Dog alerting and/or responding to epileptic seizures: A scoping review

Effectiveness of Seizure Dogs for People With Severe Refractory Epilepsy: Results From the EPISODE Study

BACKGROUND AND OBJECTIVES

The aim of this study was to evaluate whether people living with severe medically refractory epilepsy (PSRE) benefit from a seizure dog.

METHODS

An individual-level stepped-wedge randomized controlled trial was conducted. The study was conducted in the Netherlands among adults with daily to weekly seizures. All participants were included simultaneously (on June 1, 2019) while receiving usual care. Then, during the 36-month follow-up, they received a seizure dog in a randomized sequence. Participants kept a seizure diary and completed 3-monthly surveys. Seizure frequency was the primary outcome. Secondary outcomes included seizure-free days, seizure severity, health-related quality of life (HRQoL), and well-being. Data were analyzed using generalized linear mixed modeling (GLMM). The models assumed a delayed intervention effect, starting when the seizure dog reached an advanced stage of training. Effects were calculated as changes per 28-day period with the intervention.

RESULTS

Data were collected from 25 participants, of whom 20 crossed over to the intervention condition. The median follow-up was 19 months with usual care and 12 months with the intervention. On average, participants experienced 115 (SD 164) seizures per 28-day period in the usual care condition and 73 (SD 131) seizures in the intervention condition. Seven participants achieved a reduction of 50% or more at the end of follow-up. GLMM indicated a 3.1% decrease in seizure frequency for each consecutive 28-day period with the intervention (0.969, 95% CI 0.960-0.977). Furthermore, an increase in the number of seizure-free days was observed (1.012, 95% CI 1.009, 1.015), but no effect on seizure severity measured with the NHS3. Generic HRQoL scores improved, as reflected in the decrease in EQ-5D-5L utility decrement (0.975, 95% CI 0.954-0.997). Smaller improvements were observed on overall self-rated HRQoL, epilepsy-specific HRQoL, and well-being, measured with the EQ VAS, QOLIE-31-P, and ICECAP-A, respectively.

DISCUSSION

Seizure dogs reduce seizure frequency, increase the number of seizure-free days, and improve the quality of life of PSRE. The magnitude of the effect on generic HRQoL indicates that seizure dogs benefit PSRE beyond the impact on seizure frequency alone. Early discontinuation of seizure dog partnerships suggests that this intervention is not suitable for all PSRE and requires further study.

TRIAL REGISTRATION INFORMATION

This study was registered in the Dutch Trial Register (NL6682) on November 28, 2017. Participants were enrolled on June 1, 2019.

CLASSIFICATION OF EVIDENCE

This study provides Class III evidence that seizure dogs are associated with a decrease in seizure frequency in adult patients with medically refractory epilepsy.

The role of trained and untrained dogs in the detection and warning of seizures

Seizure unpredictability plays a major role in disability and decreased quality of life in people with epilepsy. Dogs have been used to assist people with disabilities and have shown promise in detecting seizures. There have been reports of trained seizure-alerting dogs (SADs) successfully detecting when a seizure is occurring or indicating imminent seizures, allowing patients to take preventative measures. Untrained pet dogs have also shown the ability to detect seizures and provide comfort and protection during and after seizures. Dogs' exceptional olfactory abilities and sensitivity to human cues could contribute to their seizure-detection capabilities. This has been supported by studies in which dogs have distinguished between epileptic seizure and non-seizure sweat samples, probably though the detection of volatile organic compounds (VOCs). However, the existing literature has limitations, with a lack of well-controlled, prospective studies and inconsistencies in reported timings of alerting behaviours. More research is needed to standardize reporting and validate the results. Advances in VOC profiling could aid in distinguishing seizure types and developing rapid and unbiased seizure detection methods. In conclusion, using dogs in epilepsy management shows considerable promise, but further research is needed to fully validate their effectiveness and potential as valuable companions for people with epilepsy.

The use of mantrailing dogs in police and judicial context, future directions, limits and possibilities - A law review

The extraordinary capabilities of the canine nose are increasingly being used by law enforcement agencies in many countries to solve and reconstruct crimes. As a result, this type of forensic evidence can be and is still being challenged in the courts. So far, only a few publications have addressed the jurisprudence concerning mantrailing. We provide an overview of the jurisprudence in Germany and the USA, as well as insights from France. Relevant databases were searched, and 201 verdicts from Germany and 801 verdicts from the USA were analyzed. As a result, 16 published verdicts on the topic of mantrailing were found for Germany, and 44 verdicts since 2010 were found for the USA. The use of mantrailers and human scent discrimination dogs is employed in the investigative process in all three countries. The results derived from these methods are admissible as evidence in court, albeit not as sole evidence.

Are children and dogs best friends? A scoping review to explore the positive and negative effects of child-dog interactions

Personal wellbeing is greatly influenced by our childhood and adolescence, and the relationships formed during those phases of our development. The human-dog bond represents a significant relationship that started thousands of years ago. There is a higher prevalence of dog ownership around the world, especially in households including children. This has resulted in a growing number of researchers studying our interactions with dogs and an expanding evidence base from the exploration of child-dog interactions. We review the potential effects of child-dog interactions on the physical, mental, and social wellbeing of both species. A search of the SCOPUS database identified documents published between January 1980 and April 2022. Filtering for key inclusion criteria, duplicate removals, and inspecting the references of these documents for additional sources, we reviewed a total of 393 documents, 88% of which were scientific articles. We were able to define the numerous ways in which children and dogs interact, be it neutral (e.g., sharing a common area), positive (e.g., petting), or negative (e.g., biting). Then, we found evidence for an association between childhood interaction with dogs and an array of benefits such as increased physical activities, a reduction of stress, and the development of empathy. Nonetheless, several detrimental outcomes have also been identified for both humans and dogs. Children are the most at-risk population regarding dog bites and dog-borne zoonoses, which may lead to injuries/illness, a subsequent fear of dogs, or even death. Moreover, pet bereavement is generally inevitable when living with a canine companion and should not be trivialized. With a canine focus, children sometimes take part in caretaking behaviors toward them, such as feeding or going for walks. These represent opportunities for dogs to relieve themselves outside, but also to exercise and socialize. By contrast, a lack of physical activity can lead to the onset of obesity in both dogs and children. Dogs may present greater levels of stress when in the presence of children. Finally, the welfare of assistance, therapy, and free-roaming dogs who may interact with children remains underexplored. Overall, it appears that the benefits of child-dog interactions outweigh the risks for children but not for dogs; determination of the effects on both species, positive as well as negative, still requires further development. We call for longitudinal studies and cross-cultural research in the future to better understand the impact of child-dog interactions. Our review is important for people in and outside of the scientific community, to pediatricians, veterinarians, and current or future dog owners seeking to extend their knowledge, and to inform future research of scientists studying dogs and human-animal interactions.

Hereditary predisposition of water voles (Arvicola amphibius L.) to seizures in response to handling

Finding out the hereditary predisposition to seizures in response to specif ic external stimuli is important for understanding the causes of epileptiform conditions, developing new methods for their prevention and therapies. In the water vole, individuals with convulsive seizures are found both in natural and laboratory conditions. The data of long-lasting maintenance and breeding of water voles in vivarium conditions were analyzed in order to establish a hereditary predisposition to convulsive seizures, and the inf luence of sex and age on their development. In the vivarium, seizures are provoked by handling and are observed in 2.4 % of voles caught in the natural population with cyclic f luctuations in abundance. Seizures are observed more often in individuals caught in the phases of decline and depression of abundance than in individuals caught in the phases of rise or peak. Convulsive states are probably an element of adaptive behavior formed in the predator-prey system. In natural conditions, individuals predisposed to convulsive seizures may have a selective advantage when under increasing pressure from predators. Convulsive seizures in response to handling were noted in 29.8 % of descendants of captive-bred water voles. The proportion of such individuals increased signif icantly if one or both parents had convulsive states, which indicates the presence of a hereditary predisposition to seizures. In parent–offspring pairs, a signif icant correlation was found between the average age of onset of the f irst seizures in parents and their offspring, r = 0.42, p <0.01. The minimum age of registration of seizures in the water vole is 39 days, the maximum is 1105 days, and the median is 274 days. Predisposition to seizures is not related to sex. Genes that control the occurrence of seizures have a pleiotropic effect on life span, since individuals with seizures live longer in vivarium conditions than individuals with a normal phenotype. The water vole can serve as a suitable model object for studying the nature of convulsive states and the evolution of longevity

Understanding the participation outcomes for persons with disability when partnered with assistance dogs: A scoping review

Introduction

Assistance dogs are trained to support persons living with disability and mitigate limitations that hinder their participation in everyday activities. Despite participation being a frequent challenge for people with disabilities, evidence linking assistance dog provision to improved participation outcomes is underdeveloped. This scoping review aimed to improve understanding by mapping the participation outcomes claimed in research on assistance dogs using the International Classification of Functioning (ICF), Disability and Health framework.

Methods

Using the Arksey and O′Malley's six‐step framework, this scoping review searched six databases. Data were collected, mapped and summarised in accordance with the domains outlined in the ICF.

Results

In total, 38 studies across 41 papers met the inclusion criteria. Included studies investigated assistance dogs who were partnered with people living with physical disabilities, mental illness, autism and chronic conditions that require alerting (e.g., epilepsy and diabetes). Mapping of participation outcomes suggested that assistance dogs can have a positive impact on participation in many areas of daily life.

Conclusion

Findings can assist practitioners, funders and policymakers to recognise the value of assistance dogs as a support for people with disability. However, further research is needed to address limitations regarding study designs, for example, the outcome measures used.

A Scoping Review of the Benefits and Challenges of Using Service Dogs for Finding and Maintaining Employment

Purpose Having a service dog can help increase the independence of people with disabilities and they are considered a reasonable accommodation within employment settings. The objective of this scoping review was to understand the benefits and challenges of using a service dog in gaining and maintaining employment. Methods Systematic searches of seven international databases led to 19 studies meeting our inclusion criteria. Using a narrative review approach, we analyzed these studies regarding their sample characteristics, methods, results and quality of evidence. Results Nineteen studies were included in the review, which spanned across 6 countries over a 24-year period. Our findings showed that the benefits of having a service dog included improvements in employment status, employers' recognition of service dogs as a workplace accommodation, lower absenteeism, ability to travel to work, and other career-related benefits. Challenges with having a service dog included discrimination and exclusion, and lack of employers' awareness of service dogs and people with disabilities. Conclusions Our findings highlight several benefits and challenges of having a service dog in the workplace. More research is needed to explore the impact of service dogs on employment, health and productivity in the workplace and how this may vary by type of disability and service dog.

The "olfactory fingerprint": can diagnostics be improved by combining canine and digital noses?

A sniffer (detecting) dog is conventionally defined as an animal trained to use its olfactory perceptions for detecting a vast array of substances, mostly volatile organic compounds (VOCs), including those exceptionally or exclusively generated in humans bearing specific pathologies. Such an extraordinary sniffing performance translates into the capability of detecting compounds close to the femtomolar level, with performance comparable to that of current mass spectrometry-based laboratory applications. Not only can dogs accurately detect "abnormal volatilomes" reflecting something wrong happening to their owners, but they can also perceive visual, vocal and behavioral signals, which altogether would contribute to raise their alertness. Although it seems reasonable to conclude that sniffer dogs could never be considered absolutely "diagnostic" for a given disorder, several lines of evidence attest that they may serve as efficient screening aids for many pathological conditions affecting their human companions. Favorable results have been obtained in trials on cancers, diabetes, seizures, narcolepsy and migraine, whilst interesting evidence is also emerging on the capability of early and accurately identifying patients with infectious diseases. This would lead the way to proposing an "olfactory fingerprint" loop, where evidence that dogs can identify the presence of human pathologies provides implicit proof of the existence of disease-specific volatilomes, which can be studied for developing laboratory techniques. Contextually, the evidence that specific pathologies are associated with abnormal VOC generation may serve as reliable basis for training dogs to detect these compounds, even (or especially) in patients at an asymptomatic phase.

The Untrained Response of Pet Dogs to Human Epileptic Seizures

Epilepsy is a debilitating and potentially life-threatening neurological condition which affects approximately 65 million people worldwide. There is currently no reliable and simple early warning seizure-onset device available, which means many people with unstable epilepsy live in fear of injury or sudden death and the negative impact of social stigmatization. If anecdotal claims that untrained dogs anticipate seizures are found to be true, they could offer a simple and readily available early warning system. We hypothesized that, given the extraordinary olfactory ability of dogs, a volatile organic compound exhaled by the dog's epileptic owner may constitute an early warning trigger mechanism to which make dogs react by owner-directed affiliative responses in the pre-seizure period. Using 19 pet dogs with no experience of epilepsy, we exposed them to odours that were deemed to be characteristic of three seizure phases, by using sweat harvested from people with epilepsy. The odours were delivered to a point immediately under a non-epileptic and seated pet dog owner's thighs. By altering the alternating odours emerging from sweat samples, captured before seizure, during a seizure and after a seizure, and two nonseizure controls, we were able to record the response of the 19 pet dogs. Our findings suggest that seizures are associated with an odour and that dogs detect this odour and demonstrate a marked increase in affiliative behaviour directed at their owners. A characteristic response of all 19 dogs to seizure odour presentation was an intense stare which was statistically significant, (p < 0.0029), across the pre-seizure, seizure and post-seizure phases when compared to control odours of nonseizure origin.

Pet Therapy as a Nonpharmacological Treatment Option for Neurological Disorders: A Review of the Literature

Animal therapy and ownership have been studied as a nonpharmacologic treatment option for cardiovascular and psychological disorders. Animal companionship is less studied in neurological disorders such as stroke, dementia, Parkinson's disease, multiple sclerosis, Huntington's disease, epilepsy, and acute brain injury. This review examines the effects that emotional support dogs, dog therapy, or dog ownership has on these specific neurological disorders. It may serve as a nonpharmaceutical option to improve patient symptoms, quality of life, or the disease course itself. Articles were gathered which studied the effect of animal-assisted therapy, pet therapy, dog ownership, and physical activity on neurological disorders. Studies relating to the topic were then assessed for the impact on neurological disorders which ranged from cognition, mobility, quality of life, mood, and improvement of disease course. Dog therapy and ownership were found to improve mood, quality of life, and disease symptoms across multiple neurological disorders. It also encouraged physical activity which was shown to help many diseases studied, even ones associated with skeletal muscle apoptosis, such as Huntington's disease. Dog therapy and ownership are a safe and effective nonpharmaceutical approach to treating chronic and progressive neurological disorders.

The effects of assistance dogs on psychosocial health and wellbeing: A systematic literature review

Beyond the functional tasks that assistance dogs are trained for, there is growing literature describing their benefits on the psychosocial health and wellbeing of their handlers. However, this research is not only widely disparate but, despite its growth, has not been reviewed since 2012. Our objective was to identify, summarize, and methodologically evaluate studies quantifying the psychosocial effects of assistance dogs for individuals with physical disabilities. Following PRISMA guidelines, a systematic review was conducted across seven electronic databases. Records were independently screened by two authors. Studies were eligible for inclusion if they assessed outcomes from guide, hearing, medical, or mobility service dogs, if they collected original data on handlers' psychosocial functioning, and if the outcome was measured quantitatively with a validated, standardized measure. Studies on psychiatric service dogs, emotional support dogs, and pet dogs were excluded. Of 1,830 records screened, 24 articles were identified (12 publications, 12 theses) containing 27 studies (15 cross-sectional, 12 longitudinal). Studies assessed the effects of mobility (18), hearing (7), guide (4), and medical (2) assistance dog partnerships with an average sample size of N = 83. An analysis of 147 statistical comparisons across the domains of psychological health, quality of life, social health, and vitality found that 68% of comparisons were null, 30% were positive in the hypothesized direction, and 2% were negative. Positive outcomes included significant effects of having an assistance dog on psychological wellbeing, emotional functioning, self-esteem, and vitality. However, it is of note that several methodological weaknesses of the studies make it difficult to draw any definitive conclusions, including inadequate reporting and a failure to account for moderating or confounding variables. Future research will benefit from stronger methodological rigor and reporting to account for heterogeneity in both humans and assistance dogs as well as continued high-quality replication.

The impact of service dogs on children, youth and their families: A systematic review

BACKGROUND

Having a service dog can help to increase independence and well-being among people with a disability or a chronic health condition. Although there has been an increasing use of service dogs among children and youth their impact has not yet been synthesized.

OBJECTIVE

The purpose of this article was to conduct a systematic review assessing the impact of service dogs on children, youth and their families.

METHODS

Systematic searches of seven international databases from 1985 to 2020 led to 29 studies meeting our inclusion criteria. Using a narrative synthesis review approach we analyzed these studies regarding their sample characteristics, methods, results and quality of evidence.

RESULTS

There were 29 studies in our review that included 1121 children and youth (or parents representing them) that spanned across six countries over a 32-year period. Although the outcomes of the impact of service dogs varied across the studies, 23/29 of them reported an improvement in at least one of the following: physical health (i.e., diabetes management, seizure management, mobility), psychological health (i.e., quality of life, safety, behavior, stress, anxiety, self-confidence and independence), social well-being (i.e., social interactions, school and work) and dog-owner-bond. Children, youth and their parents also described several challenges in owning a service dog.

CONCLUSIONS

Our findings highlight that service dogs have potential to provide many benefits for children, youth and their families. Further research, including more rigorously designed studies, is needed to fully understand their impact.

Is there a Profile of Spontaneous Seizure-Alert Pet Dogs? A Survey of French People with Epilepsy

Simple Summary

Very little is known about dogs that could alert their owner of an impending epileptic seizure. Here, we explored the profiles of untrained dogs that spontaneously show seizure-related behaviors. Using a self-reporting questionnaire, we found that these dogs do not have a particular profile (e.g., sex, breed, age, epilepsy of the owner), but bonding is perceived as better when the dog alerts compared to a dog who does not alert. Personality traits helped discriminate between these two types of dogs; seizure-alert dogs were scored higher for Motivation, Training Focus and lower in Neuroticism than non-alerting dogs. In addition, we reported alert-related behavior characteristics (e.g., the dogs that alerted the more frequently stayed close and stared at their owner when he/she had a seizure). Our results are in line with the existing literature and help further the understanding of seizure-alert dogs. In particular, we suggest that some personality traits could be a basis for the selection of future assistance dogs.

Abstract

Despite controversies and the lack of research, dogs are empirically selected and trained to perform as service dogs, in relation to the dogs’ and future owners’ characteristics. We assessed the characteristics of both humans and dogs in an unbiased population (not selected or trained) of spontaneous seizure-alert by pet dogs and investigated whether we could replicate previous findings. We addressed a self-reporting questionnaire to French people with epilepsy. We analyzed the general characteristics of the humans and pet dogs and their behaviors that could alert their owner before a seizure. In addition, we used the Monash Canine Personality Questionnaire refined to evaluate pet dogs’ personality through five different traits, and the Monash Dog-Owner Relationship scale to assess human–dog relationships. In line with previous reports, we found no particular factor, either pet-, people- or epilepsy-related that could be associated with the presence or absence of alert behaviors. Alert behaviors and circumstances were explored and three different alert patterns emerged. In terms of personality, seizure-alert pet dogs scored significantly higher than non-alerting dogs for the traits “Motivation” and “Training Focus” and lower for “Neuroticism”. The owner–dog bond score was significantly higher for seizure-alert dogs than for non-alerting dogs.

Evaluating the Effectiveness and Cost-Effectiveness of Seizure Dogs in Persons With Medically Refractory Epilepsy in the Netherlands: Study Protocol for a Stepped Wedge Randomized Controlled Trial (EPISODE)

Background: Epilepsy is associated with a high disease burden, impacting the lives of people with epilepsy and their caregivers and family. Persons with medically refractory epilepsy experience the greatest burden, suffering from profound physical, psychological, and social consequences. Anecdotal evidence suggests these persons may benefit from a seizure dog. As the training of a seizure dog is a substantial investment, their accessibility is limited in the absence of collective reimbursement as is seen in the Netherlands. Despite sustained interest in seizure dogs, scientific knowledge on their benefits and costs remains scarce. To substantiate reimbursement decisions stronger evidence is required. The EPISODE study aims to provide this evidence by evaluating the effectiveness and cost-effectiveness of seizure dogs in adults with medically refractory epilepsy.

Methods: The study is designed as a stepped wedge randomized controlled trial that compares the use of seizure dogs in addition to usual care, with usual care alone. The study includes adults with epilepsy for whom current treatment options failed to achieve seizure freedom. Seizure frequency of participants should be at least two seizures per week, and the seizures should be associated with a high risk of injury or dysfunction. During the 3 year follow-up period, participants receive a seizure dog in a randomized order. Outcome measures are taken at multiple time points both before and after receiving the seizure dog. Seizure frequency is the primary outcome of the study and will be recorded continuously using a seizure diary. Questionnaires measuring seizure severity, quality of life, well-being, resource use, productivity, social participation, and caregiver burden will be completed at baseline and every 3 months thereafter. The study is designed to include a minimum of 25 participants.

Discussion: This protocol describes the first randomized controlled trial on seizure dogs. The study will provide comprehensive data on the effectiveness and cost-effectiveness of seizure dogs in adults with medically refractory epilepsy. Broader benefits of seizure dogs for persons with epilepsy and their caregivers are taken into account, as well as the welfare of the dogs. The findings of the study can be used to inform decision-makers on the reimbursement of seizure dogs.