Paroxysmal Disorders Flashcards
1. Recognize phenotypes of paroxysmal conditions that mimic epileptic seizures such as narcolepsy/cataplexy, movement disorders, neuromuscular weakness, behavioral diseases, syncope, and episodic pain. 2. Describe or recognize clinical and historical features that help discriminate etiologies of paroxysms, such as event frequency duration, and temporal density, triggering factors, physical examinations findings, level of consciousness, and recovery rate. 3. Generate an appropriate list of diff
What is a paroxysmal disorder?
myriad of conditions whose common clinical denominator = episodic, transient, and (generally) self-limiting abnormalities in behavior, movement, or consciousness in an animal who appears normal in between episode.s
“Paroxysm” = sudden recurrence, outburst, or intensification of symptoms
What are the three etiologies of paroxysmal disorders?
- Epileptogenic (idiopathic/genetic v. structural v. unknown etiology)
- Non-Epileptogenic (neurologic v. cardiovascular)
- Unknown (episodic pain)
What is a non-epileptogenic/cardiovascular paroxysm?
Syncope
What are the 5 types of non-epileptogenic, neurologic paroxysms?
- Narcolepsy/Cataplexy
- Behavioral disorders (aggression, OCD)
- Transient Vestibular Attacks
- Movement Disorders (Paroxysmal Dyskinesias, Episodic Postural Tremor Syndromes)
- Neuromuscular Weakness
What is an epileptogenic paroxysm?
Seizure/epileptic seizure
Characteristics that discriminate seizures from other paroxysmal events (5):
- Seizures associated with SLUDDGE-M (autonomic dysfunction)
- Seizures cause UMN signs; other paroxysmal events (PE) cause LMN signs
- Seizures occur at rest or while sleeping; PE occur after a “trigger”
- Seizures cause unconsciousness; PE maintain consciousness
- Seizures can take hours-days to recover from; PE have immediate recovery
These are all ON AVERAGE- not true for every case!
Salivation, Lacrimation, Urination, Defecation, Digestion, Gastrointestinal upset, Emesis, Miosis + Muscle-spasming
What paroxysm is an autosomal recessive mutation found in dobermans, labrador retrievers, and dachsunds? What are its phenotypes?
~Non-epileptogenic, neurological paroxysm~
Narcolepsy/Cataplexy
- sudden & complete atonia, causing collapse
- Lasts several seconds-minutes, recovery is immediate
Dog presents for 6-month hx of lip-smacking episodes & repeated swallowing multple times a day, occurring within 1 hour of eating. Appears anxious prior to episodes. Muscle tone remains normal. You eventually dx with severe esophagitis on upper GI endoscopy. What type of paroxysm is this?
~Non-Epileptogenic Paroxysm~
PAIN: episodic discomfort w/ intervening periods of relative normalcy.
this case = atypical manifestation of upper GI disease
other examples: chiari-like malformation & syringomyelia, feline orofacial pain syndrome
Dog has conscious episodes of fly-biting, walking around and pouncing on invisible objects. No autononic signs & normal muscle tone. Episodes occur several times/day, 2x/month, and the dog experiences hours of severe aggression afterwards. Baseline data is normal. No response to ASDs. What is your next step?
EEG – dx with focal hallucinogenic seizures
EEG shows focal spikes -> indicative of seizure acitivity.
Focal seizures in dogs (sometimes called partial seizures) only affect one half of the brain, and within a particular region of that half. These seizures are described as either simple or complex, depending on your dog’s level of awareness while the seizure is occurring. Dogs usually remain conscious during a simple focal seizure, whereas consciousness is likely to be more impaired if your dog has a complex focal seizure.
Hallucinogenic (psychomotor) seizures are focal seizures where the seizure is more like an episode of abnormal behavior than an actual convulsion. The pet’s consciousness is disturbed by this type of seizure as the pet appears to be hallucinating or in an altered state.
What is a transient vestibular attack? What is it commonly associated with in dogs?
Non-epileptogenic, neurological paroxysmal disorder
- transient signs of vestibular disease (head tilt, ataxia, nystagmus)
- spontaneously resolves within 24h
- commonly associated w/ systemic hypertension, hypothyroidism, cerebellar hypoplasia, otitis media/interna
Paroxysmal Dyskinesia
Falls under movement disorders, which are non-epileptogenic, neurological paroxysmal disorders.
- “Dyskinesia” = general term referring to group of CNS disorders that that impair normal posture, muscle tone, or locomation WITHOUT affecting consciousness.
- “Paroxysmal Dyskinesias (PD) = type that manifests as episodic hyperkinesis and is often genetic w/ distinct breed predispositions
hyperkinesis = abn. incr./uncontrollable movements, typically muscular
Two types of mvmt disorders: PD & idiopathic head tremors
“Cramp”/Hypertonicity in Scottish Terriers
1. classification
2. phenotype
3. triggers
4. progression
- Type of PD
- Kyphosis; stiffness/bunny hoppinh of pelvic limbs
- Triggers = stress, excitement, exercise
- Severity/frequency decreases with tx (diazepam + SSRI) and age
PDs = mvmt. disorders (non-epileptogenic, neurological)
Two types of mvmt disorders: PD & idiopathic head tremors
Canine Epileptoid Cramping Syndrome of the Border Terrier (Spike’s Disease)
1. classification
2. phenotype
3. triggers
- Type PD
- Inability to stand or walk, involuntary flexion or ext. of ≥ 1 limbs, dystonia
- Stress, excitement, waking up, extreme temps
PDs = mvmt. disorders (non-epileptogenic, neurological)
Two types of mvmt disorders: PD & idiopathic head tremors
Idiopathic head tremors
1. Signalment
2. Phenotype
3. Prevention/Tx
- < 4y/o Bulldogs, Boxers, Dobermans, Boston Terriers, Labs
- Focal tremor of head +/- vertical or horizontal head excursions
- 80% of dogs can be interrupted by owner; ASDs have no effect
Are a type of PD
PDs = mvmt. disorders (non-epileptogenic, neurological)
Two types of mvmt disorders: PD & idiopathic head tremors
Syncope
1. Classification
2. Phenotype
3. Muscle tone
4. Level of consciousness
5. Duration
- Non-Epileptogenic, Cardiovascular Paroxysmal Disorder
- Sudden, transient collapse & rapid recovery
- Full-body flaccidity
- Reduced-to-absent consciousness
- Lasts only seconds
typically no pre- or post-episodic signs
