Feline Hyperesthesia Syndrome with self-trauma to the tail: retrospective study of 7 cases and proposal for integrated multidisciplinary diagnostic approach

Case 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.