Paroxysmal Disorders

Question 1

What is effected by episodic or paroxysmal events?

Answer 1

Behavior, movement, sensation, autonomic function and consciousness

Question 2

What is a paroxysm?

Answer 2

sudden outburst, recurrence or intensification of symptoms

fit, spasm or seizure

Question 3

What are the 3 main etiologies of paroxysmal events?

Answer 3

Epileptogenic - brain/seizure
Non-Epileptogenic - syncopal or neurologic
Unknown - episodic pain

Question 4

How can you differentiate seizures from mimics?

Answer 4

History: Breed/age onset, interepisodic exam findings, trigger, body parts effected, symmetry, conciousness, muscle tone, autonomic dysfunction, frequency, duration, rate of recovery

Cameras and video help

Question 5

What are some major signs of narcolepsy?

Answer 5

Trigger: Pasing out when trying to eat
Sudden collapse
Flaccid
Consciousness partially impaired
Anesthesia can worsen it

Question 6

What is cataplexy?

Answer 6

Abrupt and complete loss of all muscle tine - sleep paralysis

Question 7

What is the neurotransmitter that is progressively lossed with aging making the animal narcoleptic-catapley?

Answer 7

Orexin (Maintain wakefulness vs sleep)

Question 8

What are your differentials for a dog that is flybiting several times a week, will respond during the episode and has no apparent triggers?

Answer 8

Seizure (haullicinations), Gastrointestinal or Eye Disorder

-GI - esophagus issue trying to pass food

Question 9

Signs: Lip smacking, repeated swallowing, occur within an hour of eating, nervous before episode, variable in length, vomit after episode, no response to treatment to antibiotics
Trigger: feeding
Autonomic: Vomit
Differentials?
Diagnostics?
Diagnosis?

Answer 9

Diff: Focal seizure, GIT, Behavior (OCD)
Diagnostics: CBC, Chem, UA, Bile Acid, Fecal, Abdominal ultrasound, GI endoscopy
Diagnosis? Upper GIT disease

Question 10

Episode:
Breed Disposition: Border Collies
Chasing rabbits not there
Conscious
No autonomic
Young
Aggression on recovery
Diagnostics:
Diagnosis:

Answer 10

CBC, Chem, UA, EEG (bad) and MRI/CSF
Diagnosis: Epilepsy

Question 11

Episode:
Confusion and staring in space couple times a week
Consciousness: Dazed
Wobbly
Wont respond to owner
normal interictal
Keppra no help
Exam: Nystagmus, vestibular ataxia
Diagnosis?

Answer 11

Transient Vestibular Attacks
-Hypothyroid, hypertension

Question 12

Episode:
Breed: Scottish Terrier
Hx: stiffness and difficulty walking over past 2 weeks, painful and hunched since puppy, normal between
Diff:
Exam: Kyphosis, 2 engine gait
Tigger: excitement
Muscle tone: Spastic
Diagnosis:

Answer 12

IVDD - prednisone
Diagnosis: Dystonia - Scottie cramp or hypertonicity
Treatment: grow out, SSRI, goes away on own, non-painful or harmful

Question 13

What is dystonia?

Answer 13

Muscle condition that causes them to contract

Question 14

What causes a saw horse stance, diarrhea, dyskinesia and dystonia in a Border Terrier?

Answer 14

Gluten sensitivity
Treatment: Gluten Free Diet

Question 15

Scenario:
Bull dogs
Focal facial seizure since 6 months
Normal interictal, normal diagnostic, no response to phenobarbital and high level
PU/PD
Signs: head shaking, conscious, responsive (up or down or side to side)
Trigger: stress
Younger than 4 years
Diagnosis:
Treatment:

Answer 15

Idiopathic Head Tremor
Breeds Predisposed: Bull dog, doberman, boxer, lab
Treatment: distract them during episode and take of seizure meds (doesn’t fix)

Question 16

Scenario:
Progressive seizure 9 months
-Fall over, leg stiffness, relax, urinates, unconscious
- less 30 seconds multiple times a day
Normal between
ASD not helping
Brady cardia, 3rd degree AV block
Diagnosis:
Treatment:

Answer 16

Syncope
Pacemaker

Question 17

Scenario:
sudden collapse, unresponsive, urination, floppy, immediate recovers, few seconds
Differnitals:

Answer 17

Diff: syncope, narcolepsy or atonic seizure

Question 17

Scenario:
Fall over unconcous, leg stiff, then relax, goes to bathroom, autonoic, myoclonus followed by flaccidity

Answer 17

Syncope

Question 18

Scenario:
older, multifocal diffues intracrnial sign, nodding motion of head, few times a day

Answer 18

Episodic postural repetitive myocolus of head

Question 19

What is myoclonus?

Answer 19

brief involuntary contraction of a muscle or group followed by relaxation (Sign)

Twitch or jerk movement of head, muscle fasciculations

Question 20

What are the stages of a seizure?

Answer 20

Prodromal - before seizure light signs
Aura - Earliest sign of seizure (bitter taste, dizz)
Ictus - during seizure
Post-ictal - Recovery
Inter-ictal - Between Seizure