Q: My aunt’s cat Maya, that we believe is 10 years old, was recently diagnosed with Feline Hyperesthesia Syndrome. She adores Maya but doesn't know whether to seek a specialist’s help, continue to live with the cat as normal but avoid touching her very sensitive back or put the cat to sleep. Maya constantly bites her back and tears the fur out, without drawing blood. As long as we have had Maya, her back has always had ripples, but we never thought it would become something so dangerous to her health. What course of action is in Maya's best interest?
A: Feline Hyperesthesia Syndrome (FHS) (also called “rolling skin syndrome”) is a condition that usually appears in cats between the ages of 1 and 4. Siamese and other Asian breeds have a higher prevalence of this syndrome.
Clinical signs of FHS include sudden bouts of hyperactive (sometimes aggressive) behavior, frantic grooming around the tail or flank, an obsession or fixation with the tail (including occasionally viciously attacking the tail), rippling or rolling of the skin (hence the name “rolling skin syndrome”), dilated pupils with a strange look to the eyes, extreme sensitivity to touch along the spine (sometimes, petting or scratching the cat along the spine can trigger the bizarre behavior), sudden mood swings and loud crying or meowing. Cats can show any or all of the behaviors described above.
No one knows exactly what causes FHS, but there are a few possible explanations. It may be a type of seizure activity, and the fact that some affected cats respond to anti-convulsant medication seems to support this explanation. Another possibility is that this is a form of obsessive-compulsive disorder, with the obsession being that of self-directed grooming. The fact that many cats respond to anti-obsessional medications is in support of this argument. Some people feel that it is caused by a combination of the two. There may be an inherited tendency toward FHS, given that certain Asian breeds are more susceptible to FHS.
There is no test to diagnose FHS. A diagnosis of FHS is made after other causes of the clinical signs are excluded by diagnostic tests, and by a positive response to treatment. Blood tests and other diagnostic tests will likely be necessary to rule out medical causes that may be confused with FHS, including hyperthyroidism, parasitic skin infections, skin allergies, etc.
Effective anti-obsessional drugs include clomipramine (clomicalm) and fluoxetine (Prozac). Be aware that it might take 3 or 4 weeks for an initial response to the drug. By 16 weeks, the full effect of the drug should be known. When anti-obsessional therapy is ineffective or only marginally effective, try anti-convulsants. The first drug to try in cats is usually Phenobarbital. With appropriate environmental and pharmacologic treatment, affected cats often can be rehabilitated and lead normal lives.
Regards,
Arnold Plotnick, DVM