University of Edinburgh

Feline Hyperesthesia Syndrome with self-trauma to the tail: retrospective study of 7 cases and proposal for integrated multidisciplinary diagnostic approach Pablo Amengual Batle 1, Clare Rusbridge 2,3, Tim Nuttall 1, Sarah Heath 4, Katia Marioni-Henry 1 Corresponding author1Hospital for Small Animals, Royal (Dick) School of Veterinary Studies and the Roslin Institute, University of Edinburgh, United Kingdom 2 Fitzpatrick referrals, Godalming, United Kingdom3 School of Veterinary Medicine, Faculty of Health & Medical Sciences, University of Surrey, Guildford, United Kingdom4 Behavioural Referrals Veterinary Practice, Chester, United Kingdom AbstractCase Series summary. This was a retrospective study on clinical features and response to treatment in 7 cats with Feline Hyperaesthesia Syndrome (FHS) and tail mutilation. FHS is a poorly understood disorder characterised by skin rippling over the dorsal lumbar area, episodes of jumping and running, excessive vocalisation, and tail chasing and self-trauma. The majority of the cats were young, with a median age of 1 year at the onset of clinical signs, male (6/7), and with access to the outdoors (5/7). Multiple daily episodes of tail chasing and self-trauma were reported in 5/7 cats, with tail mutilation in 4/7 cats. Vocalisation during the episodes (5/7) and rippling of lumbar skin (5/7) were also reported. Haematology, serum biochemistry, Toxoplasma gondii and FIV/FeLV serology, MRI scans of brain, spinal cord and cauda equina, CSF analysis and electrodiagnostic tests did not reveal any clinically significant abnormalities. A definitive final diagnosis was not reached in any of the cats, but hypersensitivity dermatitis was suspected in 2 cases. A variety of medications was used alone or in combination including gabapentin (6), meloxicam (4) antibiotics (4), phenobarbital (2), prednisolone (2), and topiramate (2); ciclosporin, clomipramine, fluoxetine, amitriptyline and tramadol were used in one cat each. Clinical improvement was achieved in 6 cases; in 5 cats complete remission of clinical signs was achieved with gabapentin alone (2 cats), a combination of gabapentin/ciclosporin/amitriptyline (1), gabapentin/prednisolone/phenobarbital (1) or gabapentin/topiramate/meloxicam (1). Relevance and novel information. This is the first retrospective study on a series of cats with FHS. The diagnostic work up did not reveal any significant abnormalities of the central or peripheral nervous system; dermatological and behavioural problems could not be ruled out. We propose an integrated multidisciplinary diagnostic pathway to be used for the management of clinical cases and for future prospective studies. IntroductionFeline hyperaesthesia syndrome (FHS) is a poorly understood disorder of cats characterised by a wide variety of clinical signs. This condition was first reported in 1980 and several names have been used since including “apparent neuritis”, “atypical neurodermatitis”, “rolling skin syndrome” or “twitchy cat disease”.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Tuttle", "given" : "Jennifer", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the American Veterinary Medical Association", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "1980" ] ] }, "page" : "47", "title" : "Feline hyperesthesia syndrome", "type" : "article-journal", "volume" : "176" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "1", "plainTextFormattedCitation" : "1", "previouslyFormattedCitation" : "1" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }1 Despite the disparity of names used to describe this disorder, the reported clinical signs are reasonably consistent and include tail chasing, biting or licking the lumbar area, flank, anal area, or tail; and skin rippling and muscle spasms of the dorsal lumbar area, which may be spontaneous or elicited by a light touch. Other clinical signs such as excessive and unusual vocalisations, episodes of apparently wild and uncontrolled jumping and running, hallucination and behaviours that mimic signs of oestrus were described in the first report on this condition by Tuttle in 1980.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Tuttle", "given" : "Jennifer", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the American Veterinary Medical Association", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "1980" ] ] }, "page" : "47", "title" : "Feline hyperesthesia syndrome", "type" : "article-journal", "volume" : "176" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "1", "plainTextFormattedCitation" : "1", "previouslyFormattedCitation" : "1" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }1 Although FHS has been described for almost 40 years its aetiology is still unknown; indeed, many clinicians consider FHS an umbrella term, which covers a variety of conditions ranging from excessive skin twitching to mutilation associated with a variety of pathologies.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "1118881303, 9781118881309", "author" : [ { "dropping-particle" : "", "family" : "Mu\u00f1ana", "given" : "K. R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "chapter-number" : "Feline Hyp", "container-title" : "Blackwell's Five-Minute Veterinary Consult: Canine and Feline", "edition" : "6th", "editor" : [ { "dropping-particle" : "", "family" : "Tilley", "given" : "L P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Smith", "given" : "F W K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2016" ] ] }, "page" : "497", "publisher" : "John Wiley & Sons", "publisher-place" : "Ames, IA", "title" : "Feline Hyperesthesia Syndrome", "type" : "chapter" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "2", "plainTextFormattedCitation" : "2", "previouslyFormattedCitation" : "2" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }2 In fact, clinical signs consistent with FHS have been anecdotally reported in association with dermatological (e.g. flea allergic or hypersensitivity dermatitis), behavioural (e.g. compulsive disorder and displacement behaviour), orthopaedic (e.g. trauma to tail) and neurological conditions (primary epilepsy or secondary to encephalitis or brain tumours, spinal disease such as intervertebral disc disease, neoplasia or infectious myelitis).ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "1118881303, 9781118881309", "author" : [ { "dropping-particle" : "", "family" : "Mu\u00f1ana", "given" : "K. R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "chapter-number" : "Feline Hyp", "container-title" : "Blackwell's Five-Minute Veterinary Consult: Canine and Feline", "edition" : "6th", "editor" : [ { "dropping-particle" : "", "family" : "Tilley", "given" : "L P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Smith", "given" : "F W K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2016" ] ] }, "page" : "497", "publisher" : "John Wiley & Sons", "publisher-place" : "Ames, IA", "title" : "Feline Hyperesthesia Syndrome", "type" : "chapter" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "ISSN" : "1940-8307", "author" : [ { "dropping-particle" : "", "family" : "Ciribassi", "given" : "John", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Compendium continuing education for veterinarians.", "id" : "ITEM-2", "issue" : "3", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "116-121", "publisher" : "Veterinary Learning Systems", "publisher-place" : "Yardley, PA :", "title" : "Feline Hyperesthesia Syndrome", "type" : "article-journal", "volume" : "31" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "2,3", "plainTextFormattedCitation" : "2,3", "previouslyFormattedCitation" : "2,3" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }2,3 In the most severe form, cats with clinical signs of FHS can severely damage or even mutilate their tails requiring immediate medical assistance.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "1118881303, 9781118881309", "author" : [ { "dropping-particle" : "", "family" : "Mu\u00f1ana", "given" : "K. R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "chapter-number" : "Feline Hyp", "container-title" : "Blackwell's Five-Minute Veterinary Consult: Canine and Feline", "edition" : "6th", "editor" : [ { "dropping-particle" : "", "family" : "Tilley", "given" : "L P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Smith", "given" : "F W K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2016" ] ] }, "page" : "497", "publisher" : "John Wiley & Sons", "publisher-place" : "Ames, IA", "title" : "Feline Hyperesthesia Syndrome", "type" : "chapter" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "URL" : "", "accessed" : { "date-parts" : [ [ "2017", "11", "17" ] ] }, "author" : [ { "dropping-particle" : "", "family" : "Shell, L G, Katherman, A E, Morgan", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Veterinary Information Newtwork", "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "0" ] ] }, "title" : "Feline Hyperesthesia Syndrome", "type" : "webpage" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "2,4", "plainTextFormattedCitation" : "2,4", "previouslyFormattedCitation" : "2,4" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }2,4 Treatment with several medications with different indications, such as antiepileptic drugs (e.g. phenobarbital, diazepam), anti-inflammatory drugs (e.g. prednisolone), adjuvant analgesics (e.g. gabapentin), behaviour modifying medications (e.g. lorazepam, oxazepam, buspirone, amitriptyline, fluoxetine, paroxetine or clomipramine), a synthetic progestin (megestrol acetate), and vitamins and other supplements (acetyl-L-carnitine, coenzymes, riboflavin, vitamin E) has been proposed, however, to date we are not aware of any scientific study reporting results of these treatments in cats with clinical signs of FHS.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "1940-8307", "author" : [ { "dropping-particle" : "", "family" : "Ciribassi", "given" : "John", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Compendium continuing education for veterinarians.", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "116-121", "publisher" : "Veterinary Learning Systems", "publisher-place" : "Yardley, PA :", "title" : "Feline Hyperesthesia Syndrome", "type" : "article-journal", "volume" : "31" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Tuttle", "given" : "Jennifer", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the American Veterinary Medical Association", "id" : "ITEM-2", "issue" : "1", "issued" : { "date-parts" : [ [ "1980" ] ] }, "page" : "47", "title" : "Feline hyperesthesia syndrome", "type" : "article-journal", "volume" : "176" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "abstract" : "Adult cats may be presented with symptoms of thoracolumbar skin twitching, vocalizing, and whipping the tail in distress. Some cats will also mutilate the rump and tail areas. Symptoms may be occasional or occur as multiple daily episodes, which interfere with a quality life for pet or owner. Routine tests are normal and the actual cause in unknown. No lesions have been found on necropsy. Two week drug trials with prednisone at 1 mg/kg, q12h, or phenobarbital at 2-4 mg/kg, q12h, or diazepam at 1-2.5 mg, q8-12 may be tried, but often fail to relieve clinical signs. Megestrol acetate at 5 mg, SID, for 1 week, then 2.5 mg, daily or every other day, for 2 weeks, may be tried. If signs improve, reduce to 2.5 mg once or twice weekly. Be aware of side effects of this drug in cats. Buspirone is another non-benzodiazepine anti-anxiety drug which has been given to cats at dosages of 2.5-7.5 mg, q12h, for spraying in the house. Veterinarians have reported some success with buspirone in cats with hyperesthesia syndrome as well.", "author" : [ { "dropping-particle" : "", "family" : "Chrisman Cheryl L.", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "112th IN VMA Conf Proc", "id" : "ITEM-3", "issued" : { "date-parts" : [ [ "1996" ] ] }, "title" : "Feline Hyperesthesia Syndrome", "type" : "paper-conference" }, "uris" : [ "" ] }, { "id" : "ITEM-4", "itemData" : { "ISBN" : "1118881303, 9781118881309", "author" : [ { "dropping-particle" : "", "family" : "Mu\u00f1ana", "given" : "K. R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "chapter-number" : "Feline Hyp", "container-title" : "Blackwell's Five-Minute Veterinary Consult: Canine and Feline", "edition" : "6th", "editor" : [ { "dropping-particle" : "", "family" : "Tilley", "given" : "L P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Smith", "given" : "F W K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-4", "issued" : { "date-parts" : [ [ "2016" ] ] }, "page" : "497", "publisher" : "John Wiley & Sons", "publisher-place" : "Ames, IA", "title" : "Feline Hyperesthesia Syndrome", "type" : "chapter" }, "uris" : [ "" ] }, { "id" : "ITEM-5", "itemData" : { "URL" : "", "accessed" : { "date-parts" : [ [ "2017", "11", "17" ] ] }, "author" : [ { "dropping-particle" : "", "family" : "Shell, L G, Katherman, A E, Morgan", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Veterinary Information Newtwork", "id" : "ITEM-5", "issued" : { "date-parts" : [ [ "0" ] ] }, "title" : "Feline Hyperesthesia Syndrome", "type" : "webpage" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "1\u20135", "plainTextFormattedCitation" : "1\u20135", "previouslyFormattedCitation" : "1\u20135" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }1–5The aims of this retrospective study were to report the results of diagnostic investigation and treatment in cats presenting with clinical signs associated with FHS (i.e. skin twitching, vocalization and/or over grooming/mutilating of the tail without apparent inciting cause) and formulate an integrated multidisciplinary diagnostic approach to be used for the management of clinical cases and for future prospective studies. Case series descriptionThe electronic databases of two referral veterinary centres were retrospectively searched for information on signalment, history, clinical presentation, diagnostic work up and treatment of cats with clinical signs compatible with FHS.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Tuttle", "given" : "Jennifer", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the American Veterinary Medical Association", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "1980" ] ] }, "page" : "47", "title" : "Feline hyperesthesia syndrome", "type" : "article-journal", "volume" : "176" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "1", "plainTextFormattedCitation" : "1", "previouslyFormattedCitation" : "1" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }1 Inclusion criteria were a history of attacking or over-grooming the tail causing soft tissue damage associated with either vocalisation and/or lumbar hyperaesthesia, manifested as rippling of the lumbar skin occurring spontaneously or induced by gentle touch. Videos (Video 1) were also evaluated when available. Seven cats met the criteria and were included in the study; information on signalment and clinical presentation are summarised in Table 1. All 7 cats were domestic shorthairs, 6 were male and one female; 2 male cats were entire and the other 5 were neutered. The median age of presentation was 1 year old (range 1-7 years). Two cats were indoor only. Episodes of tail chasing causing superficial soft tissue trauma were reported in all cats as per inclusion criteria, and in some cats the damage was deeper (i.e. mutilation) leading to removal of a conspicuous part of the tail in 4 out of 7 cats (Figure 1 and Video 1). These episodes occurred multiple times per day in 5 cats, multiple times per week in one cat and the frequency was not reported for one cat. Vocalisation during the episodes was reported in 5 cats and rippling of the dorsal lumbar skin occurring spontaneously or induced by gentle touch was reported in 5 out of 7 cats. In addition to the clinical signs described above, 3 cats presented with dermatological signs including dandruff, alopecia, and erythema; 2 of these cats also had a history of intermittent gastro-intestinal signs (vomiting and diarrhoea). One cat had a prior history of unacceptable urination of suspected behavioural etiology. All cats received a complete physical and neurological examination, which did not reveal any other abnormalities. Results of haematology and biochemistry were available for all cats and were unremarkable. Serology for Toxoplasma gondii and FIV/FeLV was performed in 5 and 6 cats respectively. Mildly positive IgG titres for Toxoplasma gondii (1:100, normal ≤1:50) with negative IgM titres were found in two cats suggesting previous exposure to the agent. FIV and FeLV serology was negative. Five cats had MRI scans of the skull and vertebral column including caudal vertebrae, and cerebrospinal fluid analysis (total cell count, cytology and protein concentration) was performed in 3 cats. No significant abnormalities were detected in any of the cats with either diagnostic procedure. Four cats underwent electrodiagnostic tests including electromyography of the muscles of the pelvic limbs and tail (in all 4 cats) and motor nerve conduction studies of the sciatic-tibial nerves (2 cats). The electrodiagnostic studies were normal with the exception of prolonged insertional activity and mild spontaneous activity detected in the muscles of the tip of the tail in 2 cats; both cats had mutilated the tip of their tail and, therefore, these mild abnormalities could have been associated with recent muscle trauma and were considered of unknown clinical significance. Dermatological tests were performed in 2 cats with clinical signs suggestive of a dermatological condition. The tests included cytology of skin lesions and coat brushing and intradermal testing for environmental allergens (negative) in one cat and a serological test for detection of IgE antibodies to flea antigens (negative) in another cat. Four cats received regular flea treatment, one indoor-only cat did not receive any flea preventative and the information was not available for 2 cats.A definitive final diagnosis was not reached in any of the cats. Hypersensitivity dermatitis was suspected in 2 cases, but it could not be proven since the diagnostic work up for this condition was performed elsewhere and detailed information was not available. A variety of medications were used alone or in combination to treat the clinical signs prior or after referral, including gabapentin (6 cats), meloxicam (4), antibiotics (4), phenobarbital (2), prednisolone (2), and topiramate (2). Ciclosporin, clomipramine, fluoxetine, amitriptyline and tramadol were used in one cat each. In 2 cats with gastro-intestinal and dermatological problems an exclusion diet was also attempted, but the dietary trial failed due to poor owner compliance. Four cats received a combination of two or more medications, while 3 cats showed improvement with monotherapy. Clinical improvement was achieved in 6 cases; in 5 cats complete remission of the clinical signs was achieved with gabapentin alone (2 cats) or a combination of gabapentin/ciclosporin/amitriptyline (1), gabapentin/prednisolone/phenobarbital (1) or gabapentin/topiramate/meloxicam (1). Two of these cats with severe clinical signs (case 2 and 6) had a recurrence of clinical signs approximately 2 years from remission after all medications had been briefly interrupted (case 2) or the topiramate dose tapered (case 6); another case was lost to follow up during the slow tapering of prednisolone (see Table 1). One cat had a reduction in frequency of the episodes following treatment with clomipramine alone (see Table 1). A diagnostic pathway for FHS (shown as a flow diagram in Figure 2) was created based on the information collected with this study and the combined experience of specialists in Neurology, Dermatology and Behavioural Medicine. The diagnostic pathways also includes proposal for future pharmaceutical trials.DiscussionThis retrospective study is, in the authors’ knowledge, the first study reporting the results of diagnostic work up and treatment of cats with clinical signs of FHS. The main limitations of this study are its retrospective nature and the limited number of cases included. The definition of FHS is still controversial as some authors consider mutilation of the tail part of the clinical presentation of FHS,ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "Adult cats may be presented with symptoms of thoracolumbar skin twitching, vocalizing, and whipping the tail in distress. Some cats will also mutilate the rump and tail areas. Symptoms may be occasional or occur as multiple daily episodes, which interfere with a quality life for pet or owner. Routine tests are normal and the actual cause in unknown. No lesions have been found on necropsy. Two week drug trials with prednisone at 1 mg/kg, q12h, or phenobarbital at 2-4 mg/kg, q12h, or diazepam at 1-2.5 mg, q8-12 may be tried, but often fail to relieve clinical signs. Megestrol acetate at 5 mg, SID, for 1 week, then 2.5 mg, daily or every other day, for 2 weeks, may be tried. If signs improve, reduce to 2.5 mg once or twice weekly. Be aware of side effects of this drug in cats. Buspirone is another non-benzodiazepine anti-anxiety drug which has been given to cats at dosages of 2.5-7.5 mg, q12h, for spraying in the house. Veterinarians have reported some success with buspirone in cats with hyperesthesia syndrome as well.", "author" : [ { "dropping-particle" : "", "family" : "Chrisman Cheryl L.", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "112th IN VMA Conf Proc", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "1996" ] ] }, "title" : "Feline Hyperesthesia Syndrome", "type" : "paper-conference" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "5", "plainTextFormattedCitation" : "5", "previouslyFormattedCitation" : "5" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }5 while other clinicians consider tail mutilation a different entity associated with neuropathic pain, possibly secondary to prior trauma to the tail and/or caudectomy.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "", "ISSN" : "0195-5616", "author" : [ { "dropping-particle" : "", "family" : "Mathews", "given" : "Karol A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Veterinary Clinics of North America: Small Animal Practice", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "1365-1414", "title" : "Neuropathic Pain in Dogs and Cats: If Only They Could Tell Us If They Hurt", "type" : "article-journal", "volume" : "38" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "6", "plainTextFormattedCitation" : "6", "previouslyFormattedCitation" : "6" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }6 To address this controversy, we decided to include in this retrospective case series only cats with clinical signs associated with the classical form of FHS, such lumbar hyperaesthesia, rippling skin, vocalization, and episodes of attacking or over-grooming the tail causing soft tissue damage or mutilation. Self-trauma to the tail was chosen as inclusion criteria since in our experience this represents the most debilitating clinical sign that may lead to referral and/or recurrence of clinical signs after partial caudectomy.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/jsap.12257", "ISSN" : "00224510", "author" : [ { "dropping-particle" : "", "family" : "Simons", "given" : "M. C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ben-Amotz", "given" : "R.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Popovitch", "given" : "C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Small Animal Practice", "id" : "ITEM-1", "issue" : "10", "issued" : { "date-parts" : [ [ "2014", "10" ] ] }, "page" : "509-514", "title" : "Post-operative complications and owner satisfaction following partial caudectomies: 22 cases (2008 to 2013)", "type" : "article-journal", "volume" : "55" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "7", "plainTextFormattedCitation" : "7", "previouslyFormattedCitation" : "7" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }7FHS is a debilitating condition, especially in the most severe cases with mutilation of the tail. However, there is a tendency to treat FHS with a series of therapeutic trials prior to referral, including surgical removal of the injured part and/or a variety of medications. This reluctance to refer cases of FHS is not unexpected, considering the fact that the etiopathology and organ systems involved in the development of this constellation of clinical signs remain unclear 38 years after the first report.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Tuttle", "given" : "Jennifer", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of the American Veterinary Medical Association", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "1980" ] ] }, "page" : "47", "title" : "Feline hyperesthesia syndrome", "type" : "article-journal", "volume" : "176" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "1", "plainTextFormattedCitation" : "1", "previouslyFormattedCitation" : "1" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }1 Ciribassi suggested that FHS is a behavioural displacement disorder, in which the cat develops high motivation for two or more conflicting behaviours (e.g. eating or escaping another cat) that might lead to a species-appropriate but unrelated behaviour such as grooming. If this conflicting situation persists for a prolonged period of time the cat may manifest displacement behaviour even when the competing motivations are not present leading to a compulsive behaviour.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "1940-8307", "author" : [ { "dropping-particle" : "", "family" : "Ciribassi", "given" : "John", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Compendium continuing education for veterinarians.", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "116-121", "publisher" : "Veterinary Learning Systems", "publisher-place" : "Yardley, PA :", "title" : "Feline Hyperesthesia Syndrome", "type" : "article-journal", "volume" : "31" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "3", "plainTextFormattedCitation" : "3", "previouslyFormattedCitation" : "3" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }3 Based on this premise, FHS signs should diminish and/or disappear after initiation of behaviour modification and/or treatment with psychoactive medications such as selective serotonin reuptake inhibitors (SSRIs, e.g. fluoxetine) or tricyclic antidepressants(e.g. clomipramine or amitriptyline), and glutamate-modulating medications (such as topiramate and gabapentin) (see Figure 2).ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "1940-8307", "author" : [ { "dropping-particle" : "", "family" : "Ciribassi", "given" : "John", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Compendium continuing education for veterinarians.", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "116-121", "publisher" : "Veterinary Learning Systems", "publisher-place" : "Yardley, PA :", "title" : "Feline Hyperesthesia Syndrome", "type" : "article-journal", "volume" : "31" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "", "ISBN" : "1570-159X/1875-6190", "abstract" : "Objective: Obsessive-compulsive disorder (OCD) is a mental disease commonly associated with severe distress and impairment of social functioning. Serotonin reuptake inhibitors and/or cognitive behavioural therapy are the therapy of choice, however up to 40% of patients do not respond to treatment. Glutamatergic signalling has also been implicated in OCD. The aim of the current study was to review the clinical evidence for therapeutic utility of glutamate-modulating drugs as an augmentation or monotherapy in OCD patients. Methods: We conducted a search of the MEDLINE database for clinical studies evaluating the effect of glutamate-modulating drugs in OCD. Results: Memantine is the compound most consistently showing a positive effect as an augmentation therapy in OCD. Anti-convulsant drugs (lamotrigine, topiramate) and riluzole may also provide therapeutic benefit to some OCD patients. Finally, ketamine may be of interest due to its potential for a rapid onset of action. Conclusion: Further randomized placebo-controlled trials in larger study populations are necessary in order to draw definitive conclusions on the utility of glutamate-modulating drugs in OCD. Furthermore, genetic and epigenetic factors, clinical symptoms and subtypes predicting treatment response to glutamate-modulating drugs need to be investigated systematically.", "author" : [ { "dropping-particle" : "", "family" : "Marinova*", "given" : "Zoya", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fineberg", "given" : "De-Maw Chuang and Naomi", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Current Neuropharmacology", "id" : "ITEM-2", "issue" : "7", "issued" : { "date-parts" : [ [ "2017" ] ] }, "page" : "977-995", "title" : "Glutamate-Modulating Drugs as a Potential Therapeutic Strategy in Obsessive-Compulsive Disorder", "type" : "article", "volume" : "15" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "3,8", "plainTextFormattedCitation" : "3,8", "previouslyFormattedCitation" : "3,8" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }3,8 Although in some cases this therapeutic approach might be satisfactory, in our study 2/4 cats achieved complete remission of clinical signs only after anti-inflammatory or immunosuppressive medications were added to psychotropic drugs. Some authors suggested that the episodes of wild and uncontrolled jumping and running, tail chasing and vocalisation seen in FHS cats are a manifestation of epileptic activity.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISSN" : "0046-3639", "author" : [ { "dropping-particle" : "", "family" : "Shell", "given" : "L G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "FELINE PRACTICE", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "1994" ] ] }, "page" : "10", "title" : "Feline Hyperesthesia Syndrome", "type" : "article-journal", "volume" : "22" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "9", "plainTextFormattedCitation" : "9", "previouslyFormattedCitation" : "9" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }9,ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/jvim.12297", "ISSN" : "08916640", "author" : [ { "dropping-particle" : "", "family" : "Pakozdy", "given" : "A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Halasz", "given" : "P.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Klang", "given" : "A.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Veterinary Internal Medicine", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2014", "3", "1" ] ] }, "page" : "255-263", "title" : "Epilepsy in Cats: Theory and Practice", "type" : "article-journal", "volume" : "28" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "10", "plainTextFormattedCitation" : "10", "previouslyFormattedCitation" : "10" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }10 The partial response to treatment with antiepileptic drugs (AEDs) such as phenobarbital, gabapentin or topiramate and some owners’ reports that FHS cats appear to be dazed and their pupils dilate during or immediately before the episodes seem to support the theory of focal epileptic seizures. An extensive neurological work up, including neurological examination, haematology, biochemistry, MRI of the central nervous system, evaluation of peripheral nerves and muscles with electrodiagnostic tests, CSF analysis and serology for Toxoplasma gondii, FeLV and FIV was performed in 3 cats in our study and a more limited work up, including blood work and MRI, was performed in 2 additional cats without evidence of intra- or extracranial causes of seizures. These findings do not rule out the possibility that FHS could be an idiopathic form of epilepsy characterised by focal seizures, but the results of the diagnostic work up and the incomplete response to treatment with AEDs cast doubt on this hypothesis. Furthermore, the rippling or rolling of the skin over the lumbar spine occurring spontaneously or in response to gentle touch conforms to the definition of allodynia and/or alloknesis, which are abnormal sensory states wherein normally innocuous stimuli elicit unpleasant sensations or aversive responses (e.g. pain or itch).ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "", "ISSN" : "0195-5616", "author" : [ { "dropping-particle" : "", "family" : "Mathews", "given" : "Karol A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Veterinary Clinics of North America: Small Animal Practice", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "1365-1414", "title" : "Neuropathic Pain in Dogs and Cats: If Only They Could Tell Us If They Hurt", "type" : "article-journal", "volume" : "38" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "6", "plainTextFormattedCitation" : "6", "previouslyFormattedCitation" : "6" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }6,ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/978-3-540-29805-2_154", "ISBN" : "978-3-540-29805-2", "author" : [ { "dropping-particle" : "", "family" : "LaMotte", "given" : "Robert H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Encyclopedia of Pain", "editor" : [ { "dropping-particle" : "", "family" : "Schmidt", "given" : "Robert F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Willis", "given" : "William D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2007" ] ] }, "page" : "52-55", "publisher" : "Springer Berlin Heidelberg", "publisher-place" : "Berlin, Heidelberg", "title" : "Allodynia and Alloknesis", "type" : "chapter" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "11", "plainTextFormattedCitation" : "11", "previouslyFormattedCitation" : "11" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }11 The response of some cases of FHS to treatment with gabapentin and topiramate may support presence of neuropathic itch or pain, since these AEDs have been successfully used for the treatment of neuropathic itch and pain in humans and veterinary patients including cats.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "", "ISSN" : "0195-5616", "author" : [ { "dropping-particle" : "", "family" : "Mathews", "given" : "Karol A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Veterinary Clinics of North America: Small Animal Practice", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2008" ] ] }, "page" : "1365-1414", "title" : "Neuropathic Pain in Dogs and Cats: If Only They Could Tell Us If They Hurt", "type" : "article-journal", "volume" : "38" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1111/vde.12124", "ISSN" : "09594493", "author" : [ { "dropping-particle" : "", "family" : "Grant", "given" : "David", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rusbridge", "given" : "Clare", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Veterinary Dermatology", "id" : "ITEM-2", "issue" : "3", "issued" : { "date-parts" : [ [ "2014", "4", "1" ] ] }, "page" : "n/a-n/a", "title" : "Topiramate in the management of feline idiopathic ulcerative dermatitis in a two-year-old cat", "type" : "article-journal", "volume" : "25" }, "uris" : [ "" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1111/vde.12218", "ISSN" : "09594493", "author" : [ { "dropping-particle" : "", "family" : "Ortalda", "given" : "Christian", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Noli", "given" : "Chiara", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Colombo", "given" : "Silvia", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Borio", "given" : "Stefano", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Veterinary Dermatology", "id" : "ITEM-3", "issue" : "4", "issued" : { "date-parts" : [ [ "2015", "8", "1" ] ] }, "page" : "235-e52", "title" : "Oclacitinib in feline nonflea-, nonfood-induced hypersensitivity dermatitis: results of a small prospective pilot study of client-owned cats", "type" : "article-journal", "volume" : "26" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "6,12,13", "plainTextFormattedCitation" : "6,12,13", "previouslyFormattedCitation" : "6,12,13" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }6,12,13 Gabapentin is a structural analogue of γ-aminobutyric acid (GABA) neurotransmitter that was originally designed as an anticonvulsant, but has been found to be more effective in the treatment of neuropathic pain and anxiety in humans and companion animals.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.2460/ajvr.71.7.817", "ISBN" : "0002-9645 (Print)\\n0002-9645 (Linking)", "ISSN" : "00029645", "PMID" : "20594085", "abstract" : "G abapentin, a structural analogue of GABA, has been used as an adjunctive antiepileptic drug to treat partial seizures in humans. 1,2 Gabapentin has been used to treat all types of neuropathic pain, 3 and it also can be used to reduce postoperative pain and the amount of postoperative opioids required in humans. 4 Although gabapentin resembles GABA, it does not interact with GABA A or GABA B receptors, nor does it in-hibit GABA uptake. It is not metabolized into GABA or a GABA agonist. 5 Data suggest that it binds to the \u03b12\u03b4 accessory subunit of voltage-dependent calcium chan-nel complexes 6 and has an inhibitory effect on voltage-gated calcium channels. 7 To date, there has been no consensus on the mechanism of action of gabapentin. In cats, there are a limited number of options for drugs that provide analgesia without undesirable ad-verse effects. Opioids are controlled substances and their use can lead to dysphoria, whereas NSAIDs can cause toxic effects in cats. 8 Alternative analgesic drugs for oral administration are needed. Objective\u2014To determine the pharmacokinetics of gabapentin in cats after IV and oral administration. Animals\u20146 healthy female adult domestic shorthair cats. Procedures\u2014Gabapentin was administered IV (4 mg/kg) or orally (10 mg/kg) in a crossover randomized design. Blood samples were obtained immediately before gabapentin admin-istration and at various times up to 960 minutes after IV administration or up to 1,440 minutes after oral administration. Blood samples were immediately transferred to tubes that contained EDTA and were centrifuged at 4\u00b0C. Plasma was harvested and stored at \u201320\u00b0C until analysis. Plasma concentrations of gabapentin were determined by use of liquid chromatography\u2013mass spectrometry. Gabapentin concentration-time data were fit to com-partment models. Results\u2014A 3-compartment model with elimination from the central compartment best de-scribed the disposition of gabapentin administered IV to cats, but a 1-compartment model best described the disposition of gabapentin administered orally to cats. After IV administra-tion, the mean \u00b1 SEM apparent volume of the central compartment, apparent volume of distribution at steady state, and clearance and the harmonic mean \u00b1 jackknife pseudo-SD for terminal half-life were 90.4 \u00b1 11.3 mL/kg, 650 \u00b1 14 mL/kg, 3 \u00b1 0.2 mL/min/kg, and 170 \u00b1 21 minutes, respectively. Mean \u00b1 SD systemic availability and harmonic mean \u00b1 jackknife pseudo-SD terminal half-life after oral administrat\u2026", "author" : [ { "dropping-particle" : "", "family" : "Siao", "given" : "Kristine T.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pypendop", "given" : "Bruno H.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ilkiw", "given" : "Jan E.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "American Journal of Veterinary Research", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2010" ] ] }, "title" : "Pharmacokinetics of gabapentin in cats", "type" : "article-journal" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "abstract" : "Introduction Gabapentin has been extensively prescribed off-label for psychiatric indications, with little established evidence of efficacy. Gabapentin and pregabalin, a very similar drug with the same mechanism of action, bind to a subunit of voltage-dependent calcium channels which are implicated in the aetiopathogenesis of bipolar disorder, anxiety and insomnia. This systematic review and meta-analysis aims to collect and critically appraise all the available evidence about the efficacy and tolerability of gabapentin and pregabalin in the treatment of bipolar disorder, insomnia and anxiety.Methods and analysis We will include all randomised controlled trials (RCTs) reported as double-blind and comparing gabapentin or pregabalin with placebo or any other active pharmacological treatment (any preparation, dose, frequency, route of delivery or setting) in patients with bipolar disorder, anxiety or insomnia. For consideration of adverse effects (tolerability), single-blind or open-label RCTs and non-randomised evidence will also be summarised. The main outcomes will be efficacy (measured as dichotomous and continuous outcome) and acceptability (proportion of patients who dropped out of the allocated treatment). Published and unpublished studies will be sought through relevant database searches, trial registries and websites; all reference selection and data extraction will be conducted by at least 2 independent reviewers. We will conduct a random-effects meta-analysis to synthesise all evidence for each outcome. Heterogeneity between studies will be investigated by the I2 statistic. Data from included studies will be entered into a funnel plot for investigation of small-study effects. No subgroup analysis will be undertaken, but we will carry out sensitivity analyses about combination treatment, psychiatric comorbidity, use of rescue medications and fixed versus random-effects model.Ethics and dissemination This review does not require ethical approval. This protocol has been registered on PROSPERO (CRD42016041802). The results of the systematic review will be disseminated via publication in a peer-reviewed journal.", "author" : [ { "dropping-particle" : "", "family" : "Houghton", "given" : "Kerensa T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Forrest", "given" : "Alexandra", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Awad", "given" : "Amine", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Atkinson", "given" : "Lauren Z", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stockton", "given" : "Sarah", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Harrison", "given" : "Paul J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Geddes", "given" : "John R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cipriani", "given" : "Andrea", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "BMJ Open", "id" : "ITEM-2", "issue" : "3", "issued" : { "date-parts" : [ [ "2017", "3", "1" ] ] }, "title" : "Biological rationale and potential clinical use of gabapentin and pregabalin in bipolar disorder, insomnia and anxiety: protocol for a systematic review and meta-analysis", "type" : "article-journal", "volume" : "7" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "14,15", "plainTextFormattedCitation" : "14,15", "previouslyFormattedCitation" : "14,15" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }14,15 Gabapentin is reported to be a safe medication, the suggested initial dosage for analgesia is 3 mg/kg p.o. q24h titrated upwards to 5 – 10 mg/kg PO q8-12h as needed; mild side-effects are reported, including sedation and ataxia.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Plumb", "given" : "Donald C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Plumb's veterinary drug handbook", "edition" : "8th", "editor" : [ { "dropping-particle" : "", "family" : "Plumb", "given" : "Donald C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "415-417", "publisher" : "PharmaVet Inc", "publisher-place" : "Ames, Iowa", "title" : "Gabapentin", "type" : "chapter" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "16", "plainTextFormattedCitation" : "16", "previouslyFormattedCitation" : "16" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }16 Topiramate is a glutamate-modulating anticonvulsant medication with a reportedly complex mechanism of action including blockage of voltage-dependent Na+ channel and potentiation of GABA-A neurotransmission, and inhibition of AMPA and kainate receptor facilitation of Ca2+ influx.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.2147/PRBM.S58601", "ISSN" : "1179-1578", "abstract" : "Glutamate, an excitatory central nervous system neurotransmitter, is emerging as a potential alternative pharmacological treatment when compared to gamma-aminobutyric acid (GABA)-, dopamine-, and serotonin-modulating treatments for neuropsychiatric conditions. The pathophysiology, animal models, and clinical trials of glutamate modulation are explored in disorders with underlying inhibitory deficits (cognitive, motor, behavioral) including obsessive\u2013compulsive disorder, attention deficit hyperactivity disorder, Tourette syndrome, trichotillomania, excoriation disorder, and nail biting. Obsessive\u2013compulsive disorder, attention deficit hyperactivity disorder, and grooming disorders (trichotillomania and excoriation disorder) have emerging positive data, although only scarce controlled trials are available. The evidence is less supportive for the use of glutamate modulators in Tourette syndrome. Glutamate-modulating agents show promise in the treatment of disorders of inhibition. ", "author" : [ { "dropping-particle" : "", "family" : "Grados", "given" : "Marco A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Atkins", "given" : "Elizabeth B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kovacikova", "given" : "Gabriela I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "McVicar", "given" : "Erin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Psychology Research and Behavior Management", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2015", "4", "28" ] ] }, "page" : "115-131", "publisher" : "Dove Medical Press", "title" : "A selective review of glutamate pharmacological therapy in obsessive\u2013compulsive and related disorders", "type" : "article-journal", "volume" : "8" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "17", "plainTextFormattedCitation" : "17", "previouslyFormattedCitation" : "17" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }17 In addition to anticonvulsant properties, there are reports of a potential beneficial effect of topiramate in the treatment of obsessive-compulsive disorders and self-mutilation in humans and idiopathic ulcerative dermatitis in a cat.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.2147/PRBM.S58601", "ISSN" : "1179-1578", "abstract" : "Glutamate, an excitatory central nervous system neurotransmitter, is emerging as a potential alternative pharmacological treatment when compared to gamma-aminobutyric acid (GABA)-, dopamine-, and serotonin-modulating treatments for neuropsychiatric conditions. The pathophysiology, animal models, and clinical trials of glutamate modulation are explored in disorders with underlying inhibitory deficits (cognitive, motor, behavioral) including obsessive\u2013compulsive disorder, attention deficit hyperactivity disorder, Tourette syndrome, trichotillomania, excoriation disorder, and nail biting. Obsessive\u2013compulsive disorder, attention deficit hyperactivity disorder, and grooming disorders (trichotillomania and excoriation disorder) have emerging positive data, although only scarce controlled trials are available. The evidence is less supportive for the use of glutamate modulators in Tourette syndrome. Glutamate-modulating agents show promise in the treatment of disorders of inhibition. ", "author" : [ { "dropping-particle" : "", "family" : "Grados", "given" : "Marco A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Atkins", "given" : "Elizabeth B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kovacikova", "given" : "Gabriela I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "McVicar", "given" : "Erin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Psychology Research and Behavior Management", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2015", "4", "28" ] ] }, "page" : "115-131", "publisher" : "Dove Medical Press", "title" : "A selective review of glutamate pharmacological therapy in obsessive\u2013compulsive and related disorders", "type" : "article-journal", "volume" : "8" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1034/j.1399-5618.2001.030306.x", "ISBN" : "1398-5647", "ISSN" : "1399-5618; 1398-5647", "PMID" : "11465678", "abstract" : "This letter to the editor describes a case of topiramate administration, with an on-off-on design, which was characterized by long-term remission of self-mutilation. The case was a 24-yr-old woman with bipolar-II major depression and borderline personality disorder. The case suggests that topiramate, as ad-on therapy, can be safe and effective in combating self-mutilating behavior. 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Janssen-Cilag, High Wycombe, UK), 5 mg/kg p.o. q12h; this after treatment with gabapentin 10 mg/kg p.o. q12h, pregabalin (Lyrica; Pfizer, New York, USA) 5 mg/kg p.o. q12h and phenobarbital 12.5 mg p.o. q12h for 4 weeks each failed to improve the clinical signs.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/vde.12124", "ISSN" : "09594493", "author" : [ { "dropping-particle" : "", "family" : "Grant", "given" : "David", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rusbridge", "given" : "Clare", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Veterinary Dermatology", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2014", "4", "1" ] ] }, "page" : "n/a-n/a", "title" : "Topiramate in the management of feline idiopathic ulcerative dermatitis in a two-year-old cat", "type" : "article-journal", "volume" : "25" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "12", "plainTextFormattedCitation" : "12", "previouslyFormattedCitation" : "12" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }12 During a 30 months follow up the clinical signs were controlled by topiramate, with the exception of 2 recurrences following 2 attempts to stop this medication; no significant side effects were reported in the cat in this case report, however, sedation and inappetence have been noted in cats treated with topiramate for refractory epilepsy.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/vde.12124", "ISSN" : "09594493", "author" : [ { "dropping-particle" : "", "family" : "Grant", "given" : "David", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rusbridge", "given" : "Clare", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Veterinary Dermatology", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2014", "4", "1" ] ] }, "page" : "n/a-n/a", "title" : "Topiramate in the management of feline idiopathic ulcerative dermatitis in a two-year-old cat", "type" : "article-journal", "volume" : "25" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Plumb", "given" : "Donald C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Plumb's veterinary drug handbook", "edition" : "8th", "editor" : [ { "dropping-particle" : "", "family" : "Plumb", "given" : "Donald C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "415-417", "publisher" : "PharmaVet Inc", "publisher-place" : "Ames, Iowa", "title" : "Gabapentin", "type" : "chapter" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "12,16", "plainTextFormattedCitation" : "12,16", "previouslyFormattedCitation" : "12,16" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }12,16A definitive final diagnosis was not reached in any of the cats in our study, although hypersensitivity dermatitis was suspected in 2 cats. This is consistent with earlier anecdotal reports suggesting that dermatologic diseases may be involved in the pathogenesis of FHS.1, 2 Due to the retrospective nature of this study and the fact that the cats were referred after dermatological conditions were ruled out by the primary veterinarian, specific history and detailed information on the dermatological work up were missing. 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"formattedCitation" : "19", "plainTextFormattedCitation" : "19", "previouslyFormattedCitation" : "19" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }19 Thorough parasite control should be used to eliminate fleas, even in indoor cats.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.1365-3164.2011.01006.x", "ISSN" : "09594493", "author" : [ { "dropping-particle" : "", "family" : "Favrot", "given" : "Claude", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Steffan", "given" : "Jean", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Seewald", "given" : "Wolfgang", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hobi", "given" : "Stefan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Linek", 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"issued" : { "date-parts" : [ [ "2012", "2", "1" ] ] }, "page" : "45-e11", "publisher" : "Blackwell Publishing Ltd", "title" : "Establishment of diagnostic criteria for feline nonflea-induced hypersensitivity dermatitis", "type" : "article-journal", "volume" : "23" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "20", "plainTextFormattedCitation" : "20", "previouslyFormattedCitation" : "20" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }20 Drugs with known efficacy in feline hypersensitivity disorders include prednisolone or methylprednisolone (1-2mg/kg p.o. q24h to remission and taper), ciclosporin (Atopica Cat?, Elanco Animal Health, Basel, Switzerland; 7mg/kg p.o.q24h to remission and taper) and oclacitinib (Apoquel?, Zoetis, Parsippany, NJ, USA; 0.6-1.0mg/kg p.o. q12h to remission and then q24h).ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.1365-3164.2012.01086.x", "ISSN" : "09594493", "author" : [ { 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"plainTextFormattedCitation" : "13", "previouslyFormattedCitation" : "13" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }13 There is little information available on the potential immunosuppressive effects of oclaticinb in cats, Ortalda et al. treated 12 cats with hypersensitivity dermatitis (>12 months of age and > 3kg body weight) for 28 days and did not observe any adverse effects, however, they selected cats with negative feline immunodeficiency virus and feline leukaemia virus status and without exposure to raw meat to reduce the risk of toxoplasmosis.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/vde.12218", "ISSN" : "09594493", "author" : [ { "dropping-particle" : "", "family" : "Ortalda", "given" : "Christian", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Noli", "given" : "Chiara", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { 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mg/kg p.o. q12h.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/vde.12218", "ISSN" : "09594493", "author" : [ { "dropping-particle" : "", "family" : "Ortalda", "given" : "Christian", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Noli", "given" : "Chiara", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Colombo", "given" : "Silvia", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Borio", "given" : "Stefano", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Veterinary Dermatology", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2015", "8", "1" ] ] }, "page" : "235-e52", "title" : "Oclacitinib in feline nonflea-, nonfood-induced hypersensitivity dermatitis: results of a small prospective pilot study of client-owned cats", "type" : "article-journal", "volume" : "26" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "13", "plainTextFormattedCitation" : "13", "previouslyFormattedCitation" : "13" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }13Therapeutic trials with corticosteroids, ciclosporin or oclacitinib may help eliminate cats with hypersensitivity dermatitis and/or control itch and inflammation where this is a component of FHS (see Figure 2). Similarly, we do not have access to information that will allow us to rule out the possibility of a behavioural problem, even in cases in which a prior behavioural problem was suspected (see case 3 in Table1). Ideally, cases of FHS should be referred to a specialist in behaviour, when this is not possible, a detailed behavioural history should be collected to identify factors predisposing to anxiety, fear, over-attachment to owner, such as adoption from humane shelter, arrival of new pets in the house and multi-cat household tension (see figure 2). Then, if a behavioural disorder is suspected, attempts to reduce detrimental physiological stress and optimise the emotional state, physical and social environment should be made prior to or in conjunction with therapeutic trials with tricyclic antidepressants (TCAs) such as clomipramine or amitriptyline (the recommended dosage for both medications is 0.5 to 1.0 mg/kg p.o. q24h and should be gradually increased and gradually discontinued), or selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (0.5 to 2.0 mg/kg p.o. q24h dosages should be gradually increased and gradually discontinued). ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Plumb", "given" : "Donald C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Plumb's veterinary drug handbook", "edition" : "8th", "editor" : [ { "dropping-particle" : "", "family" : "Plumb", "given" : "Donald C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "415-417", "publisher" : "PharmaVet Inc", "publisher-place" : "Ames, Iowa", "title" : "Gabapentin", "type" : "chapter" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "ISSN" : "1940-8307", "author" : [ { "dropping-particle" : "", "family" : "Ciribassi", "given" : "John", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Compendium continuing education for veterinarians.", "id" : "ITEM-2", "issue" : "3", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "116-121", "publisher" : "Veterinary Learning Systems", "publisher-place" : "Yardley, PA :", "title" : "Feline Hyperesthesia Syndrome", "type" : "article-journal", "volume" : "31" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "3,16", "plainTextFormattedCitation" : "3,16", "previouslyFormattedCitation" : "3,16" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }3,16 The main side effects of TCAs in cats are sedation, diarrhoea, anticholinergic effects (e.g. dry mouth, mydriasis, urine retention, constipation). ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Plumb", "given" : "Donald C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Plumb's veterinary drug handbook", "edition" : "8th", "editor" : [ { "dropping-particle" : "", "family" : "Plumb", "given" : "Donald C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "415-417", "publisher" : "PharmaVet Inc", "publisher-place" : "Ames, Iowa", "title" : "Gabapentin", "type" : "chapter" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "ISSN" : "1940-8307", "author" : [ { "dropping-particle" : "", "family" : "Ciribassi", "given" : "John", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Compendium continuing education for veterinarians.", "id" : "ITEM-2", "issue" : "3", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "116-121", "publisher" : "Veterinary Learning Systems", "publisher-place" : "Yardley, PA :", "title" : "Feline Hyperesthesia Syndrome", "type" : "article-journal", "volume" : "31" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "3,16", "plainTextFormattedCitation" : "3,16", "previouslyFormattedCitation" : "3,16" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }3,16 Potentiation of arrhythmias (due to the anticholinergic effects) in predisposed patients, lowering of seizure threshold and elevation of liver enzymes may also occur, some clinicians recommend measuring liver enzymes prior to therapy, one month after initial therapy, and yearly, thereafter.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Plumb", "given" : "Donald C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Plumb's veterinary drug 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"formattedCitation" : "3,16", "plainTextFormattedCitation" : "3,16", "previouslyFormattedCitation" : "3,16" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }3,16 TCAs should be used with caution in association with other CNS depressants such as SSRIs and antiepileptic medications.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Plumb", "given" : "Donald C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Plumb's veterinary drug handbook", "edition" : "8th", "editor" : [ { "dropping-particle" : "", "family" : "Plumb", "given" : "Donald C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "415-417", "publisher" : "PharmaVet Inc", "publisher-place" : "Ames, Iowa", "title" : "Gabapentin", "type" : "chapter" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "16", "plainTextFormattedCitation" : "16", "previouslyFormattedCitation" : "16" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }16 Clomipramine is licensed for the treatment of compulsive and anxiety disorders of dogs and cats in various countries (including USA and UK), it is the most selective inhibitor of serotonin uptake of all of the TCAs with similar indications and application of SSRIs and is preferred to other TCAs such as amitriptyline for the better anti-compulsive action and palatability (Figure 2).ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "ISBN" : "9780702043352", "author" : [ { "dropping-particle" : "", "family" : "Landsberg", "given" : "Gary M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Landsberg", "given" : "Gary M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "edition" : "Third edition..", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2013" ] ] }, "publisher" : "Saunders Elsevier", "publisher-place" : "Edinburgh", "title" : "Behavior problems of the dog and cat", "type" : "book" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "22", "plainTextFormattedCitation" : "22" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }22 SSRIs, such as fluoxetine, have been advocated for the treatment of urine spraying and compulsive disorders of cats, the onset of action for SSRIs is similar to the TCAs with onset of effect 3-4 weeks from the commencement of treatment, however, for the treatment of compulsive disorders the effect may not be seen for as long as 8 weeks.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/B978-0-7020-2767-3.50017-8", "ISBN" : "9780702027673", "author" : [ { "dropping-particle" : "", "family" : "Bowen", "given" : "Jon", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Heath", "given" : "Sarah", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bowen", "given" : "Jon", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Heath", "given" : "Sarah", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Behaviour Problems in Small Animals", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2005" ] ] }, "page" : "177-184", "publisher" : "Elsevier", "title" : "Feline compulsive disorders", "type" : "chapter" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "23", "plainTextFormattedCitation" : "23", "previouslyFormattedCitation" : "23" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }23 The exact time for improvement could not be evaluated in our study and it is possible that the short duration of treatment may have affected the outcome of treatment with fluoxetine in case 4, see table 1. SSRIs inhibit the function of the liver cytochrome P450 enzymes, therefore, caution should be used when administered concurrently with other medications that rely on these enzymes for their metabolism, in particular phenobarbital, benzodiazepines, and TCAs. ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Plumb", "given" : "Donald C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Plumb's veterinary drug handbook", "edition" : "8th", "editor" : [ { "dropping-particle" : "", "family" : "Plumb", "given" : "Donald C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "415-417", "publisher" : "PharmaVet Inc", "publisher-place" : "Ames, Iowa", "title" : "Gabapentin", "type" : "chapter" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "ISSN" : "1940-8307", "author" : [ { "dropping-particle" : "", "family" : "Ciribassi", "given" : "John", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Compendium continuing education for veterinarians.", "id" : "ITEM-2", "issue" : "3", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "116-121", "publisher" : "Veterinary Learning Systems", "publisher-place" : "Yardley, PA :", "title" : "Feline Hyperesthesia Syndrome", "type" : "article-journal", "volume" : "31" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "3,16", "plainTextFormattedCitation" : "3,16", "previouslyFormattedCitation" : "3,16" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }3,16 SSRIs should not be used in combination with each other or with other drugs that increase serotonin levels, such as TCAs. ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Plumb", "given" : "Donald C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Plumb's veterinary drug handbook", "edition" : "8th", "editor" : [ { "dropping-particle" : "", "family" : "Plumb", "given" : "Donald C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "415-417", "publisher" : "PharmaVet Inc", "publisher-place" : "Ames, Iowa", "title" : "Gabapentin", "type" : "chapter" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "ISSN" : "1940-8307", "author" : [ { "dropping-particle" : "", "family" : "Ciribassi", "given" : "John", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Compendium continuing education for veterinarians.", "id" : "ITEM-2", "issue" : "3", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "116-121", "publisher" : "Veterinary Learning Systems", "publisher-place" : "Yardley, PA :", "title" : "Feline Hyperesthesia Syndrome", "type" : "article-journal", "volume" : "31" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "3,16", "plainTextFormattedCitation" : "3,16", "previouslyFormattedCitation" : "3,16" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }3,16 The main side effects of SSRIs in cats are behaviour changes (anxiety, irritability, and sleep disturbances), anorexia, diarrhoea and changes in elimination patterns. ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "author" : [ { "dropping-particle" : "", "family" : "Plumb", "given" : "Donald C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Plumb's veterinary drug handbook", "edition" : "8th", "editor" : [ { "dropping-particle" : "", "family" : "Plumb", "given" : "Donald C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "415-417", "publisher" : "PharmaVet Inc", "publisher-place" : "Ames, Iowa", "title" : "Gabapentin", "type" : "chapter" }, "uris" : [ "" ] }, { "id" : "ITEM-2", "itemData" : { "ISSN" : "1940-8307", "author" : [ { "dropping-particle" : "", "family" : "Ciribassi", "given" : "John", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Compendium continuing education for veterinarians.", "id" : "ITEM-2", "issue" : "3", "issued" : { "date-parts" : [ [ "2009" ] ] }, "page" : "116-121", "publisher" : "Veterinary Learning Systems", "publisher-place" : "Yardley, PA :", "title" : "Feline Hyperesthesia Syndrome", "type" : "article-journal", "volume" : "31" }, "uris" : [ "" ] } ], "mendeley" : { "formattedCitation" : "3,16", "plainTextFormattedCitation" : "3,16", "previouslyFormattedCitation" : "3,16" }, "properties" : { "noteIndex" : 0 }, "schema" : "" }3,16 Another limitation of this study, in addition to its retrospective nature and limited number of cases, is that none of the cats had a complete assessment and diagnostic work up performed by specialists in behaviour, dermatology and neurology. Referral to a clinical behaviourist was strongly recommended for 4 cats and referral to a dermatologist was recommended for the other 3 cats; in 4 cases the owners declined a tertiary referral due to financial limitations and 3 cats were lost to the follow up. This highlights the need for a systematic and comprehensive approach to the diagnosis of FHS. ConclusionsIn this study we retrospectively collected and analysed information on 7 cats with clinical signs of FHS including self-trauma to the tail. A definitive diagnosis for this complex constellation of clinical signs is still elusive and it is difficult to draw conclusions regarding the ideal therapy. Based on the information derived from this study and review of the available literature we formulated a diagnostic and treatment pathway for FHS and created a flow diagram for easy interpretation (Figure 2). This diagnostic pathway needs to be validated by its application on a larger number of cases, but it is the first step toward a standardised approach to this condition and forms the basis for prospective studies.ReferencesADDIN Mendeley Bibliography CSL_BIBLIOGRAPHY 1. Tuttle J. Feline hyperesthesia syndrome. J Am Vet Med Assoc. 1980;176(1):47.2. Mu?ana KR. Feline Hyperesthesia Syndrome. In: Tilley LP, Smith FWK, eds. Blackwell’s Five-Minute Veterinary Consult: Canine and Feline. 6th ed. Ames, IA: John Wiley & Sons; 2016:497.3. Ciribassi J. Feline Hyperesthesia Syndrome. Compend Contin Educ Vet. 2009;31(3):116-121.4. Shell, L G, Katherman, A E, Morgan R. Feline Hyperesthesia Syndrome. Veterinary Information Newtwork. . Accessed November 17, 2017.5. Chrisman Cheryl L. Feline Hyperesthesia Syndrome. In: 112th IN VMA Conf Proc. ; 1996.6. Mathews KA. Neuropathic Pain in Dogs and Cats: If Only They Could Tell Us If They Hurt. Vet Clin North Am Small Anim Pract. 2008;38(6):1365-1414. doi:. Simons MC, Ben-Amotz R, Popovitch C. Post-operative complications and owner satisfaction following partial caudectomies: 22 cases (2008 to 2013). J Small Anim Pract. 2014;55(10):509-514. doi:10.1111/jsap.12257.8. Marinova* Z, Fineberg D-MC and N. Glutamate-Modulating Drugs as a Potential Therapeutic Strategy in Obsessive-Compulsive Disorder. Curr Neuropharmacol. 2017;15(7):977-995. doi:. Shell LG. Feline Hyperesthesia Syndrome. FELINE Pract. 1994;22(6):10.10. Pakozdy A, Halasz P, Klang A. Epilepsy in Cats: Theory and Practice. J Vet Intern Med. 2014;28(2):255-263. doi:10.1111/jvim.12297.11. LaMotte RH. Allodynia and Alloknesis. In: Schmidt RF, Willis WD, eds. Encyclopedia of Pain. Berlin, Heidelberg: Springer Berlin Heidelberg; 2007:52-55. doi:10.1007/978-3-540-29805-2_154.12. Grant D, Rusbridge C. Topiramate in the management of feline idiopathic ulcerative dermatitis in a two-year-old cat. Vet Dermatol. 2014;25(3):n/a-n/a. doi:10.1111/vde.12124.13. Ortalda C, Noli C, Colombo S, Borio S. Oclacitinib in feline nonflea-, nonfood-induced hypersensitivity dermatitis: results of a small prospective pilot study of client-owned cats. Vet Dermatol. 2015;26(4):235-e52. doi:10.1111/vde.12218.14. Siao KT, Pypendop BH, Ilkiw JE. Pharmacokinetics of gabapentin in cats. Am J Vet Res. 2010. doi:10.2460/ajvr.71.7.817.15. Houghton KT, Forrest A, Awad A, et al. Biological rationale and potential clinical use of gabapentin and pregabalin in bipolar disorder, insomnia and anxiety: protocol for a systematic review and meta-analysis. BMJ Open. 2017;7(3). . Plumb DC. Gabapentin. In: Plumb DC, ed. Plumb’s Veterinary Drug Handbook. 8th ed. Ames, Iowa: PharmaVet Inc; 2015:415-417.17. Grados MA, Atkins EB, Kovacikova GI, McVicar E. A selective review of glutamate pharmacological therapy in obsessive–compulsive and related disorders. Psychol Res Behav Manag. 2015;8:115-131. doi:10.2147/PRBM.S58601.18. Cassano P, Lattanzi L, Pini S, Dell’Osso L, Battistini G, Cassano GB. Topiramate for self-mutilation in a patient with borderline personality disorder. Bipolar Disord. 2001. doi:10.1034/j.1399-5618.2001.030306.x.19. Hobi S, Linek M, Marignac G, et al. Clinical characteristics and causes of pruritus in cats: a multicentre study on feline hypersensitivity-associated dermatoses. Vet Dermatol. 2011;22(5):406-413. doi:10.1111/j.1365-3164.2011.00962.x.20. Favrot C, Steffan J, Seewald W, et al. Establishment of diagnostic criteria for feline nonflea-induced hypersensitivity dermatitis. Vet Dermatol. 2012;23(1):45-e11. doi:10.1111/j.1365-3164.2011.01006.x.21. King S, Favrot C, Messinger L, et al. A randomized double-blinded placebo-controlled study to evaluate an effective ciclosporin dose for the treatment of feline hypersensitivity dermatitis. Vet Dermatol. 2012;23(5):440-e84. doi:10.1111/j.1365-3164.2012.01086.x.22. Landsberg GM, Landsberg GM. Behavior Problems of the Dog and Cat. Third edition.. Edinburgh: Saunders Elsevier; 2013:130..23. Bowen J, Heath S, Bowen J, Heath S. Feline compulsive disorders. In: Behaviour Problems in Small Animals. Elsevier; 2005:177-184. doi:10.1016/B978-0-7020-2767-3.50017-8.Supplementary MaterialVideo 1 – An episode of tail chasing and vocalisation in one of the affected cats (cat 2 in Table 1) LegendsTable 1 - Signalment, clinical signs, treatment and follow up in 7 cats with FHS with tail mutilation. DSH = domestic shorthair; FS = female spayed; ME= male entire; MN = male neutered; NA = not available; AT = attacking or over-grooming the tail, flank, lumbar or perineal area; LH = lumbar hyperaesthesia (skin rippling and/or muscle spasms); M = mutilation of the tail; ST = soft tissue damage; V = vocalisation. CBC = complete blood count; EMG = electromyogram. Frequency of episodes or self-trauma and vocalisation: +++ daily, ++ weekly, + monthly or occasional.Figure 1 – Self-mutilation of the tail in one of the affected cats (cat 6 in Table 1)Figure 2 – Flow diagram of proposed diagnostic and treatment pathways for FHS. CBC = complete blood count; UA = urinalysis; EMG = electromyogram. Original work. ................
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