Episodic Falling Syndrome (EFS)
Understanding Episodic Falling Syndrome: An Inherited Neurological Condition Affecting the Cavalier King Charles Spaniel
If you are considering purchasing a Cavalier King Charles Spaniel puppy, already own a Cavalier, or are researching the breed's health, it is important to understand Episodic Falling Syndrome (EFS). Although less common than conditions such as Myxomatous Mitral Valve Disease (MMVD) or Chiari-like Malformation and Syringomyelia, Episodic Falling Syndrome is a well-recognised inherited neurological disorder unique to the Cavalier King Charles Spaniel.
The encouraging news is that, unlike many inherited diseases affecting the breed, Episodic Falling Syndrome can be identified through a simple DNA test. This allows ethical and responsible breeders to make informed breeding decisions that dramatically reduce the risk of producing affected puppies.
By understanding how Episodic Falling Syndrome is inherited, recognising the importance of DNA testing and choosing a health-tested puppy from a responsible breeder, prospective owners can play an important role in protecting the long-term health and welfare of the Cavalier King Charles Spaniel.
Overview
Condition: Episodic Falling Syndrome (EFS)
Body system affected: Nervous system and muscles
Inherited? Yes.
Cause: A mutation in the BCAN (brevican) gene.
DNA test available? Yes.
Can responsible breeding reduce the disease? Yes. DNA testing allows breeders to avoid producing affected puppies.
Can it be cured? No. There is currently no cure, but many affected dogs live happy lives with appropriate management.
What is Episodic Falling Syndrome?
Episodic Falling Syndrome is an inherited neurological disorder that affects the way muscles function during periods of excitement, exercise or stress. Despite its name, dogs experiencing an episode do not always "fall over." Instead, affected dogs develop episodes of increased muscle stiffness (hypertonicity) that interfere with their normal movement.
During an episode, muscles throughout the body become abnormally rigid, causing affected Cavaliers to adopt unusual postures and have difficulty walking or remaining upright. Importantly, Episodic Falling Syndrome is not a seizure disorder. Dogs remain conscious throughout an episode and are generally aware of their surroundings. This distinction is important because Episodic Falling Syndrome is sometimes mistaken for epilepsy by owners unfamiliar with the condition.
Why Does Episodic Falling Syndrome Occur?
Episodic Falling Syndrome is caused by a mutation in the BCAN (brevican) gene. The BCAN gene provides instructions for producing brevican, a protein that plays an important role in the normal function of the central nervous system. Researchers believe that abnormalities in this protein interfere with communication between nerve cells, resulting in episodes of abnormal muscle contraction during periods of excitement or stress. Unlike injuries or illnesses that develop during a dog's lifetime, Episodic Falling Syndrome is present from birth, although affected puppies may not show clinical signs immediately.
Why Are Cavalier King Charles Spaniels Affected?
Episodic Falling Syndrome is considered breed-specific, meaning it has been identified almost exclusively in the Cavalier King Charles Spaniel. The mutation became established within the breed many generations ago and continues to be passed from parents to offspring through inherited genes.
Fortunately, because researchers identified the responsible genetic mutation, a reliable DNA test is now available. This has been one of the most important advances in protecting the health of the breed.
How Is Episodic Falling Syndrome Inherited?
Unlike complex inherited conditions such as Chiari-like Malformation or Myxomatous Mitral Valve Disease, Episodic Falling Syndrome follows a relatively straightforward pattern of inheritance. It is inherited as an autosomal recessive genetic disorder. This means a puppy must inherit two copies of the mutated BCAN gene—one from each parent—to develop the condition. If only one copy of the mutation is inherited, the dog will not develop Episodic Falling Syndrome but will become a carrier. Understanding this pattern of inheritance is essential for responsible breeding.
Understanding DNA Test Results
DNA testing classifies Cavaliers into one of three categories.
Clear
A Clear dog has inherited two normal copies of the BCAN gene.
These dogs:
will not develop Episodic Falling Syndrome
cannot pass the mutation to their puppies
Carrier
A Carrier has inherited one normal copy of the gene and one mutated copy.
Carrier dogs:
do not develop Episodic Falling Syndrome
usually live completely normal lives
can pass the mutation to approximately half of their puppies
Because carriers are clinically healthy, DNA testing is the only reliable way to identify them.
Affected
An Affected dog has inherited two copies of the mutated BCAN gene.
Affected dogs are genetically predisposed to developing Episodic Falling Syndrome.
The severity and frequency of episodes varies considerably between individuals.
Why DNA Testing Is So Important
One of the greatest strengths of modern Cavalier breeding programmes is that DNA testing makes Episodic Falling Syndrome largely preventable. Before the discovery of the BCAN mutation, breeders had no reliable way of identifying carrier dogs.
Today, responsible breeders can test every breeding dog before planning a litter. This allows them to make informed breeding decisions while maintaining valuable genetic diversity within the breed. DNA testing has transformed the way ethical breeders manage Episodic Falling Syndrome.
Does a Carrier Dog Need to Be Removed from Breeding?
No. This is one of the biggest misconceptions surrounding inherited diseases. Current genetic management recommendations do not suggest removing every carrier dog from breeding. Doing so could unnecessarily reduce the breed's already limited genetic diversity. Instead, responsible breeders use DNA results to plan safe matings.
For example:
Clear × Clear → All puppies will be Clear.
Clear × Carrier → No puppies will be affected, although some may become carriers.
Carrier × Carrier → Approximately 25% of puppies may be affected. This mating should be avoided.
Carrier × Affected → Approximately 50% of puppies may be affected. This mating should never occur.
Affected × Affected → All puppies will be affected. This mating should never occur.
This approach allows breeders to preserve valuable bloodlines while preventing affected puppies from being born.
Responsible Breeding Makes the Difference
Because Episodic Falling Syndrome can be accurately identified through DNA testing, ethical breeders have an opportunity to significantly reduce its incidence.
Responsible breeders:
DNA test every breeding dog.
Understand the genetics behind Episodic Falling Syndrome.
Carefully plan breeding combinations.
Maintain detailed pedigree records.
Use DNA results responsibly rather than making decisions based on appearance alone.
Prioritise the long-term health and welfare of the breed.
By contrast, breeders who do not DNA test have no way of knowing whether apparently healthy dogs are carriers. As a result, they may unknowingly produce affected puppies. This is one of the clearest examples of why health testing is so important when purchasing a Cavalier King Charles Spaniel puppy.
Why Choosing a Responsible Breeder Matters
If you are searching for a Cavalier King Charles Spaniel puppy in Queensland or Australia, choosing a breeder who undertakes comprehensive health testing—including DNA testing for Episodic Falling Syndrome—is one of the best investments you can make in your puppy's future.
No breeder can eliminate every inherited disease affecting Cavaliers. However, because Episodic Falling Syndrome is inherited in a predictable way and can be identified through DNA testing, responsible breeders can prevent affected puppies from being born simply by making informed breeding decisions.
Every puppy purchased from a breeder who invests in DNA testing supports responsible breeding programmes and encourages the continued improvement of the breed's long-term genetic health.
Recognising the Signs, Diagnosis, Treatment and Living with Episodic Falling Syndrome
One of the reassuring aspects of Episodic Falling Syndrome (EFS) is that, although the condition can appear alarming, it is not usually life-threatening. Many affected Cavalier King Charles Spaniels go on to enjoy happy, active and fulfilling lives with appropriate veterinary care and sensible management. The key is recognising the signs early, obtaining an accurate diagnosis and understanding how to minimise situations that may trigger an episode.
When Does Episodic Falling Syndrome Usually Appear?
Most Cavaliers with Episodic Falling Syndrome begin showing clinical signs between 14 weeks and 4 years of age, although the majority develop symptoms during puppyhood or early adolescence.
Some affected dogs experience frequent episodes throughout life, while others may only have occasional episodes or appear to "grow out" of the condition as they mature. Because the severity varies considerably between individuals, some dogs may not be diagnosed until adulthood.
What Triggers an Episode?
Episodes of Episodic Falling Syndrome are usually triggered by excitement or situations that increase physical or emotional stimulation.
Common triggers include:
Excitement during play
Running
Vigorous exercise
Greeting family members
Visitors arriving at the home
Chasing toys or balls
Emotional excitement
Stress
Frustration
Sudden changes in activity
Importantly, episodes are not random. They are generally associated with increased excitement or exertion. Recognising your dog's individual triggers is often an important part of long-term management.
What Does an Episode Look Like?
One of the reasons Episodic Falling Syndrome can be confusing is that the appearance of an episode varies between dogs. Some episodes last only a few seconds, while others may continue for several minutes.
During an episode, affected Cavaliers may:
Develop stiff, rigid legs.
Walk with a "bunny hopping" gait.
Hold their limbs straight.
Arch their back.
Become unable to coordinate normal movement.
Collapse because of muscle rigidity.
Roll onto their side.
Remain unable to stand until the episode passes.
Unlike epilepsy, the dog remains conscious and aware throughout the episode. Many dogs continue to respond to their owners and remain alert despite being unable to move normally. Once the episode resolves, affected dogs usually return to normal without lasting weakness or confusion.
Does Every Episode Look the Same?
No. Episodes can vary significantly.
Some Cavaliers experience:
Mild stiffness lasting only a few seconds.
Others may experience:
Severe muscle rigidity.
Difficulty walking.
Complete collapse.
Episodes lasting several minutes.
The frequency also varies. Some dogs experience only a handful of episodes throughout their lives. Others may have episodes several times each week.
Is Episodic Falling Syndrome Painful?
Current evidence suggests that Episodic Falling Syndrome itself is not generally considered a painful condition. Unlike Syringomyelia, which causes neuropathic pain, Episodic Falling Syndrome primarily affects muscle control rather than causing ongoing nerve pain.
However, an episode can be:
frightening
physically exhausting
stressful for both dog and owner
In severe cases, repeated muscle contractions may leave the dog temporarily fatigued following an episode. Although the episodes themselves are not thought to cause significant pain, every affected dog should be assessed by a veterinarian to exclude other neurological conditions that may be painful.
Is Episodic Falling Syndrome the Same as Epilepsy?
No. This is one of the most common misconceptions. Although the two conditions may appear similar at first glance, they are fundamentally different.
Dogs with epilepsy:
lose consciousness
may paddle their legs
often drool
may urinate or defecate
are frequently disorientated after a seizure
Dogs with Episodic Falling Syndrome:
remain fully conscious
are aware of their surroundings
usually respond to their owners
recover quickly once the episode ends
do not experience the typical "post-seizure" recovery period seen with epilepsy
Correct diagnosis is therefore extremely important.
How Is Episodic Falling Syndrome Diagnosed?
Diagnosis begins with a detailed discussion of your dog's medical history and the episodes you have observed.
Your veterinarian may ask questions such as:
When did the episodes begin?
How long do they last?
What usually triggers them?
Does your dog remain conscious?
Does your dog recover immediately afterwards?
Videos recorded on your phone can be extremely valuable. Because episodes often occur at home, video footage frequently helps veterinarians and veterinary neurologists distinguish Episodic Falling Syndrome from other neurological disorders.
Physical and Neurological Examination
Your veterinarian will perform a thorough physical examination and neurological assessment. Between episodes, many Cavaliers with Episodic Falling Syndrome appear completely normal. This can sometimes make diagnosis more challenging.
DNA Testing
One of the greatest advances in diagnosing Episodic Falling Syndrome has been the development of a reliable DNA test.
DNA testing can determine whether a dog is:
Clear
Carrier
Affected
For dogs showing compatible clinical signs, DNA testing provides valuable information that helps confirm the diagnosis.
Additional Tests
Depending on your dog's symptoms, your veterinarian may recommend additional investigations to exclude other conditions.
These may include:
Blood tests
MRI
Referral to a veterinary neurologist
Other neurological investigations
This ensures an accurate diagnosis before treatment begins.
How Is Episodic Falling Syndrome Treated?
There is currently no cure for Episodic Falling Syndrome. Treatment focuses on reducing the frequency and severity of episodes while helping affected dogs maintain an excellent quality of life.
Every treatment plan should be tailored to the individual dog.
Medical Management
Some affected Cavaliers require little or no medication. Others benefit from medications prescribed by their veterinarian or veterinary neurologist. Treatment may include medications that help reduce abnormal muscle activity or improve neurological function. Because every dog responds differently, treatment plans often require adjustment over time. Owners should never begin or discontinue medication without veterinary advice.
Lifestyle Management
Simple lifestyle adjustments often make a significant difference.
Owners may reduce episodes by:
Avoiding situations that trigger excessive excitement.
Introducing exercise gradually.
Preventing overheating.
Maintaining a healthy body weight.
Providing consistent daily routines.
Reducing unnecessary stress.
These strategies help many affected Cavaliers enjoy active, rewarding lives.
Can Cavaliers with Episodic Falling Syndrome Exercise?
Yes. Regular exercise remains important.
However, exercise should be:
moderate
consistent
appropriate for the individual dog
Very intense bursts of excitement or strenuous activity may trigger episodes in some dogs. Your veterinarian can provide advice tailored to your dog's condition.
Living with a Cavalier Diagnosed with Episodic Falling Syndrome
Receiving a diagnosis of Episodic Falling Syndrome can initially feel overwhelming. Fortunately, many owners quickly discover that affected Cavaliers continue to enjoy wonderful quality of life.
With appropriate management, many dogs:
remain playful
enjoy walks
participate in family life
live for many years
Learning your dog's triggers often becomes one of the most valuable aspects of successful long-term management. Many owners become highly skilled at recognising situations that increase excitement and modifying them before an episode develops.
What Commitment Is Required?
Owning a Cavalier with Episodic Falling Syndrome usually involves:
Regular veterinary examinations.
Monitoring episodes.
Recording changes over time.
Administering medication if prescribed.
Avoiding known triggers.
Providing a stable, predictable routine.
Fortunately, many owners find these adjustments become part of everyday life.
What Is the Prognosis?
The outlook for dogs with Episodic Falling Syndrome is generally considered good, particularly when the condition is accurately diagnosed and appropriately managed.
Many affected Cavaliers:
have normal life expectancy
enjoy excellent quality of life
continue participating in everyday family activities
experience relatively infrequent episodes
The severity varies considerably between individuals, highlighting the importance of regular veterinary care.
Responsible Breeding, DNA Testing and Choosing a Healthy Cavalier King Charles Spaniel Puppy
One of the most encouraging aspects of Episodic Falling Syndrome (EFS) is that, unlike many inherited diseases affecting the Cavalier King Charles Spaniel, it can be effectively managed through responsible breeding.
The discovery of the genetic mutation responsible for Episodic Falling Syndrome has transformed breeding programmes worldwide. Today, ethical breeders can identify dogs that are Clear, Carriers or Affected through a simple DNA test, allowing them to make informed breeding decisions that prevent affected puppies from being born.
For prospective puppy buyers, understanding how DNA testing works is one of the most valuable tools for choosing a healthy Cavalier King Charles Spaniel puppy.
How DNA Testing Has Changed the Future of the Breed
Before the BCAN gene mutation responsible for Episodic Falling Syndrome was identified, breeders had no reliable way of knowing whether apparently healthy dogs carried the disease. Carrier dogs show no clinical signs and live completely normal lives. Without DNA testing, two carrier dogs could unknowingly be mated together, resulting in affected puppies.
Today, responsible breeders can eliminate this risk by testing every breeding dog before planning a litter. This is one of the greatest success stories in canine genetic health and demonstrates how scientific research can improve the welfare of future generations.
Why DNA Testing Is So Important
DNA testing provides certainty. Unlike many inherited diseases that require specialist examinations or MRI scans, a dog's genetic status for Episodic Falling Syndrome remains the same throughout its life. Testing only needs to be performed once.
DNA testing allows breeders to:
Identify carrier dogs.
Prevent affected puppies from being born.
Make informed breeding decisions.
Preserve valuable bloodlines.
Protect genetic diversity.
Improve the long-term health of the breed.
For puppy buyers, DNA testing provides confidence that breeders are making evidence-based decisions rather than relying on guesswork.
Understanding DNA Test Results
One of the most common misunderstandings is believing that a Carrier dog is unhealthy. This is incorrect.
Clear
A dog that tests Clear has inherited two normal copies of the BCAN gene.
These dogs:
will not develop Episodic Falling Syndrome
cannot pass the mutation to their puppies
Carrier
A Carrier has one normal gene and one copy of the mutation.
Carrier dogs:
remain healthy
do not develop Episodic Falling Syndrome
can safely be bred to a Clear dog
contribute valuable genetic diversity
Modern breeding recommendations do not suggest removing every carrier from breeding. Doing so would unnecessarily reduce the genetic diversity of the breed and could inadvertently increase the risk of other inherited diseases. Instead, responsible breeders use DNA results to select appropriate breeding combinations.
Affected
Dogs that inherit two copies of the mutated BCAN gene are classified as Affected. These dogs are genetically capable of developing Episodic Falling Syndrome. The severity varies considerably. Some dogs experience only occasional episodes throughout life, while others require ongoing veterinary management.
What Questions Should You Ask a Breeder?
If you are searching for a Cavalier King Charles Spaniel puppy in Queensland or Australia, asking informed questions is one of the best ways to identify an ethical breeder. We recommend asking:
Have both parents been DNA tested for Episodic Falling Syndrome?
Responsible breeders should immediately answer yes.
May I see the DNA certificates?
Ethical breeders are usually proud to share health-testing documentation.
Certificates should clearly identify the dog's DNA status.
Have both parents also been tested for Curly Coat Dry Eye Syndrome?
Responsible breeders generally test for both inherited conditions because both DNA tests are readily available.
Do you undertake all recommended health testing for Cavaliers?
DNA testing for Episodic Falling Syndrome is only one part of responsible breeding.
Prospective owners should also ask about:
Annual heart examinations performed by a veterinary cardiologist.
MRI screening for Chiari-like Malformation and Syringomyelia.
Eye examinations.
Patella assessments where appropriate.
Comprehensive health testing demonstrates a breeder's commitment to producing healthy puppies.
Red Flags to Watch For
Be cautious if a breeder says:
❌ "I've never seen Episodic Falling Syndrome."
❌ "My dogs don't need DNA testing."
❌ "DNA testing is unnecessary."
❌ "I've been breeding Cavaliers for years without problems."
❌ "The parents are healthy, so the puppies will be too."
Carrier dogs appear completely healthy. Without DNA testing, it is impossible to know whether apparently healthy dogs carry the mutation. Responsible breeders understand this and use DNA testing as part of their breeding programme.
Why Choosing a Responsible Breeder Matters
Every puppy purchase influences the future of the breed. When puppy buyers support breeders who invest in DNA testing and comprehensive health screening, they encourage responsible breeding practices and help reduce the incidence of inherited disease.
Conversely, purchasing puppies from breeders who do not health test removes the incentive for genetic screening and may perpetuate inherited conditions within the breed.
Choosing a health-tested puppy is not simply about protecting your own family—it also supports the long-term health and welfare of future generations of Cavalier King Charles Spaniels.
Common Myths About Episodic Falling Syndrome
Myth: Episodic Falling Syndrome is epilepsy.
Fact: Episodic Falling Syndrome is a hereditary neurological movement disorder, not a seizure disorder. Dogs remain conscious throughout an episode.
Myth: Carrier dogs are sick.
Fact: Carrier dogs remain healthy and never develop Episodic Falling Syndrome.
Myth: Every affected puppy has severe symptoms.
Fact: Clinical signs vary considerably. Some dogs experience only occasional mild episodes.
Myth: Every carrier should be removed from breeding.
Fact: Modern breeding recommendations support carefully managed breeding programmes that preserve valuable genetic diversity while preventing affected puppies.
Myth: DNA testing is optional.
Fact: DNA testing is one of the simplest and most effective health tests available for Cavaliers and is strongly recommended for all breeding dogs.
Frequently Asked Questions
Can Episodic Falling Syndrome be cured?
No. There is currently no cure, although many affected dogs live happy lives with appropriate management.
Can a Cavalier with Episodic Falling Syndrome have a normal lifespan?
Yes. Most affected Cavaliers have a normal life expectancy and enjoy excellent quality of life.
Is Episodic Falling Syndrome painful?
Current evidence suggests that Episodic Falling Syndrome is not generally considered painful, although episodes can be physically exhausting and distressing.
Should pet Cavaliers be DNA tested?
If your dog will not be bred, DNA testing is not usually medically necessary. However, some owners choose testing to better understand their dog's genetic health, particularly if clinical signs develop. Discuss the benefits with your veterinarian.
Can two healthy-looking Cavaliers produce affected puppies?
Yes. If both parents are Carriers, they can produce puppies affected by Episodic Falling Syndrome despite appearing completely healthy. This is why DNA testing is so important.
The Future of the Breed Depends on Responsible Breeding
The development of DNA testing for Episodic Falling Syndrome represents one of the greatest advances in protecting the health of the Cavalier King Charles Spaniel.
Today, there is no reason for responsible breeders to produce puppies affected by this inherited disease. By DNA testing all breeding dogs and making informed breeding decisions, ethical breeders can prevent affected puppies while preserving the valuable genetic diversity that is essential to the long-term health of the breed.
If you are searching for a Cavalier King Charles Spaniel puppy, choose a breeder who embraces health testing, willingly shares DNA test results and is committed to producing healthy, well-adjusted puppies. By supporting breeders who invest in responsible breeding practices, you are helping protect the future of one of the world's most cherished companion breeds.
In Conclusion
Episodic Falling Syndrome (EFS) is an inherited neurological disorder unique to the Cavalier King Charles Spaniel.
The condition is caused by a mutation in the BCAN gene.
A simple DNA test can identify whether a dog is Clear, a Carrier or Affected.
Responsible breeders use DNA testing to prevent affected puppies from being born.
Carrier dogs are healthy and can play an important role in maintaining genetic diversity when responsibly bred to Clear dogs.
Choosing a breeder who undertakes DNA testing is one of the best ways to reduce the risk of purchasing a puppy affected by Episodic Falling Syndrome.
Responsible breeding benefits not only your future puppy but also the long-term health and welfare of the Cavalier King Charles Spaniel.
The Cavalier King Charles Spaniel Club of Queensland encourages every prospective puppy buyer to choose a breeder who undertakes comprehensive health testing, including DNA testing for Episodic Falling Syndrome, alongside recommended cardiac examinations, MRI screening for Chiari-like Malformation and Syringomyelia, eye examinations and other relevant breed health assessments. Choosing a responsibly bred, health-tested puppy gives your new companion the very best start in life while supporting the future health, welfare and preservation of this remarkable breed.
References
Forman OP, et al. Parallel Mapping and Simultaneous Sequencing Reveals Deletions in BCAN and FAM83H Associated with Hereditary Syndromes in Cavalier King Charles Spaniels. PLoS ONE. 2012.
Knowler SP, Rusbridge C. Research into inherited neurological diseases affecting the Cavalier King Charles Spaniel.
The Kennel Club (UK) – Episodic Falling Syndrome Information
CavalierHealth.org – Episodic Falling Syndrome Information Library
University of Minnesota Canine Genetics Laboratory – Episodic Falling Syndrome DNA Testing Information
Peer-reviewed publications relating to inherited neurological disorders and genetic health in the Cavalier King Charles Spaniel.
Disclaimer
The information provided in the Cavalier Knowledge Centre is intended for general educational purposes only and is not a substitute for veterinary advice, diagnosis or treatment.