Feline Hyperesthesia Causes, Symptoms & Treatment with Dr. Stefania Uccheddu

A cat’s skin ripples, the tail whips, and suddenly the whole house feels on edge. We sit down with Dr. Stefania Uccheddu, a veterinary behaviorist and diplomate of the European College of Animal Welfare and Behavioral Medicine, to decode feline hyperesthesia - a condition that blurs the boundaries between neurology, dermatology, and behavior. 

We share what caregivers actually see - rolling skin, flank licking, tail chasing, self-directed aggression - and why these events often ride a wave of predatory frustration and low resilience. Drawing on Dr. Uccheddu's long-term study, we compare three practical paths: medication alone, behavior modification, and their combination. The headline: both meds and behavior change work, but environmental and behavioral adjustments drive stronger long-term stability. Gabapentin offers fast relief for sensory-pain arousal; fluoxetine supports emotional regulation. Used together with targeted enrichment, they give sensitive cats a calmer baseline and a safer way to live in busy human homes.

If you’re navigating hyperesthesia, this conversation delivers a blueprint. We walk through the five pillars of a cat-friendly home, consent-based handling, and play that mimics prey from stalk to catch. You’ll hear how to identify and defuse triggers, create quiet retreats, use puzzle feeders to channel focus, and prevent episodes before they crest. We also unpack early socialization gaps, orphaned kittens, and why modern indoor life can overwhelm genetically sensitive cats - plus how to taper medication after a stable year and keep gabapentin as an “emergency kit” for moves, visitors, and big changes.

Come for the science, stay for the hope. With careful observation, smart enrichment, and humane use of medication, even severe cases can turn the corner. If this helped you or someone you know, subscribe, leave a review, and share your cat’s biggest trigger - we’ll feature tips and updates in future Ask the Behaviorist segments.

Transcript

Welcome, Housekeeping, And Goals

Kristiina Wilson 0:00

Hey, and welcome back to another episode of Hist and Tell. This is episode 42. Before we get into today's episode, if you like this podcast, I would be super grateful if you would take a second and leave a rating or a review wherever you listen. It really helps more cat guardians, cat people find the show. Also, if you have a question about cat behavior that you'd like answered in an upcoming Ask the Behaviorist episode, you can submit it on our website, which is Hits and Tell Podcast, or send it to us on our Instagram, which is Hits and Tell Podcast. Okay, now that all that housekeeping is out of the way, today's episode is all about feline hyperesthesia syndrome. It's a condition that a lot of cat caregivers have seen but few fully understand. It's often described as a neurological issue or behavioral issue or sometimes a dermatological one, but as you'll hear in this conversation, the truth is maybe somewhere in between. So now that I blabbed on for almost a minute, let's get right into talking about feline hyperesthesia. Hi, and welcome to another episode of Hiss and Tell. I am your host, Christina Wilson, and with me today is Dr. Stefania Ukeru. She is a veterinary doctor and diplomate at the European College of Behavioral Medicine and Animal Welfare and also has a degree in psychology, human psychology. So welcome, Stefania. Thank you. Thank you. I'm so glad that we finally are having this chat. We've been trying to arrange it for months. Yes, that's true. Here we are. We're going to be talking today about feline hyperesthesia. And um as I was as I was telling her before we started um recording, I have a special interest in this, not only because I do sometimes see clients um who have cats with this, but because we have a cat named Babby who has feline hyperesthesia that we have been managing since she was obviously tiny. We got her as a singleton at two days old. And so I have also wondered a lot of the time how much of it comes from the fact that she wasn't able to be socialized properly and regulated. But we will talk about that as we go in in this conversation. Can you tell the listeners a little bit about exactly what is feline hyperesthesia? I think a lot of people describe it as either neurological or dermatological. What do you what do you think it is?

SPEAKER_00 2:18

Wow. Well, thanks for this first question that actually is the most difficult one. Sorry. So actually, let's consider hyperesthesia as a kind of hyper um sensitivity of the cat. So it's a syndrome, is a condition, but actually, after we consider the medical part, we should consider also how the cat and what the cat is feeling at the same time. So probably if we consider this part, we can say that it's a kind of hypersensation of the stimuli that are around the cat. And if we consider the medical part, probably is a condition that is in between neurology and behavior. So we cannot really um highlight something. So it's not just behavior and it's not just neurology, but it's like in between. So actually, for this reason, even our paper focuses on both parts. And we collaborate a lot. So anytime that we we have a case of hyperesthesia, we work together. So normally we have cases that arrive from dermatology because normally this is the first point. And after we exclude the dermatological part, then this cat starts with the neurological and behavioral consultation. So it's exactly in between, and probably we don't know not know uh like all details about this syndrome, about this pathology. And if we check the literature, we are not expert at the moment, but for sure, for sure, what is super important is to have a kind of respect of this condition because I think sometimes it's really, really underestimated.

Kristiina Wilson 4:11

I agree. Can you describe what people might see in their cat if they're exhibiting the symptoms of hyperesthesia?

Symptoms Caregivers First Notice

SPEAKER_00 4:19

Yes, of course. Actually, there is, I think the most evident part is the rolling skin. So this twitching movement that you can see in the cat normally is something that is really evident, and is normally what the the caregivers are going to tell you as the the first thing. So normally it's like, okay, yeah, I see this movement, but sometimes they describe also some hair movement, some facial different expression. And actually, in my most severe cases, aggressive behavior and also this kind of um hyperactivity, especially at the end of the day. So they said, Oh my god, so my cat is mostly normal during the entire day. And this is strange because normally people work during the entire day, so it's like okay. But then when I come back after my routine, I come back and my cat starts running everywhere. So it seems crazy. And this is normally the definition that you can receive from the caregiver that yeah, it's normally every day start running all around, and it can start being aggressive to the other cats or to me, and that's it. Right. And sometimes this is described as something that is normal for cats, but it's not. And starting from this point, especially if the cat starts biting the caregivers, then you have the problem. But sometimes, probably if if I go now and I start talking with people at the clinic right now, and I ask, how many of you are aware that this is a problem for a cat? I mean, I'm sure that probably 50% of people are not aware that this can be a problem. Yeah.

Kristiina Wilson 6:06

I wanted to add also about the tail mutilation that can happen in a lot of like the more severe cases that cats can start really attacking their own tails and sometimes really mutilate them to the point that they have to be amputated. Yeah. And and our cat who has it, she has trigger spaces, which I think leads us to talking a little bit more about the behavioral implications of this. But if she goes to certain perches in the house, she will have an attack. It's almost like these certain spots lead her to remember or c to cause her to have this. So we have to keep her from those spots, and then she's fine. It's very interesting to see how spaces in the home will lead her to have an attack rather than a time or, you know, any interactions with other cats.

Triggers, Spaces, And Predatory Frustration

SPEAKER_00 6:55

Well, just something that is really just to add something to your um description. Sometimes also you can we can observe some cats that are super um attracted by like something that is flying outside. So birds, for example, they start chirping this. Yeah, yeah. Then they start licking uh or biting the flank, or they start to have this muscle spasm, not just the rolling skin, but it's spasm. It's really uh it seems that are ready uh to the this kind of predatory behavior. So it's like ready, but then it's you you can really observe this kind of frustration that is like more and more and more and more, and they start attacking themselves too. So you you talk about tail chasing, but sometimes they attack any other part of the body, and then they start running. So it seems that it's a kind of sequence of predation, but it's not. And we have the same level of activity. And this is really curious. And when when you start talking about this part, I said, yes, this is true. And actually, I think this part is really important whenever we are considering the pathophysiology of this syndrome.

Kristiina Wilson 8:12

Right. I think people really want to, and I've been guilty of it myself, trying to label it as one or the other when I think, you know, is it neurological, is it behavioral, is it physiology, you know, physiological, is it behavioral? When I think, as you said, it it is very likely to be a combination of both. So that leads me into obviously, do you see this as a single syndrome or more of a collection of signs with different underlying pathways?

SPEAKER_00 8:36

Yeah, normally you can have different presentation, actually. So I think I don't have like the same condition. I mean, normally you have different presentation, and actually for some cats is more similar. So sometimes we we consider more the dermatological part because they have this um uh like this movement that at the beginning you said, no, no, my god, this is Puritus for sure. Right. Sometimes they start biting. So you said it's a kind of hyperesthesia in the meaning of the neurological part. So it's like it's a pain. Sometimes we also need to consider that some pain condition can be there too. So this is the first part. At the beginning, you need to exclude all this obvious part, but for sure we need to consider each individual as completely different. Probably they something that I observe in like a probably 99% of the cat is that normally they are super sensitive to like to any kind of sound. And uh they sometimes caregivers start describing the cat, and they said anytime that there is sound around, there is a kind of noise, uh, you can see this movement. So they are like more super activated by uh by noisy. So it's like this is super common actually. But for the rest, for the rest, I think it's you can observe a huge variability.

Kristiina Wilson 10:11

Right. Um, so I want to get into talking about your paper, which was super interesting, which for our listeners, I will put a link to it um at the on the podcast website. It's long-term clinical response to medical treatment, behavioral therapy, or their combination in cats with hyperesthesia syndrome. Um I really love this paper and thought it was so interesting. Do you want to, for our listeners, just tell a quick overview of your study and what you guys did?

One Syndrome Or Many Pathways

The Study Design: Neuro Vs Behavior

SPEAKER_00 10:39

Yes, thank you. So actually, you can read in the paper that we have to be group, actually. That we we can see also um more division. But at the beginning, let's focus on the main division. We have a neurological group and a behavioral group. And this is was interesting because normally the neurological group is the group that didn't receive any behavioral modification, just drug. And the behavioral group is the group that received neurological evaluation, behavioral evaluation, sometimes drugs or not, and behavioral modification all the time. And what is was interesting, I think that we were able to find a resolution. So we find a treatment in both groups. So neurologists, we we work independently. So at some point we meet together and the behavioral group and the neurological group and decide, okay, but in any case, we collect good results. Okay. But the difference was that in the case of the behavioral group, we we use all the time the behavioral modification. And this was great in long term. So actually, for sure, we can we can give a perfect treatment even just with drugs. Right. This is for sure, but actually, if you want to collect better results in long term period, actually you need a behavioral modification. Of course. And this is important because uh not because I'm the the behavioral part, the behavior. Yeah. Okay, not d not because actually I think the behavioral group win. Yeah. But this tells something about what epresthesia is, probably. Okay, because uh for sure, I I mean I had in my career a really, a really severe case of epresthesia, and this start attack the caregivers, and they were not able, they were not able to enter in their place in their home for three days. Oi, yeah. So, okay. And I'm not saying the drugs are not important. I mean, are mandatory sometimes, I mean you are receiving the case and it's like really, really severe. So drugs are super important. But the behavior medication, the behavioral modification is important too, because probably these cats need a better life. Yes. Need to change something, actually. So they need to receive something different. Because of course we love cats, we like to have cats around, but sometimes probably we need to transform something in the environment. So probably these cats are more sensitive because we can. I mean, at the moment we are not expert in this part, but probably the genetic part of this cat is different. So they are more sensitive. Probably in nature, yeah, they would be like great because they are more sensitive to so they are able to see if there is like something that is negative going on or they can prevent anything that is dangerous. So but in our places, in our houses, sometimes probably they we we miss something. Yes. So behavioral modification sometimes is the difficult part because each individual is different. Right. So it's not just okay, I opened the cat the door and they can go outside in the garden. Right. Okay, sometimes they can be scared, for example. So even to be in the garden is is not fine. So this is the difficult part. Even if you find the secret key, this is the best result that you can get.

Kristiina Wilson 14:47

I understand. So you're suggesting that that behavioral intervention for cats with feline hyperesthesia could be adding environmental stimulation, it could be adding intellectual stimulation, so that those cats who have feline hyperesthesia, possibly stemming from frustration, like predatory frustration or anxiety, or just a lower baseline threshold, have more to do in their brains so that they are less likely to get over threshold and have an attack.

SPEAKER_00 15:21

Yeah, exactly. And actually, I think that really for this is super important. I mean, for each individual, we should find the right way. I mean, for some cat, you can find some social stressor, for example. Okay, for some cat is frustration because they cannot pray, or for for some other cat is some olfactory issue. So I think it's it's really difficult. This part is really difficult because it really you really need to observe details in this case. So the the medical treatment is for me, is how can I say this is in a really polite way? Is the easy part. Easy part because it's now now we have like GABA pentin, we have floxetine. So yeah, we have something that is really okay, I know how to do this. But sometimes Yebra modification is not a protocol.

Why Behavior Change Improves Long Term

Kristiina Wilson 16:17

Right. It's true. It's not, yeah, you have to really go down when we were trying to figure that out with with our cat who has it. We had to try so many different things until we figured out exactly what she wants. She wants to have her own room where she can go to have her alone time. And then we landed on these little hunting mice that are like little plastic toys that look like mice, they're puzzle feeders. And we just fill them with her dry food for the day and close it so it's just one tiny hole. And she will work with those all day long. She loves them, she's obsessed with them. And if she gets to the point where she hardly ever has attacks anymore, but if she does, if she goes to one of those spots where she's triggered, all we have to do is give her one of those and she's immediately out of it because her brain is occupied and that's what she wants to be doing. So, but it did take quite a lot of trial and error of enrichment boxes and bird feeders, you know, and doing all the things that we normally do for the rest of our cats anyway, but figuring out exactly what worked for her to distract her a little bit differently abled brain to figure out exactly what it is that's gonna pull her out.

SPEAKER_00 17:23

Yeah.

Kristiina Wilson 17:24

But it was worth it because now she's she's much better.

SPEAKER_00 17:27

Great. And actually, I think that's something that we need to consider too. And this is like another important consideration that we are still studying at the moment. Sometime, for example, we do not consider that cat went to a different domestication process.

Kristiina Wilson 17:44

Yes.

SPEAKER_00 17:45

So, for example, if we consider dogs, any dogs that I see every day, it's like I can see this attachment bond with the human being, I can see a pattern, a behavioral pattern. Okay, I can see uh behavioral pathology, but it's like dogs are like really you can describe a behavioral pattern. And for cats, actually, you you really see some differences for each cat. And you can see that sometimes some cats were born in domestic places, but then you have cats that you they were born in the street and they are something in between feral cats. So it have um a huge difference, I think, in the genetic cat part. And sometimes probably our cats are not really ready for being just domestic cats. Sometimes you can have this feeling, and this is I know that this is not really scientific at the moment, but sometimes you can have the feeling that they have this wild part that is like strictly there. I mean, it's like wow. And you can sometimes have some patience that they are still able to pray and they they they were to catch a pigeon. Oh my god, I mean wow. They called me and the owner said, Oh my god, it was able to pray a a pigeon that is not small.

Kristiina Wilson 19:11

I mean, I yeah.

SPEAKER_00 19:14

So you can you can see that they have this wild part, and probably this something that is we still need to study much more about this topic.

Kristiina Wilson 19:23

I agree. Do you think that, you know, many many of the behaviors that are associated with this disorder, kind of the rippling skin and the aggression and the grooming, they often can also appear as we discussed in cats who have chronic stress and frustration, even though it's a little different. Um, but do you think that this syndrome could represent a failure of sort of emotional regulation in some cats? And that's why medications like fluoxetine can be helpful. And fluoxetine for listeners is an SSRI, it's essentially it's Prozac for cats.

Enrichment, Individual Plans, And Trials

SPEAKER_00 19:56

Yeah. Actually, yes. And for this reason, even in the paper, we talk about um a kind of primary dysfunction over the corticolimbic system. So probably it's a kind of behavioral response to this negative affective state or to frustration. So if you ask me, okay, okay, what where is the difference between a chronic stress and uh hyperesthesia, can you describe all the details? I don't know, actually. I mean, yes, for hyperesthesia, I can observe this and this and this, but then for chronic stress, probably I will I mean I can observe yeah, probably for chronic stress stress, I can observe something more similar to the Pandora syndrome. So sometimes for chronic stress I can have idiopathic style status, and I can have um gastrointestinal problem too. So chronic stress is it's a huge, but sometime in Pandora syndrome, probably we can observe also some cat with hyperesthesia. So this stress part is really important for cats. Actually, starting from human psychology, even in human psychology, sometimes the the concept of stress now it's it's going in another direction. So sometimes we don't talk just about stress, we talk more about low level of resilience. This is another concept that I think it's important talking about cat with hyperesthesia. So sometimes we can observe this cat with a low level of resilience. So they they have this kind of deprivation that so they don't see, they don't um they don't uh they they cannot play, they cannot see new stimuli. And then at some point when they are five years old, they move to another place and they they change their routines, but they don't have any kind of resilience, so they can deal with the really high level of stress. Right. And in the future probably we should consider also this part because uh for example in Italy many cats live just indoor for example so they don't they are not um like they are not able to cope with new stimuli for example. They are just not used to this. So anytime that there is a new something new so they change furniture or anything else there is a new member of the family, a new partner and that's it so they they can have this chronic this stress, this high level of stress. So I think this part, this topic is something that should be considered in the future a lot. So it's are we able to deal with modern cats or maybe we should consider new guidelines. Considering also the genetic part or anything else. So it's a question that is still in my mind it's I'm still considering reconsidering this all the option.

Kristiina Wilson 23:07

Yeah. Are there parallels between hyperesthesia syndrome and other stress related or compulsive behaviors that we see in cats? Like how's it different from cats who just compulsively chew with their fur or pull it pull their fur out or or things like that?

Stress, Resilience, And Modern Indoor Life

SPEAKER_00 23:22

Yeah. Actually a few years ago I published a a paper about compulsive disorder in cats and dogs. And we work with the human psychiatrist just to understand better the compulsion. I mean it's a concept that if I say the word compulsion I will oh my god if I said obsessive compulsive disorder is something that okay I'm not fine with this word. But actually when I start reading and studying the literature and I talk a lot with the human psychiatrist they said remember Stefania that an obsessive compulsive disorder starts as a coping strategy. Okay so sometimes animals start with a repetition because they are waiting so they're waiting that the environment is going to be better at some point. Okay so sometime in uh in nature sometimes there is a disaster and the you can observe some some stereotypes even in in in wild animals. But then you I mean there is a resolution of the problem then that's it. In domestic animals probably sometimes there is probably even in this condition um a genetic predisposition but actually we have to consider that probably even the hyperesthesia is a coping strategy at the beginning. So they are trying to deal with the environment okay so they would like to pray for example but they cannot but they learn I mean they they they are able to pray right so it's a kind of result of a continuous frustration probably and even in the case of sepsis compulsive disorder we start with a coping strategy. So for example we we we study the leaking behavior licking licking licking licking licking but that's it you are waiting for something else. Yeah you I mean your question was is it's really fascinating because probably in the future we're going to study more e-prestion and OCD as a coping strategy. Yeah and then you can observe pathology if the coping strategy is not enough anymore.

Kristiina Wilson 25:46

So the study noted um towards the end it noted that inadequate socialization during critical development periods could play a role and that made me wonder if could feline hyposthesia be more common in singleton cats because they didn't have really any socialization?

OCD Parallels And Coping Strategies

SPEAKER_00 26:04

Actually this is quite common and then it's common also in cats with Pandora syndrome for example so the all these uh urinary problems and gastrointestinal issues and blah blah blah so uh even in the in this case probably you can observe difficulty in dealing with like really small stress because during actually if we consider for example the mother when when you observe mother and the kitten sometime mother they start to create some small episode of difficulty event or something that is more difficult for you or they decide to leave the box and leave the kitten alone. This is stress. So sometimes we don't I mean I consider the mother as something like that is why mother but no I mean the mother is is able also to teach when you need to stop when you you are able to deal with frustration or not stop doing this okay let's do this so mother the mother is the first teacher yes of probably of the uh hypothalasmos hypophysa so it's something that teach you how to deal with stress during your life so sometime for example when people said oh but it was this kitten was one month old and the kitten was able to eat so we separate from the mother I said oh my god why yeah the sec first month and the second month are both so important in terms of learning in terms of communication but also in terms of deal with stress. Right absolutely and this is the most difficult part because as a human being I can give milk and food but I cannot teach anything about this stress.

Kristiina Wilson 28:12

Anything absolutely yeah how much do you think that there's any kind of epigenetic role do you have you heard of anything about like a mother cat who might have feline hyperesthesia and then her children having it do you think that there could be any any genetic pass down of this or any learned behavior in in cats?

SPEAKER_00 28:36

Well actually by if I quick check all my patient it's more frequent to have orphan than kitten to learn the this this part. It's definitely more frequent to be so is the worst part is to be orphan or like to be like being separated from separated too early yeah too early.

Kristiina Wilson 28:58

So that makes a lot of sense that you're just not you didn't learn how to cat appropriately or how to regulate emotions from your your parent. Right. Yeah so that that makes a lot of sense and and makes me understand more our particular case who we were her parents and we don't know how to be a cat. You know we're just two humans. So we could meet her physical needs but we could not meet her behavioral needs until she was old enough to get vaccinated and meet the rest of our cats and by then that socialization window had closed.

Early Socialization And Orphaned Kittens

SPEAKER_00 29:27

So unfortunately so when you talk in a study about behavioral therapy what sort of interventions were you talking about and were were people doing any interventions like during an attack okay so normally the first part is to respect the five pillars and the five pillar normally like super basic part about the perfect place for cats really normal like are you sure that there is any privacy space for your cat and they said yes of course okay show me the privacy and sometimes there is a no safe area for cat or um do you respect like some some in this case some again some predatory behavior so is your cat able to to prey of course not not other animals but for example do you provide any appropriate toys or um do you play with your cat for example in in this situation so um or do you respect the the old faction do you respect also everything that is related to resources let plays or like food and uh and etc etc so at the beginning I start really from the basic and sometimes I'm really surprised that some cats are they they just spend time during the Thai day just sleeping. So the normal routine is sleeping, sleeping and sleeping eating sleeping eating sleeping and so the the following steps sometimes is a kind of depressive state. Yeah. So in veterinary medicine at the moment we are not able to describe depression but sometimes they I mean probably in the future we are going to see more and more cats that they start uh with hyperesthesia but then they can show some depression too let's say in the future so it depends actually on on on the patient on the cats but um normally we ask a giver to create a positive interaction and to create a correct communication for example respect the sleeping time of your cat and respect the the the playtime so uh you can interact with your cat but respect for example if your cat for example wants to stop playing and sometimes they want to to pet the cat in any case and the cat starts biting for example yeah so we teach basic rules about communication actually I don't like to teach anything about how to deal with the aggressive event I like to work on prevention. Sure. So um I don't have like a perfect recipe in case your cat is going to attack you. So I don't know it's it's more like we we are going to work in a way that we avoid any negative interaction between you and your cat.

Kristiina Wilson 32:48

Of course oh and when I said attack I I should have clarified I didn't mean your cat is attacking you I meant if your cat has symptoms I we call it when our cat has when when our cat has it we call it an attack because she's attacking herself she's having an attack of hyperesthesia but of course if your cat is attacking you there's nothing you know you need to protect yourself and get away from the situation.

SPEAKER_00 33:11

Is there anything that people might do that would worsen the symptoms yeah for sure no punishment at all no yelling to your cat actually and don't try to hug your cat or kiss your cat at the time because it's going to be really dangerous.

Kristiina Wilson 33:29

Yeah and probably don't kiss your cat in many other circumstances and they at that point they ask me but I cannot kiss my my cat in the belly no sorry yeah with with these cats it's best to always ask for consent and permission so that you don't get your face ripped off.

SPEAKER_00 33:47

And it's a like a great idea. A great point. Yeah because I think we do not respect a cat.

Kristiina Wilson 33:55

Yeah I think always asking for consent and again a good way to do that is to just extend one finger and see if the cat comes up to you. If they do you can pat them if they don't I just don't feel like it right now and just let let them be they're doing they're doing something else just like we don't always want to be touched or hugged or kissed. Sometimes they don't either and that that's okay. So your paper looked at medical treatment alone just fluoxetine SSRI behavioral therapy alone which we've just talked about and then a combination of the two so three distinct groups and I believe all three of them had success right they were they were all successful which is is cool to see and then in the medication categories cats were still successful after the medication was withdrawn right after a year they still were asymptomatic which is great. So what stood out to you most when looking at these long-term outcomes and also I wanted to say the combination group that was the the medication and the behavioral therapy it wasn't just fluoxetine there was also GABA GABAPentin used as the medication which for for listeners is not an SSRI. It's actually like a nerve pain medication.

Practical Behavior Protocols And Pitfalls

SPEAKER_00 35:04

So just putting that out there for people who have not read the paper yet actually sometime my first choice is um actually gabapentin because you are going to receive an immediate result. Right. So sometime my choice my first choice is like to gabapentin for this reason. And sometimes I can start with fluoxetin at the same time because of course fluoxetine it's easy um if we talk about uh how many times should I administer the drugs to my cat so because fluxetine just once per day in the morning that's it. So talking about also how easy it is to give appeals to your cat which should consider also all these variables so actually in literature you can find fluxetine you can find gabapentin and um are both reported as a successful therapy for eye prestigious and actually even in our group we use both successfully but if I have to give also some practical consideration this is also the reason why sometine GABA pent will be your first choice because it's like immediate. Fluxetin is going to take at least 20 days even if for example if you start and sometime you are going to receive the first result in few days actually this is great but if you are with a really severe case for example as I I mentioned before the cat that was so aggressive that the caregiver were not able to go home for three days I start with everything. So fluxandine and gaba painting like with maximum dose for sure so it depends also on the what you are observing and um neurologists are more they respect more a kind of protocol. So my colleagues they said okay we start with fluxandin that's it but since I have the opportunity to work with neurologists and with a behavioral modification sometimes I try to adapt the protocol and actually when we we we were able to compare the result we had like great result in both groups. So this is what's great and I think this is important also because sometimes it's more common that you probably you you can get a neurological consultation but it's probably sometimes depends on where you are in the world sometimes it's more difficult to to have an immediate behavioral consultation. Right.

Medications: Gabapentin And Fluoxetine

Kristiina Wilson 37:52

So I think these results are important because okay if you suspect any prestigious let's start with the the medical treatment and then look around for a behaviorist for example so you're going to receive you're going to have a positive outcome even in the long term actually a limitation of our study is that we we collect follow-up for one year and if you uh if you ask me okay why for one year well actually normally we observe that one year was uh enough to say okay we are going okay or not but probably in the future we are going to collect result an outcome in uh 10 years time because I think it would be more important yeah and to see how it's going on because one year is okay but probably is not enough to understand how the epresthesia is going to evolve somehow I suspect and again what do I know but I suspect it may kind of go this way depending on stressors that wax and wane in the household at least from observation in our household based on your findings what would successful management of hyperesthesia realistically look like over the long term would it be you know just managing behaviorally would it be the combination of the drugs and then fading the drugs out to behavior what do you think a lifetime management is probably well in in long life term I mean um I will go for behavioral modification and but more sometimes I like to talk about optimization.

SPEAKER_00 39:34

So it's not that we are modifying something we are trying to adapt our place houses to cat life actually so it's like it's a long life project and um and I think um in in talking about long term it's also in in my therapy my dream therapy I include also um more awareness of the caregiver and for sure sometimes I think it can be useful to use GABA painting for um if you are suspecting that something is going on for example there is we are going to move or uh there is a your parents that are coming and then I start with GABA painting in because it as I said before can be useful to have something that is going to work really well and really fast. Right. So um it's a kind of emergency kit also for family because sometimes after five years they they call you back and they said oh my god you know what that I observe again rain skin and it was after five years. It's I mean where is the problem again? We it didn't solve the problem. But this is true you are not going to have a a kind of treatment forever you it's something that's part of your cat for entire life. So you are going to observe again rolling skin or sometimes you are not going to observe e-prestige anymore but after a few years these cats are going to develop like some urinary problem for example. So sometimes um and I think this is the concept of Pandora syndrome that is super fascinating. So it's not that you are observing specific pathology but sometimes it's a a a syndrome because after two years you are going to observe different signs just because your your cat is showing stress in a different way. Right.

Kristiina Wilson 41:34

So if you were gonna do a follow-up study what would you want to measure? Is there something else you'd want to add on?

Long Term Management And Relapses

SPEAKER_00 41:40

Is there anything else that you would want to study about hyperesthia okay thanks actually it would be really nice to see if the caregivers observe any other episodes for example during the following years. So you observe any other episode did you correlate for or did you associate this new episode with a new stressor for example did you add for example any new members in the family and um view I mean have you stopped the therapy because sometimes they they try to stop the therapy or um they decide to do this. So actually it would be really nice to see in the long term if there is this this kind of flotation for example or after you treat once it's just fine. So I would be really curious to check all this variable in the future and how many times for example is going to be necessary to use medical treatment for a cat with aporesthesia so uh in a in trial in in in an entire life how many times are you using the therapy or probably if it's a severe case maybe you didn't stop any time the therapy for so use medicaments for the entire life of the cat. So it would be really nice to check also this medical treatment area.

Kristiina Wilson 43:05

So is there something that you would like veterinarians and behaviorists to take away from your research when they work together or independently on these cases?

SPEAKER_00 43:15

Yeah. So I think the first point is do not underestimate epresthesia. So respect caregiver description so if they describe any of this any of these behavioral issues that are going on do not underestimate oh yeah it's a cat that's it right and if you are in in if you have any question just ask to a neurologist or a behaviorist. If you want to start with medical treatment you can do it but remember that behavioral modification and environment are so important in long term. So in the emergency you can use the therapy because now the protocol is quite good so you can use the medical treatment but please remember Also, that you need to respect cats' emotional and behavioral needs. So, this is really an important part for the future of the cat.

Kristiina Wilson 44:07

I totally, totally agree. Um, and if if people start with the medication, would you recommend that they eventually fade the medication? Or do you think some cats need to be on medication for life? What role do you think medication plays?

SPEAKER_00 44:23

I have care, I mean, normally after one year, I try to stop the medical treatment. So I start reducing the dose and I I want to see what's going on. Right. Normally I try at least once after one year. And then I see maybe sometime it's enough for the cat and we just let's stop the medical treatment and that's it. Sometimes when we reduce the dose, then we realize that rolly skin is already there and we we are not able to deal with the cat anymore. So okay, and let's let's go back actually. Right. But I think the medical treatment is something that is useful, but really we use until it's necessary, not not necessary for the entire life of the cat. Right. So not as like a blanket treatment. Yeah, exactly.

Kristiina Wilson 45:17

Sure. Is there something that gives you the most hope when you're treating cats with hyperesthesia today, especially after doing your study?

Future Research And Clinician Takeaways

SPEAKER_00 45:25

Okay. So I think that whenever we start talking about awareness in the family, I think this is a huge progress, actually. Yeah. Even because because sometimes people they decide to adopt a cat and they are not able to they are not they are not aware about anything about cat behavioral and emotional needs. And I think at the time that they deal with the pathology, they start considering more this part. Right. So now there are more and more podcasts and courses for caregivers, and this is so important. So probably in the future, we are going to see cases early, and so we can give up better treatment, and people are going to be more aware about behavioral consultation too. So I think this is a good point for the future of eprestigia. So probably we're going to see more cases, but early, probably, and people I I suppose that are going to be more aware about communicate, communication and behavior and emotion. So it uh probably in the future this um this syndrome is going to be we are going to see this syndrome in a different way, I think.

Kristiina Wilson 46:41

That sounds good. I hope so. Yeah. I hope I hope so. Great. Well, thank you so much for for coming on the podcast and for talking about your study and for all your work to help these cats with feline hyperesthesia. I really appreciate it.

SPEAKER_00 46:55

Thank you.

Kristiina Wilson 46:56

Thanks a lot. Thanks so much for listening to the show. If you're looking for one-on-one support with behavior issues like litter box problems, aggression, anxiety, or multicat dynamics, you can find me through my behavior consulting business, Catitude Adjustment, at catitude adjustment.com. If you like the episode, please consider leaving a rating or review. It really helps us grow. For more episodes, show notes, and resources, head to Hiffandtell Podcast.com. Huge thanks to Cat Beats for the music, and I'll see you next time.