Feline orofacial pain syndrome (FOPS): a retrospective study of 113 cases

Neuropathic pain in cats: Mechanisms and multimodal management

PRACTICAL RELEVANCE

Chronic pain is a significant welfare concern in cats, and neuropathic pain, which arises from aberrant processing of sensory signals within the nervous system, is a subcategory of this type of pain. To comprehend this condition and how multimodal pharmacotherapy plays a central role in alleviating discomfort, it is crucial to delve into the anatomy of nociception and pain perception. In addition, there is an intricate interplay between emotional health and chronic pain in cats, and understanding and addressing the emotional factors that contribute to pain perception, and vice versa, is essential for comprehensive care.Clinical approach:Neuropathic pain is suspected if there is abnormal sensation in the area of the distribution of pain, together with a positive response to trial treatment with drugs effective for neuropathic pain. Ideally, this clinical suspicion would be supported by confirmation of a lesion at this neurolocalisation using diagnostic modalities such as MRI and neuroelectrophysiology. Alternatively, there may be a history of known trauma at that site. A variety of therapies, including analgesic, anti-inflammatory and adjuvant drugs, and neuromodulation (eg, TENS or acupuncture), can be employed to address different facets of pain pathways.Aim:This review article, aimed at primary care/ general practitioners, focuses on the identification and management of neuropathic pain in cats. Three case vignettes are included and a structured treatment algorithm is presented to guide veterinarians in tailoring interventions.Evidence base:The review draws on current literature, where available, along with the author's extensive experience and research.

Skin Disease and Behavior Changes in the Cat

The health of the skin and coat of a cat is connected to the behavioral health of the animal. Stressed animals can cause lesions to their skin and coat such as alopecia, ulcers, and self-mutilation. On the other hand, localized or systemic health problems can cause stress, or pain, and therefore can increase overgrooming and poor skin health. When treating overgrooming and related skin lesions, all the physical and behavioral causes must be addressed through a multimodal approach.

Supernumerary maxillary fourth premolar teeth in five related Burmese cats

Case series summary

This article reports a case series of five Burmese cats with supernumerary teeth. All included cases displayed either unilateral or bilateral supernumerary maxillary fourth premolar teeth. Two cases also displayed supernumerary mandibular fourth premolar teeth, and in one case bilateral supernumerary maxillary third incisor teeth were found. Examination of the pedigrees of the affected cats revealed that all five cats were related with one common ancestor. All patients in this case series were successfully treated.

Relevance and novel information

Supernumerary maxillary fourth premolar teeth in cats have not been reported previously in the literature. As all five cats in this case series were shown to be related, supernumerary maxillary fourth premolar teeth may be yet another heritable health condition affecting the Burmese breed. Therefore, Burmese breeders should endeavour to reduce the incidence of supernumerary teeth within the breed by having animals examined by a veterinary dentist prior to breeding, and neutering affected, as well as related, individuals. Burmese cat owners must be made aware of the condition in order to institute early evaluation, diagnosis and treatment.

Mapping the genetic basis of diabetes mellitus in the Australian Burmese cat (Felis catus)

Diabetes mellitus, a common endocrinopathy affecting domestic cats, shares many clinical and pathologic features with type 2 diabetes in humans. In Australia and Europe, diabetes mellitus is almost four times more common among Burmese cats than in other breeds. As a genetically isolated population, the diabetic Australian Burmese cat provides a spontaneous genetic model for studying diabetes mellitus in humans. Studying complex diseases in pedigreed breeds facilitates tighter control of confounding factors including population stratification, allelic frequencies and environmental heterogeneity. We used the feline SNV array and whole genome sequence data to undertake a genome wide-association study and runs of homozygosity analysis, of a case–control cohort of Australian and European Burmese cats. Our results identified diabetes-associated haplotypes across chromosomes A3, B1 and E1 and selective sweeps across the Burmese breed on chromosomes B1, B3, D1 and D4. The locus on chromosome B1, common to both analyses, revealed coding and splice region variants in candidate genes, ANK1, EPHX2 and LOX2, implicated in diabetes mellitus and lipid dysregulation. Mapping this condition in Burmese cats has revealed a polygenic spectrum, implicating loci linked to pancreatic beta cell dysfunction, lipid dysregulation and insulin resistance in the pathogenesis of diabetes mellitus in the Burmese cat.

Feline comorbidities: What do we really know about feline triaditis?

PRACTICAL RELEVANCE

Feline triaditis describes concurrent pancreatitis, cholangitis and inflammatory bowel disease (IBD). The reported prevalence is 17-39% in ill referral patients. While the aetiology is poorly understood, it is known to include infectious, autoimmune and physical components. What is not known is whether different organs are affected by different diseases, or the same process; indeed, triaditis may be part of a multiorgan inflammatory disease. Feline gastrointestinal tract anatomy plays its role too. Specifically, the short small intestine, high bacterial load and anatomic feature whereby the pancreatic duct joins the common bile duct before entering the duodenal papilla all increase the risk of bacterial reflux and parenchymal inflammation. Inflammation may also be a sequela of bowel bacterial translocation and systemic bacteraemia.

DIAGNOSTIC CHALLENGES

Cholangitis, pancreatitis and IBD manifest with overlapping, vague and non-specific clinical signs. Cholangitis may be accompanied by increased serum liver enzymes, total bilirubin and bile acid concentrations, and variable ultrasonographic changes. A presumptive diagnosis of pancreatitis is based on increased serum pancreatic lipase immunoreactivity or feline pancreas-specific lipase, and/or abnormal pancreatic changes on ultrasonography, though these tests have low sensitivity. Diagnosis of IBD is challenging without histopathology; ultrasound findings vary from normal to mucosal thickening or loss of layering. Triaditis may cause decreased serum folate or cobalamin (B12) concentrations due to intestinal disease and/or pancreatitis. Triaditis can only be confirmed with histopathology; hence, it remains a presumptive diagnosis in most cases.

EVIDENCE BASE

The literature on feline triaditis, pancreatitis, cholangitis and IBD is reviewed, focusing on histopathology, clinical significance and diagnostic challenges. Current management recommendations are provided. Further studies are needed to understand the complex pathophysiology, and in turn improve diagnosis and treatment.

Neurobehavioral Disorders: The Corticolimbic System in Health and Disease

The corticolimbic system (prefrontal cortices, amygdala, and hippocampus) integrates emotion with cognition and produces a behavioral output that is flexible based on the environmental circumstances. It also modulates pain, being implicated in pathophysiology of maladaptive pain. Because of the anatomic and function overlap between corticolimbic circuitry for pain and emotion, the pathophysiology for maladaptive pain conditions is extremely complex. Addressing environmental needs and underlying triggers is more important than pharmacotherapy when dealing with feline orofacial pain syndrome or feline hyperesthesia syndrome. By contrast, autoimmune limbic encephalitis requires prompt diagnosis and management with immunosuppression and seizure control.

Feline Neuropathic Pain

Neuropathic pain represents the extreme in maladaptive pain processing. In itself, it is a disease in which pain has become exaggerated in some combination of scope, severity, character, field, duration, and spontaneity. It is almost certainly an underappreciated, underdiagnosed cause of possible significant patient morbidity in cats. This article explores the basic mechanisms, recognition, known and suspect syndromes, and prospective treatment of feline maladaptive and neuropathic pain.

Behavior as an Illness Indicator

When an owner notices a behavior change in their cat that concerns them enough to present the cat to the vet, there are 3 possibilities: the behavior change reflects a change in behavioral health (a change in psychological state), a change in medical health (a change in physical state), or a combination (comorbid medical and behavioral pathologies). Because many behavioral pathologies are diagnoses of exclusion, it is important that the veterinarian rule out all of the likely medical differentials for the changed behavior. This article is a behavior-by-behavior guide to the more common differentials for the most common problem behaviors.

Chronic pain in cats: Recent advances in clinical assessment

PRACTICAL RELEVANCE

Chronic pain is a feline health and welfare issue. It has a negative impact on quality of life and impairs the owner-cat bond. Chronic pain can exist by itself or may be associated with disease and/or injury, including osteoarthritis (OA), cancer, and oral and periodontal disease, among others.

CLINICAL CHALLENGES

Chronic pain assessment is a fundamental part of feline practice, but can be challenging due to differences in pain mechanisms underlying different conditions, and the cat's natural behavior. It relies mostly on owner-assessed behavioral changes and time-consuming veterinary consultations. Beyond OA - for which disease-specific clinical signs have been described - little is known regarding other feline conditions that produce chronic pain.

RECENT ADVANCES

Knowledge of the subject has, however, greatly improved in the past few years, informed by study of the mechanisms of pain in cats with OA and the development of pain scales that can be used by owners or veterinarians. Pain scales may facilitate the diagnosis and follow-up evaluation of chronic painful conditions, providing a basis for therapeutic decision-making. Assessment of quality of life is also recommended in cats with chronic pain, and its improvement can be used as a positive outcome in response to therapy.

AIMS

This article reviews recent advances and presents the challenges and some future perspectives on clinical chronic pain assessment. The most common feline chronic conditions associated with pain are also described.

Behavioral awareness in the feline consultation: Understanding physical and emotional health

Practical relevance: Awareness of the strong connection between observed behavior and physical and emotional health is essential for patient welfare. It is often a change in the individual's normal behavior that informs owners and veterinarians of the possibility of illness, pain and stress/distress. There is ample evidence in the feline literature that medical and behavioral health go hand in hand. In most feline cases, medical and behavioral conditions contribute concurrently to clinical signs. Clinical challenges: Our domestic cats do not express change in physiological and emotional states in a way that is easily recognized. Therefore, it can be difficult to diagnose medical and behavioral illnesses and ascertain contributions from each one to the final diagnosis. When various levels of stress are present, especially distress, this compromises behavioral and physical health, and influences treatment outcomes.

AIMS

This review is intended to help veterinarians recognize physical and behavioral changes associated with acute stress through to chronic distress, including stress-associated diseases. An emphasis on thorough history-taking will allow the clinician to ascertain which signs are behavioral and which are medical, with the understanding that they are not mutually exclusive. Equally important is the contribution of pain, chronic disease and poor environmental situations to behavioral changes and the expression of medical disorders. Evidence base: There is an increasing amount of evidence that stress and distress have profound effects on feline health, behavior and welfare. The authors have drawn on a substantial body of published veterinary research in producing this review.

Mocha tyrosinase variant: a new flavour of cat coat coloration

A novel coloration named ‘mocha’ has been identified in the Burmese cat breed from Thailand. Tyrosinase (TYR) mutations are known to be associated with coat coloration in cats, such as the sable Burmese, the points of the Siamese and albino cats. Additionally, sable Burmese that produced mocha‐colored cats had unexpected genotypes for TYR. Therefore, TYR was considered a candidate gene for mocha in cats. Sanger sequencing for genomic DNA revealed NC_018732.3:chromosome D1:45 898 609_45 898 771dup in exon 2 and intron 2 of TYR. Transcription analysis using cDNA detected c.820_936delinsAATCTC (p.I274_L312delinsNL), which caused a 111‐bp (37 amino acid) deletion in the reading frame of TYR. The identified variant was concordant with the phenotype and segregated with TYR variants in a pedigree of 12 Burmese cats. This findings of this study suggest that TYR is associated with the mocha coloration in cats. The new color variant adds to the allelic series for TYR (C > c^b = c^s > c, c²) and is recessive to full color (C); however, interactions with the c^b and c^s alleles are unclear due to the temperature‐sensitivity of the alleles.

From Feline Idiopathic Ulcerative Dermatitis to Feline Behavioral Ulcerative Dermatitis: Grooming Repetitive Behaviors Indicators of Poor Welfare in Cats

Feline idiopathic head-and-neck dermatitis—also named feline idiopathic ulcerative dermatitis (IUD)—is considered as a rare skin disease of unknown origin. It is usually associated with a crusted, non-healing, self-induced ulcer occurring most commonly on the dorsal or lateral neck or between the scapula where self-grooming by scratching occurs. Usually, IUD is diagnosed after exclusion of other causes of pruritus. In feline medicine, self-induced alopecia is recognized as a behavioral disorder (abnormal repetitive behavior) due to excessive licking, which is an amplification of a normal maintenance behavior. Such repetitive behaviors, like self-induced alopecia or self-induced wounds, are named stereotypies and considered as indicators of poor welfare. The objectives of our study were to determine, first, if the repetitive behavior associated with self-induced wounds was related to a poor welfare, and, second, if improving the welfare in the cat’s environment would lead to healing, thanks to environmental enrichment. We recruited 13 cats diagnosed with IUD by a dermatologist. These cats were referred to a behaviorist for welfare evaluation. A welfare score was attributed using a new 21-point welfare scale. The median score of the 13 IUD cats was 16, while the median score of 35 healthy cats was 7 (significant difference, p < 0.001). Major modifications of the cat’s environment and the human–cat relationship were then recommended for IUD cats. Within 15 days after environment modifications, ulcerative lesions were healed and welfare scores improved significantly (median score of 6, significantly different from the score before environmental modifications), being similar to healthy cats (no significant differences). Only one cat was treated with a psychotropic drug, owners being reluctant to improve environmental modifications. These results suggest that feline IUD is a behavioral disorder indicative of poor welfare and that it requires management by behavior specialists, proposing environmental modifications. We hence propose to rename this affection to “behavioral ulcerative dermatitis,” given that welfare scores were significantly different from healthy cats, and that environmental modifications modified welfare scores and lead to successful healing in all cases.

Complex Partial Cluster Seizures in Cats with Orofacial Involvement

Seventeen cats were presented with acute onset of complex partial seizures with orofacial involvement (salivation, facial twitching, lip smacking, chewing, licking or swallowing), motor arrest (motionless starring) and behavioural changes. In 11 cats hippocampal necrosis (HN) was confirmed by histopathology. In a further six cats hippocampal changes were suggested by magnetic resonance imaging. The mean monitoring time of eight cats which were not euthanased in the acute phase of the disease, was 408 days (60–908): four cats are still alive. In all surviving cases, the owners reported a good quality of life. We conclude that an acute cluster of complex partial seizures with orofacial involvement are often associated with HN and that HN is not necessarily a fatal condition. Supportive and antiepileptic therapy can result in remission. The long-term outcome can be good to excellent; therefore, euthanasia should be avoided in the acute phase of the signs.

Aristaless-Like Homeobox protein 1 (ALX1) variant associated with craniofacial structure and frontonasal dysplasia in Burmese cats

Frontonasal dysplasia (FND) can have severe presentations that are medically and socially debilitating. Several genes are implicated in FND conditions, including Aristaless-Like Homeobox 1 (ALX1), which is associated with FND3. Breeds of cats are selected and bred for extremes in craniofacial morphologies. In particular, a lineage of Burmese cats with severe brachycephyla is extremely popular and is termed Contemporary Burmese. Genetic studies demonstrated that the brachycephyla of the Contemporary Burmese is a simple co-dominant trait, however, the homozygous cats have a severe craniofacial defect that is incompatible with life. The craniofacial defect of the Burmese was genetically analyzed over a 20 year period, using various genetic analysis techniques. Family-based linkage analysis localized the trait to cat chromosome B4. Genome-wide association studies and other genetic analyses of SNP data refined a critical region. Sequence analysis identified a 12bp in frame deletion in ALX1, c.496delCTCTCAGGACTG, which is 100% concordant with the craniofacial defect and not found in cats not related to the Contemporary Burmese.

2015 AAHA/AAFP Pain Management Guidelines for Dogs and Cats

Rationale:

The robust advances in pain management for companion animals underlie the decision of the American Animal Hospital Association (AAHA) and American Association of Feline Practitioners (AAFP) to expand on the information provided in the 2007 AAHA/AAFP Pain Management Guidelines. The 2015 Guidelines summarize and offer a discriminating review of much of this new knowledge.

Relevance:

Pain management is central to veterinary practice, alleviating pain, improving patient outcomes, and enhancing both quality of life and the veterinarian–client–patient relationship. These Guidelines support veterinarians in incorporating pain management into practice, improving patient care.

Approaches:

The management of pain requires a continuum of care that includes anticipation, early intervention, and evaluation of response on an individual patient basis. A team-oriented approach, including the owner, is essential for maximizing the recognition, prevention and treatment of pain in animals.

Evidence base:

The Guidelines include both pharmacologic and non-pharmacologic modalities to manage pain; they are evidence-based insofar as possible and otherwise represent a consensus of expert opinion. Behavioral changes are currently the principal indicator of pain and its course of improvement or progression, and the basis for recently validated pain scores. Post-surgical pain is eminently predictable but a strong body of evidence exists supporting strategies to mitigate adaptive as well as maladaptive forms. Chronic pain is dominated by degenerative joint disease (DJD), which is one of the most significant and under-diagnosed diseases of cats and dogs. DJD is ubiquitous, found in pets of all ages, and inevitably progresses over time; evidence-based strategies for management are established in dogs, and emerging in cats.

Adjunctive, pain-modifying, analgesic drugs

Outside the realm of nonsteroidal antiinflammatory drug(NSAID) and opioid exist a broad range of medications that exert an analgesic effect, or otherwise modify and protect against pain, by manipulating various targets along the nociceptive pathway. Strength of evidence for dogs and cats can vary widely, and this article will review the available literature that may guide clinical usage in these species.

Epilepsy in cats: theory and practice

The veterinary literature on epilepsy in cats is less extensive than that for dogs. The present review summarizes the most important human definitions related to epilepsy and discusses the difficulties in applying them in daily veterinary practice. Epileptic seizures can have a wide range of clinical signs and are not necessarily typical in all cases. Whether a seizure event is epileptic can only be suspected based on clinical, laboratory, and neuroimaging findings as electroencephalography diagnostic techniques have not yet been developed to a sufficiently accurate level in veterinary medicine. In addition, the present review aims to describe other diagnoses and nonepileptic conditions that might be mistaken for epileptic seizures. Seizures associated with hippocampal lesions are described and discussed extensively, as they seem to be a special entity only recognized in the past few years. Furthermore, we focus on clinical work‐up and on treatment that can be recommended based on the literature and summarize the limited data available relating to the outcome. Critical commentary is provided as most studies are based on very weak evidence.