mild treatment for mild twitching?

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JenElliot

JenElliot

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I will start this by saying I know my cat is not hypo.

Brief history: Mali is 17 years old, diagnosed with diabetes 5-1/2 years ago. Did well with no home monitoring for over 5 years, but went into hypo and had a violent full-body seizure several months ago. Since then I began home testing and changed his diet, he has been in remission for nearly 2 months now. His BG's usually range from around 90-115.

Before having the seizure he developed a twitch, which quickly got worse and worse until he had the seizure. The twitch never went away completely, but got much better. The general agreement between me, my vet and several people here is that the twitch is caused by some (possibly permanant) neurological damage that occured from the seizure. The strangest thing about it is that it's mostly in reaction to sounds, like kissing noises, plastic crinkling, etc...

Thw twitching has gotten a little worse over the past week, so I'm looking for any ideas to help him. It doesn't seem to cause him any pain, but it scares him. His eyes bug out, and sometimes he meows and runs to me, like he's seeking comfort. :( He has a history of bad reactions to medications, so I'm hesitant to try any type of anti-seizure or anti-anxiety medications. I will be speaking with my vet soon about this, but wanted to get some opinions beforehand.
 
Wow - I know what you mean about the seizures - they're really scary.

Dude has been on insulin for 7 years now. A couple of months ago, I noticed that if/when my husband or I made a noise (like tapping our fingers on a table or clicking with our tongue - snapping our fingers at him (as we have always done if we wanted him or Mittsi to follow us) - he would twitch a bit and sort of hunker down.

Then four weeks ago, I was on the computer and he was sitting on the floor beside me - waiting for his PM test, feed and shoot routine - and I made a couple of clicking noises - he wasn't looking up at me and it was as if he didn't know where they came from and he just fell over on his side in a seizure. It only lasted a short while and then he was okay.

As soon as the vet office opened, I took him in and he had complete bloodwork, x-rays - total checkup - and there didn't seem to be anything out of order with the x-rays or bloodwork. The vet had put him on amlodipine for high blood pressure and he was on methimazole (Tap) for Hyper-T. His thyroid numbers had dropped significantly and the vet thought perhaps the dosage of the Tap was too high - he had me cut it in half and Dude hasn't had any problems or any twitching since.

I'm taking Dude in again tomorrow for a followup visit to see what his thyroid numbers are now and what his BP is now.

Is Mali taking any meds that he might be reacting to? You say he is sensitive to meds and Dude is also. A normal dose of almost any medication is usually too much for Dude. It seemed that the meds were a little too strong and the vet really thinks that's what caused the twitching and the seizure. If he's on any meds, you might want to talk to the vet about perhaps changing the dosage.

Other than that, I have no suggestions. I was as perplexed as you are - because of the way it happened.

I do hope you are able to find the source and give Mali some relief - it must be as terrifying to them as it is to us because they don't know what's happening.

Good luck - keep us updated.

Emmy & Dude (& Mittsi too)
 
That's like exactly what Mali went through, "hunker down" is a great description. And I'm so glad to find someone else who has noticed twitching in reaction to sounds, that's what's been baffling me the most because I can't find any information whatsoever about that specific trigger (I knew I wasn't crazy!).

He's on no meds right now, hasn't been for months. April 5th will mark 2 months off insulin. I'll talk to my vet again soon, and I'll probably have more blood/lab work done in the next month or so (sooner if he gets any worse). He just had a bunch of tests in January and everything was fine.

Anyone else have any ideas/input?
 
I'm no vet, doctor, or nurse.... but I know I've read and it does sound neurological to me also. They say that certain people cannot stand lights blinking ... ie Disco lights... and will have a seizure... My bet would be that your vet is right on. I'll say a prayer that things go well for you both.
 
Well, rats. I wrote you a reply, Jen, and then went to find you a link, and when I came back - NO DRAFT!

Here's the essence of it: Yes, paper crinkling can trigger a seizure. And yes, seizures can include twitching, as well as episodes of staring, frantic racing around, and a whole variety of other disconcerting activities, in addition to the stereotypical grand mal seizure with violent movements, etc. (Does your cat sort of shrink away from your hand if you try to pet him down his spine? Feline hyperesthesia shares many symptoms with feline epilepsy, and can be treated with the same medication.)

Feline epilepsy is relatively uncommon. Diagnosis is important, but frequently not definitive. You would want to check blood pressure, and have bloodwork to explore medications, parasites like toxoplasmosis, kidney and liver function, (and probably some other things that unfortunately have disappeared into cyberspace.) Some people opt for MRI/spinal taps to try to detect neurological defects or brain tumors. Most cats seem to end up being classified as having "idiopathic" epilepsy - of unknown cause. The fact that your cat had a hypo seizure does make one think that he might be having other seizures now.

It would be helpful for your vet if you keep as complete a record as possible of any possible seizure activity you notice. Dates, what you specifically noticed, duration of the activity, what was going on around him.... The general criteria for needing medication for feline epilepsy is more than one seizure a month, or more than one seizure in a 24 hour period. The problem for cats is something called "kindling." Every seizure a cat has creates a sort of pathway through the brain, and that pathway makes it easier, essentially, for the next seizure to occur. With my own cat, whose first seizure consisted of falling on his side, briefly paddling his feet, and salivating (foaming) - by the time he'd had another 15 or 16 grand mal seizures, he graduated to violent movements, longer episodes, and a terrifying snarling that was nightmarish. Some cats lose control of bladder and/or bowel.

Here is a link with some basic information: http://www.peteducation.com/article.cfm ... 18&aid=224 One caution - a drug called potassium bromide should NOT be used for cats with epilepsy. It's safe for dogs, but causes a respiratory disease in cats that may or may not go away when the medication is stopped.

The most common medication for feline epilepsy is phenobarbital. It tends to be very sedating initially. For most cats, the balance problems and the sedation eventually wears off. (My cat still tilts over when he shakes his head, and he's been on phenobarb since March, 2007.) Phenobarb can be liver-toxic, and bloodwork is recommended every six months.

A couple of suggestions for you:

1) be very cautious with vaccinations - cats with epilepsy are safer avoiding vaccinations, if possible.

2) avoid flea and tick treatment - especially the "spot-on" ones, which can trigger serious seizure disorders. There is one flea treatment (whose name I can't recall, but it starts with a "c", I think) that is a pill which can safely be used in epileptic cats.

3) anesthesia can be a problem with a seizure cat, too.

4) try Rescue Remedy - a flower essence - and see if you notice any diminishing of the frequency or severity of the twitching. You can rub it on the inside of Mali's ear, or squirt it in his mouth. There are other holistic treatments available, too. Some people have had good success with acupuncture, for example.

Your observation is very important to diagnosis. The more information you can present to your vet, the better it will be. If it is determined that Mali is having partial seizures, and all you see is twitching, I don't know what the treatment recommendation might be. I would be concerned, I guess, depending on the amount of twitching and if there is any escalation of the activity. There is "benign neglect" as a possibility, but personally, I'd be worried that there's no way to know if further neurological damage is being done or not. It's a crappy disorder.


edited twice to correct non-working links :oops:
 
Thanks for all the input Lynda! That link is one of the many, many pages I've read. He has no sensitivity with his spine, so I know that can be ruled out. We've discussed MRI's with the vet, but he would have to be put under for about an hour and a half and that would be very risky for him.

I keep a 'Mali journal' and track his diet, weight, BG's, activity level, frequency of twitching, etc... Maybe it will come in handy next time he goes in.

I'd never heard of using Rescue Remedy in cats, I'll have to look into that, thanks!
 
i was quite interested in this topic since Sweety has a twitch with her front paws recently. I asked about it at the vet last year and then her bloodwork came back low potassium & Calcium. I think that's one of the things that can cause it. anyway, that was not it since another bloodtest showed potass, ok. He didn't seem concerned about it. That was a year ago. But since there have been a couple of people bringing up the twitch here, I mentioned it to him today. Sweety was there for her T4 check. He did a check to see if there was anything wrong with thefront legs & paws, and when I told him that last week she wasn't eating and I tested her, her BG was 31 - he said that the twitch could be from low blood sugar and like some one said here, I should take note of when it happens, what's going on, when she last ate and to test her more. (I only do, occassionaly). He said although rare, some cats can become hypo, even though not on insulin. It has a name...pancreatic adonoma?
The thought of seizures scares me. I'll have to teat more to see how her bg's are going...

Good luck in finding out what's up with your baby. And if you do - keep us updated?
 
MRI/spinal tap

Probably 90% of the owners of newly diagnosed epileptic cats deal with the question of having an MRI and/or a spinal tap performed. And a significant proportion choose not to do it. It's a very expensive procedure, and as you noted, Jen, requires anesthesia, which poses its own risks. Jess, who is (was?) a vet tech member here, whose opinions and experience and knowledge I have the absolutely highest respect for, felt that these tests were generally worth doing when we discussed the topic a couple years ago. My own feeling was that my cat was fairly young when the seizures started, and judging from other members of the Yahoo EpiKitty board, the results of MRI/spinal tap very seldom, if ever, indicated that a cat had a brain tumor; most cats ended up being labeled "idiopathic". Jess' Earl, however, did indeed have a tumor, which he had surgery to remove, so you can't say "never".......

There were no veterinary neurologists in the Pittsburgh area when my Milkshake began having seizures. I traveled to Akron, Ohio, to see one who was recommended by the Internal Medicine vet I had been taking Milk to. He did some fairly cursory physical testing - tried to check Milk's gait, for example, which didn't happen because my poor little cat was so traumatized by the trip and strangers that he was practically comatose. I had made a video of one of Milk's seizures to show the neurologist, which he said was helpful. And he was noncommital about an MRI. I don't know what his recommendation would have been if Milk had been as old as your cat, or if he'd had diabetes, too, though.

Do you have access to a neurologist? The average local family vet has probably seen very few cats with epilepsy, and the medication options have changed in recent years.
 
We do have a neurologist about 30 minutes away, maybe I'll try just calling and talking to them about it.

I'm 99.99% sure it's not a brain tumor or epilepsy because he never had any twitching until right before the hypo seizure. I'm fairly confident that the continued twitching is just some neurological damage he got from having such a big seizure. And it's not THAT bad, it's just been a little worse lately so I guess I'm looking for preventative measures to take to try to keep it under control. And since it's mostly reactionary to sound, I have a decent amount of control with it, I just have to be careful about making certain noises.

And Lynda, my vets have a video on file of Mali twitching too. :) It would come and go so I filmed him for about a minute when it was really bad so I could show them what it looks like. Oddly enough, he had his seizure about 10 minutes later and we rushed him to the vet (with the video).
 
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