“Seizure-alert dogs”: Observations from an inpatient video/EEG unit

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  • Re

    s f

    , Joyce Liporace

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    ebruline 5

    ithof seg co

    2004 we monitored two patients who owned seizure dogs in the Epilepsy Care Unit at Thomas Jeerson University Hospital in

    interested in learning about seizure-alert dogs, but theirreliability remains unknown. Seizure-alert dog owners

    the behavior of seizure-alert dogs in the hospital whiletheir owners were undergoing continuous computer-as-

    Thomas Jeerson University Hospital in Philadelphia.Both patients were accompanied by their seizure-alertdogs during their admission as the patients felt more

    Epilepsy & Behavior 6 (20

    .

    * Corresponding author.E-mail address: rafael.ortiz@mail.tju.edu (R. Ortiz).1525-5050/$ - see front matter 2005 Elsevier Inc. All rights reservedwith epilepsy have reported improvements in seizurerates that they attributed to their dogs [1,2].

    If seizure dogs were able to predict seizures, theywould be of extreme benet to epilepsy patients. Oneof the most dicult aspects of epilepsy is the unpredict-ability of seizures. Many patients with epilepsy limittheir exposure to the outside world by staying at home.This social isolation contributes to depression and lowself-esteem. If people with epilepsy could be warned be-

    sisted electroencephalography (EEG) recording in theEpilepsy Care Unit (ECU). We sought to evaluate thereliability of seizure detection in these animals.

    2. Methods

    This study was a retrospective chart and video/EEGreview. Between March and May of 2004, two patientswith seizure-alert dogs were admitted to the ECU ofPhiladelphia. Both patients were accompanied by their seizure dogs during their admission, as the patients felt more secure withthe dogs. The dogs performance in alerting before a seizure was poor for patient 1 and misleading for patient 2. In our limited butobjective experience, the seizure dogs were not as eective as previously thought in predicting the seizure activity. At the sametime we must be fair and recognize the limitations that the environment of the Epilepsy Care Unit places not only on patientsbut also on seizure-alert dogs. Similar studies (in epilepsy monitoring units) of larger samples of patients are needed to determineif these trained dogs are responsible for clinical improvement in epilepsy patients. 2005 Elsevier Inc. All rights reserved.

    Keywords: Seizure dog; Seizure-alert dog; Seizure-assist dog; Epilepsy monitoring unit

    1. Introduction

    Interest in seizure-alert dogs arose in the 1980swhen a woman with epilepsy said that her dog couldpredict her seizures. Since then, the public has been

    fore their seizures, they would be less likely to suerphysical injuries or psychosocial consequences.

    Canine centers have been spending thousands of dol-lars ($10,000 to $25,000) to train seizure-alert dogs forepilepsy patients. We had the opportunity to observeCase

    Seizure-alert dogs: Observation

    Rafael Ortiz *

    Jeerson Hospital for Neuro

    Received 5 February 2005; revised 5 FAvailable on

    Abstract

    Studies have demonstrated that seizure-alert dog owners wdicult aspects for patients with epilepsy is the unpredictabilityin an inpatient epilepsy care unit where patients were undergoindoi:10.1016/j.yebeh.2005.02.012ce, Philadelphia, PA, USA

    ary 2005; accepted 24 February 2005April 2005

    epilepsy exhibit improvement in seizure rates. One of the mostizures. We evaluated the detection abilities of seizure-alert dogsntinuous computer-assisted EEG. Between March and May ofport

    rom an inpatient video/EEG unit

    www.elsevier.com/locate/yebeh

    05) 620622

  • complex partial seizures daily. His seizures had not re-sponded to three antiepileptic drugs (AEDs) and the vagal

    seizure was poor for patient 1 and misleading for patient2. However, for patient 1, the seizure-alert dog was help-

    Behful to the family because the dog alerted the familymembers to the seizure while it was occurring. We be-nerve stimulator. He was admitted to the video/EEG unitfor considerationof epilepsy surgery. Patient 1 hadownedhis seizure-alert dog for approximately a year. He and hisparents reported to his physician that they felt the dog de-tected the majority of his seizures. The alerting mecha-nism of the dog involved sitting up and barking.

    Patient 2, a 20-year-old woman, had a 4-year history ofseizures. Her seizures started after she fell o a horse andwas kicked in the head by the horse. She denied loss ofconsciousness at the time of the accident. Since that timeshe had had seizures beginningwith an aura described as acopper penny taste, followed by a change in awarenessand generalized shaking lasting approximately 2 minutes.She had been treated unsuccessfully with eight AEDs. Pa-tient 2 was admitted to the ECU for classication.

    Patient 1 had eight complex partial seizures duringhis 4-day stay in the hospital. Four seizures occurredwhile awake and four seizures during sleep. The EEG re-vealed a left frontal lobe seizure onset. The seizure-alertdog alerted the patient prior to one of the seizures byquickly standing up from a sitting position and staringat the patient for 2 seconds prior to the seizure. For se-ven of the eight seizures, the dog was sleeping and didnot alert the patient. The dog did wake up a few secondsafter the patients seizure began and alerted family mem-bers by barking and/or by constantly walking aroundthe bed. There were no false detections by the dog.

    Patient 2 had ve of her typical seizures during herstay in the ECU. Her seizure-alert dog was present dur-ing only one of her seizures. The dog alerted her, and7 minutes later, the patient had her seizure. There wasno EEG change with the seizure and the patient wasdiagnosed with nonepileptic seizures.

    4. Discussion

    In this study of two patients with seizure-alert dogs,one seizure dog did alert in advance of one of eight sei-zures. Overall, the dogs performance in alerting before asecure with the dogs. The dogs behavior before a seizurewas correlated with the video/EEG records.

    3. Cases

    Patient 1, a 17-year-old man, had a 5-year history ofintractable epilepsy.He did not have any epilepsy risk fac-tors. He had 5 to 14 atonic, generalized tonicclonic, and

    Case Report / Epilepsy &lieve that the seizure-alert dog of patient 2 contributedto her nonepileptic seizures by alerting and increasingthe frequency of her events.

    Seizure dogs have been divided into seizure-alertdogs, which alert their human companions before a sei-zure occurs, and seizure-assist dogs, which respond aftera seizure. It is well documented that a seizure-assist dogis trained to assist the human companion, but may ormay not alert.

    In the rst stage of dog training, the dog and trainerlive with a foster owner for 3 to 6 months. During thistime the trainer teaches obedience training and socialskills. In the second stage, which lasts 170 hours, thedog learns obedience skills in a variety of settings out-side the home. In the third stage, the dog and new ownerare trained together to teach the dog to assist and sup-port the owners specic disability. By this time, thedog should be able to recognize some psychologicaland behavioral changes prior to a seizure that are notrecognized by others around him or her. At the nalstage, the training continues at home where a nalassessment is the nal test.

    Multiple hospitals in large academic centers have per-formed surveys to study the dierent aspects of seizuredogs. One study concluded that dogs have an innateability to alert and/or respond to seizures [3]. Theyadded that the success of these dogs depends largelyon the handlers awareness and response to the alertingbehavior. Another study surveyed families of epilepticchildren and determined that quality of life was higherin families with a dog that responded to seizures [4].From their sample, 40% of families owned a dog, about40% of these had seizure-specic behavior, and about40% of these showed anticipatory ability.

    Strong and Brown reported their experience with 36pet dogs that had not been trained as seizure dogs and suf-fered signicant adverse health eects as a result of spon-taneously reacting to or anticipating epileptic seizures intheir owners [5]. These included three cases in which thedog died and one case in which the dog exhibited aggres-sive behavior toward humans. They say that these adverseeects have not been seen in trained seizure dogs.

    In our limited but objective experience, seizure dogswere not as eective as previously thought in predictingseizure activity. In the patient with frontal lobe epilepsy,the dog exhibited abnormal behavior, predicting a seizurebefore the only spell during which the dog was awake. Inthe patient with nonepileptic seizures, the dogs behaviorwas reinforcing the patients psychogenic events.

    We must be fair and recognize the limitations that theenvironment in the ECU places not only on the patient,but also on the seizure-alert dog. It is possible that thedogs were distracted by other people having seizures innearby rooms.

    On the basis of previously cited studies, seizuredogs do have a positive eect, at least subjectively,

    avior 6 (2005) 620622 621on epilepsy patients and their families. Similar studies

  • (ECUs) of samples of patients are needed to determine ifthese trained dogs are responsible for clinical improve-ment in epilepsy patients.

    References

    [1] Brown SW, Strong V. The use of seizure-alert dogs. Seizure2001;10:3941.

    [2] Strong V, Brown S, Huyton M, Coyle H. Eect of trained seizurealert dogs on frequency of tonicclonic seizures. Seizure2002;11:4025.

    [3] Dalziel DJ, Uthman BM, Mcgorray SP, Reep RL. Seizure-alertdogs: a review and preliminary study. Seizure 2003;12:11520.

    [4] Kirton A, Wirrell E, Zhang J, Hamiwka L. Seizure-alerting and -response behavior in dogs living with epileptic children. Neurology2004;62:23035.

    [5] Strong V, Brown SW. Should people with epilepsy have untraineddogs as pets? Seizure 2000;9:42730.

    622 Case Report / Epilepsy & Behavior 6 (2005) 620622

    "Seizure-alert dogs" : Observations from an inpatient video/EEG unitIntroductionMethodsCasesDiscussionReferences

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