Prolonged Nystagmus in geriatric rabbit

[Oldbun89]

Hello,

I have a geriatric dwarf rabbit who is approximately 12 years old. August 2022 she came down with nystagmus, head tilt and frequent bouts of GI stasis. Vets ruled out e.cunniculi and she was put on a course or Baytril and Metacam every 12 hours. Head tilt and nystagmus stayed away as long as she was medicated. She stayed on Baytril until March 2023 until the nystagmus and head tilt recurred, so she was switched to a two week course of Sulfamethoxazole, and oral Cernia - neither helped and both vets I have seen opted not to continue antibiotic treatment.

She is now on Metacam and gabapentin twice daily, and Meclizine tablets that I secured from the US (not available in Canada), 3.125mg daily for body weight of 1125 grams. The nystagmus has improved slightly with the Meclizine, but is still quite prominent. We supplement her twice daily with critical care, she is willing to eat some on her own.

She has been off of all antibiotics for two months almost, but my gut is telling me that I want to try one more round in combination with the Meclizine. Is this far reaching? Her head tilt is also odd in that she is actually able to straighten out her head on her own when her back hip is rubbed. Has anyone else experienced this? Any other advice?

 

[Popsicles]

How did they rule out e. cuniculi? Has any imaging or further investigation been done? I would be very suspicious of middle ear disease. Medication may be masking but not actually treating the underlying cause.

 

[Oldbun89]

How did they rule out e. cuniculi? Has any imaging or further investigation been done? I would be very suspicious of middle ear disease. Medication may be masking but not actually treating the underlying cause.

She was deemed low risk for e. cuniculi to begin with as was never allowed outside. She started Baytril in August 2023 and improved immediately, and then declined immediately after stopping her first 2 week course. Also her nystagmus direction is more typical of inner ear. I saw two independent exotic vets, both very rabbit savvy and they agreed that based on her profile that e.cunniculi was unlikely and also that diagnostic testing at her age and in her condition would be more harmful than helpful.

 

[Popsicles]

Testing for e.c. Is just a blood test so shouldn’t be harmful. Rabbits usually catch it as a baby and it is sub clinical for life or until it isn’t. An indoor rabbit is not immune from e cuniculi.
Direction of nystagmus will only be able to help differentiate between central or peripheral neuropathy, i.e. brain or ears, it won’t tell you what part of the ear is affected.
If you don’t want to do xrays or CT, a simple ultrasound at the base of the ear will rule out middle ear disease.
If further diagnostics aren’t performed then it’s impossible to come up with an effective treatment plan, antibiotics clearly help in the short term but aren’t fixing the underlying issue, so it’s whether you choose to investigate further or to opt for palliative treatment of antibiotics etc as and when there are flare ups.

 

[Popsicles]

She was deemed low risk for e. cuniculi to begin with as was never allowed outside. She started Baytril in August 2023 and improved immediately, and then declined immediately after stopping her first 2 week course. Also her nystagmus direction is more typical of inner ear. I saw two independent exotic vets, both very rabbit savvy and they agreed that based on her profile that e.cunniculi was unlikely and also that diagnostic testing at her age and in her condition would be more harmful than helpful.

Also you say you started on both metacam and baytril when symptoms started so it could very likely be the metacam that helped more than the baytril.