Canine Encephalitis...

First, I want to say god bless you for taking in a stray dog.

Second, below is the information I could find on the Prednisolone.

Immune-suppression with corticosteroids (such as prednisone) remains the center of therapy for Granulomatous Meningoencephalitis (GME). Once the disease is controlled, one may begin to gradually drop the steroid dose until the minimum dose required to control the disease is reached. This process can be expected to require 4 months or so. It is unusual for a patient to be able to fully discontinue medication but at least stronger immune-suppressive agents are rarely required.

A chemotherapy agent called procarbazine has been combined with prednisone to improve the legnth of GME remission. A study by Dr. Joan Coates et al. from the University of Missouri was published in the January/February issue of the Journal of the American College of Veterinary Internal Medicine. In this study, 21 dogs with GME were treated with both procarbazine and prednisone and outcomes compared to those of 11 dogs who were found to have GME on post-mortem and had received no treatment. Median survival time of the treated dogs was 14 months compared to less than one month for dogs receiving no treatment. Of the 21 dogs, 17 were able to reduce their steroid use or even discontinue it. Of the 21 dogs, 7 developed bone marrow suppression side effects and 3 dogs developed serious gastrointestinal side effects (hemorrhagic gastroenteritis). Although researchers concluded that procarbazine and prednisone was a more effective combination than prednisone alone, they did not actually include a group of dogs treated with prednisone alone in this study.

A new drug called leflunomide has been released to treat immune-mediated diseases of a type that includes GME. This is a relatively expensive treatment, which has limited use but it remains as a possible alternative to corticosteroid use for dogs that do not tolerate corticosteroid side effects.

Other drugs that show promise but have only been tested in a small number of patients include cyclosporine, an immunomodulator used to inhibit organ transplant rejection, and cytosine arabinoside, another chemotherapy agent that can be combined with prednisone.

If the GME is focal or localized, radiotherapy may be helpful. Radiation of the head or face can lead to infarction (abnormal clotting), which can in turn lead to seizures for periods as long as 5 to 6 months after therapy. Cataracts and dry eye are common results of radiotherapy should the eyes be included in the field of radiation. That said, many cases of focal GME have enjoyed complete resolution after radiation.

If seizures have been a manifestation of GME, either disseminated or focal, medication will be used to control the seizures. Anti-seizure medication is the same regardless of the cause of the seizures so something specific for GME seizures is not needed. For a review of anti-seizure medication see the section on seizure disorders.

Ophthalmic GME also uses oral corticosteroids for therapy but may also employ topical ones. If glaucoma results from GME then therapy for this is necessary. Again, therapy for this result of GME is addressed in a standard way; no specific GME glaucoma therapy is needed.

http://www.marvistavet.com/html/body_granulomatous_meningoencephali.html

Our 1 year old Boston Terrier was just diagnosed with auto-immune encephalitis (as opposed to viral) on Tuesday.  She has lost the sight in one eye and her vestibular system (balance) is affected.  The MRI showed active infection sites at her optic nerve and vestibular system.  The neurologist we consulted gave us a guarded prognosis for the return of her strength, stamina, and balance, but gave us no hope that her sight will return.  We were also told that she would be on prednisone for several months until they could determine if the disease was put into remission (not cured).  I will ask about the procarbazine mentioned in the posted answer and can let you know what the neurologist thinks of it.  We are also going to consult a canine opthamologist about her sight.  Finally, we have been encouraged to consult a holistic vet to obtain appropriate supplements to boost our dog's immune system.  I would think that the appropriateness and efficacy of various treatments would depend upon whether the disease is viral-based or immune- based.

I currently have a chi/pug with the same diagonisis, he is currently on predisone 10mg , keppra . How is your dog doing? is there any hope for my dog? Should I put him down to end his pain? thanks

We are still amidst the recovery of our 3 year old Weim from an acute onslaught of GME.  The tale is bit long but somewhat encouraging if you are trying to decide what to do for your pet.  I'll state up front that she was treaed at a Neurology specialist, and it was not inexpensive, though the ongoing treatments now are quite reasonable in my opinion.

The drama started one week when we noticed she just wan't feeling quite right - sort of lethargic.  This was on a Friday and the progression was frighteningly fast after that.  On Saturday we had her at our regular vet, where they thought it was an infection of some sort and prescribed an antibiotic and sent her on her way with a planned follow-up on Monday.  By Saturday evening she was a bit unsteady on her feet, and by Sunday morning she was quite disoriented.  We called and then brought her to the emergency vet, where they diagnosed her as ataxic and guessed she had eaten something in the yard (mushrooms? Toad?) and determined they would treat with activated charcoal.

By the next morning when we went to pick her up she was basically paralyzed, unable to walk, and a pronounced head tilt to one side.  We immediately ran her back to our vet, who strongly encouraged she be referred out to a specialist in neurology.  A trip cross town had us talking to a neurologist - she underwent an MRI which showed 'massive' inflamation of the brain.  A spinal tap also came back abnormal and they began cytosine treatments (along with several other things). She was of course admitted to the hospital.

Following a 48 hour course of chemo, she was not doing well - siezures had started, initially treated with valium and then moved to phenobarbital.  The phenobarb seemed to help the seizures but she was not improving, and we were on the verge of having her euthanized. In fact we had made the trip up to be with her when they put ehr down, and she suddenly dtarted to show reactions to our presence when they turned her around in her crate.  Over the next several days her recovery ws nothing short of miraculous.

It's been about six weeks since the initial occurrance, and she's on an extended treatment plan now.  We're taking things one week at a time, but she has decreased her prednisone treatment from 1.5 pills to 0.5 pills twice per day.  She remains on phenobarb as well - a low dosage but no seizures have recurred.  Finally, she is getting 4 cytosine injections every three weeks (over a two day period) as a maintenance treatment - the hope is to reduce the frequency of those injections over time.

As for her recovery: she's still a bit unsteady on her feet at times (specifically - quick unexpected turns will sometimes lead to a minor sprawl), but seems to be perfectly happy.  She isn't nearly as active as our other Weim at the moment, but the vet is unsure how much of that is due to her disease, and how much is due to the treatments. 

Her level of activity and awareness increaed markedly as we have decreased the volume of her pred treatments, and she has regained much of her old personality.  She definitely seems to be somewhat less visually acute than she was before - she used to see birds across the lake out back, and now doesn't really notice them on the back fence - but she took to hunting a lizard in the yard the other day, so her hunt drive is slowly returning.

Her recovery has been nothing short of remarkable.  If the vet techs had not turned her in the bed, we probably would have had her put down.  Now she is close to "normal" again and continues to improve.  How much she will recover is yet to be seen, and for how long, but for now she's doing great.  The question I kept asking was about the prognosis for recovery, or were we simply putting her through pain and/or doscomfort with no realistic hope - and the vet kept telling us they have seen them come back. 

In any case, the gist of this is simple: don't give up hope too soon.

Hi,

Very sorry to hear about your dog. Our dog, Jack, a Chihuahua was diagnosed with a form of encephalitis in 09/08. Unfortunately, this diagnosis was both devasting and expensive. We were referred to a vetrinarian neurologist who informed us that the only way to positively diagnose Jack's type of encephalitis (and therefore know how to properly treat him) is to perform a MRI and spinal tap ($3400). We paid this and he is currently being treated with prednisone and Atopica. We have been slowly taking down his dosage of prednisone as that has its own issues (Jack was always under 7lbs and now is probably close to 8). The Atopica is an immune suppressant. He get 3 pills of Atopica a day. Also unfortunate, Atopica is very expensive (it is currently costing us about $150 per month for this medication) but for us it does work and therefore is very much worth it. Even on Atopica, both my regular vet and his neurologist gave us an estimated life expectancy of 6-18 months. It has now been almost 10 months, and other than the weight gain, most people would not know there is anything wrong with Jack. He has stopped hiding and bumping into walls and his head tilt is gone. He plays and goes on walks and barks at bigger dogs :) just like a pup. He does have regular neurologist visits and on his most recent one, his neurologist (who is fantastic!!) said that she has seen dogs last a few years so we are very, very hopeful. And I guess that this is why I am writing this. Although this diagnosis is devastating, there is hope. Our hope is that a long term cure is found in time to help our dog (he turned 6 this past month). But with the proper medical care and medicine, your dog can live a happy life (hopefully for a long time). Good luck and God bless! Also, our neurologist told us that this illness is being seen in more and more small breed dogs and that it was just bad luck, nothing you could do to avoid it (we got our dog from a reputable breeder recommended by the AKC).

Our Chi Pug mix (a 12-13 year-old rescue that we got about five years ago) began exhibiting signs of a tumor or brain inflammation (encephalitis, etc.) a few weeks ago (circling, blindness, problems with her hind legs). A vet neurologist recommended an MRI and spinal tap to determine whether its a tumor or encephalitis (for $2600). From what I can determine the treatment for a tumor (if it's operable) is surgery followed by radiation (five days a week for a month or so, each treatment requiring anesthesia). I'm not sure she could even survive this at her age, and it appears that surgery/radiation can only extends the dog's life for another 6-8 months or so (on average). Is this true? I've seen estimates of 12-25K for the surgery and radiation. What experiences have the rest of you had? What kind of quality of life would she have? She's on prednisone now and I'm inclined to keep her on it for a few weeks to see if she improves. If she improves significantly is it more likely that she has encephalitis vs. a tumor? The treatment for encephalitis is prednisone and some other meds. vs. surgery and I really don't want to put her through the surgery. 

There are multiple meds that a vet can use.  We had great success with extended cytosine treatments for several months. They've mentioned that there are other options but they felt cytosine was most effective.

Sadly, Ginger started suffering from increased seizures a couple of weeks ago, and we finally had to let her go last Thursday.  Hurt terribly, especially after all she had been through.

Having said that, she was on a cytosine cycle every three weeks, her pred treatments had been reduced to 1/4 tablet twice daily, and her "real" personality had returned. Even with all of that, she had been and continued to be a very sick dog due to her GME disease.

I would certainly encourage you to ask about cytosine as an option, our neurologist was absolutely convinced that it be used as a supportive treatment with cytosine as the primary treatment, and it had a huge effect - literally saved her live, if only for 4 1/2 months.