{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T15:49:15Z","timestamp":1791906555601,"version":"4.3.4"},"reference-count":49,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"vor","delay-in-days":42,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Myoclonus consists of brief, shock-like jerks and is not reported in dogs as a neurological manifestation of hypoglycemia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Hypothesis\/Objectives<\/jats:title>\n                    <jats:p>To describe hypoglycemia-associated myoclonus in dogs and report diagnostic findings, treatment, and outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Animals<\/jats:title>\n                    <jats:p>Ten dogs presenting myoclonus and concurrent hypoglycemia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Multicenter, retrospective study of dogs presenting hypoglycemia-related myoclonus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All dogs presented with myoclonus. Neurological examination was abnormal in 5\/10 (50%). Myoclonus was generalized in 8\/10 (80%) dogs and focal (head) in 2\/10 (20%), with progression to generalized tonic\u2013clonic epileptic seizures in 5\/10 (50%). Hypoglycemia (&amp;lt;3.3\u00a0mmol\/L) was observed in all dogs (median, 2.07\u00a0mmol\/L) during the myoclonic episodes. Insulinoma was a suspected (n\u00a0=\u00a01), presumptive (n\u00a0=\u00a05), or definitive (n\u00a0=\u00a03) diagnosis in 9\/10 (90%) dogs. One dog (10%) developed iatrogenic hypoglycemia after IV administration of fast-acting human insulin and myoclonic episodes resolved after dose reduction. Among dogs with suspected, presumptive or confirmed insulinoma, 5\/9 (56%) received medical treatment alone, 3\/9 (33%) combined medical and surgical treatment, and 1\/9 (11%) was not treated. Medical treatment included, prednisolone (n\u00a0=\u00a06), diazoxide (n\u00a0=\u00a03) and therapeutic diet (n\u00a0=\u00a06). Surgical treatment consisted of pancreatic mass resection. Medical or surgical treatment resulted in short-term improvement in myoclonus frequency in all dogs, however, four were later euthanized due to recurrence of hypoglycemia and myoclonus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and clinical importance<\/jats:title>\n                    <jats:p>Myoclonus might represent an underrecognized neurological manifestation of hypoglycemia in dogs. Measurement of blood glucose concentrations is a fundamental diagnostic approach for identifying hypoglycemia-related myoclonus. Treatment can lead to clinical improvement, but prognosis is dependent on the underlying cause.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jvimsj\/aalag252","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T15:22:01Z","timestamp":1791904921000},"source":"Crossref","is-referenced-by-count":0,"title":["Myoclonus as a neurologic manifestation of hypoglycemia in dogs"],"prefix":"10.1093","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7797-6103","authenticated-orcid":false,"given":"Dakir","family":"Polidoro","sequence":"first","affiliation":[{"name":"AniCura Veterinary Practice Plantijn , 2600 Antwerp ,","place":["Belgium"]},{"name":"AniCura Vetimacs Medical Imaging , 1060 Brussels ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2815-2527","authenticated-orcid":false,"given":"Theofanis","family":"Liatis","sequence":"additional","affiliation":[{"name":"Plakentia Veterinary Clinic \u2013 Alimos , 17455 Athens ,","place":["Greece"]},{"name":"School of Veterinary Medicine, European University Cyprus , 1516 Nicosia ,","place":["Cyprus"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9282-5813","authenticated-orcid":false,"given":"Patricia","family":"\u00c1lvarez","sequence":"additional","affiliation":[{"name":"Independent Vetcare Evidensia, Pride Veterinary Referrals , DE24 8HX Derby ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3590-8348","authenticated-orcid":false,"given":"Sofie F M","family":"Bhatti","sequence":"additional","affiliation":[{"name":"Small Animal Department, Faculty of Veterinary Medicine, Ghent University , 9820 Merelbeke-Melle ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,13]]},"reference":[{"key":"2026101311215375400_ref1","doi-asserted-by":"publisher","first-page":"979","DOI":"10.1111\/jvim.14771","article-title":"Classification of involuntary movements in dogs: myoclonus and Myotonia","volume":"31","author":"Lowrie","year":"2017","journal-title":"J Vet Intern Med"},{"key":"2026101311215375400_ref2","doi-asserted-by":"publisher","first-page":"1218","DOI":"10.1111\/jvim.16108","article-title":"International veterinary canine dyskinesia task force ECVN consensus statement: terminology and classification","volume":"35","author":"Cerda-Gonzalez","year":"2021","journal-title":"J Vet Intern Med"},{"key":"2026101311215375400_ref3","doi-asserted-by":"publisher","first-page":"107216","DOI":"10.1016\/j.parkreldis.2025.107216","article-title":"IAPRD new consensus classification of myoclonus","volume":"132","author":"Latorre","year":"2025","journal-title":"Parkinsonism Relat Disord"},{"key":"2026101311215375400_ref4","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1007\/s11940-016-0404-7","article-title":"Myoclonus: pathophysiology and treatment options","volume":"18","author":"Levy","year":"2016","journal-title":"Curr Treat Options Neurol"},{"key":"2026101311215375400_ref5","doi-asserted-by":"publisher","first-page":"409","DOI":"10.7916\/D89C6XM4","article-title":"Post-hypoxic myoclonus: current concepts, neurophysiology, and treatment","volume":"6","author":"Gupta","year":"2016","journal-title":"Tremor Other Hyperkinet Mov (N Y)"},{"key":"2026101311215375400_ref6","doi-asserted-by":"publisher","first-page":"2669","DOI":"10.1073\/pnas.1614478114","article-title":"Generalized myoclonic epilepsy with photosensitivity in juvenile dogs caused by a defective DIRAS family GTPase 1","volume":"114","author":"Wielaender","year":"2017","journal-title":"Proc Natl Acad Sci USA"},{"key":"2026101311215375400_ref7","doi-asserted-by":"publisher","first-page":"1032","DOI":"10.1111\/jvim.16404","article-title":"Myoclonus in older cavalier king Charles spaniels","volume":"36","author":"Rotter","year":"2022","journal-title":"J Vet Intern Med"},{"key":"2026101311215375400_ref8","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1111\/vaa.12160","article-title":"The incidence of spontaneous movements (myoclonus) in dogs undergoing total intravenous anaesthesia with propofol","volume":"42","author":"Cattai","year":"2015","journal-title":"Vet Anaesth Analg"},{"key":"2026101311215375400_ref9","doi-asserted-by":"publisher","first-page":"e70277","DOI":"10.1002\/vms3.70277","article-title":"Opioid-induced myoclonus during premedication in two dogs with hydrocephalus proactively managed with antiepileptic medications","volume":"11","author":"Nam","year":"2025","journal-title":"Vet Med Sci."},{"key":"2026101311215375400_ref10","doi-asserted-by":"publisher","first-page":"101148","DOI":"10.1016\/j.vaa.2025.10.004","article-title":"Spontaneous tail movements during general anaesthesia after lumbosacral epidural morphine-bupivacaine in a dog","volume":"53","author":"Gomez-Martinez","year":"2026","journal-title":"Vet Anaesth Analg"},{"key":"2026101311215375400_ref11","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1111\/j.1939-1676.1995.tb01089.x","article-title":"Diagnosis of inflammatory and infectious diseases of the central nervous system in dogs: a retrospective study","volume":"9","author":"Tipold","year":"1995","journal-title":"J Vet Intern Med"},{"key":"2026101311215375400_ref12","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1053\/jcpa.2001.0521","article-title":"Relation of clinical signs to pathological changes in 19 cases of canine distemper encephalomyelitis","volume":"126","author":"Koutinas","year":"2002","journal-title":"J Comp Pathol"},{"key":"2026101311215375400_ref13","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1186\/s12917-019-2016-4","article-title":"Suspected neurological toxicity after oral application of fluralaner (Bravecto\u00ae) in a Kooikerhondje dog","volume":"15","author":"Gaens","year":"2019","journal-title":"BMC Vet Res"},{"key":"2026101311215375400_ref14","doi-asserted-by":"publisher","first-page":"1047","DOI":"10.2460\/javma.24.02.0092","article-title":"Clinical examination findings and electrolyte abnormalities of dogs with marijuana\/tetrahydrocannabinol toxicity: 223 cases (January 2017-July 2021)","volume":"262","author":"Binagia","year":"2024","journal-title":"J Am Vet Med Assoc"},{"key":"2026101311215375400_ref15","doi-asserted-by":"publisher","first-page":"510","DOI":"10.2460\/javma.22.11.0507","article-title":"Cervical jerks as a sign of cervical pain or myelopathy in dogs","volume":"261","author":"Olender","year":"2023","journal-title":"J Am Vet Med Assoc"},{"key":"2026101311215375400_ref16","doi-asserted-by":"publisher","first-page":"2298","DOI":"10.3390\/ani15152298","article-title":"Evaluation of cervical myoclonus in dogs with spinal diseases: 113 cases (2014-2023)","volume":"15","author":"Martinez","year":"2025","journal-title":"Animals (Basel)"},{"key":"2026101311215375400_ref17","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1111\/vec.70140","article-title":"Presumptive acute post-hypoxic myoclonus after return of spontaneous circulation in a cat and a dog","volume":"36","author":"Liatis","year":"2026","journal-title":"J Vet Emerg Crit Care"},{"key":"2026101311215375400_ref18","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1111\/jsap.13318","article-title":"Clinical findings, neurological manifestations and survival of dogs with insulinoma: 116 cases (2009-2020)","volume":"62","author":"Ryan","year":"2021","journal-title":"J Small Anim Pract."},{"key":"2026101311215375400_ref19","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1016\/j.eprac.2022.11.010","article-title":"Clinical presentation and diagnostic approach to Hypoglycemia in adults without diabetes mellitus","volume":"29","author":"Palani","year":"2023","journal-title":"Endocr Pract"},{"key":"2026101311215375400_ref20","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1111\/j.1748-5827.2006.00187.x","article-title":"Improved survival in a retrospective cohort of 28 dogs with insulinoma","volume":"48","author":"Polton","year":"2007","journal-title":"J Small Anim Pract."},{"key":"2026101311215375400_ref21","doi-asserted-by":"publisher","first-page":"905","DOI":"10.1292\/jvms.71.905","article-title":"Retrospective study of canine insulinomas: eight cases (2005-2008)","volume":"71","author":"Madarame","year":"2009","journal-title":"J Vet Med Sci"},{"key":"2026101311215375400_ref22","doi-asserted-by":"publisher","first-page":"151","DOI":"10.5326\/JAAHA-MS-5745","article-title":"Insulinoma in dogs: a review","volume":"48","author":"Goutal","year":"2012","journal-title":"J Am Anim Hosp Assoc"},{"key":"2026101311215375400_ref23","first-page":"642","article-title":"Hypoglycemia in dogs: causes, management, and diagnosis","volume":"59","author":"Idowu","year":"2018","journal-title":"Can Vet J."},{"key":"2026101311215375400_ref24","doi-asserted-by":"publisher","first-page":"1135","DOI":"10.1111\/jvim.15751","article-title":"Incidence of postoperative complications and outcome of 48 dogs undergoing surgical management of insulinoma","volume":"34","author":"Del Busto","year":"2020","journal-title":"J Vet Intern Med"},{"key":"2026101311215375400_ref25","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1111\/vco.12628","article-title":"Outcome after surgical management of canine insulinoma in 49 cases","volume":"19","author":"Cleland","year":"2021","journal-title":"Vet Comp Oncol"},{"key":"2026101311215375400_ref26","doi-asserted-by":"publisher","first-page":"540","DOI":"10.3390\/vetsci9100540","article-title":"Current trends in diagnosis, treatment and prognosis of canine Insulinoma","volume":"9","author":"Buishand","year":"2022","journal-title":"Vet Sci"},{"key":"2026101311215375400_ref27","doi-asserted-by":"publisher","first-page":"e27","DOI":"10.1002\/vro2.27","article-title":"Toceranib phosphate in the management of canine insulinoma: a retrospective multicentre study of 30 cases (2009-2019)","volume":"9","author":"Sheppard-Olivares","year":"2022","journal-title":"Vet Rec Open"},{"key":"2026101311215375400_ref28","doi-asserted-by":"publisher","first-page":"2463","DOI":"10.1038\/s41598-025-86782-6","article-title":"Incidence and risk factors for insulinoma diagnosed in dogs under primary veterinary care in the UK","volume":"15","author":"Kraai","year":"2025","journal-title":"Sci Rep"},{"key":"2026101311215375400_ref29","doi-asserted-by":"publisher","first-page":"e70062","DOI":"10.1111\/jvim.70062","article-title":"Generalized tremors in dogs: 198 cases (2003-2023)","volume":"39","author":"Liatis","year":"2025","journal-title":"J Vet Intern Med"},{"key":"2026101311215375400_ref30","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1002\/inpr.3","article-title":"Guide to tremor and twitch syndromes in dogs and cats","volume":"43","author":"Lowrie","year":"2021","journal-title":"In Pract"},{"key":"2026101311215375400_ref31","doi-asserted-by":"publisher","first-page":"421","DOI":"10.12968\/coan.2023.0031","article-title":"Tremor syndromes in dogs and cats: an update","volume":"28","author":"Liatis","year":"2023","journal-title":"Comp Anim"},{"key":"2026101311215375400_ref32","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1016\/j.tvjl.2016.05.011","article-title":"Classification of involuntary movements in dogs: tremors and twitches","volume":"214","author":"Lowrie","year":"2016","journal-title":"Vet J"},{"key":"2026101311215375400_ref33","doi-asserted-by":"publisher","first-page":"177","DOI":"10.21825\/vdt.91618","article-title":"Clinical approach of tremors in dogs and cats","volume":"93","author":"Liatis","year":"2024","journal-title":"Vlaams Diergeneeskd Tijdschr"},{"key":"2026101311215375400_ref34","doi-asserted-by":"publisher","first-page":"327","DOI":"10.4103\/aian.AIAN_1180_20","article-title":"Myoclonus- a review","volume":"24","author":"Chandarana","year":"2021","journal-title":"Ann Indian Acad Neurol"},{"key":"2026101311215375400_ref35","doi-asserted-by":"publisher","first-page":"551","DOI":"10.1016\/j.cvsm.2023.01.001","article-title":"Glucose counterregulation: clinical consequences of impaired sympathetic responses in diabetic dogs and cats","volume":"53","author":"Mott","year":"2023","journal-title":"Vet Clin North Am Small Anim Pract"},{"key":"2026101311215375400_ref36","doi-asserted-by":"publisher","first-page":"485","DOI":"10.1007\/s00431-006-0365-z","article-title":"Insulinoma misdiagnosed as juvenile myoclonic epilepsy","volume":"166","author":"Jaladyan","year":"2007","journal-title":"Eur J Pediatr"},{"key":"2026101311215375400_ref37","doi-asserted-by":"publisher","first-page":"658","DOI":"10.1016\/j.seizure.2008.01.005","article-title":"Myoclonic absence epilepsy with photosensitivity and a gain of function mutation in glutamate dehydrogenase","volume":"17","author":"Bahi-Buisson","year":"2008","journal-title":"Seizure"},{"key":"2026101311215375400_ref38","first-page":"1147","article-title":"Insulinoma diagnosed as drug-refractory epilepsy in an adolescent boy: a case report","volume":"54","author":"Horv\u00e1th","year":"2013","journal-title":"Rom J Morphol Embryol"},{"key":"2026101311215375400_ref39","doi-asserted-by":"publisher","first-page":"e86912","DOI":"10.7759\/cureus.86912","article-title":"Hypoglycemia-induced irreversible brain injury: a case report","volume":"17","author":"Bisht","year":"2025","journal-title":"Cureus."},{"key":"2026101311215375400_ref40","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1159\/000549545","article-title":"A case of hyperinsulinemic hypoglycaemia associated with atypical Fanconi renal tubulopathy syndrome caused by an HNF4A variant","volume":"16","author":"Garriga-Edo","year":"2025","journal-title":"Case Rep Nephrol Dial"},{"key":"2026101311215375400_ref41","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1186\/s40842-025-00234-8","article-title":"Non-diabetic hypoglycemia: bridging gaps in diagnosis and treatment: a position statement report by the Arabic Association for the Study of Diabetes and Metabolism (AASD)","volume":"11","author":"Soliman","year":"2025","journal-title":"Cardiovasc Diabetol Endocrinol Rep"},{"key":"2026101311215375400_ref42","first-page":"777","volume-title":"Small Animal Internal Medicine","author":"Nelson","year":"2014","edition":"5"},{"key":"2026101311215375400_ref43","volume-title":"Canine and Feline Endocrinology","author":"Nelson","year":"2015","edition":"4"},{"key":"2026101311215375400_ref44","doi-asserted-by":"publisher","first-page":"1299","DOI":"10.1097\/00000658-193506000-00001","article-title":"Adenoma of islet cells with hyperinsulinism: a review","volume":"101","author":"Whipple","year":"1935","journal-title":"Ann Surg"},{"key":"2026101311215375400_ref45","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1002\/9781118997505.ch4","volume-title":"Small Animal Soft Tissue Surgery","author":"Buishand","year":"2012","edition":"1"},{"key":"2026101311215375400_ref46","first-page":"423","article-title":"Hypoglycemia in a dog","volume":"50","author":"Fernandez","year":"2009","journal-title":"Can Vet J"},{"key":"2026101311215375400_ref47","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1186\/s12917-015-0461-2","article-title":"International veterinary epilepsy task force consensus report on epilepsy definition, classification and terminology in companion animals","volume":"11","author":"Berendt","year":"2015","journal-title":"BMC Vet Res"},{"key":"2026101311215375400_ref48","doi-asserted-by":"publisher","first-page":"1665","DOI":"10.1007\/s13311-020-00922-6","article-title":"Physiology-based treatment of myoclonus","volume":"17","author":"Pena","year":"2020","journal-title":"Neurotherapeutics."},{"key":"2026101311215375400_ref49","doi-asserted-by":"publisher","first-page":"44","DOI":"10.4103\/AOMD.AOMD_29_19","article-title":"Sudden jerky head movement in hypoglycemia","volume":"3","author":"Shah","year":"2020","journal-title":"Ann Mov Disord"}],"container-title":["Journal of Veterinary Internal Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jvim\/article-pdf\/40\/5\/aalag252\/71911589\/aalag252.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jvim\/article-pdf\/40\/5\/aalag252\/71911589\/aalag252.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T15:22:03Z","timestamp":1791904923000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jvim\/article\/doi\/10.1093\/jvimsj\/aalag252\/8914490"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,1]]},"references-count":49,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,9,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jvimsj\/aalag252","relation":{},"ISSN":["1939-1676"],"issn-type":[{"value":"1939-1676","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,9]]},"published":{"date-parts":[[2026,9,1]]},"article-number":"aalag252"}}