Feline Hyperesthesia Syndrome
Feline Hyperesthesia Syndrome (FHS) describes episodes in which a cat obsessively licks, scratches, or chews at themselves in response to a person or another animal touching them or spontaneously in severely affected cats. Signs may include excessive grooming of the lower back, skin along the back rippling or rolling, and aggression. FHS treatment involves behavioral and environmental modification, but medication may be required for more severe cases.
If your cat has ever swatted your hand away in response to your well-meaning belly rubs, that’s just her natural way of saying she has had enough. But if your cat suddenly attacks your hand after you scratch her lower back, that can be a sign of Feline Hyperesthesia Syndrome (FHS).
Let’s take a closer look at what causes this syndrome in cats, signs to watch for, and how to treat it.
What is Feline Hyperesthesia Syndrome?
“Hyperesthesia” means an increase in sensitivity. When a stimulus that does not normally cause pain is perceived as painful, this is referred to as “allodynia.” This term may more precisely describe Feline Hyperesthesia Syndrome.
FHS is also known by many other descriptive terms: rolling skin disease, rolling skin syndrome, apparent neuritis, atypical neurodermatitis, psychomotor epilepsy, and twitchy cat disease. No matter the name, it describes episodes in which a cat obsessively licks, scratches, or chews at herself. Sometimes this is in response to a person or another animal touching the cat. In more severely affected cats, these episodes can occur spontaneously.
FHS in cats can emerge anytime during adulthood but most often appears between the time of physical maturity and 1 year of age.
Feline Hyperesthesia Syndrome Causes
The cause of FHS in cats is not well understood. Some veterinary researchers speculate it is a behavioral disorder along the lines of Obsessive Compulsive Disorder (OCD) that leads to excessive grooming. Others suggest it is related to seizure disorders or due to injury. The true cause is likely multifactorial, meaning cats have multiple risk factors before becoming clinically affected by the syndrome. Part of the confusion is due to the variability in response to treatments. Some cats respond best to anxiety medications, while others respond better to pain and seizure control medication. Other cats may require both types of medication.
Certain breeds, such as Abyssinian, Burmese, Persian, and Himalayan cats, are at higher risk for developing FHS. This means there is likely at least some heritable genetic component to the syndrome.
Signs of Feline Hyperesthesia Syndrome
Feline Hyperesthesia Syndrome occurs in short episodes and usually involves the area right in front of a cat’s tail (lumbar spine). These episodes may last only 1 to 2 minutes. During an episode, signs of FHS in cats may include:
- Excessive grooming, especially of the lower back
- Skin along the back rippling or rolling
- Tail chasing
- Dilated pupils
Cats may attack their own tails or lower back, or they may take out their aggression on nearby people or animals.
Episodes of FHS are transient, meaning the cat can be normal and feel comfortable most of the time and then suddenly have a moment of pain. This is especially noticeable if you are petting or playing with your cat when the episode occurs. The frequency of episodes varies, as does the severity of hyperesthesia. Episodes can occur rarely (once a month) or very frequently (multiple times per day).
Diagnosing Hyperesthesia Syndrome in Cats
There is no single test for FHS. To diagnose Feline Hyperesthesia Syndrome, your veterinarian will need to rule out other possible causes of your cat’s symptoms first. Skin irritation, such as from fleas, skin allergies, dry skin, or skin infection, can cause similar signs in cats. Spinal problems, such as arthritis, injury, disc herniation, and cancer, can also present as similar episodes of pain.
In addition to a thorough physical exam, your veterinarian will conduct complete orthopedic and neurological exams to diagnose FHS in cats. Your veterinarian may also recommend diagnostic testing, such as:
Blood work and urinalysis. These will be used to evaluate your cat for a metabolic or endocrine cause of symptoms.
Radiographs. X-rays of your cat’s spine and tail will help determine whether there is a specific cause of the episodes.
MRI. An MRI (magnetic resonance image) enables a veterinarian to evaluate the physical health of the muscles and ligaments around your cat’s spine, spinal cord, and close details of the vertebral bones of the spine. This is the gold standard of evaluation for FHS.
Depending on the presentation of your cat’s symptoms, a consultation with a veterinary behaviorist may be helpful as well.
How to Treat Feline Hyperesthesia Syndrome
There is no cure for FHS in cats. If episodes can be avoided by not touching your cat in a particular location on her body, avoidance of the area is a more appropriate treatment than medicine. Similarly, if the cat’s symptoms are mild and she only grooms intently for a short moment, no medication is needed. However, if episodes of Feline Hyperesthesia Syndrome cause your cat to potentially hurt herself or others, then medication is required.
The first part of treatment of FHS is behavioral and environmental modification. This is aimed at reducing stress, anxiety, and triggers your cat has for FHS. Supplements such as coenzymes, omega-3 fatty acids, and a prescription skin support diet may also reduce the frequency and severity of FHS in cats.
For mild to moderate cases of FHS in cats, a medication called gabapentin can be very helpful in reducing the severity and/or frequency of episodes. Gabapentin reduces nerve pain and can also be helpful in reducing seizures, which may be related to FHS. Gabapentin is also useful to reduce stress in cats. For some cats, FHS is better managed with anti-anxiety medication, such as fluoxetine (Prozac) or Clomipramine. Gabapentin and fluoxetine both cost approximately $10-$30/month.
Cats with severe FHS may require multiple medications as well as periodic epidural injections (injections into the spinal column) with pain medication and steroids, costing about $100 each.
While the prognosis for FHS in cats is generally good and the syndrome can be well-managed with medication, some cats who suffer from severe cases may self-mutilate, or injure themselves, worsening pain and causing infection. Some may also become very aggressive, especially when another animal or a person touches them. These are indicators of a poor prognosis due to poor welfare for the cat.
How to Prevent Feline Hyperesthesia Syndrome
FHS in cats cannot be prevented. You can reduce the frequency or severity of episodes by reducing your cat’s anxiety and stress. Some important considerations are effective flea control (to reduce itching), regular brushing and grooming to keep your cat’s coat healthy, and stopping interacting with your cat if she shows any signs of stress.
Since there may be a strong behavioral component to FHS, providing a safe, comfortable home with plenty of regular exercise and interaction may reduce your cat’s risk.
- Obsessive compulsive disorder