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Written by a Medical Acupuncture for Veterinarians course graduate.  Author’s name available upon request.   Signed release obtained from client/author/4398.

 

 

 Abstract:

This case report describes the use of medical acupuncture for the treatment of idiopathic epilepsy, end-stage hepatic disease, and chronic arthritis in a 9 year old, female, spayed Rottweiler.  During the course of acupuncture treatment there was a decrease in the frequency of seizures seen, a decrease in the amount of ascites present, and an overall increase in comfort level as observed by the owner.

History:

The patient in this case report was diagnosed approximately 7 years prior to presentation with presumed idiopathic epilepsy.  This diagnosis was based on age of onset and having a sibling with a seizure disorder.  At the time of presentation, the current treatment regimen for the seizures was: Phenobarbitol 194.4mg bid, Levetiracetam 1000mg bid, Potassium bromide 750mg bid. Seizure frequency was 1-2 times per month and the seizures would last 1-2 minutes.

This patient presented for inappetance and vomiting in September of 2015 and was diagnosed with chronic hepatic and pancreatic inflammation with ascites via ultrasound and cytology.  The patient was treated in the hospital and released when the vomiting resolved and the eating returned.  Reduction of phenobarbital dose was attempted, but failed.  The patient was started on Furosemide 40mg bid.

Clinical Assessment:

At the time of initial evaluation for acupuncture in May 2016, the patient had significant ascites, but was eating well, with no vomiting or diarrhea.  The initial examination revealed pain in the lumbar spine, tense triceps and biceps muscles and a distended, taut abdomen with a palpable fluid wave.  There was also a generalized loss of muscle mass most obvious in the rear legs. Vitals: HR 100, RR 20, T102.6, MM=pk, CRT less than 2.  Weight = 136lbs.  Blood tests after the hospital stay in September 2015 were not repeated due to financial constraints.  In September, 2015 the abnormal laboratory values were:  Alkaline phosphatase 489, albumin 1.5, amylase 7945, lipase 9643, WBC 29, 100.  No medication was being used for pain due to liver dysfunction.

Treatment goals and medical rationale:

The goals of acupuncture treatment were to reduce seizure frequency, to decrease abdominal distension and to improve overall patient comfort.  In addition to liver disease and a seizure disorder, the patient had a slow, stiff gait.  Proprioception was weak in the rear legs and there was evidence of wearing of the nails on the middle toes of the rear limbs.  Underlying arthritis was presumed, but a lot of the slow gait was attributed to the extra weight placed on the limbs from the abdominal distension.  Acupuncture points were used that stimulated the nervous system to treat the epilepsy and to stimulate the hepatobiliary system.  Acupuncture points were also selected to decrease pain in muscle tissue in the limbs as well as lumbar spine.

Acupuncture Treatment:

A total of 4 sessions of acupuncture were given over 4 weeks with one session per week.  Only dry needling was used.  Seirin 0.20 mm needles with a tube were used during all sessions and the needles were left in place for 20-25 minutes.  The sessions were performed on a well-padded surface in a quiet exam room.  The lighting used was only natural sunlight through a window.  Calming music was played during the sessions (Through a dog’s ear) and baby food in a jar was given while needles were being placed to provide a positive association with treatment.  After the second acupuncture session, spironolactone 50mg bid and omeprazole 20mg sid were added to the treatment regimen.

Points: GV 20 and GV 14 were used for cervical nerve stimulation for epilepsy and general relaxation.  BL 18 and 19 were used to stimulate mid thoracic spinal nerves that supply the hepatobiliary tissues.  Bai Hui, and BL 23 were used to stimulate thoracolumbar and lumbar nerves for rear limb dysfunction.  BL 22 and ST 40 were used to aid with fluid retention.  SI 11 and LI 11 were used for forelimb pain stimulating the nerves that supply the muscles of the forelimbs.  LI 11 was also used for treatment of epilepsy(1).  In addition to relaxation, GV 20 has been used in treatment of epilepsy (2). ST 36 was used to stimulate the fibular nerve and aid with rear limb discomfort.  LR 3 stimulates the deep fibular nerve and was used for both the liver disease and seizures. BL60 and KI3 points were used for the stimulation of the fibular and tibial nerves for both seizures and liver disease. GB 24 and LR 14, while recommended for liver disease (1), were not used due to the severe amount of abdominal distension.  PC 6 and LI 4 were not used due to proximity to the mouth and concern for accidental needle ingestion while eating treats.  During the sessions, appetite remained excellent.

Outcome:

During the acupuncture treatment no seizures were seen.  Before treatment, seizures were seen every 3-4 weeks.  Over the course of the treatment, the ascites improved, but did not resolve.  Body weight decreased from 136lbs to 120lbs.  This loss of weight was attributed to loss of fluid likely aided by the addition of spironolactone, a diuretic, to the furosemide. No adverse events were seen and the owner felt the patient was more comfortable after each session.  The owner’s observations of improved comfort are likely a result of the effect of acupuncture treatment on chronic pain.(3)

References:

  1. Schoen, Allen M. Veterinary Acupuncture: Ancient Art to Modern Medicine. St. Louis, Missouri 2001. Mosby, Inc p 182.
  2. Klide, AM, Farnbach, GC, and Gallagher, SM: Acupuncture Therapy for the Treatment of Intractable, Idiopathic Epilepsy in Five Dogs. Acupuncture and Electro-Therapeutics Research, Vol 12, p. 71-74, 1987.
  3. Middleman, E, Gaynor, JS: A Brief overview of the analgesic and immunologic effects of acupuncture in domestic animals. JAVMA 217(8):1201-1205, 2000.