Paroxysmal Dyskinesia

Paroxysmal Dyskinesia is a “seizure-type” movement disorder increasingly being diagnosed in Labradors. Some dogs experience a full collapse – unable to control limbs and possibly experiencing muscle spasms (though remaining fully conscious and responsive), while others may just seem to have “a funny turn” (perhaps a bit wobbly/trembling/uncoordinated limbs). Frequency, as well as severity/duration of episodes, can vary considerably. Once the episode is over the dog reverts back to normal almost immediately. There is no loss of bladder/bowel control, and dogs show no signs or symptoms between episodes.

If your dog has had episodes of this type please could you contact me.

I currently have information on quite a number of these Labradors and would be very interested to hear of any more having similar episodes. A study is currently underway by UK neurologists into this condition.

This is a link to a video of my own dog who has suffered from paroxysmal dyskinesia for nine years now.

https://www.youtube.com/watch?v=MdifQO2qevg&list=UL6kh81Fq7G8U&index=1

 

Hi Paddy, how's your dog apart from these episodes?

 

He was diag with chronic pancreatitis but that was way after the episodes began. In between episodes there are no neurological signs or symptoms

 

He looks lovely from your thumbprint photo. I hadn't heard of this condition so thanks for the information.

 

my Jellybean has been diagnosed with this, her episodes started after her annual booster and I believe that this has something to do with the cause of it, she is on Pexion and Keppra and they help the severity and the frequency of the episodes.

 

Hi ady - sorry to hear that Jellybean (lovely name!) has been diagnosed with paroxysmal dyskinesia. Mark Lowrie is a veterinary neurologist at Davies Vet Specialists who is currently researching the condition. His initial study is now complete and awaiting publication. An abstract is available which gives a little of the information found during the study. I have tried to attach a copy of a short piece about paroxysmal dyskinesia and also the relevant abstract but for some reason it won't allow me to upload either document. So I have copied and pasted the article below - you may find this of interest. And as including the Abstract makes the post too long, I will include it in a second post. You will see that 39% of the labradors in the initial study went into spontaneous remission. It is now believed that there may be more than one form of paroxysmal dyskinesia affecting the breed.

It would be good to have a chat - and to share our experiences. I am keen to hear more about Jellybean and how the episodes affect her
June


PAROXYSMAL DYSKINESIA IN THE RETRIEVER LABRADOR BREED
Paroxysmal Dyskinesia is an episodic neurological condition which is increasingly being diagnosed in Labradors. It is commonly mistaken for an epileptic seizure disorder by vets and owners alike, and so it is important to understand how Paroxysmal Dyskinesia differs to epileptic seizures or fits so that it can be quickly recognised.
Paroxysmal Dyskinesia is a movement disorder and is thought to be genetic in nature (the mode of inheritance has not as yet been established). During an episode of dyskinesia the dog is fully alert and will attempt to obey commands, although he/she may have no control of limbs. Dogs remain fully conscious throughout the episode, there is no loss of bladder/bowel control, and no excessive salivation. This makes the episodes very different to epileptic seizures in which salivation, urination and a loss of awareness are expected. Episodes can sometimes be brief and fairly mild with the dog showing just a little bit of unsteadiness or incoordination of the limbs (possibly described as a “funny turn”). However other Labradors have very severe episodes despite being fully aware, which can cause full collapse and involve the entire body, and which is very distressing to both dog and owner. During these extreme episodes very severe muscle spasms may occur (which may possibly be painful). While some mild episodes may be fairly short, the severe episodes can last well over an hour. Once the episode is over recovery is immediate – the dog will get to its feet and almost instantly revert back to normal. There is no “aura” before the episode or post-ictal signs following the episode, which again makes them distinct to epileptic seizures in which a prolonged period of abnormal behaviour may be seen following a fit. Dogs are completely normal in between episodes and show no problems at all until the next episode occurs. Frequency, severity, and length of episodes can vary dramatically between dogs but also within individuals. Importantly, Paroxysmal Dyskinesia is not thought to influence life expectancy, with affected dogs often living long, full lives.
Some Labradors can have just a few episodes and then appear to go into complete remission (having no further episodes – or just very occasional ones), but others experience these episodes for the remainder of their lives with a frequency of anything from one episode every year to several per week. Dogs mostly begin having episodes of Paroxysmal Dyskinesia while young, often experiencing their first episode by the age of two. In some Labradors the episodes can be triggered by excitement, a sudden burst of energy, or startle – but others appear to have episodes without any apparent trigger.
Labradors were first identified at the Animal Health Trust as having Paroxysmal Dyskinesia about fifteen years ago, and neurologists are now diagnosing more dogs as having the condition. However until recently there has been very little awareness of Labrador Dyskinesia among the general veterinary profession. It is possible that Labradors with Paroxysmal Dyskinesia may be misdiagnosed as having epilepsy. Labradors with dyskinesia do not usually respond to antiepileptic drugs and at this time no treatment has been found to help dogs with the condition. Therefore recognising the condition is important so that Labradors are not needlessly given long-term antiepileptic drugs that may have little effect in controlling the episodes.
Recently Mark Lowrie and Laurent Garosi (Neurology Specialists at Davies Veterinary Specialists) embarked on a study into this movement disorder in Labradors with a view to correctly identifying the condition so that accurate diagnosis can be made, raising awareness of Paroxysmal Dyskinesia within the veterinary profession and the public, and hopefully finding a treatment which may help these dogs. The initial study has now been completed and an article written by Mark Lowrie is currently awaiting publication in the veterinary press. The Abstract is available below. The research project is ongoing.
The Abstract indicates that 39% of Labradors in the study went into spontaneous remission, while the remainder continue having these disabling episodes all of their lives. Dogs having clusters of episodes (defined as one or more episodes in a week) seem less likely to achieve remission. The neurologists now believe that there may be more than one form of Paroxysmal Dyskinesia affecting the Labrador breed. It is possible that these differing forms of movement disorder may not have a similar mode of inheritance. Collection of DNA samples from affected dogs may hopefully begin soon (subject to funding).
The same neurologists recently researched Canine Epileptoid Cramping Syndrome – a movement disorder which is found in Border Terriers and which has very similar signs to Labrador Dyskinesia. This study concluded that Border Terriers with CECS suffer from gluten sensitivities and a test is available to measure these antibodies. Border Terriers put onto a gluten-free diet stopped having episodes of CECS. A few Labradors with Paroxysmal Dyskinesia have been tested for these antibodies but, as yet, very high levels of gluten antibodies have not been found.
Videos are the most useful way of making a diagnosis. Therefore it is always advisable to capture an episode on film to show your veterinarian so they can pass this on to a suitably qualified neurologist. Many of the dogs diagnosed with Paroxysmal Dyskinesia have undergone thorough neurological testing and in each case all results were found to be normal. However, testing is important to ensure other conditions are not present that may cause life-threatening problems.
This is a link to a video which shows a Labrador having an episode of Paroxysmal Dyskinesia
https://www.youtube.com/watch?v=MdifQO2qevg

 

And here is the Abstract -

ABSTRACT
NATURAL HISTORY OF PAROXYSMAL MOVEMENT DISORDERS: A REVIEW OF 59 DOGS
M Lowrie, L Garosi.
Davies Veterinary Specialists, Higham Gobion, Hitchin, UK.

Although the essential clinical features of paroxysmal dyskinesia (PD) are well established in dogs, little is known about the natural history of the disorder.Delineation of the typical disease progression may assist in the evaluations of therapeutic agents during clinical trials. Our objective was to establish the natural disease course in a group of dogs diagnosed with PD that received no medication.We report the long-term outcome of a cohort of Labradors and Jack Russell terriers (JRT) with PD.
Clinical information of 59 dogs (36 Labradors; 23 JRT) with a clinical diagnosis of PD and a minimum follow-up of three years was retrospectively reviewed. Dogs receiving medication for more than eight weeks were excluded.
Labradors and JRTs with PD had a young onset (median age; two years three months and four years eight months respectively), were triggered by startle or sudden movements, and had a male bias (44/59; 75%) with the majority of these male dogs being entire (31/44; 70%). Median frequency at onset was one episode every three weeks in Labradors (range, one every six months to 12/month) and one per month in JRT (range, one every six months to two per month). Twenty-one dogs (36%; 2 JRT and 19 Labradors) had at least one event comprising cluster episodes (defined as >one episode in a week). Episode duration and frequency varied dramatically, even within an individual. Median follow-up time (from first observed episode to date of death or follow-up) in all dogs was seven years six months (range, three years to 14 years 10 months). Median frequency at follow-up was one episode every four months in Labradors (range, zero to one per month) and one every six months in JRT (range, zero to one every six weeks).
The natural history was self-limiting with a remission rate (defined as no episodes for ≥2 years) of 39% (14/36) in Labradors and 22% (5/23) in JRT. A total 75% of dogs (44/59) had an improvement in frequency and duration of PD. Eight dogs had a static course whilst seven had a progressive course. Overall the episodes were significantly reduced in terms of frequency (P

 

I do believe that bursts of emotion e.g excitement, distress exhaustion can set an episode in motion and they can be prevented in some cases although difficult to predict, jellybean has not been left alone since her first episode, and not all can be prevented but I have a scale of severity Nearly-small-medium-severe, nearly are difficult to prevent and they are the only ones that you can act on, they know they are about to have one and they give you the imminent signs, the clutch, the fast tail wag, the eyes give it away, I believe that I have helped prevent two by literally mind change talking ball and food and talking walkies, she is off colour for about 10 minutes, then this can be an indication that she will have one in the next week ,
when I say Jellybean has not been left at all I mean it, I have not been to the bathroom alone in years, I gave up work until I could find a job that would allow me to bring her to work, my husband and I have not socialised , I have a food diary of everything that she eats I have records of every seizure, sneeze cough cold ailment, she has suffered with a bad shoulder, she gets cystitis and has had that since a pup on and off, If she gets a high temperature at all e.g bladder infection or a cough, then she is prone so I try and get antibiotics into her at first sign then I am battling the fact that Keppra do not work along side Keppra in my opinion . she is slightly over weight and I think this helps as her drugs work in the tissue, I strongly believe that it was kicked off by over inoculation, she had her last dhpp at 12 months and was having episodes roughly 16 days - 30 days, then she had a rabies vaccine for her passport within the week she had 5 episodes on a grand scale and collapsed with exhaustion after several, she is 3 years without a single inoculation and has a small/med episode roughly every 100 days plus, Keppra is the muts nuts but it is very expensive! her episode diary shows no real pattern until she went on keppra where you can see that other health issues and emotional stresses can contribute to an episode, you really need to spend every minute of everyday with your dog to see the unnoticeable warning signs, leg twitches in their sleep are indications that something is brewing, its difficult to explain but they have a look in their eye a worried look that most pet owners wouldn't notice, sometimes the membranes in the eye turn pinkish the day before, they become clingy and need to pee more often (could of course be related to her cystitis ! but then if she knows she is going to have one she needs a pee, I don't know she would just die if she thought she'd had an accident in the house! lol) she can't get too hot and gets up several times in the night as she needs to go out and cool off, and she does things like this with haste like she is telling me she needs to cool down or else!! food is not a factor that I can say with all honesty! its not diet related, we have given her the vit b shots we have changed the diet, we have changed the diet back!!! carrots might help she has a lot of fruit and veg, but research says that carrots help people with epilepsy, we were told that she is unlikely to have an episode when she is out and generally will only occur when in a safe familiar environment, this is not entirely true last august she had one in the car, we held up the n72 for over 20 minutes!!!

 

Jellybeans episodes seem to start with a tightening of the stomach, then the chest, then she has a straightening of the front and rear limbs, then the face and neck tense as if she is try to push her neck into her shoulders, her front limbs contort and she twists her whole body rigid, she almost holds her breath, which is not good when her neck is arched and her head is on her chest or twisted around, tears stream from her eyes, she yelped and wet herself the first time she had one but she is used to it now, the first ones we used to keep her stood up! good old stiff upper lip and walk it off girl you will be fine, her first 5 were like this upright and only lasted 15 minutes, the severe ones seem to go on for ages, multiple episodes of varying degree, and seem to come in pairs, a medium one followed by a grand nightmare, heart breaking even to the point where I thought it would kill her, she tried many epileptiod drugs but after her MRI CT and many other tests at Dublin Veterinary Hospital before they put her on Keppra which by the way does not work alone she needs pexion as well. Jellybean is kept in a calm environment at all times, no raised voices, in fact when my husband and I row we have to do it in a jolly tone so we don't upset her! she sleeps on our bed between my husband and I so that We can tell if she has one in the night, she has had a few at night, usually if she has got too hot or has woken suddenly,

 

Ady - I have tried to PM you but it seems you are not able to received PM's (maybe because you are new to the site?).

As far as having episodes outdoors - Monty has had several episodes while on walks/playing (his very first one happened outdoors when we were doing some training/rewarding with ballplay) but nowadays they usually happen indoors. In the early years all of his episodes were related to excitement/sudden burst of energy but now they happen at any time - while situations that would previously have triggered an episode usually pass uneventfully. His most recent episode was in the early hours of New Years day (he was stressed due to fireworks)

I have tried many dietary changes over the years (including avoiding grains) and also many supplements etc. None have seemed to make any difference. You will see from my previous post that most labradors with PD have not been found to respond to epilepsy drugs. You may know that some Border Terriers suffer from what was formerly called Canine Epileptoid Cramping Syndrome which is a form of paroxysmal dyskinesia. The neurologist leading the current research project into labrador dyskinesia recently published his findings regarding his research study into CECS in Border Terriers - and it has been shown that in Border Terriers this is a gluten-sensitive movement disorder. There is not evidence at this time that PD in labradors may be gluten related disorder..

Monty's episodes vary considerably in length/severity. They mostly average around 10 minutes but occasionally he has a "mini" episode where he has that stressed look/limbs a bit uncoordinated momentarily but a full collapse may not develop (these don't happen very often).. However, he has also had very extreme episodes which can last up to an hour and a half and involve very severe muscle spasms.(these are very scary! - both for him and for me) Just over the last year he's had 19 episodes He is always fully conscious and responsive throughout.

I am currently in contact with around 50 owners of labradors with suspected episodes of dyskinesia (mostly in the UK but a few overseas dogs). Many of these owners have been willing to share pedigree information which I have been able to pass on to the researcher. The current train of thought is that there may well be more than one form of dyskinesia in the breed.and while one is likely to prove to be recessive, it is possible that the other form (or forms) may have different mode(s) of inheritance

I have found that if I allow Monty to keep trying to struggle to his feet - the episode is likely to last longer and become more severe. So I try to keep him lying down (though not always possible) until the episode seems to be over. Once the episode has passed he gets to his feet and runs around as if nothing had happened. Like yourself I leave him alone as little as possible (he sleeps in my room and has had quite a few episodes during the night). On one occasion he fell down a full flight of stairs as he had gone into an episode while lying on the landing and he tried to get to me.

Please feel free to keep in contact

June


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what medication is Monty on?

 

Jellybean has been trialling Keppra it is a human drug and definitely helps, I have no pedigree for Jellybean, although her breeder has been incredible, really lovely helpful man, who breeds working Labradors, Jellybeans grandmother on her mothers side is a red setter introduced into the breeding plan to help eradicate other disorders eg hips, there is no history of PD that they could recall but then I am in Ireland and People still have not caught up with UK dog care here. she had a blood disorder that vanished and I cant for the life of me remember what it was called greyhounds and Lundahunds are prone to it and it can kill, she has been tested regularly for it and has shown so signs in three years.
When Jellybean has an episode now, I lie on the floor with her to stop her from hurting herself, and constantly talk to her trying to keep her comforted and secure, we also try and massage her back and neck as her neck is very tight. I really feel for you and Monty its such an awful thing to happen to any animal but when its your baby its heart breaking, I have a kit in the kitchen ready, stesolid, stethoscope, vets info, camera, I don't leave the house without a handbag of pills !!! she has pills at 9am 3pm 9pm on the dot everyday!

 

polycythaemia!!!!

 

Monty is not currently on any medication. And none of the labrador research study were on meds either. When he was first diagnosed at the Animal Health Trust back in 2007 they said that they did not advise medication at that stage - but may consider a trial with one of the new epilepsy drugs if things became worse. Since then researchers both in the UK and in the US have said that labradors with PD do not normally respond to epilepsy medication. As he later developed chronic pancreatitis, I would glad that we had opted against the medication route as some of the epilepsy drugs can actually cause pancreatitis. Of course the fact that many labradors have been found to go into remission without meds clouds the picture somewhat because if a dog goes into remission while on meds - how can we tell whether it may be one of those that would have gone into remission anyway regardless of meds.

On one occasion, because Monty had experienced a few very long episodes the vet and I decided that I would have rectal diazepam on hand to try if an episode became really bad. The next fairly severe episode he had I used the rectal diazepam and the episode became much, much worse (the worse I've ever seen).. In view of the adverse reaction I have been advised never to use it again. Anecdotally I have heard of a few dyskinesia dogs whose episode worsened when on Keppra and other newer epilepsy drugs..

Like yourself - I have found that the best way to deal with Monty during an episode is to be down there on the floor holding him, giving lots of comfort and reassurance. In a way it's probably harder for them because they remain fully conscious and aware - they know what is happening to them but can't do a thing about it. It must be terrifying for them. On a positive note - labradors with paroxysmal dyskinesia have been found to have a normal life-span.

J

 

Not come across that before - seems unlikely to be linked to the episodes

 

oh my doesn't it vary?? rectal stesolid I think helps jellybeans episodes severity, I keep a close watch on Jellybean's stomach as I worry about pancreatic disorders or worse from use of the Pexion, In much respect I would be scared to take Jellybean off of the drugs as she was so horrifically ill before she went on them, before Jellybean started having episodes she was training to be a sniffer dog and we had what I called drug rags that were almost marinated in cannabis! that you could hide anywhere and she could smell them out! this is still one of her favourite games today finding new places to hide them is the problem, I felt that Pexion did nothing alone, yet if I give her one or the other neither work but both together are fantastic and in the right balance at the exact time of day 1500mg keppra and 200mg of Pexion per day.

 

when she had her first blood test after her first episode it came back that she was polycythemic, like I said after three years of testing for it never seen again!

 

You have got to stick with whatever works for your own dog.

 

Jellybean has become so humanised because of her episodes, makes it worse in a way, If I go out on my own I feel lost as she is with me most of the time when my husband has her she gets most annoyed that I did not take her with me! the people in my local town are great I can take her in all the shops/bank/ hairdressers/ Doctors etc.

 

I use stesolid on Jellybean the minute an episode starts, I don't even wait to see the severity of it anymore