| dc.description.abstract | Granulomatous meningoencephalitis (GME) is a non-suppurative inflammatory disease
that affects the central nervous system (CNS) of dogs. It is characterized histologically
by the formation of large perivascular cuffs of mononuclear cells in the parenchyma and
meninges of the brain and/or spinal cord. GME can affect any breed or age, however,
young to middle-aged dogs, females and small purebreds such as toy and terrier breeds
and Poodles tend to be overrepresented. Clinical and neurological symptoms of GME
often have an acute and rapidly progressive onset, which will be fatal if left untreated.
Based on morphological and clinical neurologic abnormalities, three forms of GME
have been described; disseminated/multifocal, focal and ocular/ophthalmic form.
Clinical signs vary greatly because they reflect the arrangement and location of the CNS
lesion. The aetiopathogenesis of the disease remains unknown, although immunemediated
mechanism is suspected. GME can only be definitely diagnosed by brain
biopsy or post mortem histopathological evaluation of brain tissue. It is therefore
commonly referred to as meningoencephalitis of unknown aetiology (MUE), which
comprises all canine CNS inflammatory diseases for which there are no
histopathological confirmation and no infectious cause have been identified.
High dose, long-term immunosuppression has been proven to be the key to a successful
therapy. Corticosteroids (primarily prednisone) have been the mainstay of treatment, but
due to significant adverse effects, high possibility of relapse and short survival times,
new and more effective treatment protocols have been suggested. More recently,
supplemental immunosuppressive drugs have been employed in an attempt to prolong
survival times and increase the quality of life. A review of azathioprine, cyclosporine,
cytosine arabinoside, lomustine, leflunomide and procarbazine as adjunctive
immunomodulatory agents is provided in this thesis.
Also included in this thesis are case reports of 9 dogs presumptively diagnosed with
GME. Their treatment regimes are different, but a common denominator is that more
than one supplemental immunomodulatory drug was used. All dogs are still alive and
8/9 dogs are without any medications and living a symptom free life. Even though the
results of these case reports are inadequate to be considered as scientific data, it opens
up possibilities of a more favourable long-term outcome. | en |
