Welcome to the latest edition of the BVNS Neurotransmitter.

Sassy Chupacabra

Sassy is an 11-year-old female domestic short-hair cat.

Sassy has had intermittent “fights” with her own
back legs for years. Owner describes that Sassy
scratches her own ear with her back leg, and then,
she seems surprised that her leg touched her. She
then attacks the offending paw, which hurts, and
then she proceeds to roll around and bite and
scratch herself. She once got a hind claw stuck
through her “eyebrow” narrowly missing her eyelid.
Episodes were only once a month or so. Owner
says talking to Sassy during the episode makes her
growl more, so they have not tried to interfere.

Recently, a second cat has been added to the household. The other cat is minimally aggressive
toward Sassy. He will guard the litterboxes, but otherwise, he shows little interest in her. Since
addition of the second cat, the rolling and self attacking episodes have gotten more frequent and
more violent. No skin wounds have been seen, but owners are concerned that Sassy will hurt
herself. She is also now having episodes where her pupils dilate, she licks her lumbar region
aggressively, she swings her tail around vigorously, and then she runs away as if something has
bitten her.
Sassy has had mild, very intermittent left forelimb lameness for approximately 5 years. Since
adoption 7 years ago, she also has episodes when she is falling asleep where her ears and facial
muscles exhibit brief myoclonic jerking movements. She is very agile despite the forelimb
issue hand has no difficulty jumping on and off tall furniture or playing vigorously with toys. She is
sleeping well and eating well. She vomits about once every 2 weeks when she eats too quickly; the
vomitus is always undigested food. No diarrhea, coughing, or sneezing have been noted. Her
weight is stable. Her CBC, chemistry profile, urinalysis, and T4 are all WNL.

EXAM FINDINGS
Physical and neurological exam are completely normal. Sassy is outgoing, vocal, and mildly
fractious during the appointment.

DIFFERENTIAL DIAGNOSIS
Feline Hyperesthesia Syndrome, atypical seizures, and less likely pain episodes.

TREATMENT

Sassy was started on 2.5mg fluoxetine once daily. Within 2 weeks, the episodes had
decreased by 90% in frequency and were much shorter and less violent than before. The
occasional limping and also the face twitching episodes were unchanged.

FINAL DIAGNOSIS: FELINE HYPERETHESIA SYNDROME

Feline Hyperesthesia Syndrome, also known as “rolling skin disease,” has been described as a
form of Obsessive Compulsive Disorder in cats. It can be related to a primary behavioral issue,
like inter-cat stress in Sassy’s case, or it can be a response to chronic pain. Some cats with Feline
Hyperesthesia Syndrome go on to develop more readily identifiable true epileptic seizures.
Testing is aimed at ruling out systemic causes of discomfort and ruling out seizures. Neurological
tests that may be performed include a brain MRI with cerebrospinal fluid analysis, and
electroencephalogram to check for seizure-like brain electrical activity, and/or a treatment trial
with an anti-epileptic drug. If no neurological or pain cause is identified, then a treatment trial
with a serotonin enhancing medication like fluoxetine or clomipramine can be helpful. Referral to
a board certified veterinary behaviorist should also be considered.
Sassy was started on 2.5mg fluoxetine once daily. Within 2 weeks, the episodes had
decreased by 90% in frequency and were much shorter and less violent than before. The
occasional limping and also the face twitching episodes were unchanged.

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