Professional Documents
Culture Documents
Muscle Atrophy
Muscle Atrophy
Muscle atrophy is not a single disease, it is simply the loss of muscle mass and it can
have a range of clinical presentations and underlying causes. This complexity can
make it a challenge to diagnose its underlying cause and to treat appropriately.
Muscular atrophy can be grouped into three broad categories based on the
underlying reason for the atrophy. Muscle atrophy can be caused by:
Within each category, there can be specific diseases affecting the nerves, muscles or
body weight, as outlined below:
(2) Myopathies
Severe rhabdomyolysis
Polysaccharide storage myopathy (PSSM)- homozygotes with two copies of
the mutation can have topline atrophy
Inflammatory myositis- Lyme’s disease
Immune mediated myositis (IMM)
Rimmed vacuolar myopathy
IMM and calciphylaxis
Cushings disease
Vitamin E deficient myopathy
Chronic infections
Degenerative diseases
Malabsorptive disoredress
Finally, certain diagnostic tests may be appropriate based on the history and clinical
signs and suspected type of myopathy. A diagnostic tree for muscle atrophy is
provided below for suggestions.
Potentially helpful diagnostic tests include;
Ultrasound: This helps determine the extent and depth of focal muscle atrophy.
Compare the left and right sides in the same spot to assess degree of muscle
involvement.
Electromyography (EMG). If available, this can identify muscles with neurogenic
atrophy through the presence of positive sharp waves and abnormal electrical
potentials
CK and AST activity. Rule out myodegenerative processes such as IMM or
severe rhabdomyolysis
Serum vitamin E – Rule out EMND, vitamin E deficient myopathy
GYS1 genetic test for type 1 PSSM. A genetic test is available for horses with
severe chronic topline atrophy or drafts with generalized atrophy
ACTH or dexamethasone suppression test if Cushings-related muscle loss is
suspected.
Muscle biopsy provides information about the type, cause and severity of
theatrophy at a cellular level, and likelihood muscle will regenerate as outlined
below.
How does a muscle biopsy help a horse with muscle atrophy? What muscle should be
biopsied?
1) For generalized atrophy and suspected EMND, a biopsy of the sacrocaudalis muscle
is recommended.
2) For atrophy of the topline muscles and suspected immune-mediated myopathies,
two biopsies are recommended;
a. Fresh semimembranosus biopsy
b. Formalin-fixed TruCut samples (14 gauge) of the epaxial muscles.
3) For evaluation of focal muscle atrophy, a fresh open biopsy of the specific muscle
group affected is highly recommended.
4) For exertional myopathies and suspected PSSM-related atrophy semimembranosus
muscle.
What determines how fast a muscle will atrophy?
Some disease processes cause very rapid muscle atrophy. A third of the muscle mass
may disappear in a day with immune-mediated myositis and rimmed vacuolar
myopathy. If very severe, acute rhabdomyolysis can result in muscle atrophy within a
week of onset. Muscle wasting over a period of a month occurs with vitamin E
deficient myopathy, EPM and trauma to a nerve. Slow progressive atrophy occurs with
EMND and systemic diseases.
The best treatment plan will depend on the underlying cause of your horse’s atrophy.
In some cases this may involve oral treatment with medications such as vitamin E or it
may involve a corticosteroid for immune-mediated diseases. To help muscle recover
its full form, additional therapies such as physical rehabilitation therapy, therapeutic
ultrasound and electrical muscle stimulation may be indicated. Your veterinarian will
guide treatment based on the underlying cause of atrophy.
Muscle has a remarkable ability to regenerate and many horses do return to a normal
muscle mass and full function, depending on its cause. Nerve damage may take up to
a year to know whether it will fully regenerate which will be followed by a return of
muscle mass. Immune mediated muscle atrophy can be dramatic but muscle mass
often returns with treatment. In some cases, atrophy may have progressed to the
point where connective tissue has replaced the muscle fibers, in which case the
prognosis for full recovery of muscle mass is more guarded. The replacement of
muscle fibers with connective tissue is often apparent on a muscle biopsy.