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Phantom Scratching and COMS

  • December 1, 2015 3:32 PM EST

    Caudal Occipital Malformation Syndrome (COMS) is a condition that affects the spine and often the brain, initiating phantom pains and odd behaviors. Because it occurs at birth, it is difficult for dog owners to have a baseline of what is normal behavior for their pet. Through proper understanding of the disease, symptoms and pain management options, owners can determine that baseline, and rest assured that they are making the best-informed treatment decisions for their pet.



    Synopsis of condition:

    COMS is a malformation of the occipital bone due to overcrowding of the caudal fossa. The overcrowding can kink the brainstem and lead to distorted CSF flow. When CSF obstruction becomes chronic, it can cause a buildup of CSF fluid, creating a condition known as Syringohydromyelia. The Cavalier King Charles Spaniel is by far the most common dog breed affected by the condition, and the frequency of COMS diagnosed among spaniels has increased drastically over the last decade.

    COMS can result in clinical symptoms of fluid accumulation in the brain and seizures, though most clinical signs are associated with the CSF flow distortion of Syringohydromyelia. When the fluid buildup triggers cell damage in the dorsal horn, increased pain substances initiate neuropathic pain that manifests as phantom scratching, poorly localized pain, twitches, pain during grooming or pain when touching the feet.

    Conventional management

    Treatment objectives:

    • Adjust spine to relieve compression and obstruction
    • Control neural processing and pain pathways
    • Decrease inflammation
    • Treat clinical signs, such as seizures

    To achieve these objectives, treatments such as spinal manipulation, massage, laser, and acupuncture have been applied in conjunction with medication. Surgery has also been considered useful at early stages of the disease to prevent progression and relieve compression. 

    Breakthroughs in Diagnosis and Treatment

    MRIs can easily reveal the overcrowding of the caudal fossa, kinks and herniation in the brain, as well as enlargement of the syrinx. Though the basic MRI process cannot show distorted CSF flow, phase contrast MR can be used to determine the full scope of the affectation. However, this method is not yet commonly used in veterinary medicine.

    Current treatment methods for canines fall short due to an incomplete understanding of COMS in dogs. This provides an open field for research of long-term treatment. 

    Integrative care options

    Typical treatments may not be effective in all patients, and in some cases can worsen the condition. On the other hand, applications of targeted pulsed electromagnetic field (tPEMF) therapy showed positive, visible results in patients when typical treatment methods failed. With simple, 15-minute daily therapy, pain significantly decreased and patient appeared comfortable and relaxed with no signs of conditional distress. This therapy provides a hopeful outlook for patients suffering from the condition and its associated complications.

    Learn more on:
    Neuropathic Pain in the Evidence Based Update Roundtable Discussion.
    Self Injurious Behaviors - Part I and Part II