C10019887 / invoice 10000

Reason: Initial - Shaking Episodes Appointment Notes: Hx req 10/03History:Frankie is a 2-year-old, female spayed Cocker Spaniel presenting for evaluation of paroxysmal episodes.Three episodes have occurred since November 2025.The episodes are characterised by sudden, whole-body, myoclonic jerking movements. Consciousness appears to be preserved.The first episode occurred in November 2025, lasted approximately one hour, and was associated with hyperthermia.The second episode occurred in the morning after being under a blanket and was also associated with hyperthermia. It lasted for approximately one hour.The most recent episode occurred three weeks ago in the middle of the night, lasting on and off for two hours. Hyperthermia was not noted. Frankie attempted to sleep, urinated, and drank water during this episode.Frankie is reported to be normal between episodes. Distraction attempts (moving rooms, offering water) have not aborted the episodes.Previous medical history includes a suspected but unconfirmed parasitic infection as a puppy, which resolved with treatment.Vaccinations, flea, and worming are up to date. Diet is commercial dry food with a home-cooked mix of chicken/kangaroo, vegetables, and rice. Travel is limited to Albury-Wodonga.Recent bloodwork performed three weeks ago was reportedly unremarkable. A vet noted agitation on mid-thoracolumbar spinal palpation at a recent visit. The owner has a pre-dispensed anti-seizure medication at home (diazepam or midazolam), name to be confirmed.Physical Examination:Mild to moderate muscle soreness on palpation of the epaxial and iliopsoas muscles bilaterally. No overt pain on direct spinal palpation. Otherwise, the physical examination was unremarkable.Neurological Examination:- Mentation: appropriate quality and level- Gait: strongly ambulatory with no overt signs of ataxia, paresis or lameness- Posutral reactions: intact paw positioning and hopping in all four limbs- Spinal reflexes: intact patella, withdrawal and perineal reflexes; cutaneous trunci to the level of L5 bilaterally- Cranial nerves: unremarkable- Palpation: no overt hyperaesthesiaNeuroanatomical localisation: neurologically normal at time of examinationAssessment:The paroxysmal events are most consistent with myoclonic jerks.Differential diagnoses for the myoclonic jerks include:1. Seizure activity (e.g., idiopathic epilepsy, myoclonic epilepsy). The prolonged duration of episodes with rapid return to normal is somewhat atypical for seizure activity.2. Paroxysmal dyskinesia (a movement disorder).3. Structural intracranial disease (e.g., inflammatory, infectious, neoplastic). Considered less likely given the chronicity and intermittent nature of signs with a normal interictal period.4. A neurodegenerative condition. Considered unlikely given the age and breed, but cannot be ruled out.The thoracolumbar and iliopsoas muscle soreness is considered an incidental finding and unlikely to be the cause of the myoclonic episodes.Summary:Discussed the nature of myoclonic jerks and the primary differential diagnoses. The underlying cause is often not identified.Discussed gold standard investigation with MRI of the brain and CSF analysis to rule out structural disease, noting that it is more likely that imaging would be unremarkable.A watch-and-wait approach is also reasonable at this stage, given the low frequency of episodes.Recommended attempting to distract Frankie with food or a walk at the onset of the next episode. If distraction is unsuccessful, the owner can administer the rectal/intranasal anti-seizure medication they have at home to see if it aborts the episode. This may help differentiate between a seizure and a movement disorder.Advised the owner to contact me with the name of the medication they have.If episodes become more frequent or severe, a trial of a daily anti-seizure medication (e.g., Keppra) could be considered, as it can be effective for myoclonus even if not seizure-related.For the muscle soreness, recommended physiotherapy and restriction of strenuous activities like jumping.Medication:Continue to have the previously dispensed anti-seizure medication (diazepam or midazolam - to be confirmed) on hand to administer during a prolonged episode if distraction fails.Re-examination:Re-examination or further investigation is recommended if there is an increase in the frequency or severity of the episodes, or if any new neurological signs develop between episodes (e.g., behaviour changes, circling, blindness). The owner will remain in contact to provide updates on Frankie's progress. I will perform a literature search for breed-specific neurodegenerative conditions and contact the owner if anything significant is found.Kind regards,Dr Samantha Gilbert BVSc BSc DipECVNEuropean Specialist in Veterinary Neurology.    Vital Signs