Paroxysmal Disorders

Question 1

What are paroxysmal disorders?

Answer 1

constellation of conditions whose common clincial denominator is the association with episodic, transient, and generally self limiting abnormalities in behavior, movement, or consciousness in an animal that appears normal in between episodes

Question 2

What is a paroxysm?

Answer 2

A sudden recurrence, outburst, or intensification of symptoms

Question 3

What is the most important step in classifying a paroyxsmal disorder?

Answer 3

Obtaining a thorough history from someone that witnessed the event

Question 4

Paroxysmal disorders can result from _ or _ etiologies

Answer 4

epileptogenic or nonepileptogenic

Question 5

Non-epileptogenic causes can result from what diseases?

Answer 5

neurological or cardiovascular

Question 6

What are some examples of neurologic non-epileptogenic etiologies

Answer 6

narcolepsy, cataplexy, movement disorders, neuromuscular weakness, behavioral stereotypes

Question 7

What is an example of a cardiovascular nonepileptogenic etiology

Answer 7

syncope

Question 8

What are examples of epiletpgenic causes

Answer 8

idopathic/ genetic, structural, or unknown epilepsides

Question 9

What is narcolepsy/ cataplexya

Answer 9

rare disease affecting the neuronal circuit in brain that regulates the sleep/wake cycle. Specifically involves abnormalities of the hypocretin/orexin neurotransmitter.

Question 10

Narcolepsy can be inherited or genetic, what is this caused by?

Answer 10

a mutation in the HCRTR2 gene resulting in abnormality hypocrin/orexin receptors in the brain
-this is autosomal recessive in dobermans, dachunds and lab retrievers

Question 11

The acquired form of narcolepsy occurs due to?

Answer 11

hypocretin/orexin deficiency in the brain , affects older animals

Question 12

What are the CS of narcolepsy?

Answer 12

cataplectic attacks are the primary manifestation of the disease. Sudden and complete atonia causing collapse lasting several seconds to minutes

Question 13

What are cataplexy triggers?

Answer 13

feeding, excitement/stress, concurrent disease

Question 14

Do the animals remain conscious during a narcoleptic attack?

Answer 14

Yes, particullary at the beginning . Episode can usually be interrupted with petting or interacting with the animal

Question 15

How quickly do animasl recover from a narcoleptic episode?

Answer 15

quickly. can experience dozens of episodes throughout the day

Question 16

How do we diagnose narcolepsy?

Answer 16

Uusually based on CS +/- a genetic test where applicable.
-episodes can be induced using food induced cataplexy test or pharmacologically induced with physotiigimine.

Question 17

What does an EEG show during a cataplexy or narcolepsy episode?

Answer 17

low amplitude, fast waves consistnet with paradoxial sleep

Question 18

How can we test for the acquired form of narcolepsy?

Answer 18

Genetic testing for the HCRTR2 mutation or measurement of CSF hypocretin/orexin concentrations

Question 19

How do we treat narcolepsy?

Answer 19

Imaprimaine, clomipramine, yohimbine
-treatment of excessive sleepiness can be done with stimulants
-some cases of acquired can have resolution if the stimulus disappears

Question 20

Describe behavioral disorders that are characterized as episodic stereotypies

Answer 20

-aggression or compulsive disorder
-many manifest as continous rhythmic pacing, oral facial autism (lip smacking) or tail chasing

Question 21

How are animals in between behavioral episodes?

Answer 21

usually normal
-there is no alteration in consciousness or muscular tone during these episodes but there is usually an identifiable trigger

Question 22

what are transient vestibular attacks?

Answer 22

A rare syndrome that is characterized by recurrent, transient signs of vestibular disease (head tilt, nystagmus, vestibular ataxia) that resolves spontaneously within 24 hours

Question 23

What has transient vestibular attacks been associated with in dogs?

Answer 23

systemic hypertension, hypothyroidism, otitis media/interna, and cerebellar malformations/ degernative disease

Question 24

How are animals in between vestibular attacks?

Answer 24

they are normal , do not have impaired consciousness during episode

Question 25

In cases with vestibular attacks that have cerebellar malformations or neurodegenerative disease how can vestibular designs be induced?

Answer 25

by manipulating the head position

Question 26

How can transient vestibular attacks resolve?

Answer 26

if underlying etiology can be identified and successfully managing and treating hypertension, hypothryoidis

Question 27

What is paroxysmal dyskinesias?

Answer 27

Dyskinesias is a general term referring to a heterogenous group of CNS disorders that impair normal posture muscle tone or locomotion without affecting consciousness.

Question 28

Cramp or hypertonocity in scottish terriers

Answer 28

-trigger is stress or excitement, exerise

Question 29

Cramp age of onset

Answer 29

most are less than 1 year of age -autosomal recessive inheritance

Question 30

Describe CRAMP

Answer 30

-duration of episode -> less than 30 minutes -frequency of episodes depends on trigger pehnotype -> stiffness or bunny hopping of pelvic limbs, kyphotic posture ], stiffness may also involve thoracic limbs

Question 31

How do we treat CRAMP How does it progress

Answer 31

diazapam and fluoxetine. severeity and frequency decrease with age, treatment and behavioral modification

Question 32

Canine epileptoid cramping syndrome of the border terrier (spike's diseas)

Answer 32

trigger -> stress, excitement, waking up, temperature extremes -age of onset -> majority less of 3 years of age durationg of episodes -> 1 minutes to 3 hours frequency of episodes -> multiple per day, month or per year

Question 33

How does spikes disease look? -treatment

Answer 33

inability to stand or walk, involuntary flexion or extension of multiple limbs , dysotonia or vomiting -may resolve with gluten free diet

Question 34

Paroxysmal nonkinesogenic dyskinesias of the Chinook

Answer 34

trigger -> unknown age of onset -> most cases less than 3 years of age duration of episodes -> less than 1 hour frequency of episodes ->several per day, per year to per lifetime

Question 35

Chinook phenotype treatment/progression

Answer 35

sustained limb flexion, flailing or kicking of the limbs, ocassionally head tremor -unknown

Question 36

Episodic, postural or tremor syndromes

Answer 36

tremors are involuntary, rhythmic oscillatory movements of a body part with symmetric velocity in both directions of movement -postural tremors actional related tremors that occur when muscles are supporting the body against gravity

Question 37

Episodic, postural tremor of the head and neck (head tremor or head bobbers) Signalment triggers phenotype diagnosis treatment prognosis

Answer 37

-boston terrior, bulldog, bocer, doberman predisoposed, usuually mean age less than 4 years -can be triggered by illness, surgery or other stressors -focal tremors of the head that can results in horizontal or vertical head excersions . they can last seconds to hours. Episodes can be interrupted in a majority of dogs -signalement history and CS -various anticonvulsant medications have been tried but dont seem to work -non progressive disease

Question 38

neuromuscular weakness

Answer 38

Myathesnia gravis and polymyositis may cause paresis that may eventually cause collapse. THe collapse is usally associated with historical or clincial evidence an excerise associated exacerbation of weakness and the animal often has other CS of disease . Typically do not recover rapidly or completely after collapse

Question 39

What is syncope

Answer 39

udden, transient loss of consciousness and postural tone. During the syncopal attack, the animals will have flaccid muscle tone, but some will display myoclonic jerks of the limbs or head at the episode onset, and some animals will display autonomic signs (urinate

Question 40

How do animals with syncope appear before and after an attack?

Answer 40

Animals with syncope do not typically show any pre- or post-episodic signs; exercise and stress may precipitate syncopal events; and recovery from an episode is nearly instantaneous.

Question 41

How often can animals with syncope have episodes?

Answer 41

There can be multiple episodes/day, and episodes frequently occur in rapid succession

Question 42

What are other non-epileptogenic causes of paroxysms?

Answer 42

Pain -Several disorders are classically characterized by clinical signs of episodic discomfort with intervening periods of relative normalcy. These include Chiari-like malformation and syringohydromyelia, feline orofacial pain syndrome (FOPS), and intermittent claudication. In addition to their paroxysmal nature, these conditions can be accompanied by abnormal body postures, stereotypical behaviors, or reluctance to move in the absence of more classical signs of associated with pain.

Question 43

Epileptic seizures

Answer 43

ecurrent, transient, and sudden, often stereotypical motor, sensory, autonomic, or psychic disturbance that results of excessive or abnormal synchronous electrical activity in the brain. Epileptic seizures can result from a genetic predisposition to seizures (genetic/idiopathic epilepsy), secondary to many brain diseases (structural epilepsy), or for unknown reasons.

Question 44

How can we differentiate seizures from other paroxysmal events?

Answer 44

Many seizures will have an identifiable premonitory event, the aura, in which the animal displays abnormal behaviors, such as attention seeking, hiding, etc that occur a few minutes prior to the ictus

Question 45

Seizures are the most common paroxysmal event aoscciated with _ signs -are they conscious?

Answer 45

autonomci -their consciouness is impaired

Question 46

Seizures very commonly _ muscle tone. What is the most common semiology of a seizure?

Answer 46

-increased -generalized tonic-clonic seizure. the animal first goes stiff (tonic phase), becomes recumbent, and then develops rhythmic alternating muscle contractions (tonic-clonic phase) which may progress to running type movement

Question 47

Seizures first often manifest how?

Answer 47

in the face/head as eyelid twitching movements and then secondarily generalize

Question 48

When do seizures most often occur

Answer 48

at rest or when the animal is sleeping

Question 49

What are most common for focal or generalized seizures?

Answer 49

rhythmic alternating or muscle contractions

Question 50

Most animals with epilepsy will look how?

Answer 50

each seizure will look the same

Question 51

How long does the typical ictal event last

Answer 51

less than 1-3 minutes

Question 52

What are common after a seizure

Answer 52

post ictal abnromalitesi and can last hours to day -fear, aggression blindness, increased appetite and ataxis