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A 2023 study published in the Journal of Veterinary Internal Medicine by Bouché et al. provides insights into the diagnosis and management of degenerative myelopathy (DM) in dogs, based on a survey of veterinary neurologists and rehabilitation specialists. The survey, conducted in 2021, gathered responses from 190 neurologists and 79 rehabilitation professionals across multiple countries, shedding light on current practices and highlighting areas for improvement.

Diagnosis Practices

Among neurologists, 80% reported that owners most frequently opt for euthanasia when their dog becomes nonambulatory paraplegic, with incontinence (22.6%) and other complications like respiratory or neurological compromise also influencing this decision. 

• Notably, only 40.5% of neurologists routinely discuss necropsy for a confirmative diagnosis, with 13.8% never broaching the topic. 
• In rehabilitation settings, 59% of specialists always test for the SOD1 mutation, a genetic marker strongly associated with DM, particularly in breeds like the Pembroke Welsh Corgi. 
• However, advanced diagnostics like spinal MRI (10%) and CSF analysis (8%) are less commonly used, and electrodiagnostic testing is rarely employed (82% do not use it). 

This suggests a reliance on clinical presentation and genetic testing for presumptive diagnoses, with definitive confirmation often reserved for post-mortem analysis.

Management and Rehabilitation Strategies

Rehabilitation plays a critical role in managing DM, with 99% of respondents prioritizing strength preservation and 98% focusing on coordination improvement. 

• Common interventions include at-home exercises (65%), strength-building exercises (62%), underwater treadmill therapy (81%), and gait training (70%). 
• Adjunctive therapies such as laser (85%), acupuncture (75%), and pulsed magnetic fields (57%) are also widely utilized. 
• Nearly all respondents (94%) recommend assistive walking devices, while only 32% and 33% suggest vitamin supplements or dietary changes, respectively. 
• In-clinic rehabilitation is standard, with most professionals recommending weekly (43%) or twice-weekly (32%) sessions tailored to the dog’s needs. 
• Client education is a cornerstone, with 88.4% of neurologists and 35% of rehabilitation specialists emphasizing support for owners in managing bladder function, mobility, and quality of life.

Key Takeaways

• The survey underscores the collaborative approach between neurologists and rehabilitation professionals, with ongoing care often transitioning to rehabilitation specialists or primary care veterinarians. 
• Regular exercise and physical therapy are central to slowing disease progression and enhancing patient well-being. 
• However, the limited use of advanced diagnostics and variability in discussing necropsy highlight opportunities for standardizing diagnostic protocols. (But as a rehab professional myself, I don’t see the need for more advanced diagnostics… what does it change? – LEH)
• The study also emphasizes the importance of owner education and support, particularly as DM progresses to nonambulatory stages.

Implications for Veterinary Practice

Veterinarians managing DM cases should integrate genetic testing (e.g., SOD1 mutation) into their diagnostic workflow, particularly for at-risk breeds, while considering the judicious use of imaging or CSF analysis to rule out differential diagnoses. Rehabilitation plans should be individualized, incorporating a mix of in-clinic and at-home therapies to optimize mobility and quality of life. Open discussions about necropsy can aid in confirming diagnoses and advancing research. This survey provides a roadmap for aligning clinical practices with current standards, ultimately improving outcomes for dogs with DM and their owners.

For further details, the full article is available through the Journal of Veterinary Internal Medicine (DOI: 10.1111/jvim.2029).