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Author Topic: Immune mediated polyneuropathy  (Read 577 times)

KassieandArchie

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Immune mediated polyneuropathy
« on: February 20, 2020, 04:06:24 PM »

Hello, newbie here.

I have had a little look through the current chats and havenít spotted anything about immune mediated polyneuropathy. I understand itís quite unusual and each case varies significantly.

It would be great to hear anyone elseís stories if you have a dog with this condition, my boy has just been diagnosed and we will be commencing with treatment next week.

The neurologist has recommended a course of steroids followed by an immunosuppressant. Is anyone elseís dogs on similar treatment? Or seen results with an alternative treatment? The nerves affected with Archie are his cranial nerves which I believe is even more unusual.

I look forward to chatting with you!

Thanks, Kassie
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Jo CIMDA

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Re: Immune mediated polyneuropathy
« Reply #1 on: February 20, 2020, 05:05:40 PM »

Hi Kassie and welcome

I am sorry Archie is unwell.  Polyneuropathy is such a broad  label and it can take form in many different ways. Has the vet narrowed it down to a specific diagnosis?  The most common immune mediated polyneuropathy  in dogs (and it isn't that common) is myasthenia gravis. 

What symptoms does Archie have?

Jo
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KassieandArchie

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Re: Immune mediated polyneuropathy
« Reply #2 on: February 21, 2020, 08:40:35 AM »

Hi Jo,

Thank you for your message. The diagnosis was from a neurologist after an MRI and CSF tap. He didnít say there was a specific known syndrome for the symptoms Archie has. So we just have the diagnosis of Ďimmune mediated polyneuropathy affecting the cranial nervesí

The symptoms he has are a head tilt to the left, and paralysis of the left side of his face - doesnít blink his left eye and when he pants the left side of his mouth droops. The rest of his body is unaffected and his QoL is also unaffected so far, but we have been told that this could spread to other cranial nerves which could be fatal.

His muscles were also checked for function and they are normal (although atrophied temporal muscles) so I think that rules out MG

Thanks again, Kassie
« Last Edit: February 21, 2020, 08:52:15 AM by KassieandArchie »
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Jo CIMDA

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Re: Immune mediated polyneuropathy
« Reply #3 on: February 23, 2020, 04:32:03 PM »

Hi Kassie

These obscure neurological diseases can be tricky to diagnose and also, one successful treatment regimen won't necessarily be as successful in another dog.  This, unfortunately,  is the vagueness of neurological disease in dogs.

 I am very interested to know how Archie is being treated - dose of steroids and duration etc.   As this is a relatively rare disease, it also may help others out there who are having similar problems with their dogs.  If Archie is on an immunosuppressive dose of prednsiolone then a  giving Archie a gastroprotectant such as omeprazole would be prudent.

I do hope Archie will improve soon. 

Jo
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KassieandArchie

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Re: Immune mediated polyneuropathy
« Reply #4 on: April 18, 2020, 04:10:10 PM »

Good afternoon

I thought Iíd drop a quick update about Archies progress here.

Following the diagnosis of Ďimmune mediated cranial polyneuropathyí we found out that his CSF results came back showing Staph. This was thought to most likely be contamination (😒) but itís was decided to be too risky to ignore. We treated with antibiotics for 1 month with no improvement.

In Archies case, nerves V, VII and VIII are affected.

Following from this we decided to treat with prednisolone (25mg twice daily) for 1 month. We are now just over 3 weeks in and he has regained some motor function to his left eye. Sensory function is still limited but small wins!

We have been monitoring side effects and thankfully he hasnít had any gut issues so a gastroprotectant wasnít used. He has however had lots of other side effects but the progress has outweighed these so we have continued with the treatment.

Going forward, we aim to reduce his dose to 15mg twice daily for a month and monitor progress. We have the option of adding in other anti-cancer drugs but we have decided not to do that just yet.

We have also added some vague physio to help rebuild his temporal muscles - lots of chewing to Archies delight!

Archie remains in good spirits and ever unaware of his wonky face!

Of course, if anyone has any experience with this please do share! Iíd love to hear about any other pups in a similar boat, or if anyone has any questions about his condition Iíd be happy to help if I can at all.

Kassie
« Last Edit: April 18, 2020, 04:14:54 PM by KassieandArchie »
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Jo CIMDA

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Re: Immune mediated polyneuropathy
« Reply #5 on: April 19, 2020, 04:51:31 PM »

Hi Kassie

Thank you for the update and the good news that prednisolone is having some positive effect.   It is lovely that Archie is not bothered by his 'wonky' face and that he is doing well in other ways.

I would give a gastroprotectant, such as omeprazole, even though he is not exhibiting any adverse gastrointestinal signs because this can build up and cause gastric ulceration later on, and this causes more problems.   Unless there is good reason not to give a gastroprotectant, then why not?

I have not had a dog with polyneuropathy but I have had a dog that has had masticatory myositis affecting the muscles of the face, including those that affect chewing,  and temporal muscles, so I somewhat understand what Archie is experiencing. I presume the oesophageal muscles controlling his swallowing are not affected.  Now he has started on the prednisolone, and you have seen improvement, I am hoping that it will get no worse (because it is now under control)  but it will gradually get better.

Watch the adverse effect of prednsiolone, and reduce if necessary, even if it means introducing another immunosuppressive drug such as leflunomide or mycophenolate mofetil.

I look forward to the next update.

All the best
Jo
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KassieandArchie

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Re: Immune mediated polyneuropathy
« Reply #6 on: May 01, 2020, 10:11:01 PM »

Hi Jo

Thanks for the response, itís nice(?) to hear someone else who has experienced similar problems, although not nice all the same!

So we are 2 weeks in to Archies reduced dose (15mg 2X daily) if prednisolone and he is pretty much back to his old self -side effects wise -which is amazing! It really shows that he must have been feeling pants on the higher dose.

His face has not changed, still limited sensory function, and motor function to his mouth. Maybe this will take time?

With the nerves that were shown to be affected on the MRI, Iím not sure if his swallowing is affected. He does seem to swallow more than normal but it isnít causing him any issues so hopefully that wonít progress.

We still have two more dose reductions (each course is a month) before we reassess and decide which medication to go for - Iím not sure what our options are yet.

Will keep you updated!

Thanks again

Kassie
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Jo CIMDA

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Re: Immune mediated polyneuropathy
« Reply #7 on: May 02, 2020, 12:32:12 PM »

Hi Kassie

It is quite amazing how quickly the body responds to a lower dose of preds. 

They key to success  is to gauge it by the clinical signs and be flexible as to when the next reduction is needed.   It is all about tailoring the protocol to the individual.  When the dose of preds is tolerable it is often better to reduce more gradually and taper off over a longer period of time, but the clinical signs of disease and side effects of the drug dictate.

Archie's face may not change but he doesn't know any difference and as long as he is a happy and healthy boy it doesn't matter.

It is going in the right direction.

Jo
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