title: A newly designed radiation therapy protocol in combination with prednisolone as treatment for meningoencephalitis of unknown origin in dogs: a prospective pilot study introducing magnetic resonance spectroscopy as monitor tool.
abstract: BACKGROUND
  A plethora of treatment options have been described for canine meningoencephalitis of unknown origin (MUO), yet a gold standard has not been established. The aim of this prospective pilot study was to document the effect of a newly designed 30 Gray (Gy) radiation therapy (RT) protocol plus corticosteroids as treatment for focal and multifocal MUO, to monitor clinical and imaging changes during the course of the disease with conventional magnetic resonance imaging (MRI) and proton MR Spectroscopy (H-1 MRS) and to detect the occurrence of radiation related side effects.
  
  
  RESULTS
  Six dogs (3 with focal and 3 with multifocal lesions) were included in the study. The RT protocol used consisted of 30 Gy in 10 fractions. The neurological status of all six dogs improved during RT, with 3 of 6 cases returning to a normal condition. One dog was euthanized early during follow-up (<3 weeks after end of RT). Three month follow up MRI was normal in one dog and improved in 3 dogs and H-1 MRS normalized in 4. In the dog without improvement of the MRI lesions, the N-acetyl aspartate continued to decrease, while choline and creatine concentrations remained stable during that time. This dog was euthanized 18 month after the end of RT due to relapse. One dog was lost to follow up 12 month after completion of RT. The other 3 dogs are still alive at the time of writing.
  
  
  CONCLUSIONS
  RT with 30 Gy in 10 fractions can provide an additional option for anti-inflammatory treatment of focal and multifocal MUO. The protocol used for treatment monitoring was feasible while no side effects of RT could be observed during the follow up period. Moreover, H-1 MRS could represent a new and non-invasive tool to control the progression of the disease during the treatment course.
authors: Division of Neurology, Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, CH-8057, Zurich, Switzerland. kbeckmann@vetclinics.uzh.ch.
authors: Katrin
authors: K
authors: Beckmann
authors: Division of Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, CH-8057, Zurich, Switzerland. icarrera@vetclinics.uzh.ch.|Graduate School for Cellular and Biomedical Sciences, University of Bern, Freiestrasse 1, CH-3012, Bern, Switzerland. icarrera@vetclinics.uzh.ch.
authors: Inés
authors: I
authors: Carrera
authors: Division of Neurology, Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, CH-8057, Zurich, Switzerland. fsteffen@vetclinics.uzh.ch.
authors: Frank
authors: F
authors: Steffen
authors: Division of Neurology, Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, CH-8057, Zurich, Switzerland. lgolini@vetclinics.uzh.ch.
authors: Lorenzo
authors: L
authors: Golini
authors: Division of Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, CH-8057, Zurich, Switzerland. pkircher@vetclinics.uzh.ch.
authors: Patrick R
authors: PR
authors: Kircher
authors: Division of Radiation Oncology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, CH-8057, Zurich, Switzerland. uschneider@vetclinics.uzh.ch.|Institute for Radiotherapy, Radiotherapy Hirslanden AG, Witellikerstrasse 40, CH-8032, Zurich, Switzerland. uschneider@vetclinics.uzh.ch.
authors: Uwe
authors: U
authors: Schneider
authors: Division of Radiation Oncology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, CH-8057, Zurich, Switzerland. crohrer@vetclinics.uzh.ch.
authors: Carla Rohrer
authors: CR
authors: Bley
mesh_terms: D000818:Animals; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D004283:Dog Diseases / Q000188:drug therapy* / Q000209:etiology / Q000532:radiotherapy*; D004285:Dogs; D005260:Female; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008590:Meningoencephalitis / Q000188:drug therapy / Q000209:etiology / Q000532:radiotherapy / Q000662:veterinary*; D010865:Pilot Projects; D011239:Prednisolone / Q000627:therapeutic use*; D011446:Prospective Studies; D011878:Radiotherapy / Q000662:veterinary*
chemical_list: D000893:Anti-Inflammatory Agents; D011239:Prednisolone
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