depletion of some chemical compound in the dog's central nervous system, most probably serotonin.

 I had some wonderful mentors in my youth, old terrier men who took me under their wing and taught me much about the breed and breeding, terriers and dogs in general. At that time, Scottie cramp was something that was talked about but was seldom seen. One or two in a lifetime was the norm, if you read the old books you will see reference to it with the same rider, that it is seldom seen. But, the Scottie cramp that is referred to is always the traditional form of Scottie cramp, usually becoming apparent at about 4-6 months and coming on after certain stimuli. It is never the type seen in young puppies often showing up a few days after inoculations and progressively deteriorating from then on. It is an episodal affliction that usually diminishes with maturity. It is not a constant ongoing affliction such as what we now see in Cerebral Abiotrophy. The old timers in the breed have been honest and thorough in their documentation and Cerebral Abiotrophy’s symptoms are not mentioned. I believe it is a relatively recent addition to the problems affecting the Scottish Terrier.

The first time that I noticed this problem was in the spring of 1994 at dog show that was held in the Alberta. This building had recently held a cattle show and it was inadequately cleaned between the two shows. Several dogs of various breeds and sizes that had been at the show became ill with some or all of the following symptoms; diarrhea, vomiting, inappetence, fever, anorexia, eye discharge. They all became noticeably unsteady in their movement. After a time, many dogs that had not been in attendance at the show also became ill in the same way. Some dogs made full recoveries, some had to be euthanized and some retained some residual movement problems. It progressed through the pet community through the summer and it came to be known as the “Wonky Flu”. The number of cases dropped off with winter and it ceased being a concern. Although, a few cases show up every spring and I have heard of it appearing in other communities, by veterinarians who are seeing a cluster of dogs with movement problems of no known cause.

A Southern Alberta breeder of Irish Wolfhounds had a litter born in 1996. When the puppies were about 8 weeks old, some of them started to show a deterioration of muscle tone and an unsteadiness of gait in the rear. After extensive testing it was determined that the puppies were infected with “Neospora”, a protozoan parasite. It was a mystery as to how they had come in contact with the parasite as it had only been seen in the Southern United States at that time and had only been diagnosed in dogs a few times. As it turned out, some 14 hours North in the Peace River district the cattle ranchers were dealing with an outbreak of Neospora in their cattle. Researchers in this area suspected a connection to the wild canine population. It was felt that Neospora had been in the canine population for a long time but had been unidentified and misdiagnosed as other conditions. The Irish Wolfhounds had been infected in their own backyard as they lived on acreage adjacent to a field that pastured cattle.

The puppies were treated with Clindamycin and the Neospora was stopped. Unfortunately, the damage that had been done was not reversible. While the puppies were able to make improvements from the point at which the parasite was stopped, they could not be returned to “normal”.

I became very interested in this parasite and learned as much as I could about it. One of the characteristics which impressed me was their ability to be passed from mother to offspring in utero. This gives it the potential to be mistaken for an inherited disorder. I also noted that the parasite will affect only some of the puppies, usually when the immune system is suppressed or stressed, i.e.; immediately after inoculations, after shipping to a new home, a dog show or after another illness.

June 1999, I had a litter of 6 Scottie puppies; all were thriving until given inoculations at seven weeks. Within 36 hours every puppy in the litter was showing some degree of rear movement disorder. This did not appear to be normal “Scottie cramp” but was more of an ataxia like syndrome.  I was needless to say devastated. About one week later I decided to deworm and used a product called Drontal Plus manufactured by Bayer (ingredients: Praziquantel, Pyrantel and Febantel) at the suggested dosage.

Within 36 hours of deworming these puppies they had all returned to normal movement. This was almost a miraculous occurrence and I tried to analyze what had just occurred. I came to the conclusion, that either one of the drugs in Drontal plus had a neurological side effect or we had just killed a parasite. I called my vet, Dr. Gary Carter (Calgary, AB) and asked him if there were any known side effects of this nature to these drugs and told him what had occurred. He didn’t believe there were any side effects of this nature and felt it likely we had killed a parasite but decided to check with Bayer. The head research vet from Bayer contacted me and told me that all of the drugs used in Drontal plus have been well tested and have been in use for a long time and there were no known neurological side effects for any of them. He felt we had probably killed a parasite, probably protozoan. He told me that one of the drugs in Drontal was shown to have some effect on protozoa. (Note: Since that time both Praziquantel and Febantel have been shown to be effective against protozoa.) The puppies were also tested for exposure to Neospora and all tests proved negative. I dewormed the puppies with a second dosage 10 days later and kept the puppies for an extended period of time. The movement problems did not return. They were placed in homes and were followed and all remained healthy. *See attached document

Bayer was interested in following up with further studies and agreed to supply us with Drontal Plus to be used on puppies diagnosed with “Scottie cramp” ie: movement disorders. The Canadian Scottish Terrier club advertised on their web site that we were interested in Scotties with Scottie cramp for a study and offered any who were interested some Drontal Plus for their afflicted dogs.

We had a little interest and what we found was that some puppies if caught early, usually those that showed signs of ataxia/cramping at 6-10 weeks of age could improve. Dogs that had been afflicted for some time showed very little or no improvement. In a conversation with Bayer, it was suggested that we were probably dealing with more than one disorder and that the puppies that improved were probably afflicted with a protozoan parasite yet to be named.

Nothing further was done as there wasn’t enough interest to warrant it. Locally we did notice that dogs of many breeds would show early symptoms of movement disorders and/or topline issues that could be improved with certain antibiotics (Tetracycline, Metronidazole, Sulfamethoxizole & Trimethoprim, Clindamycin and Drontal Plus.) It was also found that bitches that had been experiencing fertility issues if given Tetracycline from the time estrus started until 2 weeks after the 1^st breeding were more likely to conceive and carry to term.

Two years ago, a dog imported from Brazil acquired the movement disorder six weeks after arriving here. We were able to completely return him to normal with the use of the antibiotic “Clindamycin”. This helped us to have a clear course of action for treatment and some of the individual dog studies follow:

Indy a wire haired fox terrier born April 1998, arrived in Alberta, Canada October 2002 from Brazil through the US. He had been shown throughout the US and South America. 6 weeks after arriving he became very unsteady on his feet and was progressively deteriorating. He reached a point of being too unstable to rise on his own or urinate without assistance. He was seen by Dr. Mark Rubensohn (Calgary, AB) who did blood and urine analysis both showed nothing abnormal. Stool samples were normal, temperature was normal. Clindamycin was prescribed on the possibility that Neospora tests would prove positive. The Blood test for Neo-spora and other possible causes also showed negative results. But, after beginning treatment with Clindamycin, 75mg BID, improvement was rapid with deterioration stopping after 36 hours and improvements evident from that point on. The dog had some residual muscle weakness that returned to normal within 2-3 months. 2 years have passed and there has been no reoccurrence. He is a healthy dog completely steady on his feet. *See attached document

Maggie has produced several puppies with problems she lives on a Dairy farm

The following are from Maggies 1^st litter of  4 puppies  born  4/1/00 

Lexi - female puppy with Scottie cramp or ataxia type symptoms at 3 months this puppy has done well according to our last contact with the owners. No treatment was given

Tiffy – Born 04/01/00 to Maggie

She has been generally healthy.  Her topline has never seemed right.  She has been somewhat itchy with no signs of rashes or sores.   She has never produced a viable puppy.   She has conceived twice, producing one puppy each time, neither lived.   An autopsy was done on the first puppy; samples were saved as this puppy was not mobile in any way from birth.  The second puppy was still born.  She has been treated occasionally with Tetracycline *See attached document

The other two puppies appear to be normal.

The following are from Maggie’s 2^nd litter of 6 puppies born 11/20/03     

Molly, female Scottish terrier puppy arrived in Alberta, Canada April 2004. At the age of six months she became unsteady on her feet and progressed rapidly with symptoms of extreme ataxia. She was seen by Dr. Mark Rubensohn and he observed her in several episodes of unsteadiness to the point of being unable to stand. Tests were done, temperature, blood and urine showed nothing abnormal, neospora tests were negative. Stool tests did show some Coccidia, she was put on TMS 120mg BID and showed immediate improvement, reverting to normal ambulation. Dr Mark Rubensohn witnessed the improvement to complete normalcy while on antibiotic treatment. When she completed the 14 day prescription she began to deteriorate immediately. Put back on TMS she required a larger dosage 240mg BID to obtain improvement and she remained on TMS for 30 days. Again she deteriorated almost immediately when taken off of the prescription.

She was put on Clindamycin 75 mg BID and immediately improved, she remained normal while on Clindamycin. She remained on Clindamycin for 6 weeks and still retains relatively normal ambulation with only some small residual effects from the times when she deteriorated between prescriptions. *See attached document

Zeplin – male Scottish Terrier presented at 3 ½ months with rear movement problems.  X-rays, blood tests showed no indications of any problems.  Communication with the owner broke down at this time, no further updates possible.

Toni – female Scottish Terrier given second Vaccination at 3mons - one week later movement problems were seen resembling Scotty cramp. But, unlike Scottie cramp, it progressively got worse, especially when excited.  Her back became very roached.  Some days she would not be able to walk without falling over.  She also had a skin rash that could become very red and scabby but never itchy. 

A hair analysis was sent away and we were given a summary of the treatment path.

*(See attached document)

June 4/04 - She was put on TMS   1 – 250 mg pill a day An immediate improvement was seen.  But after 8 or 9 days movement problems reoccurred so we doubled her dose to 500mg once a day. She did well for a period 3 weeks and then relapsed to some extent.

July 1/04 – some movement abnormalities have returned intermittently. She was medicated for 10 days with Clindamycin 100mg BID, 10 days with Metronidazole  500mg once a day, 5 days with Drontal Plus 2 pills once a day then Tetracycline 250mg BID until Aug 16.

Aug. 16/04 - She developed a lump in the throat and had a significant relapse.

Aug. 18/04 - prescribed Clindamycin 100mg once a day.  Stopped TMS treatment.  Biopsy done on throat lump. Biopsy was sent to the Saskatoon Vet College, results were inconclusive.

Aug. 20/04 – significant improvements are apparent there is no hopping while walking, no stiff leggedness .  she is feeling good but is not eating.  Still hopping while running.

Aug. 22/04 – Increased dosage to 150 mg Clindamycin once a day. Still not eating.

Aug. 23/24 – added  240 mg TMS once a day.  Eating small amounts.  She is still hopping while running.

September 1/04 – Toni is doing  very well.  The lump in her throat is almost gone.  She is more willing to eat.  She is moving more freely with a stiff legged gait only when she breaks out into a run.  Lively and very playful now.  She is on 150mg of Clindamycin once a day and 240mg TMS TID

*(See attached document)

September 15/04 – Toni has returned to a near normal state. Her health, her skin, her movement all appear normal. She is running, playing, jumping on furniture, wrestling with other dogs. These are things she was never able to do before.

September 23/04 – started reducing TMS while maintaining Clindamycin.

Oct 7/04 –  she has had a significant relapse, she is on 240mg TMS once a day, 150mg Clindamycin once a day.

Oct 11/04 – she was returned to higher dosages of 240mg TMS BID and 150 mg Clindamycin BID

Oct 23/04 – she has again returned to near normal movement and her overall health is improving.

Tululah – female Scottish Terrier - Phoned owners when problems arose with other puppies.  The owners said she seemed fine but sometimes noticed that she had a stiffness in her rear leg.  X-rays etc. were done with no abnormal findings.

The other two puppies appear normal

Additional dogs with problems include:

Aaron – male Scottish Terrier Born 6/10/02

July 05, 2004 - He seemed normal in every way until he went to a dog show in Winnipeg MB. A friend noticed strange rear leg movement and arching of back while he was being gaited in the ring. Another competitor described it as the worst case of Scotty cramp they had ever seen.  He returned home on the 8^th and we notice progressively worsening rear movement and arching of his back, he also vomited on the Wednesday and Thursday.  

July 8, 2004 – prescribed Clindamycin in the evening which we gave immediately, improvement was evident by noon the next day. A video was taken of him gaiting on Friday noon. Movement problems are still evident on the tape but significantly decreased from the day before. 

Aug. 15^th  Aaron is doing very well.  He seems normal in every way. 

Tory – Born 08/07/94

In the last few years it has been difficult for him to climb or descend stairs, he has been unable to lift his leg to urinate without falling over. His rear leg movement, leg muscles and back have been slowly but progressively deteriorating.  Because of our success with the younger dogs we decided to start this dog on a treatment of Tetracycline 250 mg BID in the middle of July.  We have noticed a significant improvement in his abilities in day to day activities

September 1/04 - Tory is doing very well.  His topline is very different now.  It has been six weeks since starting his treatment.  He is very playful and is able to run more. He is now able to climb stairs, run and lift his leg to urinate. 

 A video was taken of his improvement.  We are gradually taking him off of the Tetracycline.

September 30/04 - Tory has been off of Tetracycline 1 week and we have noticed regression, he is stumbling more and losing his topline.

October 7/04 –  We have started Tory on 150mg Clindamycin once a day.

October 23/04 – He is on Clindamycin 150mg once a day. He is improving daily, he can run again and has reverted to near normal movement. His topline has improved and his overall health and attitude are good.

Because of Tory’s success we have started 2 other older dogs on treatment and will continue to monitor and videotape them. Their history follows:

Teddy a male Scottish terrier born July 1993 was a healthy puppy born in Alberta, Canada. At about 9 months of age his topline started to roach and his tail developed a distinctive curl. He slowly deteriorated and by 1 ½ years of age was clearly having unsteadiness on the rear. It has continued to deteriorate over the years in a pattern of holding steady and then having a period of deterioration usually accompanied by other health concerns such as ear infections or skin pyoderma.

August 23, 2004 - He has been started on a regimen of  75mg Clindamycin tablets BID. A video has been taken for comparison. Aug 29, I received a call from Teddy’s owner expressing amazement at the improvements she is seeing in his overall health. He has a higher energy level, he is sleeping and eating better, his skin condition is improved and he is more mobile. I will continue to monitor him and will video him again in a few weeks.

Sept 23, 2004 – Teddy has improved in several ways but most obvious is that he is no longer shaking and can stand and look about without problems. He is moving with more confidence but is still stepping very high behind.

Drum - a male Scottish terrier born May 1997 was a healthy puppy born in Alberta Canada. At about 8 months of age his topline started to roach and his tail developed a distinctive curl. He slowly deteriorated and by 1 year of age was clearly having unsteadiness on the rear. It has continued to deteriorate over the years in a pattern of holding steady and then having a period of deterioration. He was given Drontal Plus once per month and while on it he appeared to be able to maintain his condition with little deterioration. He was taken off the Drontal Plus approximately two years ago when because of current literature and studies, it was assumed that he had the inherited form of Cerebral Abiotrophy. He has deteriorated rapidly since that time. He currently has extreme muscle atrophy on the right rear leg and does not weight bear on it.

Aug 30, 2004.- He has been started on a prescription of Clindamycin

 He has been videotaped and we will follow up with further video.

Sept 23, 2004 – Drum’s owner describes his improvements as miraculous. He is no longer shaking and has better head control. He is weight bearing on his right rear leg. He is moving with much more ease and confidence and is able to climb over door sills and back onto his favorite spot looking out of the window. These are things he has been unable to do in over 6 months.

 *See attached document

Gracie is added to the video to demonstrate traditional Scotty Cramp

           

Additional note:

Both Cheryl Lang and I have each had a puppy born in the last 2 years who had to be euthanized because of paralysis from birth with no known cause.

This document accompanies a DVD. To navigate in the DVD, highlight a dog and press play and it will show you a clip from the date shown on the screen. There are multiple menu screens, if you look on the bottom right hand side you will see a multiple headed arrow, if you highlight it and press play it will take you to the next menu. If you highlight the single arrow head and press play it will play through from start to finish.