service dog

Responding When You Get Questions about Seizure Dogs

The concept that dogs may be able to respond to a seizure or to warn of an impending seizure has gained popularity in the last few decades. Your patients and their families may want to discuss this with you and may solicit your guidance and assistance in obtaining or training a dog to respond to and/or predict seizures.

While there is currently no rigorous, classic research (randomized controlled trials) to support the use of dogs in this way, there is some limited qualitative and observational evidence. You should keep in mind that this can be an emotional issue for some patients. Strive to understand their perspectives while discussing the kinds of data and evidence currently available with them. In this article, we’ll define some terms, review the data, and explore ways to help your patients and their families understand the issues.

Seizure Dog Popularity Started from Anecdotal Reports

The popularity of domesticated dogs as pets is high, and many people with epilepsy live in households with pet canines. The notion that some of these pets can learn to respond to, or even alert to seizures prior to clinical manifestations, began with anecdotal reports.

The concept isn’t unreasonable given the apparent propensity of many domesticated dogs to attend to their owner’s behaviors.

  • Some patients and their families have described changes in their dog’s behavior in response to an ongoing seizure. These “seizure response dogs” may notify others that a seizure is occurring.
  • Some patients and their families have described changes in their dog’s behavior that occur prior to overt clinical manifestations of a seizure. These “seizure alert dogs” may notify a patient or others that a seizure will occur.

These concepts, combined with legislation and policies supporting the notion of dogs as service animals, created an opportunity for dogs to live with people with epilepsy for the purpose of responding to or warning of impending seizures. Commercial enterprises offer to train pets or to provide trained dogs as service animals for people with epilepsy. The cost can be substantial. Your patients and their families may believe that such a service dog will be helpful and may solicit your assistance in supporting their efforts to obtain a “seizure dog.”

What the Scientific Evidence Shows

A variety of technological solutions are being developed for seizure detection and prediction at home, but can dogs learn to do this?

The idea may not be as far fetched as it seems. For example, evidence suggests that some domesticated dogs can reliably discern different human emotions1.

In a review published in 2018, Catala et al.2 applied PRISMA3 criteria to the available literature on this topic.

  • They sought to identify the key characteristics of a seizure dog, assess methodology and risk of bias, and summarize outcomes.
  • They found 28 studies, five of which included quantitative data and met PRISMA criteria.
  • They found no reliable evidence that dogs can either respond to or warn of seizures.

In a broader review of commercially available seizure detection methods suitable for use at home, Jory et al.4 found similar methodological limitations.

Thus, at this time there is no robust classic research supporting the use of dogs or other potential seizure detection strategies at home.

Talking with Your Patients

Discussing expectations surrounding a seizure dog’s abilities with patients and families may be difficult. Relying solely on classic research in your discussion may feel like a dismissal of their beliefs as incorrect, which may compromise their confidence in you as a provider and make it difficult for you to provide the best care possible.

A balanced approach may be best. Explain the concept of levels of evidence and medical decision-making. This article on understanding the strength of evidence and research may be helpful to them. Follow that by:

  • Acknowledging that a lack of classic evidence doesn’t prove that some dogs can’t learn these skills.
  • Discuss how a dog can provide other benefits like emotional support and skills training like alerting and fetching.
  • Talk openly about their expectations of what they want the dog to do.
  • Encourage them to ask questions and set clear expectations with any trainers they consider, including understanding what their role will be in the training.

The goal is to help them make an informed decision about what is best for their family.

References

  1. Albuquerque N, Guo K, Wilkinson A, Savalli C, Otta E, Mills D. 2016 Dogs recognize dog and human emotions. Biol. Lett. 12: 20150883 http://dx.doi.org/10.1098/rsbl.2015.0883
  2. Catala A, Cousillas H, Hausberger M, Grandgeorge M (2018) Dog alerting and/or responding to epileptic seizures: A scoping review. PLoS ONE 13(12): e0208280. https://doi.org/10.1371/journal.pone.0208280
  3. Moher D, Liberati A, Tetzlaff J, Altman DG, and the PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. Ann Intern Med.;151:264–269. doi: 10.7326/0003-4819-151-4-200908180-00135. (https://annals.org/aim/fullarticle/744664/preferred-reporting-items-systematic-reviews-meta-analyses-prisma-statement)
  4. Jory, Caryn et al. Safe and sound? A systematic literature review of seizure detection methods for personal use. Seizure - European Journal of Epilepsy, Volume 36, 4-15. http://dx.doi.org/10.1016/j.seizure.2016.01.013
Authored By: 
Michael Gruenthal MD, PhD
Patty Obsorne Shafer RN, MN
Authored Date: 
04/2019
Reviewed By: 
Elaine Kiriakopoulos MD, MSc
Elaine Wirrell MD
on: 
Monday, April 8, 2019