Treatment options for syringomyelia


Unfortunately, treatment options are relatively limited for CM/SM. There is no cure for the condition, so the goal is pain management. There are generally two approaches to achieve this end: 1) surgery, or 2) medication for pain. There are two forms of surgery, decompression, during which the foraman magnum (opening into the spine from the skull) is widened, which relieves pressure on the cerebellum and restores better flow of the cerebral spinal fluid; and placement of a shunt, which is a tube inserted into the syrinx to drain it into another part of the dog's body. You can read more about these options here:

Surgery

A variety of medications are used for treating SM, with neurologists generally starting with common, mild pain relievers like carprofen, aspirin or metacam, advancing on up to the neurological pain reliever Neurontin (gapapentin) and its stronger form Lyrica, and/or steroids. Some people work with holistic vets and combine a conventional and holistic approach. A holistic approach alone has not been sufficient for relieving pain in cavaliers with more severe forms of SM. You can read more about all these treatment approaches, and download a treatment diagram recommended by Dr Clare Rusbridge, here:

Medications

People with affected cavaliers naturally want to know if the condition is likely to worsen, and whether they should opt for the surgery or a medications approach. There is no single right answer. People may choose different options depending on their individual dog's diagnosis, their inclination or disinclination to follow a particular approach, financial considerations, and other variables. As Clare Rusbridge notes in Canine Chiari-like Malformation and Syringomyelia, progression is highly variable. Some dogs may never have symptoms, or never have more than mild symptoms and never worsen, some decline rapidly, some gradually worsen. It is known that while progression can often be halted by surgery, existing neurological damage cannot generally be reversed. This places an extra consideration on if and when to opt for surgical intervention.

Pain, and what SM dogs experience

Please note that if a cavalier is showing ANY symptoms due to CM/SM, this is likely an indication of at the very least, significant discomfort and shouldn't be ignored or passed off as minor pain that doesn't need relief. Many dogs also will simply endure, not showing signs of pain until they become very uncomfortable. Some dismiss scratching as a sign of "only" mild discomfort, but researchers believe scratching indicates neurological (nerve) damage to the dorsal horn area of the spine and evidence of real pain.

Measuring pain in SM dogs for diagnostic purposes can be difficult, but is done by some neurologists using a scale developed by Dr. Clare Rusbridge and accepted for general use at the first annual meeting of neurologists working on canine SM in London, Nov 2006. It has been revised by the group of researchers, and may be downloaded here.

 Researchers and neurologists say it is impossible to know for sure what the animal is experiencing even if not showing outward signs of pain. Neurologists and surgeons who treat human SM say patients typically experience severe and chronic headaches, for example. But canine neurologist have noted that a headache is not a form of pain easily expressed by a dog. It therefore is helpful to many SM dogs owners to review a list of the symptoms noted by human sufferers with SM, as they can explain what their dogs experience. Certainly, SM dog owners can often make a potential link between what human SM patients experience and the behaviours of their SM dog.

ASAP, the American Syringomyelia Alliance Project, a support group, offers this helpful list of human symptoms for both the Chiari malformation and for syringomyelia (note that the Chiari malformation without SM also produces significant pain for humans).

Syringomyelia
· Headaches and chronic pain · Loss of sensitivity, especially to hot and cold · Muscle weakness and spasticity · Numbness in hands and feet · Motor impairment · Loss of bowel and bladder control · Osteoporosis and scoliosis · Paralysis or quadriplegia

Chiari
· Severe head and neck pain · Headaches brought on by coughing, sneezing or straining · Difficulty swallowing · Frequent gagging and choking · Dizziness and vertigo · Balance problems · Muscle weakness · Loss of fine motor skills · Poor hand coordination · Blurred or double vision · Hypersensitivity to bright lights · Nystagmus (involuntary eye movements) · Difficulty in tracking objects · Tinnitus (buzzing or ringing in the ear) · Hearing loss · Vocal cord paralysis · Sleep apnea