How Seizure Dogs Work
Seizure-alert dogs give new freedom to epilepsy sufferers - CNNHealth.com
Seizure-Alert Dogs Save Humans With Early Warnings - National Geographic News
The following paper was submitted for a college class in October 2010 by Erick Dillard, Daniel's father. I hope you will get a lot of information from this.
Seizure Alert Dogs and Uncontrolled Epilepsy
Brigham-Young University Independent Study
My eleven year old son is an epileptic that has been having uncontrolled seizures his entire life. How can epilepsy patients achieve a better quality of life when they have frequent and uncontrolled seizures, and when medication, diet, surgery, and medical implants are not effective? This paper discusses what is a seizure, epilepsy, and epilepsy’s commonality. The essay will first provide definitions for the terminology to be applied and will establish the commonality for uncontrolled seizures experienced by epilepsy patients. The essay will also evaluate the typical lifestyle challenges remaining for individuals with epilepsy. The potential benefits, and limitations, of seizure alert dogs will be explored as an adjunct to traditional methods. Sources applied will include medical journals, periodicals, discussion papers, and web sites. The conclusion reached is that seizure alert dogs have a potential benefit beyond traditional medical treatment. They often hasten intervention that limits harmful effects of seizures, and in some instances, reduce their frequency, thus substantially improving the quality of life for epilepsy patients.
Keywords: seizure, epilepsy, quality of life, seizure alert dog.
Seizure Alert Dogs and Uncontrolled Epilepsy
Dr. Stephen Brown (2005) discusses in his book, Complementary and Alternative Therapies for Epilepsy,” probably up to two-thirds of adults with epilepsy lack a useful warning method for their seizure.” (p. 312). How can epilepsy patients achieve a better quality of life when they have frequent and uncontrolled seizures, and when medication, diet, surgery, and medical implants are not effective? This essay will explore how a seizure alert dog can be a useful option for a better quality of life for some individuals suffering from uncontrolled seizures.
It’s important to understand the nature of both seizures and epilepsy in order to appreciate the quality of life of an epileptic. Dr. David Spencer (2007) defines a seizure as a disruption in the electrical activity of the brain. The electrical signals in the cells have an abnormal firing at the same time in parts of or the whole brain. This electrical activity causes a person to have uncontrolled convulsions in parts of or the whole body. A person having a seizure can have hallucinations, confusion, odd taste sensation, and even lose consciousness (Spencer, 2007). Dr. Spencer further states that epilepsy is diagnosed when a person has two seizures that aren’t caused by illness, injury, drugs, injury, disease, birth complications, or other types of triggers, Spencer et al. Dr Litt & Krieger (2007) assert that epilepsy is a common disease affecting over 60 million people worldwide with up to a one third of these people unable to control their seizures with medication (Litt & Krieger, 2007). Dr. Spencer (2007) discussed that in the US there are 2.5 million people that have epilepsy with 125,000 new cases of epilepsy yearly and about 70% of these cases do not know the determining factor causing the seizures (Spencer et al., 2007). The greatest concern for most epilepsy patients is wondering when or where the next seizure will occur (Litt et al., 2007). There is a lot of stress and worry with patients who are having frequent seizures. The stress and worry comes from wondering when the next seizure will occur, which can dramatically affect someone’s quality of life. Having established that epilepsy is a common disease that affects a large number of patients world wide, it is very important for these individuals to have a reliable warning system to alert them to an impending seizure, which could also reduce physical injury. In some cases epilepsy patients were even home bound due to worry, anxiety, and injury, due to their uncontrolled seizures. A reliable warning system would help them regain their independence and confidence, as well as prevent serious injury, as illustrated by the experience of Ryan.
Neurology Now (2006) magazine tells the story of Ryan suffering a humiliating experience. Ryan had a tonic-clonic seizure in front of his friends at school that caused him to lose control of his bowels. Because of the severity of this experience and many other seizures while at school, Ryan would no longer return to school. However, Ryan’s life changed when he received a golden retriever named Skitter. Skitter is a seizure alert service dog that is able to alert to Ryan’s seizure about 20 minutes in advance. Ryan was so convinced, after a period of time, that Skitter would alert in advance to his seizures that Ryan returned to school. Skitter traveled with Ryan everywhere and one day while in class Skitter starting pacing around the classroom. The teacher advised Ryan to go to the nurse’s station and lay down like he normally does before a seizure. However, after twenty minutes Ryan was fine but after thirty minutes later another child in the classroom had a seizure (Shaw, 2006). This story illustrates how impactful a seizure alert dog can be in giving a person a much better quality of life. Ryan was able to regain his independence during an important time of life because Skitter was able to give him the reliable warning he needed to get to a safe place to have his seizure.
A seizure alert dog is a service dog that can alert to a seizure in advance. According to a study in Seizure (1999), seizure alert dog’s have the ability to be able to detect a seizure usually ten to fourty-five minutes in advance (Strong. Brown. & Walker, 1999). A seizure alert dog can’t be trained to detect seizures because this is a natural ability the dog has or doesn’t. However, a dog can be trained to give an advance warning signal after the canine determines a seizure is eminent. A University of Florida (2003) study showed advance warning signs are usually whining, anxious barking, pacing, or an intense stare (Dalziel. Uthman. Mcgorray. & Reep , 2003). This university study further discussed that nobody knows exactly how a dog is able to detect a seizure in advance but there are two theories. One of the theories is the dog can detect subtle body posture changes (Dalziel. Uthman. Mcgorray. & Reep, 2003). A dog’s main form of communication is reading body posturing and facial cues, so it’s very plausible that dogs are able to read subtle differences in a person’s posture prior to a seizure (Dalziel et al., 2003). This may not be the primary way a dog detects a seizure but is a secondary confirmation method. The most probable way a dog can detect a seizure in advance is through smell. Gina Shaw (2006) in Neurology Now states that dogs have a sense of smell that is theorized to be three to four hundred times stronger than humans, and may sniff out chemical changes prior to a seizure (Shaw et. al., 2006). Karen Shirk (2010) stated in a phone conversation that using smell is the best form of training for a seizure alert dog. Shirk claimed that their success rate for accuracy and consistency was 85% in their first placement of a seizure alert dog with a new owner. (K.Shirk, personal communication. August 27, 2010). The University of Florida (2003) study reports dogs, while out of sight, and then coming up to them and alerting (Dalziel et al., 2003)). 4 Paws for Ability’s success with training by scent and with reports of dogs alerting while out of site of their owner demonstrate that scent should be the primary mode of detecting a seizure in advance while sensing a subtle change in body posture as a secondary confirmation of an impending seizure.
Having examined how a seizure alert dog can predict a seizure lets examine is their proof a seizure alert dog can reliably detect a seizure. Are there studies that show similar results as 4 Paws for Ability? When examining clinical studies or discussion papers it’s difficult to establish that seizure alert dog ’s can reliably detect seizures within the rigors of numerous and large population clinical studies. There are few studies on seizure alert dog ’s and some of these studies didn’t reach clinical significance or had a small number of participants. However, there is some valuable data that does discuss the efficacy and reliability of a seizure alert dog detecting seizures in advance, which is important to examine. One study in Epilepsy & Behavior (2008) demonstrated seizure alert dog’s can reliably predict seizures in 13 patients after being paired with a dog for 4 weeks. The study showed that 11out of 13 patient’s dog’s had reliable timing when alerting to their seizures as well as no missed seizures. The advanced warning for alerting was at least 31 minutes and 85% of patients reported no missed alerting events (Kirton. Winter. Wirrell. & Snead 2008). This study helps to demonstrate that seizure alert dog ’s can be a reliable predictor of impending seizures at least a half hour in advance. This half hour advance warning is very important in helping an epileptic regain control over their quality of life. Having a half hour notice gives someone the opportunity to get to a safe place and lie down, which could greatly reduce the possibility of physical injury due to a seizure. The presence of only 13 patients was a disadvantage in this study. In a discussion paper in Neurology (2007), the anticipatory behavior of 9 seizure alert dog ’s never failed to predict a seizure in advance, however the author stated that further retesting was needed to validate the impressive results (Doherty. Haltiner 2007). The author has a valid point that further testing does need to be done to validate these impressive results. Both of these studies show that seizure alert dog ’s can reliably detect a seizure in advance but there is a need for much larger and numerous studies to demonstrate the reliability of seizure alert dog ’s predicting seizures while under the rigors of a clinical study.
We just obtained our own seizure alert dog named Dove three weeks ago, but so far the seizure alerting results are inconclusive. Dove was lying on the dark bedroom floor at 4:00 a.m. My son was sleeping under the covers when Dove jumped up on the bed and started whining and intensely staring at my wife. One hour later my son had a seizure. The interesting thing to note is the only time Dove has whined and stared is before Daniel has a seizure. There are plentiful anecdotal stories within the media demonstrating how effective seizure alert dog ’s are in improving a person’s lifestyle by being able to predict seizures in advance. National Geographic (2009) tells the story of Jacob, who lived as recluse for almost four years due to his fear of having a seizure while in public. Jacob adopted a Rottweiler/German shepherd mix puppy named Patra from the local animal shelter. Patra alerted to Jacob’s seizure starting around six months of age by head butting Jacob in the back of the knees 20 minutes prior to a seizure. This advance notice gave Jacob the time he needed to find a safe place to lay down during the seizure. Jacob believed Patra was able to smell the chemical change within his body. Patra is now six years old and is able to also alert to Jacob’s low blood sugar, migraines, and pulmonary heart value infection (Seizure Alert Dogs, 2009). These anecdotal reports confirm the findings that dogs can dramatically improve an epilepsy patient’s life just like Patra and Skitter did for their owners. The studies I’ve sited and the anecdotal reports show there is proof similar to 4 Paws for Ability’s success that canines can reliably detect their owner’s seizures in advance.
One of the interesting benefits of owning a seizure alert dog is the possibility that the number of seizures a person has could be reduced. It has been documented by Seizure that the more anxious a person becomes the more likely they will have a seizure, plus it is suggested that a reciprocal relationship may exist between anxiety and seizures (Strong et. al, ). Seizure further discusses the social stigma attached to epilepsy, the low self-esteem and low control of one’s life when encountering uncontrolled seizures, which mean that all of these factors can affect a person’s quality of life. The Seizure discussion paper concludes by reasoning that having an early warning system for seizures may reduce psychological problems like anxiety and depression and even improve the quality of a person’s daily life (Strong et. al.1999). The study published in Epilesy & Behavior (2008) demonstrated that seizures were reduced with 69% of the patients (Kirton et al, 2008). In another study published in Seizure (2002), “there was a significant overall reduction with patients who had tonic-clonic seizures during the 12 week study and they maintained their reduction in seizures during the 24 week follow up” (Strong. Brown. Huyton. & Coyle, 2002). The Journal of Veterinary Behavior (2009) reported increases in the patient’s perception of safety, social contact, decreases in the average number of seizures, and medical interventions due to the dog’s seizure alerting. The seizure alert dog ’s also had a positive effect on health and social contact. (Kersting. Belenyi. Topal. & Miklosi, 2009). These studies demonstrate that a seizure alert dog can reduce the average number of seizures a person has, which could dramatically improve the quality of a person’s life. An interesting development that can be a result of a reliable service dog is the probability that a person will encounter a more active social life. Having a seizure alert dog that reliably predicts seizure can give a person the confidence to become more active in life just like Jacob and Ryan. It isn’t clear that engaging in more social activities will reduce the number of seizures but it could certainly help. In my phone interview with Shirk, (2010) she relayed an incredible story about a mentally handicapped child named Katie. Katie also had uncontrolled epilepsy when 4 Paws for Ability placed a seizure alert dog named Cody in 2002. Incredibly Katie never had another seizure until Cody passed away in 2008. Katie started having seizures while waiting for a new seizure alert dog, which arrived in 2009. When Katie’s new seizure alert dog , named N’Sync, arrived she once again has remained seizure free. I asked Shirk how could a handicapped child who doesn’t understand the importance of their service dog have such an incredible response of no seizures. Shirk stated that it has been well documented that just having a family pet can reduce a person’s stress, depression, and even blood pressure. Even a person who is mentally disabled like Katie should benefit by improving their mood and consequentially lowering their number of seizures. (personal communication August 27, 2010). A major impact in improving the quality of an epileptic’s life is reducing the number of seizures they have. Aseizure alert dog has the ability to reduce a person’s stress by being a constant companion and showing unconditional love just like a family canine pet would. Reviewing the clinical review papers, clinical studies, and phone conversation with Karen shows a high probability that seizure alert dog’s could reduce a person’s stress and improve their lifestyle. A person having a seizure alert dog can give them the confidence they desire by being able to have locus of control. The person can have a more socially active life which could further improve a person’s well being and may further reduce a person’s average number of seizures.
A seizure alert dog isn’t an option for everyone who has tried to control their seizures through all of the conventional medical options. The University of Florida (2003) study figures the training of seizure alert service dog takes 6 months-2 years and costs $6,000-24,000 (Dalziel et al., 2003). The time and costs could prohibit many people from being able to afford a service animal. Fundraising may be necessary to raise the costs needed for a service animal. An option for some people is to locate a local trainer who has experience training seizure alert dog ’s. However, this can also be challenging due to the few canine trainers that have the necessary experience with seizure alert dog ’s, and locating a dog that has the natural seizure alerting ability. Dalziel (2009) stated there also isn’t a specific breed, age, or gender that works best for a seizure alert dog (Dalziel et al.). You must also decide if the average monthly cost is affordable, I figure that our seizure alert dog should be around $90-100 a month due to the increased medical preventative maintenance costs. The last and most important reason to consider is that there isn’t any guarantee that the service dog will alert. Some facilities like 4 Paws for Ability will exchange the seizure alert dog for another one if the original dog doesn’t alert. It would be wise to read the training facilities contract to see if there is some guarantee if a canine fails to alert to the handler’s seizures.
There are 2.5 million American’s with epilepsy and one-third of these people don’t have an effective method to control their seizures (Litt et al., 2007). There are many patients that have used traditional methods like medication, surgery, diet, and medical implants but fail to have control over their seizures. Plus in another study the patients reported increases in the perception of safety, social contact, decreases in the average number of seizures, and medical interventions. The seizure alert dog ’s also had a positive effect on health and social contact. (Kersting. Belenyi. Topal. & Miklosi, 2009). The numerous cited clinical studies, anecdotal reports from the media, and the phone conversation with Shirk demonstrate that seizure alert dog ’s can have a positive impact in the quality of life of an epileptic. There is a need for further testing to help establish how a seizure alert dog can detect seizures as well as larger studies to better assess the efficacy of seizure prediction. By an epileptic having a seizure alert dog that reliably alerts to seizures, they could see a major improvement through lower stress, anxiety, and depression, which could result in a more active social life, plus a reduction in the average number of seizures. I believe it was said best by a patient in one of the clinical studies when referring to his dog Rupert, “ Before I had Rupert, I had a lot of epilepsy and a little bit of life. With Rupert I now have a lot of life with a little bit of epilepsy!” (Brown & Strong 2001).
UPDATE: I will be giving an update at the end of 2010 on how Dove is doing in predicting our son's seizures.
Brown, S. (2005). Complementary and alternative therapies for epilepsy. In Dogs and Human Seizures, (p. 311) New York: Demos Medical Publishing.
Brown, S., & Strong, (2001). The use of seizure-alert dogs. Seizure, 10, 39-41. Retrieved on September 26, 2010, from Excelsior College Journal Linker database.
Dalziel, D., Uthman, B., Mcgorray, S., Reep, R., (2003) Seizure- alert dogs: a review and preliminary study. Seizure, 12, 115-120. Retrieved on September 26, 2010, from Excelsior College Journal Linker database.
Doherty, M., & Haltiner (2006). Wag the dog: skepticism on seizure alert canines. Neurology, (68), 4. 237. Retrieved September 30, 2010, from University of South Alabama MD Consult database.
Kerstig E., Belenyi, B., Topai, J., Miklosi, A., (2009), Veterinary Behavior, 4, (2), 89. Retrieved on September 26, 2010, from Excelsior College Journal Linker database.
Kirton, A., Winter, A., Wirrell, E., Snead, O. C., (2008). Seizure response dogs: a formal training program. Epilepsy & Behavior 13, 499-504. Retrieved on September 26, 2010, from Excelsior College Journal Linker database.
Litt, B., & Krieger, (2007). Of seizure prediction, statistics, and dogs: a cautionary tail. Neurology, Volume 68, Issue 4. Retrieved September 30, 2010, from University of South Alabama MD Consult database.
Kersting, E., Belenyi, B., Topai, J., Miklosi A., (2009) Judging the effect of epilepsy-seizure alert dogs on human well-being by a self-administered questionnaire. Journal of Veterinary Behavior, (4) 2, 84. Retrieved on September 26, 2010, from Excelsior College Journal Linker database.
Seizure-alert dogs save human with early warnings. (2009). Retrieved August 28, 2010, from http://news.nationalgeographic.com/news/2003/04/0416_030416_seizuredogs_2.html
Shaw, G., (2006) Helping paws. Neurology Now, (2), 4, 27-29. Retrieved September 30, 2010, from University of South Alabama walters kluwer/ovid sp database.
Spencer, C, (2007) . Understanding seizure dogs. Neurology, Volume 68, Issue 4. Retrieved September 30, 2010, from University of South Alabama MD Consult database.
Strong, V., Brown, S., Huyton, M., Coyle, H. (2002). Effect of trained seizure alert dogs on frequency of tonic-clonic seizures. Seizure, (2002) 11, 402-405. Retrieved on September 26, 2010, from Excelsior College Journal Linker database.
Strong, V., Brown, S., Walker, R. (1999). Seizure alert dogs-fact or fiction? Seizure, (8) 62-65. Retrieved on September 26, 2010, from Excelsior College Journal Linker database.