Felis ISSN 2398-2950

Feline hyperesthesia

Synonym(s): Rolling skin syndrome, Rippling skin syndrome, Twitchy cat disease/syndrome, Atypical neurodermatitis

Contributor(s): Karen Overall

Introduction

  • Feline hyperesthesia syndrome has been variously called rolling skin syndrome, neuritis, twitchy cat disease, and atypical neurodermatitis (Shell, 1994).
  • Syndromes are collections of related non-specific signs that may co-occur, but may have underlying etiologies and may not represent a singular diagnosis.
  •  The behaviors demonstrated in feline hyperesthesia include:
    • Those mimicking estrus (eg rolling).
    • Biting at the tail, flank, anal, or lumbar areas, generally with barbering and/or self-mutilation.
    • Skin rippling and muscle spasms or twitching (usually dorsally) often accompanied by vocalization, running/jumping (possibly escape behaviors), hallucinations, and self-directed aggression (ritualistic motor behavior).
      There is little published information on feline hyperesthesia and behaviorists may have differing opinions on the syndrome.

Pathogenesis

Etiology

  • Genetic liability.
  • Social and environmental stressors (eg new additions to household, alterations in schedules, moving house).
  • Anxiety-related conditions are notoriously heterogeneous and vary depending on duration of condition (which likely alters neurochemical pathology) and brain regions recruited. Progress is being made in the rodent and human literatures through investigations into effects of sensory stimulation.
  • Processing and extent of sensory stimulation and/or its perception is key.
    • Arousal is associated with a cutaneous response generated by types 1 and 2 slow-adapting (SA) epidermal units.
    • Rate of discharge that is proportional to the amount of displacement of the hair or the indentation of the skin in cats.
    • Interactions of SA  units with rapid-adapting (RA) units in the vibrissae around the face, lips, mouth, and guard hairs to generate the classic biting response that follows vibrissae stimulation in predatory situations.
    • Feline body and head posture affect mediation of responses through descending spinal tracts and may augment the duration and intensity of extensor activity.
    • Cutaneous and proprioceptive feedback interacts to program the relative timing of flexor and extensor activity. In the fulminant form these bouts resemble the classic chewing/aggression mediated by the ventromedial hypothalamus/amygdala.
    • Cholecystokinin B (CCK-B) (central brain) receptors are involved in the firing of feline jaw musculature and so may affect the form of some of these behaviors that involve licking or biting.
    • Anxiety, pain and pruritus are related at both the central level and at the level of the dorsal horn of the spinal ganglion Itch and pain: overlap and interaction of pathways .

Predisposing factors

General

  • Injury.
  • Pruritic conditions.
  • Atopic conditions.
  • Non-specific anxiety.
  • External reinforcement from owner.
  • Anxiety, which can be external or internal, is broadly defined as the apprehensive anticipation of future danger accompanied by somatic symptoms of tension (vigilance and scanning, autonomic hyperactivity, increased motor activity and tension).
    • For anxiety to be pathological it must be exhibited out-of-context, or in a degree or form that would be sufficient to accomplish an ostensible goal.

Specific

Pathophysiology

  • Etiology is complex but doubtless involves numerous serotonin receptors.
    • There is now considerable evidence that nociception and anxiety affect the same serotonin receptors, especially the 5-HT1A and 5-HT2A, which is particularly important for peripheral nociception (Lanfumey et al, 2008).
    • Itch and pain also share peripheral and central pathways (Schmetz, 2010; Patel and Dong, 2010).
    • Sensitization of a stimulus response to pain or itch is possible at both the peripheral and central level and may involve endorphins, cytokines, histamine, nerve growth factor and other receptors/neurotransmitters already discussed.
  • There is virtually no research on feline hyperesthesia so the extent to which social and environmental change and associated anxiety v. endogenous factors contribute to anxiety is unknown.
  • In its full-blown form, feline hyperesthesia meets the diagnostic criteria for obsessive-compulsive disorder/compulsive disorder (OCD/CD) (repetitive, stereotypic motor, locomotory, grooming, ingestive, or hallucinogenic behaviors that occur out-of-context to their normal occurrence, or in a frequency or duration that isin excess of that required to accomplish the ostensible goal).
    • When this occurs clients report that their cat is extremely focused in his response to the rippling and that it can be impossible to distract him from it. The behavior may cease only when the cat is exhausted, when physically prevented from responding (eg wrapped in a blanket) or disrupted by a profound (and often startling) sensory change (eg being scooped up and put unceremoniously outside).
  • Cats have an atypical response to arousal, in general, when their hypothalamus is stimulated.
    • Cats isolated from other cats for most of the first year of life exhibit a response characterized by galvanic skin responses and disruption of regular sleep rhythms.
    • Excitation of the ventromedial hypothalamus (VMH) and amygdala leads to a defensive response in cats.
    • Stimulation of the lateral amygdala facilitates predatory attack and defensiveness in cats, but stimulation of the lateral amygdala using high intensity also recruits the ventral hippocampus in these behaviors, providing a partial explanation for why repetition is so problematic. The hippocampus plays a major role in associational learning.

Timecourse

  • Variable.
  • Early on in the development of the condition the cat can be interrupted from the behavioral responses. As the condition progresses, interruption may not be possible and attempts to do so may be met with frank aggression.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Patel K N, Dong X (2010) An itch to be scratched. Neuron 68 (3), 334-339 PubMed
  • Schmelz M (2010) Itch and Pain. Neurosci Biobehav Rev 34 (2), 171-176 PubMed.
  • Lanfumey L, Mongeau R, Cohen-Salmon C et al (2008) Corticosteroid-serotonin interactions in the neurobiological mechanisms of stress-related disorders. Neurosci Biobehav Rev 32 (6), 1174-1184 PubMed.
  • Hart B L, Cliff K D, Tynes V V et al (2005) Control of urine making by use of long-term treatment with fluoxetine or clomipramine in cats. J Am Vet Med Assoc 226 (3), 378-382 PubMed.
  • Ciribassi J, Luescher A, Pasloske K S et al (2003) Comparative bioavailability of fluoxetine after transdermal and oral administration to healthy cats. Am J Vet Res 64 (8), 994-998 PubMed.
  • Overall K L, Dunham A E (2002) Clinical features and outcome in dogs and cats with obsessive-compulsive disorder: 126 cases (1989-2000). J Am Vet Med Assoc 221 (10), 1445-1452 PubMed.
  • Seksel K, Lindemann M J (1998) Use of clompipramine in the treatment of anxiety-related and obsessive-compulsive disorders in cats. Aust Vet J 76 (5), 317-321 PubMed.
  • Shell L G (1994) Feline hyperesthesia syndrome. Feline Pract 22 (6), 10 VetMedResource.

Other sources of information

  • There are numerous papers in the veterinary literature, especially that pertaining to dermatology.
  • Overall K L (2012) Manual of Clinical Behavioural Medicine for Dogs and Cats. Elsevier.
  • Rang H P, Dale M M, Ritter J M, Flower R J, Henderson G (2012) Analgesic drugs. In: Rang and Dales Pharmacology. Seventh Edition. pp.503-524.
  • Ciribasi J (2009) Understanding behavior: feline hyperesthesia syndrome. Compend Contin Educ Vet 31 (3), E10 PubMed.
  • Mellor D J, Cook C J, Stafford K J (2000) Quantifying some responses to pain as a stressor. In: The biology of animal stress the principles and implications for animal welfare. Edited by Moberg G P and Mech J A, CABI Publishing, Wallingford, pp171-198.
  • Overall K L (1997) Clinical Behavioural Medicine for Small Animals, Mosby. Source for many of the original references pertaining to the neurobiology of feline biting.


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