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Dr. B.
Dr. B., Veterinarian
Category: Dog
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Experience:  I have over 20 years experience in small animal and emergency veterinary medicine
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bulldog head tremors cause and treatment

Resolved Question:

What's the best course of action?
Submitted: 11 years ago.
Category: Dog
Expert:  Dr. B. replied 11 years ago.

Has your dog had any tests done yet? If so, can you tell me what the results were? Was your vet able to observe these tremors?

How old is your dog?

Are there any other symptoms? Are the tremors continuous or intermittent? Do they generalize to other parts of the body?

Have any medications been tried?

If you can answer these questions for me, I will be able to help you better. Thanks.

Customer: replied 11 years ago.
Reply to Dr. B.'s Post: All blood work was normal. Numerous vets have observed the tremors. Phenobarbital did not work and agitated her. We have not had any type of brain scan, yet. She shakes her head (only) rapidly from side to side for 30 seconds upto 5 minutes. This occurs every 2-4 hours. She has been either at our vets office or an emergency clinic for the past 40 hours. They are giving her valium as needed. She is 15 months old and spayed.
She had either Intercept or Setinel last month- which some bloggers about this condition suggest might be the cause.

Also,see below:
Head Bobbing
What you are showing in this videotape is called "idiopathic head bobbing" and it is commonly seen in the boxer, doberman and bulldog; It is a benign problem and not a seizure; do not let your vet treat it with anticonvulsants such as phenobarbital or kbr as they will not work; If you have questions google "bulldog, head tremors, glass" and you will see a letter I sent previously to another veterinarian regarding this syndrome in a bulldog;

I hope this is helpful to all;

Sincerely XXXXX DVM, ACVIM (Neurology)
Neurology and Neurosurgery
Red Bank Veterinary Hospital

Here is the reply from Dr. Glass:

Thanks for sharing the videotape with us.

The videotape is a classic; the videotape shows a great example of what is referred to as "idiopathic head bobbing syndrome"; we see this most commonly in the bulldog, doberman and boxer although I have seen it in a lab as well as in some mixed breed dogs; the head bobbing can be either up and down or side to side; usually activity, such as concentrating on food or a toy, makes it go away but not always; it can be very episodic in the sense that it may go away for months only to reappear; sometimes it seems to increase in frequency; the exact cause is not known nor is the anatomic dx; we believe strongly it has something to do with the stretch receptors in the neck
- ie the gp or maybe gsa fibers in mm bundles - although this is only a theory; we use to teach that it had something to do with basal nuclei of the brain like parkinsons but that is unlikely.

I have scanned a few dogs but have not found anything as of yet; the good news is that it absolutely does not harm the dog; in fact the dog does not seem to even be bothered at all; it bothers the owners immensely but all you need there is some good client communication; the key with this dz is NOT to treat it as a seizure with anticonvulsants as that absolutely does not work; I unfortunately had to get involved in too many of these cases that are on super high doses of anticonvulsants - one from Penn that almost died -18000K later in their ICU - they came for a second opinion - stopped all the meds and the dog was perfectly fine; we have tried lots of meds to no success but who cares as it does not affect the dog.

I usually tell vets to treat the owner not the dog in these cases as client education is the key.

Dr. DeLahunta, Dr. Kent and I have an article coming out in July compendium on involuntary mvmt disorders - we have described this syndrome in that article.

Paroxysmal Dyskinesia is a movement disorder. There are brief attacks of the symptoms with the dog appearing perfectly normal between the episodes; the same way there are discrete attacks of seizures in epilepsy. Dyskinesia refers to an abnormal, involuntary movement or posture. Movement disorders usually originate from the deeper areas (the basal nuclei) of the brain. These areas are responsible for translating the commands from higher brain areas (e.g. get the ball) into movements (e.g. stand up, begin trotting, etc). The distinction in the human between seizure activity and dyskinesias is based on looking for abnormal electrical activity on the surface of the brain with an EEG.

By definition, seizures have abnormal EEG activity, while paroxysmal dyskinesias do not. People with paroxysmal dyskineasis often experience a decrease in episodes as they age while epileptic people and dogs will worsen with age.    Let's talk now about Head Tremors in the Bulldog. In my experience, head tremor activity in the Bulldog usually starts around the age of 2 years old. The motion you will see will almost always be a fast side to side rocking motion (ear to shoulder ear to shoulder) occurring in rapid succession. Occasionally I have seen an up and down motion (like they are shaking their heads to say yes) but for the most part it is the same fast rocking. The way it was defined to me was that the neuron cluster that controls a certain motor function, in this case head movement, begins to fire continuously. The reason for this rapid fire is truly unknown.

I have not experienced any drooling or other body part involvement. It has always been isolated to the head. When you call the dog's name they can stop the bobbing motion for a few seconds and will look at you, then it will kick in again. They can move their heads and watch you move from place to place, they can even walk around etc. Scenario I: The bully will be sleeping very soundly and all of a sudden the head will start rocking usually from side to side very quickly- occasionally you might experience one bobbing up and down. This sudden head motion will cause the bully to awaken suddenly. An episode will last from 15 to 30 seconds, sometimes longer. It may stop on its own and then as the dog lies down to go back to sleep the head tremor will reoccur.

Scenario II: A bitch will be pre-season or just come into season. Males head is bobbing for all it is worth. Scenario III: A bitch is post whelp, in the milk let down phase of lactation, and trying to nurse a litter of hungry pups. In this case the bitch has had surgical trauma as the result of a C section, is in pain, is not eating and is trying to make milk. This, in my opinion is different than the head tremors described in Scenario I and II.   When you see this What Do You Do? The first time we experienced this phenomena was a scenario III post whelp I panicked. I grabbed the puppies off the bitch and almost caused one to aspirate. When I gained a little composure I called a breeder friend of mine and explained what I was seeing. She told me that it was not uncommon and I should try to get some sugar, honey, Karo syrup into her. The thought is that the blood sugar had experienced a sharp drop at that point in time thus stimulating this type of a response. We gave the girl the Karo and low and behold the tremors stopped within a couple of seconds. The next time we witnessed this behavior was a little different. The bitch was not post whelp. However, she was 3 days prior to coming into season. She had been sleeping on the couch. We gave her honey. It stopped. Started up 15 minutes later we repeated the karo. Same result.

We gave her frozen yogurt, same result. This went on for almost 24 hours with the length of time between episodes varying from 10-15 minutes to as long as a half hour. Needless to say we packed her up and went off to the vet who said: this is not unusual in this breed. Normally we don't do anything. Epilepsy meds have proven to be ineffective for the most part; phenobarb has too many side effects. The Veterinarian stated that they suspect it has something to do with the growth activity at this age or stress, which can cause a sudden drop in glucose levels in the blood. There can be different things or circumstances that can trigger an episode. Such as a traumatic experience, and injury, hormones, etc. In this girls case we have determined that it is a hormone trigger, specifically at the time of a progesterone spike associated with ovulation. The vet recommended Calcium and Taurine supplementation twice daily. As you know calcium is one of the minerals needed for healthy nerve growth and electrical conductivity, Taurine is an amino acid that works with Calcium. The Vet said she might grow out of it. So, we took that information and we asked for a referral to a neurologist.

This specialist did all of the neurological tests and determined she was fine. She ordered ionized calcium levels along with several other specific blood tests. The results all came back normal. She recommended an MRI to determine if there was an injury or tumor. We declined this step at the time, due to finances but decided if she showed any other neurological symptoms such as falling down or aggression, which could be indicative of an injury or tumor, that we would come back to do the MRI. Six months went by on the Calcium, Taurine supplementation to which we added a heaping tablespoon of Ricotta cheese every morning and every couple of days a heaping bowl of frozen vanilla yogurt with honey in the evening. No incidents. The day we bred her in at the time of the progesterone spike indicating ovulation that we were waiting for she had one mild episode then nothing for the entire pregnancy. The episodes started up the second week of lactation when the calcium bolus given at the time of the C- section was gone and 6 hungry puppies were pulling on her calcium/glucose levels. Five months have since passed and she has been just fine no episodes.

My Recommendations:
1. If your dog exhibits this head bobbing behavior a. DON'T PANIC!!! This could only worsen the situation by adding additional stress on the dog. b. Give them a bowl of ice cream or frozen vanilla yogurt with honey to get the situation under control. If you don't have any of those then Ensure, Pediasure, Karo syrup all work because of the sugar and or calcium content. Liquids work quicker because they are absorbed into the mucosa of the mouth.

2. Call your veterinarian and advise of the situation. Schedule an appointment for a visit and have your vet do a health screening with blood work. Odds are the blood work for calcium and sugar will be fine.

3. Keep a record of each episode, every time one occurs describe it in great detail, time it occurred how long, how frequent. Give this info to the vet when you see him.

4. IF they do not get any worse than the head bobs don't do anything else but observe and document. If the behavior changes in any way call the vet, you may need additional assistance at this point. Two other behaviors I would like to mention briefly are the fly chasing and the circling behaviors. Fly chasing is just that, the dog seems to be chasing and trying to catch imaginary flies. Again, if you call the dog by name he will stop and look at you then resume the behavior. The other is circling. This looks like VERY slow motion tail chasing. Usually in the same direction each time it happens. IF you call the dog they will stop to acknowledge you then start up again. In this case, I go over and give my girl a nudge and she stops and resumes whatever she had started to go outside to do.

This seems to happen outdoors only, so I sometimes wonder if bright sunlight is the trigger mechanism for her. In any event both of these behaviors are neurological events. Basically harmless. Both of these dogs are on the same calcium and taurine supplementation. The supplementation has basically eradicated the fly chasing in the one dog and the episodes of circling are fewer with the other dog. In closing I would like to say that these behaviors are basically just annoyances to you and the dog. I would never discourage you from having the dog checked by a Veterinarian. Remember, every dog just like every person is different and they react differently to certain stimuli and medications. I suggest you try this regimen and if the behavior continues see your veterinarian for more extensive testing and follow up.
Expert:  Dr. B. replied 11 years ago.

It's great that you have already done a lot of research on this. As you probably already know, this is a recognized, although poorly understood syndrome seen in bulldogs (also boxers and dobermans). It is not believed to be a seizure disorder as these dogs do not respond to anti-convulsant medications (as you found out with the phenobarb) and so I doubt if the ongoing valium treatment at the E. clinic is doing much good either.

As far as what is an appropriate tests to help determine the cause, you probably already know this from the research you have done. Besides the blood work that has already been done, an MRI of the brain and analysis of the cerebrospinal fluid via a spinal tap, but bulldogs with this syndrome have normal results on this test. Essentially they would be done to make sure there is not something else going on, like a tumor or infection.

If you have not already consulted a veterinary neurologist, this would be a good thing to do. I believe there is currently a study going on by Dr. Karen Munana at North Carolina State University using a drug called keppra as a possible treatment for this. I do not have any more information about this study or whether this drug has been of any use in this syndrome, but your vet could call Dr. Munana and get more information to see if this is a possible treatment choice. If you happen to live close to NCSU, you could see about participating in the study. Dr. Munana's email address is [email protected] if you would like to try to contact her yourself.

Others have tried using antioxidants (vitamin A, C and E) but I don't know if there has been any success with these. It would be a safe thing to try though.

I wish I could tell you exactly how to make this stop happening in your beloved friend, but I'm afraid there are not really anyone really knows how to best help these dogs. Luckily, most of these dogs seem to do fairly well and learn to get along just fine even with the ongoing head tremors.

I could find no reputable references that suggested Interceptor or Sentinel could be playing a role in this syndrome.

Please let me know if you need additional information about this.

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