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Does fampridine help with spinal cord trauma?

Species: Cat
Breed: Domestic short hair
Age: 3-6 months
Has there been any success, or even attempt, at treating paralysis in cats using "Ampyra", aka fampridine or dalfampridine?

I understand this drug was recently approved for human MS patients, and also shows promise for damaged but not severed spinal cords, though that would be an off-label use at this time, if I've got my facts straight.

Her vet has prescribed prednisone and some Chinese homeopathic remedy, and suggested acupuncture, but gave a poor prognosis for ever walking again. The injury was too small to show up on an x-ray.

Bottom line, should I ask our vet to consider prescribing this?

- Kevin

Online vet, Dr. Marie

Dr. Marie replied:

First of all, I'm very sorry to hear that Bastet is paralyzed. Thank you for asking an interesting question. One of the reasons why I run this website is so that I can learn things. I have never heard of using this drug and so I have done some research for you.

The name of the drug that you are asking about is 4-aminopyridine. It works by blocking channels in the spinal cord that transmit potassium. As a result, damaged spinal cord nerves can become more excited and possibly function better.

This study done on dogs showed that there was an improvement in nerve function after an injection of aminopyridine. However, this improvement only lasted a few hours. Several of the dogs in this study had side effects such as seizures after the injection was given.

I have just spent a good amount of time searching about this drug (using all of the possible names for it) on Veterinary Information Network. This is a private site where tens of thousands of vets (including neurology specialists) talk about interesting cases and treatments. If there is a new treatment that is available, it will be talked about on VIN.

Unfortunately I could not find any cases where a vet was trying this medication on a cat or a dog. The neurologists on VIN have dedicated their lives to learning about the best treatments for spinal injuries in dogs. If Ampyra was showing any promise they definitely would be talking about it.

I did find some discussion about PEG (polyethylene glycol). This drug can be used after a spinal cord injury to help to reduce damage to the nerves. But even this is experimental and there have not been any good studies done to really prove that it works. Most neurologists are not using it.

I wish I had more positive information for you!

Dr. Marie.

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Customer reply:

Dr. Marie,

Thank you very much for your time and effort.

We are in the position of enumerating the possible drastic actions. I wasn't holding out any hope at all for a magic shot that would fix her spine, but I was thinking a daily pill of this stuff might restore some control and sensation, especially of the bodily functions.

The point is, experimental approaches are worth considering if any data exists to support a reasonable chance of improvement.

As to the Ampyra then, I'm more concerned with the lack of data on felines than the seizure risk; the abstract said that happened at higher intravenous doses. Problem is, the first molecule might do that to a cat, seems like nobody knows, and that seems a little _too_ experimental.

As for the PEG, the question becomes, why are some but not most neurologists using it? Is there a negative side effect or some other unacceptable risk factor, or are they simply not convinced it's doing any good? In my view, the former is a showstopper, the latter merely a brake.

As to acupuncture; similar problem. Pricking needles into her is a questionable risk to me, since it seems about as likely to work as the ancient herbs - odds just this side of nil, but the herbs have much lower impact. Should I be more willing to try acupuncture? The vet said she'd done it twice with positive result on one and no improvement on the other.

As to surgery; we were told the procedure would have to have been performed immediately, and we were not able to get her to a vet fast enough. Honestly, on a moment's notice, we would not have been able to secure the $5000. That kind of money takes time for us.

For whatever it's worth, we're disinclined to consider euthanasia at this time, though it's only been a week since the injury. We (myself, my wife, and Bastet) are all still learning to deal with her handicap status. She seems eager enough to keep living thus far, mobility impairments and bathroom embarrassments notwithstanding. When someone can demonstrate that she's actually in serious misery, then and only then will we consider putting her out of it. Until then, Bastet's quality of life is for her to judge, and we'll support her as best we can.

That's really the ultimate question right there - are there any other options we should be looking at?

Thank you again for your time, and please know that your sympathy is very deeply appreciated.

- Kevin

Online vet, Dr. Marie

Dr. Marie replied:

You have brought up some good questions. It's hard to know whether most of the neurologists are not using these medicines because of lack of proof or simply because no one has ever done it before!

I am inclined to think though that these products are not likely to work otherwise someone would be using them.

I have seen a number of animals live with a spinal injury and do quite well. The biggest concern is really whether or not your cat can fully empty her bladder. I have had clients who have learned how to express their cat's bladder. So, if you need to do so, your vet can teach you how to do that.

I really don't have much experience with acupuncture so it's hard for me to comment on whether it is helpful. You could ask your vet about the possibility of seeing a veterinary chiropractor. I have had a number of animals do well with chiropractic treatment. But, I am not sure if they do chiro on animals with paralysis or not.

I have seen a number of dogs who do well with wheelchairs. I would imagine cats can learn as well! You can check out some of these resources for wheelchairs for animals by scrolling to the bottom of the linked page.

I think it's a good idea to wait a while before making any decisions as some animals can slowly recover from spinal injuries.

Thank you so much for the bonus. It is greatly appreciated!

Dr. Marie.

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Dr. MarieDr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.

Is an online vet visit just as good as a trip to your veterinarian? No! But, many times, asking an online veterinarian a question can help save you money. While Dr. Marie can't officially diagnose your pet or prescribe medications, she can often advise you on whether a vet visit is necessary. You can also ask Dr. Marie for a second opinion on your pet's condition.