Feline Hyperesthesia Syndrome

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feline hyperesthesia cat with dilated pupils

Your cat is lounging in the windowsill, looking perfectly serene. Then, all of a sudden, she perks up, jumps off the windowsill, and runs screaming through your home. 

What on earth just happened?! 

No, your cat didn’t just get spooked by a ghost. She probably just had an episode of a rare and bizarre disease called feline hyperesthesia syndrome (FHS).  

Quick Overview: Feline Hyperesthesia Syndrome

text-size Other Names: Twitch-Skin Syndrome in Cats, rolling skin syndrome, twitchy cat disease
search Common Symptoms: Episodes of rippling or twitching skin of the lower back, dilated pupils, hyperactivity or agitation, tail chasing, signs of irritation or pain when petted or touched, running and vocalizing. Some cats also have seizures.
medical-files Diagnosis: Diagnosis is based largely on signs at home consistent with the syndrome. Diagnostic testing like labwork and x-rays may be considered to rule out other causes. Advanced imaging like MRI to image the brain and spinal cord. Skin testing to rule out fleas and other skin irritations.
cat Diagnosed in Cats: Sometimes
pill Requires Ongoing Medication: Sometimes
injection-syringe Vaccine Available: No
jam-medical Treatment Options: Cases warranting treatment may include anticonvulsant medication, anxiety medication, sedatives, obsessive-compulsive medication, and supplements.
home Home Remedies: Calming supplements and products like Feliway may help if the syndrome is related to anxiety.

What Is Feline Hyperesthesia Syndrome?

Hyperesthesia is defined as abnormally increased skin sensitivity. FHS is frustrating for cats and cat parents alike. It is not curable but can be managed with medication and behavioral changes. 

Feline Hyperesthesia Syndrome Causes And Risk Factors

FHS is also known as ‘rippling skin syndrome’ and ‘twitchy cat syndrome.’ Certain cat breeds—Persian, Siamese, Abyssinian, and Burmese—are genetically predisposed to FHS. Although any age of cat can be affected, the first episode of FHS usually appears between ages 1 and 5. Males and females are equally affected. 

Cats who live in a high-stress environment or tend to be nervous or hyperactive might be at an increased risk of developing FHS. 

Although the exact cause of FHS remains unknown, there are a few theories about this disease’s origins. One theory is that FHS is a form of epilepsy. Another theory is that it’s a form of obsessive-compulsive disorder.

Because certain breeds are predisposed to FHS, genetics are also thought to play a role. An additional theory is that FHS is caused by abnormal electrical activity in different parts of the brain. 

Feline Hyperesthesia Symptoms

FHS symptoms are widely variable. The syndrome’s episodes typically occur at dawn or dusk. These episodes range from a few seconds to a few minutes, with variable frequency. Often, a cat parent cannot stop an episode once it starts, which can be very distressing. 

The spine and tail are the most frequently affected areas of the body. Symptoms can start as mildly unpleasant but quickly progress to irritating and debilitating.  

Symptoms of feline hyperesthesia include:

  • Seizures  
  • Dilated pupils  
  • Skin twitching  
  • Self-mutilation  
  • Attacking the tail 
  • Pain when petted  
  • Licking or biting the paws  
  • Vacant staring into space  
  • Running and screaming through the house 
  • A sudden stop in normal behavior, with a startled look  
  • Sudden and drastic behavioral changes (e.g., increased or decreased aggression, hyperactivity) 

Itchy skin conditions like flea allergies can worsen the symptoms. Also, many of these symptoms are seen with other health conditions, so the presence of these symptoms does not automatically indicate FHS. 

Feline Hyperesthesia Syndrome Diagnosis

FHS is a diagnosis of exclusion, meaning that other diseases need to be ruled out before FHS can be diagnosed. The diagnostic process for FHS is lengthy. If your cat has any of the symptoms listed above, be prepared for your cat to undergo a lot of testing before your veterinarian confirms an FHS diagnosis. 

First, your veterinarian will need a history of the symptoms:  

  • What symptoms you’ve observed 
  • When the symptoms started 
  • Severity of symptoms
  • Frequency and duration of FHS episodes 

If possible, show your vet a video recording of one of your cat’s FHS episodes. 

If your veterinarian suspects FHS, they will start ruling out other conditions that could explain your cat’s symptoms. Basic diagnostic testing usually begins with a physical exam, bloodwork, urinalysis, skin tests, a neurologic examination, and spinal x-rays. 

Below are the disease categories that your veterinarian will rule out: 

Dermatologic

Common itchy skin conditions include flea allergy dermatitis and atopic dermatitis. Your veterinarian will first prescribe flea control and anti-inflammatory medications (corticosteroids) to try to manage the itching. Your vet might also recommend omega-3 fatty acid supplements. 

Neurologic

If symptoms persist after treating the skin, your vet will then consider neurologic conditions, like epilepsy and spinal disease. This will require spinal x-rays and a neurologic exam. Your vet may refer you to a veterinary neurologist. 

Musculoskeletal

If your cat still isn’t getting better, then painful orthopedic conditions like osteoarthritis will need to be ruled out. Pain medication and complementary therapy (acupuncture, massage) may be tried. 

If all of these disease categories have been ruled out, FHS will become the likely cause of your cat’s symptoms.  

FHS Treatment

Once your veterinarian has made the FHS diagnosis, it will be time to devise a treatment plan to eliminate your cat’s discomfort and improve her quality of life. Behavioral changes and medication are used for treatment. Treatment plans need to be personalized for each affected cat. 

Behavioral Changes

If you want to sleep better, first you have to figure out what is causing your cat’s stress

Behavioral changes, such as those listed below, can reduce your cat’s stress and anxiety, both of which can trigger FHS episodes.  

The following adjustments may help:

  • Redirect your cat away from stressful situations  
  • Create and maintain a normal daily routine for feeding and playtime 
  • Eliminate competition for resources in a multi-cat household (e.g., multiple safe spaces, separate feeding locations, multiple litterboxes) 
  • Provide environmental enrichment, such as hiding treats around the house, engaging in interactive playtime, and providing cat-friendly structures like windowsill perches 

Medication

Behavioral modifications might not be enough to adequately manage FHS. This is where medication comes in.  

Currently, there are no FDA-approved medications specifically for FHS.

Fortunately, other medications can be used to manage the syndrome’s symptoms: 

  • Specific serotonin reuptake inhibitors: These drugs make sure that there’s plenty of serotonin, a neurotransmitter, in the brain. Serotonin regulates mood and can even reduce a cat’s obsessive-compulsive behaviors. Examples include Prozac® and Zoloft®. 
  • Anti-seizure medications: If your cat’s FHS episodes involve seizures, then anti-seizure medications like phenobarbital and gabapentin can reduce the seizure frequency.  

These medications are typically started at a low dose. Monitor your cat’s response to the medications so that your veterinarian can know whether to make dosage adjustments. Your vet will perform periodic blood tests to evaluate your cat’s liver and kidney function.  

Ideally, your cat will be able to be weaned completely off medication, but some cats will need lifelong medical therapy to control FHS. 

Final Thoughts

FHS is a complex and frustrating condition. Left unmanaged, FHS can be debilitating for your cat and significantly decrease their quality of life. 

If you notice symptoms of FHS in your cat, don’t delay in scheduling a veterinary appointment. Work closely with your veterinarian to develop a management plan to relieve your cat’s symptoms and restore her normal quality of life. 

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About JoAnna Pendergrass, DVM

JoAnna Pendergrass, DVM, is a veterinarian and freelance medical writer in Atlanta, GA. After graduating from the Virginia-Maryland College of Veterinary Medicine with her veterinary degree, JoAnna completed a 2-year research fellowship in neuroscience at Emory University. During this fellowship, she learned that she could make a career out of combining her loves of science and writing. As a medical writer, JoAnna is passionate about providing pet parents with clear, concise, and engaging information about pet care. Through her writing, she strives not only to educate pet parents, but also empower them to make good health decisions for their pets. JoAnna is a member of the American Medical Writers Association and Dog Writers Association of America.

6 thoughts on “Feline Hyperesthesia Syndrome

  1. Debra Crnkovic

    I am interested in discussing FHS with a medical professional who has specific knowledge regarding this particular syndrome. My feline is currently being treated for the possibility of the syndrome and I have more in-depth questions regarding the medications that are used to treat FHS and the dosing and side effects. My Vet is very helpful but lacks the in depth knowledge to answer my questions. Can you help me?
    Thank you for your assistance.

    Reply
    1. Karen P

      Hi Debra,
      Were you able to get help? I experienced watching my daughters cat have this episode to a tee last night and I was so concerned. It came on the heels of a 2 day stomach issue (diarrhea) from eating I believe a single can of spoiled wet food. I think the stress was too much for the cat. Have you gotten help? I have a feeling most vets will not be experienced and I am praying for a holistic route.
      Thank you , From Florida

      Reply
  2. Karen P

    Hi Debra,

    Were you able to get help? I experienced watching my daughters cat have this episode to a tee last night and I was so concerned. It came on the heels of a 2 day stomach issue (diarrhea) from eating I believe a single can of spoiled wet food. I think the stress was too much for the cat. Have you gotten help? I have a feeling most vets will not be experienced and I am praying for a holistic route.

    Thank you , From Florida

    Reply
    1. small mallory photoMallory Crusta

      Hey Karen, if you’d like to make sure that your message reaches Debra, you’ll need to make sure to hit the small “reply” link just under her comment on the left side. This will send a notification to the user’s email address. As I suggested to Debra, I would encourage you to try posting about your experience in the All About Cats Community. I’m sorry your daughter’s cat is going through all of this, and I hope we can gain a better understanding of this condition soon. Both of my cats (especially Wessie, my older one) show some signs of FHS, and it is indeed a bewildering condition in need of more research.

      Reply
      1. Karen

        Thank you Mallory! I took her to the vet today and her exam was “normal” and the vet basically said the condition is really not treatable unless you want to get heavy into a pharmaceutical route— which based upon her mild symptoms at this time isn’t warranted. I’m looking to try CBD oil or treats and a pheromone spray to calm nerves. Any experience or feedback is welcome!

        Reply

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