Encephalitis in Maltese (GME)

Encephalitis has been known to go by different names depending on the lesions that result from the inflammation: 

GME--granulomatous meningoencephalitis;  MUE--meningoencephalomyelitis of unknown etiology; NME---necrotizing meningoencephalitis and NLE---necrotizing leukoencephalomyelitis.

For the purpose of this overview, we will use the umbrella term of GME as all forms are diagnosed and treaed similarly.

What is GME?:

GME is an inflammatory autoimmune disease of the central nervous system (CNS) that comes on quickly and is life-threatening.  Simply put, the body's immune system goes haywire for some unexplained reason and begins to attack itself, in this case, the CNS (usually the brain).   Rheumatoid arthritis and lupus in humans are examples of autoimmune diseases.

Three Types of GME:

Focal:  Affects one location in the CNS.  The onset of this form is the slowest--about 3-6 months.  Ophthalmic:  Involves the optic nerve and eye.  The most commmon symptom is sudden loss of eyesight.  Disseminated or multifocal:  Involves multiple areas in the CNS.  The disseminated form comes on very rapidly (within days) and has the worst prognosis.  It is possible for a dog to have more than one type at the same time.

Symptoms of GME:

The sort of symptoms seen, depend on which type of GME is present:  blindness, drowsiness circling, seizures, behaviour changes, weakness in some or all four legs, head pressing, neck pain and imbalance.  In short, just about any neurological symptom can occur.  ****If your Maltese ever shows sudden signs of any type of neurological disorder, besides getting the dog to the vet right away, make sure your veterinarian is aware of GME as a possible cause.  If it is GME, time is of the essence!  The soooner treatment is started, the better the outcome.

Diagnosing GME:

Bloodwork is usually the first step to rule out an infection or organ problem (such as a liver shunt).  An X-ray may be done to rule out something like a ruptured disc.  The diagnosis of GME is primarily done throught an MRI combined with the examination of cerebral spinal fluid (CSF) done by a spinal tap.  These two tests will pretty much confirm GME.

Treatment of GME:

If GME is left untreated, the outcome will likely be fatal.  It is imperative that GME be treated aggressively  to stop the inflammatory process as soon as possible.  High doses of steroids (usually prednisone) should be started as soon as a definitive diagnosis is suggested.  Once the patient is stable, then immunosuppressive steroids and chemotherapy drugs in combination can be utilized.  With the newer therapies, it is possible to achieve remission.  However, the individual prognosis will vary from dog to dog.  Should a dog recover, it is strongly recommended that no vaccines be given in the future.

Possible Causes of GME:

There is mounting evidence that suggests a genetic component may be present in certain Maltese making them susceptible to developing GME if the conditions are right.  Often, there is some sort of stress to the immune system or "trigger" that sets GME in motion, such as a vaccination or an illness of some sort.  At this time, there is no way to predict what dogs will develop GME.  There is no DNA test available.  As far as we know, GME is not infectious  (meaning it is not passed around from dog to dog).  Common sense dictates that affected animals should never be used for breeding.

What is being done?:

The American Maltese Association is actively working with Dr. Renee Barber, DVM, a leading researcher of GME.  It is hoped that a genetic marker will be found and from that, a DNA test can be developed.  What is desperately needed right now is DNA samples (blood or cheek swabs) from affected and healthy dogs.  Monetary donations would also be gratefully accepted.  Please contact Pam Whitener for DNA submission forms and/or where to send donations at:  pamw4501@yahoo.com 

Support Group:   Yahoo Groups  New GME dog