Written for CatCentric by H. Abbandonato, MSc, BScENR, BSc, BA, October 2015
Rolling skin disease, twitchy cat syndrome, atypical neurodermatis, neuritis, psychomotor epilepsy, and pruritic dermatitis1,3.
Sometimes written hyperaesthesia.
“Increased sensitivity to sensory stimuli (touch, sound, sight)”7. The word hyperesthesia refers to abnormally sensitive skin1.
If you’re familiar with Feline Hyperesthesia Syndrome (FHS), you’re probably aware that this disorder is not well documented or easily treated. But if not, you’ve come to the right place! I am going to take this opportunity to address the research, possible treatments, and my personal experience with FHS so that we can better understand why cats and even dogs are exhibiting this bizarre behaviour, and what you can do about it.
Symptoms (not all symptoms may be present):
- Twitchy or rolling skin on shoulders, back and/or tail
- Excessive licking, biting or gnawing at back and/or tail
- Dilated pupils
- Crying out as if frightened
- Frantic or uncoordinated movement
- Excessive scratching
- In extreme cases, the tail will be severely damaged and may be amputated for relief.
What causes Feline Hyperesthesia?
Feline hyperesthesia is considered idiopathic as no single factor has been linked to its cause11. The first study was conducted by Dr. Jean Holzworth at the Angell Memorial Animal Hospital9. Cats that are often in situations of chronic overstimulation, anxiety or aggression trigger changes in the brains natural chemical balance resulting in the FHS disorder2. Moreover, it is thought to be brought on by a combination of environmental and social stressors similar to other skin conditions11. In addition, Oriental and Siamese breeds are pre-disposed to exhibiting mania during stress and anxiety, thus FHS is more common in these breeds1,4.
- 1Flea allergy dermatitis (FAD)
- 4Fungal infections
- 4Mite infestations
- 1Dry, itchy skin, often from a poor diet (e.g. dry food/kibble)
- 4Food allergies or sensitivities
- 1,2Stress (could be caused by changes in routine, moving, other pets, loss of territory, aggression, fear, etc.)
- 10Environmental toxins (e.g. paint, smoke, air fresheners, plastic food bowls, household cleaners, over vaccination, pesticides, etc.)
Ciribassi (2009) states that other systematic diseases such as toxoplasmosis, hyperthyroidism, spinal or skin conditions, pruritus, FLUTD, anal sacculitis, and myositis should be ruled out first as they could contribute to the disorder. Exposure to insecticides, in particular, snail and slug bait (metaldehydes), permethrin, and to the rodenticide, bromethalin may also cause clinical signs of hyperesthesia8. A side-effect of oxymorphone, an analgesic and opioid drug when given with anaesthesia could cause hyperesthesia among other effects and pets should be monitored carefully when under the influence8. Animals with brucellosis, a zoonotic disease or meningitis will typically exhibit hyperesthesia as well as a list of other symptoms8.
Explaining the Behaviour
According to Guaguère & Prélaud (1999) when skin conditions are caused by behavioural disorders, seen as over-licking, nipping and biting the body repetitively, it causes the body to over release endorphins which upsets the serotonin and dopamine levels resulting in a stereotypic or repeated behaviour6. A reduction in serotonin may cause skin sensitivity and lead to a depressive state as it regulates hormones possibly explaining the twitchy or rolling skin and signs of fear. Furthermore, dopamine regulates muscular and motor activity, and initiates “stop signals”, but in excess can lead to stereotypic behaviours such as exhibited in behavioural hyperesthesia. Due to the imbalance of hormone levels, FHS is considered to be classified as intermittent anxiety which can lead to prolonged neurovegetative disorders6. To treat anxiety, vets will prescribe three types of regimes: behavioural therapy, pheromone therapy or the use psychotropic drugs6. In addition, feline hyperesthesia is thought to be a mild condition that is not progressive, but severe episodes of over-grooming and biting may result in skin damage that could be sore, or become infected over time2.
Treating Feline Hyperesthesia
Step 1 – Investigate It!
When treating any new behaviourally based illness or issue, the first step is to become Sherlock Holmes and investigate it! Start by documenting the behaviour in terms of frequency, time of day, duration, location, severity, current events that occur in conjunction, etc. This is extremely helpful not only to you, but to your Veterinarian who may be able to help you determine what is triggering it.
Step 2 – Look for Patterns
Often times patterns can be found, which can help you to minimize the episodes and treat it accordingly. Examples of what to look for:
Is your cat having an episode every time your dog is around?
Is it in the same area where a stressful stimulus is present?
Is it before meal time?
Do episodes occur every day?
How many times and when?
Does your cat react the same way during an episode and how?
Step 3 – Talk to your Vet
Discuss the patterns and behaviours with your vet. Depending on the cause and severity, treatments vary. I always recommend trying to determine the cause and address it in a holistic manner before treating with anti-inflammatory, analgesic, anti-depressant or anti-seizure medications as they can change the behaviour of your pet and may cause side-effects with long-term use.
- Spirit essences or Bach remedies depending if the event is brought on by stress;
- Omega-3 supplements could help to improve nerve function and in some cases reduce the severity of the FHS episodes;
- Valerian herbal supplement that reduces anxiety (talk to your vet first about its use and dose)
- A scheduled feeding routine instead of free-feeding;
- A diet with a high moisture content, canned or raw food;
- Avoid petting over touching close to the tail and lumbar region; and
- Increasing play time to help your cat build confidence and decrease stress.
Commonly prescribed medications
Mixed results have been found when prescribing phenobarbital (anti-seizure drug), prednisone (corticosteroid), or both5. Other medications that may be prescribed are amitryptyline or fluoxetine serotonin-enhancing drugs, or prednisolone an anti-inflammatory, or gabapentin an anti-seizure and analgesic drug4. Drug treatment depends on each particular case and should be discussed with your vet11. Keep in mind that many of these drugs are not approved for this syndrome and your permission will be required2.
A success story
This section will include our Black Bear’s Feline Hyperesthesia story. Blackie is a domestic medium-hair female cat who began her attacks at the young age of one. She would run around the house with a twitch in her backside. She would furiously try and lick the spot, stop and meow, and continue running in this fashion until she was panting. It was an incredibly bizarre and frightening behaviour to watch. We would try and calm her down, but instead it just made her more stressed. The best thing we could do was leave her be until the episode had passed. We brought her to the vet who then diagnosed her with Feline Hyperesthesia and stated that the veterinary community is not aware of the cause or correct treatment for this disorder and mentioned the use of various medications.
We brought her home and noticed that her attacks began every time she would steal our older cat’s food. Within 5-10 minutes of consuming a new food she would begin an episode. Thus, started our mission to determine what type of food sensitivity she had. The first step was to put her on a hypoallergenic diet to see if it controlled her attacks and surprisingly it did. Next we used the process of elimination; testing the addition of novel proteins or different ingredients to her diet. Interestingly, we noticed that she reacted to almost all the foods we tried with no success. After a month being on the hypoallergenic dry food, she began vomiting after meals. We found one food that seemed to partly reduce her episodes, but caused her to develop itchy bumps on her skin. After much research, I decided it was time to put her on a species appropriate diet, i.e. raw food. Currently, she gets 50/50 raw and wet and is thriving.
Every once in awhile she may have a very mild attack and we have found in her case, that feeding her either her daily meal or a snack will halt the episode altogether indicating that it may be related to meal-time anxiety or digestive discomfort, rather than a food allergy. In our case, we feel as though her attacks are both nutritionally and behaviourally brought on. I personally think that due to her past diet of mostly dry foods, and the melamine contamination recall (she was fed a recalled diets and has only one kidney) it has caused her to have an imbalanced and weak digestive system that is not able to adapt well to change. I also believe that for her specifically, any dietary changes bring her anxiety which can worsen and trigger FHS except with the raw food of which she tolerates three protein sources that she couldn’t in any other form. Today, she is 11 years old with a silky shiny black coat, plays like a kitten, and we couldn’t be happier!!
1Becker, K. 2012. Does your cat suddenly bolt from the room, looking back like something’s chasing her? http://healthypets.mercola.com/sites/healthypets/archive/2012/04/04/feline-hyperesthesia-symptoms.aspx [accessed in July & October 2015].
2Cathealth. 2015. Feline Hyperesthesia. http://www.cathealth.com/adoption/bringing-home-a-new-cat [accessed on October 2015]
3Ciribassi, J. 2009. Feline hyperesthesia syndrome. Compendium Continuing Education for Veterinarians. 31(6): 254.
4Cornell University College of Veterinary Medicine. 2014. Hyperesthesia Syndrome. http://www.vet.cornell.edu/fhc/Health_Information/HyperesthesiaSyndrome.cfm [accessed July, September & October 2015].
5de Lahunta, A., Glass, E. & Kent, M. 2015. Veterinary neuroanatomy and clinical neurology 4th ed. Elsevier Inc. St. Louis, MO, USA. 500pgs.
6Guaguère, E. & Prélaud, P. 1999. A practical guide to feline dermatology. Merial. 293 pgs.
7Jack, C.M. & Watson, P.M. 2008. Veterinary Technician’s Daily Reference Guide: Canine and Feline 2nd Edition. Blackwell. Iowa, U.S.A. 740pgs.
8Jack, C. M. & Watson, P.M. 2014. Veterinary Technician’s Daily Reference Guide: Canine and Feline 3rd Edition. Wiley Blackwell. Iowa, U.S.A. 908pgs.
9March, P.A., Fisher, J.R. & Potthoff, A. 1999. Electromyographic and histologic abnormalities in epaxial muscles of cats with feline hyperesthesia syndrome. ACVIM Proc. 13: 238.
10Rudnick, D. 2013. Feline Hyperesthesia Syndrome, Rolling Skin Disease. https://www.purelypets.com/wellness-center-archives-4/54-feline-hyperesthesia-syndrome [accessed October 2015]
11Weiss, E., Mohan-Gibbons, H. & Zawistowski, S. 2015. Animal behaviour for shelter veterinarians and staff. Wiley Blackwell. Iowa, U.S.A. 101pgs.
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