High dose, long term, immunosuppression is the key to successful therapy for all autoimmune diseases of the CNS. For this reason it is imperative that infectious causes of CNS inflammation be ruled out by diagnostic testing since immunosuppressive therapy would obviously worsen these conditions. The following therapies have been found to have efficacy in treating CNS autoimmune disease:
1. Corticosteriods in immunosuppressive doses1,2,3
2. CCNU (Personal communication March, P, Ohio State University)4
3. Cyclosporine Modified by Microemulsion-Neoral®(Novartis
Pharmaceuticals Corporation, East Hanover, New Jersey 07936)5,6
4. Cytarabine7,18
5. Leflunomide15
6. Procarbazine7,19
7. Radiation Therapy8,3
Corticosteroids, primarily prednisone, is the drug of first choice and is often used as the sole therapy. It is important that immunosuppressive doses be used initially, and therapy be sustained at high doses, very gradually tapered over many months or relapses are likely to occur. A six-month tapering dosage schedule of prednisone that often works is as follows:
1 mg/lb Q 12 hours for 4 days
0.5 mg/lb Q 12 hours for 17 days
0.5 mg/lb Q 24 hours for 35 days
0.25 mg/lb Q 24 hours for 60 days
0.25 mg/lb Q 48 hours for 60 days
Dogs weighing less than 5 kgs are dosed as 5 kg dogs, and dogs weighing 5 to 10 kgs are dosed as 10 kg dogs. Dogs weighing over 35 kg are dosed as 35 kg dogs. Prednisone alone, used in the above dosage schedule, in about 75 percent of cases will cause permanent remission when neutrophilic or eosinophilic meningitis or focal GME of the posterior or rostral fossa of the brain are treated. |