Feline Hyperesthesia Syndrome (Twitchy Cat Syndrome)

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What Is Feline Hyperesthesia Syndrome?

Feline hyperesthesia syndrome (FHS)—also called rolling skin disease and twitchy cat syndrome—generally involves muscle contractions that a cat can’t control, along with changes in their behavior.

FHS remains poorly understood and may have neurological, psychological, or dermatological (skin) causes.

Hyperesthesia refers to an increased sensitivity to touch.

Cats with FHS have an overreaction to having their skin touched, most often in the lower back area.

A variety of other conditions that can look very similar must be ruled out before feline hyperesthesia syndrome is diagnosed.

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Feline Hyperesthesia Symptoms

A cat with feline hyperesthesia syndrome typically has intermittent bursts or episodes of signs lasting 20 to 30 seconds.

During these episodes, you may observe any of the following symptoms:

  • Rippling or twitching of skin on the lower back (both after touch and for no apparent reason)

  • Dilated pupils

  • Brief bursts of jumping and running, as if startled

  • Excessive meowing and other noises

  • Tail-chasing

  • Biting or licking the lower back, sides, hind paws, rear, or tail

  • Pain or discomfort when petted or touched

  • Tiredness

If you touch your cat during an FHS episode, you could make the signs worse, and your cat might become aggressive. Your cat will not have control over their reaction.

If you notice your cat’s back twitching or any of the other signs listed above, it’s best to stay calm and try not to handle your cat, even though the signs can be severe and even frightening.

What Causes Feline Hyperesthesia?

Veterinary professionals and researchers aren’t currently sure what causes feline hyperesthesia syndrome. Because different cats with hyperesthesia respond to different types of treatment, there may be multiple underlying causes. In some cats, feline hyperesthesia syndrome is diagnosed along with another underlying condition.

Causes of feline hyperesthesia syndrome are usually considered dermatological (skin problems), neurological (problems with the nervous system), or psychological (mental health problems). Each of these may have different triggers for FHS episodes.

Dermatological Causes of FHS

  • Allergies, including food hypersensitivity

  • Immune-system-related disease

Neurological Causes of FHS

Psychological Causes of FHS

Feline hyperesthesia syndrome can happen in any cat, though it may be found more frequently in AbyssinianBurmesePersian, and Siamese cats.

FHS is also more common among younger cats.

How Vets Diagnose Feline Hyperesthesia Syndrome

If your cat is showing mild to moderate signs of feline hyperesthesia syndrome, contact your vet within 24 hours.

If a severe episode occurs and lasts longer than two to three minutes, take your cat to an emergency vet as soon as possible, particularly if self-injury is occurring.

Your vet may perform the following tests:

  • A dermatological (skin) workup to identify possible flea allergies, even if your cat does not go outdoors.

    • The skin workup will also seek to rule out environmental and food allergies, underlying skin infections, and acral lick granulomas.

  • Blood work to rule out hyperthyroidism, which has been associated with increased arousal and overgrooming.

  • An evaluation for pain or a neurological condition, such as spinal arthritis.

  • A behavioral evaluation to rule out conditions like obsessive-compulsive disorder (OCD).

  • Medication trials may be part of the workup process. When cats are under stress, they can be very good at hiding signs of pain or discomfort.

    • Evaluating their response to a medication targeting pain or itchiness, for example, can provide valuable information.

Keep in mind that FHS can occur in conjunction with a skin, neurologic, or behavioral disorder.

Diagnosing your cat with one of these conditions does not mean they don’t also have feline hyperesthesia syndrome.

Hyperesthesia in Cats Treatment

Once other conditions have been ruled out and feline hyperesthesia is diagnosed, your veterinarian may need to consult with or refer you to a veterinary behaviorist for a full treatment plan.

Your treatment plan may include:

  • Changes to the environment. Because FHS-type behaviors can result from stress or anxiety brought on by changes in the home, your veterinarian may discuss ways to alleviate your cat’s anxiety in the home.

    • This can include changes such as creating a safe space for the cat that’s inaccessible to dogs or children and ensuring there are enough litter boxes and that they’re routinely cleaned.

    • Changes in the home should be made slowly. Adding pheromone diffusers to the environment might also be recommended.

  • Medication or supplements. Gabapentin, which can reduce nerve pain and anxiety, is a common medical recommendation for cats with FHS.

    • Other behavioral medications like amitriptyline may be recommended. Skin supplements like omega-3 fatty acids or anti-anxiety supplements could be used, but you must get all supplements approved by your veterinarian before adding them to your pet’s daily regimen.

  • Behavior modification. Behavioral modification will involve desensitizing your cat to specific stimuli over time or otherwise using techniques to shape behavior. Veterinary behaviorists may have good behavior modification suggestions for your FHS cat.

The purpose of treatment is to make changes that help reduce the number of episodes.

Behavior modification will give your cat a different emotional response or behavior to perform during times of stress.

Recovery and Management of Feline Hyperesthesia Syndrome

In one study, six out of seven cats showed significant improvement with medication, and five cats had resolution with just one medication.

For some cats with hyperesthesia, the episodes may come back after several months. For others, the relief lasts much longer.

FHS often requires lifelong management to prevent recurrence of episodes.

For cats whose episodes are triggered by stress or anxiety, management will include keeping a low-stress home and making any changes to your cat’s environment slowly over time whenever possible.

Cats on anti-anxiety medications may require their medications for life.

Prevention of Feline Hyperesthesia Syndrome

Not all cases of FHS are preventable. In many cases, no preventable predisposing cause is found.

You can prevent hyperesthesia brought on by parasites by keeping your cat on year-round parasite preventives. Keeping your cat indoors also decreases their risk of flea infestation.

When making big changes in the home, such as the addition of a new child or partner, consider how to avoid triggering stress and anxiety by altering the home slowly ahead of the change.

You might speak with your veterinarian about short-term anxiety medications ahead of big life changes to help your cat remain low anxiety during times of change.

Feline Hyperesthesia Syndrome FAQs

What triggers hyperesthesia in cats?

Often, there is no known predisposing trigger for hyperesthesia in cats.

However, hyperesthesia can be brought on by skin conditions, neurologic conditions, pain, or mental health conditions.

Are cats with hyperesthesia in pain?

Based on the intense reaction that cats with hyperesthesia have to touch, it's been suggested that touch may be painful to them. In some cases, hyperesthesia is brought on by pain, as well.


1. Ruiz-Suarez N, Bhatti S, Hermans M, da Silva C, Hesta M. Food hypersensitivity and feline hyperaesthesia syndrome (FHS): A case report. Veterinární Medicína. 2021; 66:363–367.

2. Amengual Batle P, Rusbridge, C, Nuttall T, Heath S, Marioni-Henry K. Feline hyperaesthesia syndrome with self-trauma to the tail: retrospective study of seven cases and proposal for an integrated multidisciplinary diagnostic approach. Journal of Feline Medicine and Surgery. 2019;21(2).

3. Marioni-Henry K, Amengual Battle P, Nuttall T, Rusbridge C, Heath S. Diagnostic investigation in 13 cats with suspected feline hyperesthesia syndrome. Journal of Veterinary Internal Medicine. 2016: 30(4):1438-1439.


Krista A. Sirois, DVM (Clinical Behavior Resident)


Krista A. Sirois, DVM (Clinical Behavior Resident)


Dr. Krista Sirois received her Doctorate of Veterinary Medicine in 2016 from Louisiana State University School of Veterinary Medicine....

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