Seizures/tilted head

Hi everybody, Maybe somebody would regonize this: Female cat, 8 years old, no known problems before this. Symptoms every 3 weeks; - tilted head - ataxia - neurologic "seizures" - trouble jumping Symptoms every day life - trouble with high jumps - swaying with her head when she comes in corners. It started in november 2019. Since september 2020 she has it every 3-4 weeks. Things we already did; MRI scan, CT scan (2x), bloodwork, bloodwork parasite, urine, heart echo, they checked her ears with a small camera, (2x). She had different kind of medicine and antibiotics, like middle ear infection, prednison, now she had gabapentin, but still she gets those seizures and tilted head etc. So every 3-4 weeks, for 24-48 hours, and she is back to her "normal" self. We have been to every specialist and hospital here, but nobody knows because the symptoms dont add up to any kind of disease, because after those 24 hours she is a normal cat. She plays, she eats, everything is "fine" then, and 3 weeks later she is ill again. We just said to eachother, after 24 hours its like a reset button is pressed, she goes from a very sick cat to a healthy cat right in front of our eyes. Maybe this can be a little helpfull; in the scans they made they saw a soft tisseu mass, by her temporal bone, but every specialist said that its way too small to cause any of this symptoms and its just a suprise find and nothing to worry about. "Maybe she is born with it"  i have the image of it if it may help anybody.   Thank you.

Hello!  It sounds as though you have been to a lot if vets including specialists, who obviously have the advantage over me in that a) it's their specialism and b) they can see the patient.   I am pleased that you have posted, but also curious - having visited plural specialists / hospitals, what has led you to still to be seeking information from me online?  I understand that the specialists might have had various things they didn't understand, but they have done multiple tests and assessments - which I cannot.   (More to follow)

If so many tests have been done, I am skeptical of the suggestion that they have founding nothing - there would have been results to those tests, even if only that things were 'normal.'  It sounds likely, for instance, that the vets have worked very hard to localise the problem within the head.  Perhaps the absence of a big enough lesion hints at a wider disease; perhaps two different brain areas have been affected, or perhaps the problem is at a cellular level (which cannot be seen in a scan), maybe involving certain neurotransmitters (the chemicals between neurones) or a virus.  Certain viruses can obviously be ruled out by serology; what does this leave?   I am aware that this sounds like an issue of twisting words around, but even if a diagnosis has not been reached, the vets must by now have ruled out certain 'types' of disease in favour of others, so either this is a brand new disease that no-one has ever recorded in the history of veterinary science, or there are possible explanations / variants that are still on the list.  We call the possibilities 'differentials' (to be continued)......

A good question for your specialist then, might be 'What differentials have you already ruled out', and 'what differentials are still on your list'?  And then, 'Which of these do you think is most likely at the moment?  Is this something that can be tested for?'  And, more importantly, 'Is there anything else that can be done to treat these signs?  If we find (the remaining differentials) will there be some treatment you can offer?'.  Sometimes, there isn't, which begs the question whether it's useful to continue to look, or whether the concern is with managing the symptoms as well as possible.

Some congenital (birth) problems may fit into that category.  My advice would therefore to go back to your specialists and to try and to ask a lot more about what *might* be going on.  Sometimes, a diagnosis can't be reached - sometimes due to escalating costs, sometimes because the technology doesn't exist to know more.  It's worth understanding from your vet, what they know now and how far from the limit of scientific understanding this case is.  Without having some logical understanding of this, it must be difficult to make a decision as regarding what to do next.  I hope that this helps.

Common causes of head tilts involve damage to the vestibular nerve.  It is difficult to comment on the seizure-like activity; is there true seizure activity with in the brain, or are there tremours? Might the blood sugar be low, for example (this is often mistaken for fits)?  Might one have caused the other, or the two things happened separately?   This does sound like a fascinating case, but a difficult one for everybody concerned.  Best of luck and please do let us know what answers are found.

Thank you, i didnt know how to reach this website again, so sorry for my late response.   Well, we have asked our vets this, and the answer is simply we dont know anymore, there arent any test left over to be done. Believe me we asked.   We ruled out any organ disease, heart, liver, lungs,  kidneys etc. We ruled out parasites, urine research and blood research. We ruled out the ears, they have been inside her ears multiple times with a soort of camera with which they can see her eardrums and middle ear i believe. We ruled out FIP, and any other disease which can be diagnosed with blood. I dont know if i could upload a picture here. But i have most of her file and tests. We've reached a part of her treatment with whatever medicine they can think of and just try is something helps. We have 3 options so far. Movement disorders, we have tried medicine which didnt go well at all, she came depressed, was scared of us, she lay in her letter box, and it wasnt good, so we stopped. Epilpsy- some kind of epilepsy drug, we havent tried it yet. Pain/nerve damage- gabapentine in combination with metacam, we are now trein gabapentine, which is the first drug she have any kind of response to. But it doesnt stop her tilted head and ataxia, it somewhat stops the seizures, but not completly- when she had a relapse, she is sick for 48 hours, but the seizures is always in the 24 hours. They dont last long a few seconds,  but when she has gabapentine they stop for about 6/7 hours and they start again until its time for her new dose of gabapentine ( every 8 hours) and they stop agaim for the next 6/7hours and they again seizures until the next dose. And then mostly they stop after the 24 hours. Her tilted head is what seems to take the longest to recover and her ataxia. Since she had become ill, she dont walk the stairs anymore and we tried to make our house so accesable for her, so her scratching pole is new so she doesnt have to jump so high. Now she has "in-between-steps" so she can get to the highest level. The only thing we can try now in our eyes, is make sure the seizures stops completly and take her in for a scan the 4th time to see what happens in her head in those 48 hours. We have thought maybe she has some ménière disease? Or maybe there is something happening inside her head in those 48 hours. I dont know, maybe i am holding onto hope a bit much. But we have ruled so many things out. Also it was recommend by our vets to retake scans every 6 months to see if something changes, we did that 3 times, but nothing had changed eventhough her symptoms become worse.