The Mysterious Case of Lemon the Bobble-Head

by Dr. Abigail Roeters

It was two days before Christmas and I was resting comfortably on the couch with all 3 dogs in toe. Lemon being the cuddler she is, was lying next to me and relaxing. All of the sudden she lifted her head and began to shake back and forth almost as if she was acting like a bobble-head doll. She was staring at me in confusion but seemed to be conscious and know I was there. I began talking to her and calling her name but the head movements continued for about 30-60 seconds, then she stopped. I thought it was a fluke so didn’t think much of it. A few minutes later the same thing happened. It occurred another 5 times within about an hour period and at that point I was alarmed. Was she having a seizure? Could this be a complication of her heart disease? What as going on?

I took a few videos of the episodes Lemon was having and sent the videos to some colleagues to get their un-biased opinions on whether they thought I should be greatly alarmed. We discussed back and forth and during that time she did not have anymore episodes. One of my colleagues was finishing up a neurology residency, how lucky was I! He obviously couldn’t give me a full diagnosis with-out seeing her, doing a physical exam and potentially running other diagnostics. However, he said that the episodes she was experiencing looked to be consistent with Idiopathic Head Tremor Syndrome.

Idiopathic Head Tremor Syndrome is a condition characterized by three classic movements: rotational (“bobble head”), up and down (“yes”), and side to side (“no”). Most dogs are alert and responsive during these episodes and most neurologist don’t believe that this is a true seizure, more likely a paroxysmal dyskinesia (group of movement disorders characterized as abnormal involuntary movements that recur episodically and last only a brief time). It is called “idiopathic” because there is no known cause. Ideally a full neurology work up is recommended but the results of these tests are all typically normal. There are no known treatments or medications that are recommended at this time. There are actually certain breeds of dogs that are more prone for this potentially happening too and they include labrador retriever, doberman pinscher, boxer, and English bulldog.

I am grateful for the expertise and opinions of my colleagues and to know that this is not a condition that is going to affect Lemon’s quality of life. She has had a few more episodes since the initial ones in December but continues to live a normal happy, healthy life.

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