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What is GME/NME
Granulomatous Meningoencephalomyelitis??
Granulomatous Meningoencephalomyelitis (GME)
Submitted by Cindy Fern-King
Granulomatous Meningoencephalitis also known as GME is an inflammatory disease of the central nervous system (CNS) in dogs. Granulomatous inflammation involves infiltration by cells called "mononuclear cells." These cells normally engulf and destroy debris. In GME, these cells form cuffs around the blood vessels of the brain and spinal cord (mostly in the white matter). The cuffs join at adjacent vessels forming actual masses or nodules. If the meninges (the fibrous membrane that surrounds the brain or spinal cord) are primarily affected, the disease is called 'meningitis'. Encephalitis refers to inflammation of the brain (encephalo- = brain and - itis = inflammation) and 'myelitis' refers to inflammation of the spinal cord. If the meninges, brain and spinal cord are all involved then the disease is called 'meningoencephalomyelitis'. Most inflammatory disease predominantly affects the brain and so 'encephalitis' is often used as a general term for inflammatory disease of the nervous system. There are several forms of GME; focal, multifocal and ophthalmic and a dog can have more than one type. There is also another form called NME (Necrotizing Meningoencephlalitis) that is similar to Pug Dog Encephalitis. In short this is an inflammatory disease involving the brain, brain stem and or spinal column.
The cause of this disease is unknown at this time and is generally considered an autoimmune response disease (that is, the body for some unexplained reason attacks itself). Often there is some sort of stress or 'trigger' that sets GME in motion. GME is the second most common inflammatory disease of a dog's nervous system after canine distemper. It is a disease of young to middle age dogs but may occur at any age in either gender and is not exclusive to toy breeds. The sort of neurological signs that are seen depend totally on what area or areas of the CNS involved. Seizures, neck pain, imbalance or incoordination, walking in circles, blindness, head pressing, listlessness, tilted head, facial abnormalities, and weakness can be seen. This does not leave out much in the way of neurological symptoms.
The diagnosis of GME can be difficult for the inexperienced practitioner. Neurological symptoms can occur from a variety of other sources including toxins, epilepsy, hepatic encephalopathy from a liver shunt, tumors, bacterial or viral infections etc. Therefore it is important that GME be taken into consideration when trying to make a diagnosis. The current protocol to diagnose GME is done with a MRI combined with the examination of the cerebral spinal fluid by spinal tap and is the best techniques currently available. High doses of steroids are started as soon as a definitive diagnosis is suggested. Immunosuppressive and chemotherapy drugs in combination are the current and most effective treatment of this CNS disease.
Much of the veterinary material portrays this disease as progressive and fatal. If GME is left untreated the prognosis is very poor. With the advent of new treatments the quality of life by those affected has greatly improved. The survival time if aggressively treated is truly much longer than what is currently portrayed in much of the material that is presently available. Although many dogs affected with GME can relapse, with aggressive immunosuppressive therapy and the newer treatment with chemotherapy drugs, permanent remission can be accomplished. This disease takes time and dedication from the owner and veterinarian/ neurologist to treat but results can truly be achieved.
While it is unknown at this time if GME is inheritable, Yorkshire Terriers can develop this disease. Affected animals should never be used for breeding and family history should be investigated.
Thank you to Cindy Fern-King for allowing me to use her words to best describe GME?NME so we can all understand what it is and what we all need to do about it.
Reference sites:
A support group for owners of dogs with GME (Granulomatous Meningoencephalomyelitis) or NME (Necrotizing Meningoencephalitis)
•Necrotizing Leukoencephalitis (NLE)
•Synonyms: necrotizing encephalitis of the Yorkshire terrier
•Breeds: Yorkshire Terrier , Chihuahua , Shih-Tzu, slightly older dogs (1 to 10 years old)
•Clinical features: Multifocal localization (forebrain and brainstem), central vestibular disease common, chronic progressive
There are no tests to definitively diagnose these diseases other than direct brain biopsy or autopsy examination. Many reports on GME and necrotizing encephalitis suggest that these are inevitably progressive and fatal disorders. These studies are usually based on autopsy reports and therefore all examined animals have died from the disease. We have seen a large number of animals with idiopathic encephalitis respond to immunosuppression and so a final diagnosis cannot be made. GME and necrotizing encephalitis may simply reflect one of the most severe forms of immune-mediated encephalitis. There has also been some speculation that GME may represent a form of the cancer lymphoma.
Granulomatous Meningoencephalitis
This common inflammatory brain disease in dogs is abbreviated GME. The cause is unknown. Female dogs of small breeds, especially terriers, Dachshunds, Poodles, and Poodle crosses, are predisposed. Although GME can occur at any age, most affected dogs are 2 to 6 years of age.
A chronic form of GME called Pug encephalitis occurs as an inherited disease in Pugs between the ages of 9 months and 4 years. It often begins with seizures, confusion, and loss of memory. This form of the disease has also been seen in Yorkshire Terriers and Maltese.
GME can affect all parts of the brain (the disseminated form), or only specific areas (the focal form). There is a rare ocular form that targets the optic nerves of the eyes.
The disseminated disease appears suddenly and progresses over a matter of weeks. It is characterized by incoordination, stumbling, falling, circling, head tilt, seizures and, dementia.
The focal disease begins with symptoms such as those of a brain tumor. Behavior and personality changes may predominate. The focal disease progresses to the disseminated disease over a period of 3 to 6 months.
The ocular disease is characterized by sudden blindness with a dilated pupil. It progresses to the disseminated disease more slowly than does the focal disease.
GME can be suspected when a toy dog such as a Poodle inexplicably develops confusion, disorientation, seizures, or other neurological signs that progress rapidly over a matter of weeks. A spinal tap with analysis of cerebrospinal fluid helps confirm the diagnosis. A CAT scan or MRI is useful in determining the form and location of the disease.
Treatment: Corticosteroids and immunosuppressive drugs may slow the progression of GME and provide temporary relief for several months. However, GME is almost invariably a progressive and fatal disease.
Necrotizing encephalitis (NE) is a category of noninfectious inflammatory encephalitides that includes two pathologically distinct disorders – necrotizing meningoencephalitis (NME) and necrotizing leukoencephalitis (NLE). These are thought to represent autoimmune disorders. Both disorders are similar in that they are characterized by multiple cavitary necrotic nonsuppurative inflammatory brain lesions that involve both gray and white matter. It is very possible that NME and NLE represent variants of the same disease process.
In NME, the lesions are typically found in the cerebrum, with consistent involvement of the leptomeninges. Extensive cerebral cavitations with a loss of demarcation between gray and white matter are typical for NME. Although Pug and Maltese dogs are most commonly affected by NME, other breeds reported with this disorder included Chihuahua, Shih Tzu, Pekingese, Papillon, and Boston Terrier.
Necrotizing leukoencephalitis (NLE) is characterized by similar lesions that often involve the brain stem in addition to the cerebrum, with less consistent involvement of the leptomeninges and cerebral cortex (i.e., mainly white matter). Yorkshire Terriers appear to be the most common breed afflicted by NLE, but this disease may also affect other small-breed dogs (reports include Pugs, Maltese, Chihuahuas, French Bulldogs).
Plea from Isabella's Mother, Connie Lamanteer
As you can see, there are many different variations of this disease. research is so badly needed in all of them. Please, if you think you may have had this and lost a little one to it, or you may have one now and you really do not know what is going on with it, help can be found for you. Like so many others before me, I had never heard of this disease and knew nothing about it. The more I read and researched the more I learned, I also found it is not just our beloved Yorkie breed, many breeds are effected by this......
The more we learn about it, the more we will know about it and how to treat it and most of all prevent it. But this can't be done without your help.....Please consider going to the Form submissions page, click on the link and print it out take it to your vet, your toy breed clubs, show them what is needed.....Dr. Renee Barber also needs healthy dog samples.....it will be completely confidential betwen you and Dr. Renee Barber.
Please do NOT let another little one die from this dreaded disease, you can help.
Thank you
Isabella
March 2, 2010........August 5, 2011
R.I.P. Beautiful Girl
