Canine epileptoid cramping syndrome (CECS) in Border Terriers

CECS stands for canine epileptoid cramping syndrome. It has previously also been known as paroxysmal dyskinesia (PD) of Border Terriers.

CECS is a condition with paroxysmal dyskinesia. The term paroxysmal means that affected dogs are generally normal and then periodically develop signs associated with disease before returning to normal again. Dyskinesia means an involuntary movement of the body. So, in this condition apparently normal dogs suddenly have episodes where they cramp or develop tremors and movement disorders.

The term CECS is a probably not a good name for the condition and it now appears more appropriate to use the term paroxysmal gluten-sensitive dyskinesia. A recent study performed at Davies Veterinary Specialists led by Mark Lowrie (currently neurologist at Dovecote Veterinary Hospital) has revealed a link between PD and gluten sensitivity. A blood test for gluten sensitivity in Border terriers is now being developed. A genetic basis for the syndrome is suspected but no specific genetic abnormality has so far been found.

This condition can be very variable, affected animals may have episodes of staggering and wobbliness, be unable to stand, have trembling attacks, or cramping of muscles in the belly, neck, leg and back. In a cramping attack dogs may adopt an unusual position or have their legs held out rigidly or bent up and be unable to stretch them. There is no loss of consciousness during the attacks, though some dogs find the episodes distressing and behave abnormally during an attack.

Episodes may occur in Border terriers as young as 6 weeks and may first be seen in animals up to 7 years of age. They can last from minutes to hours and can sometimes occur in clusters. Between attacks, dogs appear completely normal. In many affected dogs, there is increased intestinal motility during an episode, which manifests as gurgling tummy sounds (borborygmus). Mild to severe gastrointestinal signs such as borborygmi, vomiting or diarrhea can also occur between episodes.

Your veterinarian may ask you to provide a video recording of an episode to help differentiate CECS from other conditions such as some forms of epileptic seizure (fits).

Many involuntary muscle movement disorders occur in discreet episodes. Consequently, when examined between attacks, most animals are completely normal.

Your veterinarian will want to rule out a physical problem affecting the brain and may recommend performing an MRI scan of the brain, and collection of some fluid from around the brain (cerebrospinal fluid (CSF) tap) for analysis. Blood and urine testing may also be done to exclude underlying metabolic or hormone disorders. Serological tests on a simple blood test for gluten sensitivity are indicated to confirm the diagnosis.

Currently, the most effective way to manage CECS is by using a gluten-free diet, although it can take several weeks before an improvement is noted. Strict adherence to a gluten-free diet should completely stop the episodes. If the diet is being strictly controlled, then a blood test will be able to detect the reduction in the immune response so repeat testing for gluten sensitivity is indicated at 3 months to monitor compliance to the diet.

Most dogs with CECS can live a relatively normal life. Strict dietary control will be necessary lifelong to try to ameliorate the episodes. If an episode occurs all you can try to do is comfort and reassure your dog. It is thought that there is a genetic component to the disease so affected dogs should not be allowed to breed and it makes sense not to repeat matings which produced affected puppies.