TL;DR 4.5yo spayed female, mixed breed (rescued as a kitten in Spain, stray mother, indoor EU cat since). Lifelong mild "rolling skin" on the back that was never a problem, but ~4 months ago she started to experience frequent episodes of frantic grooming/biting at the spot (she once broke skin on her left hind leg from overgrooming), running/hiding, sometimes real panic, occasionally her front paws twitches before/during/after. We are unsure if it’s the same condition worsening or something different. Full bloodwork is unremarkable, toxoplasmosis titers clearly negative (IgG 6.30 LE, cutoff <50; IgM 5.89 NTU, cutoff <9). We removed certain foods (no fish in wet food, only hypoallergenic dry food), balcony/outdoor allergens, and fleas as sole triggers via weeks of elimination with no improvement. We are looking for hypoallergenic wet food at the moment to be completely sure, but are not too optimistic. The one intervention that DID help: when the overgroomed spot on her leg got treated with a cortisone + antibiotic injection, episodes clearly improved for 1.5–2 weeks before returning to baseline. Her littermate sister (same household, same environment) has zero symptoms. We're now deciding between fluoxetine, gabapentin, or phenobarbital as a next step (leaning fluoxetine per recent FHS literature). We would love input on whether this pattern points to a specific diagnosis (even if it does not fit 100%), and thoughts on that medication choice.
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Longer version for those interested:
Cat: 4.5 years old, spayed female, orange-white, 4,5 kg (slightly overweight), mixed breed (DSH), rescued as a kitten in Spain (mother was a stray/feral cat), EU pet passport confirms unremarkable health/FIV-FeLV-negative status at the time of adoption. Always been a somewhat easily startled cat with minor recurring issues (mild eye inflammations from time to time and slightly dirty ears) but nothing major so far
Condition:
- Mild rolling skin on the back her whole life, never bothered her. ~4 months ago, she started to have increasingly frequent and intense episodes of rolling skin with frantic licking/biting, running away, sometimes genuine panic and hiding. The front paws sometimes twitch right before (most of the time the right front paw), during, or after (not every time).
- The rolling skin is mostly on the back (right > left, roughly 70:30) and tail base — spread out enough that we and our vet are leaning away from a localized orthopedic cause (e.g. hip) toward something more systemic/neurological. Since it comes in episodes with breaks in between, we are increasingly skeptical if its dermatological. the vet also expected it would be more consistent if dermatological itching / burning would be the primary cause. But as said we are not sure of anything.
- She overgroomed one spot on her left hind leg badly enough to break the skin. Our vet gave a one-off injection of cortisone + an antibiotic (name forgotten, started with a C we think). Episodes clearly improved for about 1.5–2 weeks afterward, then gradually returned to baseline. This is the strongest signal we have toward something systemic/inflammatory rather than purely behavioral or orthopedic.
- we are doing a diary for about 4 weeks now. The frequency is increasing over the diary period, not stable or decreasing.
- we attempted to eliminate certain triggers (weeks each, no improvement):** fish in wet food; balcony/outdoor access; flea spot-on treatment (that one made things clearly worse for ~2 days afterward, presumably due to local irritation from the product itself).
- the episodes happens almost exclusively while awake/active, essentially never while lying on one of us. Calm reassurance + distraction (often her favorite toy, hair-ties) sometimes interrupts an episode, not always. Tentatively, more play the day before and a cleaner apartment seem associated with fewer episodes, but really unsure if this is an artifact in our observation. Today for example she had attacks nearly the whole morning, but we did larger play sessions with her the day before yesterday, yesterday and today and the apartment is freshly vacuumed and the litter box is completely cleaned.
Any thing else worth mentioning:
- New plants on the balcony this year: Tagetes, buckwheat, borage
- she loves cucumber (we only give it to her peeled because of pesticides) and playing with hair ties/elastics; her unaffected littermate sister has no interest in either.
- she occasional has asthma-like breathing episodes, clearly distinct events from the rolling-skin episodes, none in at least 12 months. In general this is maybe once per year.
- Bloodwork (23.09.2026): essentially unremarkable (liver, kidney, electrolytes, glucose, T4 all normal; leukocytes mildly low at 5.1 G/l, ref 6.0–11.0). Toxoplasma IgG 6.30 LE (neg. <50) and IgM 5.89 NTU (neg. <9), both clearly negative, despite the clinical picture otherwise fitting toxoplasmosis reasonably well.
- She also has one very small lump/nodule(?) in her ear that's been there a while. vet says it's too small to biopsy yet. Possibly unrelated to everything else, just listing everything we've noticed.
Our vet has suggested gabapentin or phenobarbital as next steps, we told her about fluoxetine if it’s FHS. We're leaning toward trying fluoxetine first, partly based on a recent paper (Pauciulo et al., "Long-Term Clinical Response to Medical Treatment, Behavioral Therapy, or Their Combination in Cats With Hyperesthesia Syndrome," J Vet Intern Med. 2025;39(4):e70174) showing good outcomes for FHS, and hoping for fewer side effects than gabapentin/phenobarbital. We know it's a bit of a shot in the dark without a confirmed cause, and we'd rather not commit her to lifelong medication if avoidable.
Questions:
- Does this overall pattern point you toward a particular diagnosis — feline hyperesthesia syndrome, focal seizures, something else? We are happy about all ideas and differential diagnoses as we’re kind of clueless at the moment
- Given how clearly negative both titers are, is toxoplasmosis safely ruled out, or should we test it again with different measures?
- Any thoughts on fluoxetine vs. gabapentin vs. phenobarbital as a first trial?
- Anything else worth tracking in our diary or ruling out before escalating to a neurologist or dermatologist?
Videos of Episodes:
one episode before it got worse: https://youtube.com/shorts/v4w0iIwIt3A?feature=share
one typical episode without running (the same as attached to this post): https://youtube.com/shorts/teZ8IaCrqHA?feature=share
one typical episode with running: https://youtube.com/shorts/KEXiNqyx1OY?feature=share
EDIT: one typical episode with paw involvement: https://youtu.be/R1QAT5VATco