NME cases are doing much better then I thought... at least in Taiwan

Long-term outcomes and prognostic factors in dogs with meningoencephalitis of unknown origin and suspected necrotic lesions on magnetic resonance imaging: 37 cases (2007–2020

Chih-Ching Wu and Ya-Pei Chang

Background
Necrotizing encephalitis (NE), comprising necrotizing meningoencephalitis (NME) and necrotizing leukoencephalitis (NLE), is a form of noninfectious meningoencephalomyelitis of unknown origin (MUO) in dogs. It is characterized by necrotic lesions detectable via MRI and disproportionately affects certain small breeds. The study aimed to evaluate long-term outcomes, survival rates, progression-free survival (PFS), and prognostic factors in dogs with clinically diagnosed NE based on MRI findings.

Methods
This retrospective cohort study included 37 dogs diagnosed with NE between 2007 and 2020 at the National Taiwan University Veterinary Hospital. Inclusion criteria required MRI evidence of necrotic lesions, cerebrospinal fluid (CSF) abnormalities, and at least 6 months of follow-up or a documented first relapse. Outcomes were assessed based on survival data and relapse timing. Statistical analyses included Kaplan-Meier survival curves and Cox proportional hazards regression to evaluate correlations between clinical, imaging, and treatment variables and survival outcomes.

Results
-Survival and Relapse:
-Median overall survival (OS) was 639 days, with a progression-free survival (PFS) of 233 days.
-Early relapse within 6 months significantly reduced OS.
-Dogs experiencing their first relapse at prednisolone doses below 0.75 mg/kg/day had a shorter PFS.

-Seizure Dynamics:
-Seizures occurred in 75.7% of cases, with a 100% recurrence rate post-diagnosis.
-Cluster seizures or status epilepticus were noted in 48.6% of dogs.

-Prognostic Factors:
-Dogs with clinical signs lasting 29 days to 6 months had a higher risk of early relapse (Odds Ratio: 3.26; p=0.009).
-Use of cyclosporine as an add-on immunosuppressant before the first relapse marginally reduced PFS (p=0.048).

-Treatment Outcomes:
-Most dogs (94.6%) received immunosuppressive therapy, primarily prednisolone combined with cytosine arabinoside, cyclosporine, or mycophenolate mofetil.
-Long-term management with aggressive immunosuppressive protocols was associated with improved outcomes compared to historical data.

Limitations
The study was limited by its retrospective design, absence of histopathological confirmation, and potential diagnostic overlap with other conditions such as granulomatous meningoencephalitis. Variability in treatment protocols and small sample size may have influenced the findings.

Conclusions
NE is associated with fair long-term survival in dogs receiving aggressive immunosuppressive therapy. Early relapse is a critical determinant of overall survival. Early and robust anticonvulsive and immunosuppressive interventions may improve outcomes. These findings highlight the need for standardized treatment protocols and further exploration of diagnostic biomarkers for canine NE.

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