Paroxysmal Disorders

Question 1

How can you differentiate seizures from other paroxysmal events?

Answer 1

seizures are most commonly associated with autonomic signs (salivation, urination, and defecation). and are associated with impairment of consiousness.
Most animals have premonitory events (auras).

Question 2

What is a paroxysmal disorder?

Answer 2

a sudden outburst, recurrence, or intensificaiton of symptoms.
Owners describe them as “fits” “spasms” or “seizures”.
These events are episodic, transient, and self-limiting abnormalities in: behavior, movement, autonomic function, and consciousness.

Question 3

T/F: paroxysmal disorders may result from epileptogenic or non-epileptogenic etiologies.

Answer 3

true
non-epileptogenic causes include: syncopal syndromes or neurogenic syndromes (narcolepsy, vestibular events, neuromuscular weakness, and movement disorders)

epileptogenic causes include idiopathic epilepsy, structural epilepsy, or unknown epilepsy.

Question 4

what are the 5 stages of a seizure?

Answer 4

1. prodromal – behavior abn. preceeding electrical changes
2. aura – EEG abnormalities present and behavior changes
3. ictus – actual seizure
4. post-ictal
5. inter-ictal

Question 5

What is the genetic component of narcolepsy/cataplexy? How does this compare to the acquired form?

Answer 5

Genetic: mutation of a gene that results in abnormalities of orexin receptors in the brain.

Acquired – orexin deficiency in brain (older animals)

Question 6

_________ has a clinical manifestation of sudden and complete atonia causing collapse lasting several seconds to minutes. This is usually triggered by feeding, excitement, stress, or concurrent disease.

Answer 6

cataplexy

Question 7

Does an animal with narcolepsy/cataplexy remain conscious/responsive to owner?

Answer 7

Yes. these episodes can actually be interrupted or distracted from occurring.
These animals also recover very rapidly.

Question 8

How can you diagnose an animal with narcolepsy/cataplexy?

Answer 8

1. clinical signs
2. what the signs are induced by (food, physostigmine, etc.)
3. EEG during episode – low amplitude, fast waves (parodoxical sleep)
4. genetic test for HCRTR2 mutation (genetic form) or measure CSF orexin concentrations (acquired form)

Question 9

What is the treatment for narcolepsy/cataplexy?

Answer 9

imiramine, clomipramine, yohimbine

Question 10

Some behavioral disorders (aggression and OCD) can be characterized by epidodic steriotypies. What are the following characteristics of this type of non-epileptogenic episodes –

Remain conscious?
Altered muscle tone?
Identifiable trigger?

Answer 10

Remain conscious? yes
Altered muscle tone? no
Identifiable trigger? yes

Question 11

what 2 conditions in dogs can cause transient ischemic attacks and lead to vestibular signs that do not affect their consciousness and resolve within 24 hours?

Answer 11

systemic hypertension
hypothyroidism

Question 12

How do you treat transient vestibular attacks?

Answer 12

manage the underlying etiology

Question 13

__________ is a CNS disorder that impairs posture, muscle tone, or locomotion without altering consiousness

Answer 13

paraoxysmal dyskinesia

Question 14

A 1 yo scottish terrier presents to your clinic because the owners say its walking weird. You notice the patient is severely kyphotic and is bunny hopping in its pelvic limbs. Overall the patient is very stiff.
You diagnose this patient with Scottie cramp/hypertonicity. The owners say that he never loses consciousness though.

How do you decide to treat this patient?

Answer 14

diazepam +/- fluoxetine

you also tell the owners that this can be triggered by excitement.

Question 15

A 2 yo border terrier presents to your clinic unable to walk and have involtunary flexion and extension of 2 limbs. You diagnose this patient with canine epileptoid cramping syndrome.

What treatment option do you offer this patient?

Answer 15

gluten-free diet

you tell the owners this is triggered by stress, excitement, waking up, or temperature extremes.

Question 16

What is the treatment for chinook seizures (this is a paroxysmal dyskinesia)?

Answer 16

we do not know

Question 17

A 3 yo boston terrier presents to your clinic because the owners think it is having a seizure. On arrival, you notice a focal head tremor. When you call the dog’s name, the head tremor stops when the dog looks at you, but then restarts shortly after.

What is your diagnosis and what is your treatment plan?

Answer 17

diagnosis is episodic postural tremor syndrome of the head and neck

there is no treatment. this condition is non-progressive and the prognosis is good.

Question 18

What is different about conditions that cause neuromuscular weakness and collapse (myasthenia gravis, polymositis, etc.) versus conditions such as narcolepsy or syncope that also cause collapse?

Answer 18

patients with neuromuscular weakness will NOT recover rapidly or completely as do patients with narcolepsy.

Question 19

________ is the sudden, transient loss of consiousness and postural tone. Patients experience flaccid muscles, myoclonic jerks of the limbs and head, and autonomic signs. Recovery, however, is instantaneous. There are typically no pre or post-episodic sigs.

Answer 19

syncope

Question 20

how long can regular seizures last?

Answer 20

up to 3 minutes