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 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 with 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.

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