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Abstract

Clinical scenario You are presented with a 4-year-old male neutered Boston Terrier with a five day history of seizures, progressive mentation changes and compulsive circling. The patient has had no previous ailments or been on any previous treatments. Multifocal intensities were noted within the forebrain on MRI (T2-weighted). Mixed mononuclear pleocytosis with increased protein concentration was noted on cerebrospinal fluid (CSF) examination. Negative serology and CSF titres for Neospora caninum and Toxoplasma gondii were performed. A provisional diagnosis of MUO is made for which you want to start treatment soonest, but you are unsure of the effectiveness of using a combination of cytosine arabinoside with prednisolone compared with prednisolone alone. The evidence There is limited available evidence for treating MUO involving CA in combination therapy with prednisolone or prednisolone alone. Five studies were located examining the effect of CA in combination with prednisolone, with a relatively small number of cases reported in each of these. Only one paper was identified studying the use of prednisolone alone for treatment of MUO. The available evidence is weak as five studies were case series, with high likelihood of bias, the inability to detect much of the bias, and the inability to estimate a treatment effect. A repeat literature search involving different chemotherapeutic treatment options for MUO could be beneficial. Whilst there is no direct comparison between these two treatment options, CA with prednisolone had greater actual and estimated median survival time than prednisolone as a sole therapy in dogs with MUO.