Neurologic disease in the canine and feline patient can affect multiple locations, specifically the brain, the spinal cord, and neuromuscular systems. A multitude of clinical signs can be observed, from behavioral changes to seizures to weakness to paralysis to, simply, pain. The incorporation of complementary and alternative medicine into conventional medical practice in the human arena is piquing interest in the subject in veterinary medicine as well. Complementary and alternative veterinary medicine (CAVM) encompasses a broad spectrum of treatment modalities to include acupuncture, chiropractic, herbology, light therapy, and massage therapy. Other therapies—such as therapeutic ultrasound, electrical stimulation, and physiotherapy to include aquatherapy (pool swimming, underwater treadmill) as well as land therapies—exist and are used alone or in combination with the above treatments. The goals of incorporating complementary medicine practice into conventional practice are to (1) improve the quality of life of the patient and owner, (2) diminish pain, and (3) incorporate a more holistic view of the veterinary patient. The use of CAVM in the treatment of neurologic disease has the same goals as previously mentioned. The use of CAVM for neurologic disease includes selective and adjunctive treatment of seizures, cerebrovascular disease, vestibular disease, intervertebral disc disease, caudal cervical spondylomyelopathy, high-velocity disc injury, fibrocartilaginous embolism, myopathies, and neuropathies. CAVM may be helpful to those patients who (1) have nonsurgical lesions, (2) are geriatric, (3) are anesthetic risks, (4) are recovering from or coping with a surgical or medical neurologic malady, or (5) are in pain. The key point to remember is that CAVM can be used in combination with conventional medicine once a definitive diagnosis has been established and all options are offered to the owner. This chapter aims to familiarize the reader with CAVM and its use in the treatment of various neurologic diseases that affect companion animals and provide scientific evidence for its validity and efficacy.

Acupuncture has been used for thousands of years and has its roots in Chinese and ancient Indian cultures. It was first introduced into Western civilization in the early 1900s and has since gained popularity as a mode of therapy for multiple diseases. Acupuncture is based on two of the fundamental concepts of Chinese medicine and philosophy: yin and yang, and qi. The theory behind acupuncture involves the stimulation of specific anatomic points in the body to achieve a therapeutic effect. This scientific theory of acupuncture revolves around the acupoint, of which there are an estimated 365 on the body surface. An acupoint can vary in size from 2 mm to 50 mm and is composed of the triad of connective tissue, a nerve bundle, and a vascular bundle; this triad has been recognized through electron microscopy. Acupoints are joined by theorized meridians or pathways; there are 14 major meridians that run on the body surface and connect the acupoints, which have a very low electrical resistance. The stimulation of acupoints has been shown to stimulate the release of inflammatory mediators such as corticosteroids, endorphins, and enkephalins. The scientific basis of acupuncture is being studied through multiple NIH grants and there are a number of theories surrounding its efficacy. Several processes have been proposed to explain acupuncture’s effects, focusing mainly on pain. When acupuncture points are stimulated, the central nervous system (CNS) is stimulated to release chemicals such as hormones into the muscle, spinal cord, and brain that may help to change the experience of pain and to promote the body’s natural healing abilities. Three main mechanisms are proposed:

• Conduction of electromagnetic signals in which stimulated acupoints are thought to be conductors of such signals at an increased rate and thus promote the flow of biochemicals such as endorphins and enkephalins, as well as stimulating immune system cells.
  
• Activation of opioid systems, in which several types of opioids may be released centrally during treatment, thus decreasing pain.
  
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  Changes in brain chemistry, sensation and involuntary body functions by the altering release of neurotransmitters and neurohormones in a positive manner.

Chiropractic manipulation has been a mode of therapy in human medicine for a number of years and, like acupuncture, has become very popular in the treatment of companion animals. Chiropractic theory is based upon manual spinal manipulations and revolves around the relationship and interactions between spine biomechanics, and neurologic mechanisms. Therapy is aimed at the vertebral column to alter disease progression. Multiple terminologies are used in chiropractic care. The term “subluxation” is commonly used and implies an abnormal positional relationship of the vertebral bodies that can have an effect upon normal biomechanical and neurologic function, although multiple definitions arise in the medical and veterinary discussion of chiropractic medicine. The pathophysiology of subluxation has numerous theories and includes the facilitation hypothesis, which states that subluxations produce a lowered threshold for firing in spinal cord segments. Other theories include somatoantonomic dysfunction, nerve compression, compressive myelopathy, fixation, axoplasmic aberration, and the neurodystrophic hypothesis, to name a few. Therapeutic methods include spinal manipulation, and spinal adjustment. Spinal manipulation is categorized as mechanical and neurologic. Again, the mechanical effects are defined as subluxation, characterized as a spinal joint strain or sprain associated with local and referred pain and muscle spasms. The neurologic effects are both direct and indirect, and affect both the central and peripheral nervous systems. Spinal manipulation involves low-velocity, low-amplitude manual thrusts to multiple spinal joints to extend them slightly beyond their normal passive range of motion (PROM). An adjustment is a specific physical action designed to restore the biomechanics of the vertebral column, and thus indirectly influences neurologic function. It is a high-velocity force applied in a specific direction to a specific vertebra. In human medicine, chiropractic research has demonstrated short-term benefits in the treatment of acute lower back pain, headache, and neck pain. The effects on other musculoskeletal systems are more neutral. Spinal mobilization has been shown to have a number of physiological effects, including reduction of muscle spasms and inhibition of nociceptive transmissions, with the goal of improving joint function and pain alleviation. In veterinary medicine, similar concepts apply, with multiple applications that range from active movement of the joints between vertebral segments to those using low-force techniques. Multiple techniques and treatment theories (ranging from the role of CSF in spinal column function to potential neuropathology at the intervertebral foramen) make this treatment modality, in veterinary medicine, controversial. The goal of the veterinary chiropractor is to divide the spinal column into function or “motor units” for a more concise concept of the biomechanics of spinal movements, misalignments, and adjustments of subluxated segments. A motor unit comprises two adjacent vertebrae, the intervertebral disc, articular facets, ligaments, muscles, tendons, nerves, and blood vessels that unite the two vertebrae as one unit. The chiropractic philosophy is based upon the concepts of homeostasis; this therapy, like acupuncture and other alternative therapies, must be tailored to the individual patient and performed when an adequate diagnosis has been made and all options have been discussed with the client.

   Indications for chiropractic therapy in the neurologic small animal patient can include:

• spinal hyperpathia (cervical, thoracolumbar, lumbar) in the absence of progressive neurologic deficits in cases of intervertebral disc disease or high-velocity disc injury
  
• neuromuscular disease such as myopathy (inflammatory, immune mediated, or infectious myositis) or neuropathic disease associated with endocrine disease, such as hypothyroidism or idiopathic causes
  
• muscle ligament, bone or tendon pain most commonly associated with underlying orthopedic disease that is either chronic or acute (i.e. traumatic)
  
• degenerative disease (spondylosis associated with the vertebral column).