Question Details
Unusual Neuromuscular Case Has Stumped Seven Neurologists... And Us Too.
by holisticinToga - April 2, 2018
Sorry for the long post but this is the last stop for our very unusual patient. Maggie is an approx 3-4 year old FS MBD from Puerto Rico with an unknown history. She initially presented for, and continues to suffer from, severe episodes of seizure-like episodes of uncontrolled movements. These episodes begin with her pawing at her face, chewing at her feet and then progress into full body spasms (with patient recumbent). Unlike a seizure, however, she can be talked out of the episodes and they stop completely when the foster mom (a veterinarian) picks her up.

Maggie has seen a neurologist (who subsequently consulted with seven others including DeLaJunta) and had a normal MRI of spine and brain, normal nerve and muscle biopsies and normal EMG. She has also seen a dermatologist. She has had no response to Pheno, Keppra, Prednisone, Methocarbamol, Gabapentin, Diazepam, Alprazolam, Mexiletine, Apoquel, Benadryl, and even Cerenia. A gluten-free diet was recommended based on a paper on Phenotypic characterization of canine epileptoid cramping syndrome in Border Terriers. Her only response to therapy has been to Baclofen (a drug that treats skeletal muscle spasms) combined with Gabapentin.

Alarmingly, she has many episodes per day (during a one hour consult, she had six although her meds were due, so they do increase in frequency). She is worse in rainy weather and in the late afternoon before feeding time (when meds are still on board). There are no other known triggers.

I have uploaded a link to videos as these episodes are difficult to describe and unlike anything i have ever seen (or learned about). There are several different components to this:
- she will walk with a stiff-legged gait (sometimes dragging it) three times a day
- violent scratching happens once or twice a day
- seizure-like episodes with vocalizing as if in pain. This is accompanied by a market voice change. Her breathing is also affected... rather spastic as if her diaphragm muscle is involved.

Other comments about her:
-she seems to sleep peacefully at night, is not an active dreamer but will occasionally be found in an almost "rigor mortis" stance... this is better with the Baclofen.
- her body is (understandably) very hot after an episode
- being carried in a Baby Bjorn keeps the episodes from happening. Not a thunder shirt, however.
- there are no known GI sensitivities and her skin and nails appear healthy
- her personality is very friendly with people and with dogs at home. She was a bit timid at the vet hospital

Tongue/Pulse: tongue- pink, pulses- wiry

Thoughts on basic patterns?

My thoughts on this are that we are dealing with a severe Liver Wind situation (pawing at face) combined with a Shao Yang Stage disorder? But it also occurred to me that this could be similar to the Jue Yin excess Dr. Marsden describes in his seizure lectures. Any help with basic patterning and herb selection would be much appreciated. We are her last stop!
Replies
by naturevet
April 9, 2018
Hi Kristina,

There may be a couple of things going on here, but right now I'm guessing the dog is predominantly Blood or Yin deficient, with an element of Shao Yang disharmony. When you treat the dog with acupuncture, go point by point, and note which points and type of stimulation to them improves the pulse. That will give us more certainty. From a conventional point of view, given the Latin American origins, I'd wonder about distemper, but I also would have guessed that would have shown up in the MRI. Anyway, we theoretically don't need the conventional diagnosis to proceed.

Signs of Blood deficiency include:

  • Muscle spasms, as evidenced by the response to the muscle relaxant; presumably being carried in the Baby Bjorn allows the dog to completely relax, and thus not precipitate any spasms

  • Late afternoon onset - Yang is still on the surface at this time, while Yin is retreating inwards. If there is Yin deficiency, there is insufficient Yin to balance the Yang of the upper body and extremities, and seizure activity (or itch) results


Shao Yang disharmonies can aggravate tendencies to Yin Yang imbalance on the surface. Wiry pulses can be associated with Shao Yang disharmonies.

They can also cause Heat in the Yang Ming (causing for example itch along the Yang Ming channels of the face). Blood deficiency equates to or can aggravate Yang Ming dryness.

Given the above, I'd start perhaps with Bu Gan Tang and see where it gets you. Although it does not address the Shao Yang, it does tonify Blood and Yin, and so should ameliorate some of the symptoms. We can follow up later with Xiao Chai Hu Tang to get a complete improvement if needed.

Alternatively, you can try Tian Ma Gou Teng Yin which is the quintessential formula for seizures from Blood deficiency. Where spasticity is prominent, however, we need to use Bu Gan Tang, too, at least in addition. So, might as well start there, and see what happens.

Hopefully this will get the case started. Feel free to follow up and remember to check the response of the pulse to acupuncture, if BGT fails to deliver. It's important, too, to follow up on this dog in person, to make sure before we change anything that there are not at least some subtle improvements.

Hope this helps,

Steve
by holisticinToga
April 10, 2018
Thank you! Bu Gan Tang was my gut reaction to this case as I had remarkable success with it in a patient who used to "freeze up" and become unresponsive at times. Alert, but not there. Her neuro and cardio work ups were unremarkable and a week on Bu Gan Tang put an abrupt end to the episodes. Will try to write the case up here some time. In the meantime, I will keep this case updated as changes occur. Thank you again!
Reply to this question.
You must be logged in to reply