By Thomas R. Collins
February 29, 2024
In the first effort to evaluate the intervention using a randomized design, researchers found that having a seizure dog reduced the frequency of seizures in adults with severe refractory epilepsy, according to new findings published in Neurology on Feb. 28.
The patients with seizure dogs had more seizure-free days and improved quality-of-life metrics compared with those receiving usual care only, which consisted of antiseizure medications and neurostimulation, as well as assistive care services and technologies such as occupational therapy and wearable alarm devices. But they also observed that those who had seizure dogs also had a considerable discontinuation rate, potentially complicating the widespread use of the dogs.
"These findings highlight the potential benefits of seizure dogs in reducing seizure frequency and enhancing quality of life in this target population," said Valérie van Hezik-Wester, MSc, a researcher in health economics and outcomes research at the Erasmus University Rotterdam, the Netherlands.
Study Details
Seizure dogs are trained to respond to a seizure by pressing an alarm button, retrieving medication, or preventing harmful movements. They also sometimes develop alerting behavior, anticipating an impending seizure.
In the study, researchers used a "stepped wedge" design, in which participants are randomized to move from the control to the intervention group over time in a randomized fashion. All participants eventually cross over to the intervention group unless they drop out first.
People 18 and older were eligible to participate if they had medically refractory epilepsy, an average of two or more seizures a week, seizure characteristics associated with a high risk of injuries or dysfunction, and the ability to care for a seizure dog. Participants were randomized at the start of the study to a time point when they would begin with a seizure dog.
The crossover point from control to intervention was six months after placement of a pre-trained dog and 12 months after a seizure dog passed the socialization and obedience test in the coaching trajectory. The researchers reasoned that the dogs start providing benefits when the participant and the dog have bonded and when the dog's training is focused on epilepsy-specific tasks.
Twenty-five patients participated, and six discontinued before the end of the follow-up period. Twenty-five patients were observed in the control condition, 20 of whom also were followed in the intervention condition.
The median follow-up was 21 periods of 28 days, or 20 months, in the usual care condition and 13 periods, or 12 months, in the intervention condition.
Participants had an average of 115 seizures per 28-day period in the usual care condition and 73 per 28-day period in the intervention condition. The median seizure frequency was 37.5 for the usual care condition and 24 while receiving the seizure-dog intervention.
The average seizure frequency over the last three 28-day periods in the intervention condition was 31.1 percent lower than that in the usual care condition. In the intervention condition, researchers found a reduction of 25 to 49 percent of seizures for four participants and 50to 100 percent for seven. One had a 25 to 49 percent increase in seizure frequency, and two had an increase of 50 percent or more. For the other six, the change in frequency was less than 25 percent—four with a decrease and two with an increase, researchers reported.
"It seems that, just as in traditional epilepsy treatments, there appear to be 'responders' and 'non-responders,' with some benefitting from the intervention more than others," Hezik-Wester said.
For each consecutive 28-day period with the intervention, seizure frequency decreased by an average of 3.1 percent.
During the intervention, participants reported 15 seizure-free days per 28-day period, compared with 11 for the usual care period.
Researchers also found significant improvements in health-related quality-of-life scores, especially on the EuroQol (EQ-5D-5L), which is used to measure health benefits in analyses of cost-effectiveness.
"Although the participating assistance dog schools did not actively train dogs for seizure alerting … they did observe spontaneous alerting behavior in over one-third of the dogs in our study," Hezik-Wester said. "As a result, the findings of our study predominantly assess the efficacy of dogs trained for seizure response while also acknowledging the presence of innate alerting behavior in a subset of these dogs."
Research into the mechanisms involved in alerting behavior could help with the selection of dogs most likely to develop this skill or assist in developing training methods to acquire this alerting behavior, she said.
The Commitment to Care
Neil Kulkarni, MD, assistant professor of clinical pediatrics at The Ohio State University College of Medicine, said that, in his experience, patients with the greatest seizure burden tend to have the best results with epilepsy service dogs.
"These patients often have limited medical options and the relationship that the epilepsy service dog seems to improve the quality of life for both patient and family," he said. "I agree with the premise that the article makes; that it is likely the reduction of stressors that improves both the seizure frequency as well as the quality of life for these individuals."
He said the study has "significant limitations," though, which were acknowledged by the authors: relatively small sample size and results that cannot be easily generalized, blinding was not possible, and a lack of clarity about whether other interventions that also reduce stress could have similar effects.
The research team also did not investigate whether discontinuation of the epilepsy service dog produced a rebound effect on seizure frequency, he said.
Dr. Kulkarni said greater insurance coverage might lead to more use, since the cost is a frequent barrier.
"I imagine that insurance companies may require further evidence before they start covering more costs," he said, "but this could be an intervention for medically refractory patients that helps reduce their seizure frequency."
February 29, 2024
In the first effort to evaluate the intervention using a randomized design, researchers found that having a seizure dog reduced the frequency of seizures in adults with severe refractory epilepsy, according to new findings published in Neurology on Feb. 28.
The patients with seizure dogs had more seizure-free days and improved quality-of-life metrics compared with those receiving usual care only, which consisted of antiseizure medications and neurostimulation, as well as assistive care services and technologies such as occupational therapy and wearable alarm devices. But they also observed that those who had seizure dogs also had a considerable discontinuation rate, potentially complicating the widespread use of the dogs.
"These findings highlight the potential benefits of seizure dogs in reducing seizure frequency and enhancing quality of life in this target population," said Valérie van Hezik-Wester, MSc, a researcher in health economics and outcomes research at the Erasmus University Rotterdam, the Netherlands.
Study Details
Seizure dogs are trained to respond to a seizure by pressing an alarm button, retrieving medication, or preventing harmful movements. They also sometimes develop alerting behavior, anticipating an impending seizure.
In the study, researchers used a "stepped wedge" design, in which participants are randomized to move from the control to the intervention group over time in a randomized fashion. All participants eventually cross over to the intervention group unless they drop out first.
People 18 and older were eligible to participate if they had medically refractory epilepsy, an average of two or more seizures a week, seizure characteristics associated with a high risk of injuries or dysfunction, and the ability to care for a seizure dog. Participants were randomized at the start of the study to a time point when they would begin with a seizure dog.
The crossover point from control to intervention was six months after placement of a pre-trained dog and 12 months after a seizure dog passed the socialization and obedience test in the coaching trajectory. The researchers reasoned that the dogs start providing benefits when the participant and the dog have bonded and when the dog's training is focused on epilepsy-specific tasks.
Twenty-five patients participated, and six discontinued before the end of the follow-up period. Twenty-five patients were observed in the control condition, 20 of whom also were followed in the intervention condition.
The median follow-up was 21 periods of 28 days, or 20 months, in the usual care condition and 13 periods, or 12 months, in the intervention condition.
Participants had an average of 115 seizures per 28-day period in the usual care condition and 73 per 28-day period in the intervention condition. The median seizure frequency was 37.5 for the usual care condition and 24 while receiving the seizure-dog intervention.
The average seizure frequency over the last three 28-day periods in the intervention condition was 31.1 percent lower than that in the usual care condition. In the intervention condition, researchers found a reduction of 25 to 49 percent of seizures for four participants and 50to 100 percent for seven. One had a 25 to 49 percent increase in seizure frequency, and two had an increase of 50 percent or more. For the other six, the change in frequency was less than 25 percent—four with a decrease and two with an increase, researchers reported.
"It seems that, just as in traditional epilepsy treatments, there appear to be 'responders' and 'non-responders,' with some benefitting from the intervention more than others," Hezik-Wester said.
For each consecutive 28-day period with the intervention, seizure frequency decreased by an average of 3.1 percent.
During the intervention, participants reported 15 seizure-free days per 28-day period, compared with 11 for the usual care period.
Researchers also found significant improvements in health-related quality-of-life scores, especially on the EuroQol (EQ-5D-5L), which is used to measure health benefits in analyses of cost-effectiveness.
"Although the participating assistance dog schools did not actively train dogs for seizure alerting … they did observe spontaneous alerting behavior in over one-third of the dogs in our study," Hezik-Wester said. "As a result, the findings of our study predominantly assess the efficacy of dogs trained for seizure response while also acknowledging the presence of innate alerting behavior in a subset of these dogs."
Research into the mechanisms involved in alerting behavior could help with the selection of dogs most likely to develop this skill or assist in developing training methods to acquire this alerting behavior, she said.
The Commitment to Care
Neil Kulkarni, MD, assistant professor of clinical pediatrics at The Ohio State University College of Medicine, said that, in his experience, patients with the greatest seizure burden tend to have the best results with epilepsy service dogs.
"These patients often have limited medical options and the relationship that the epilepsy service dog seems to improve the quality of life for both patient and family," he said. "I agree with the premise that the article makes; that it is likely the reduction of stressors that improves both the seizure frequency as well as the quality of life for these individuals."
He said the study has "significant limitations," though, which were acknowledged by the authors: relatively small sample size and results that cannot be easily generalized, blinding was not possible, and a lack of clarity about whether other interventions that also reduce stress could have similar effects.
The research team also did not investigate whether discontinuation of the epilepsy service dog produced a rebound effect on seizure frequency, he said.
Dr. Kulkarni said greater insurance coverage might lead to more use, since the cost is a frequent barrier.
"I imagine that insurance companies may require further evidence before they start covering more costs," he said, "but this could be an intervention for medically refractory patients that helps reduce their seizure frequency."
