Abstracts

Rationale: Seizure prediction and alerting is an important function for individuals with epilepsy and their families, particularly in childhood epilepsy where parents wish to minimize the potential for harm. The unpredictability of many aspects of epilepsy, both ictal and post-ictal, can increase social isolation. The ability of seizure-alert dogs to behaviorally anticipate seizures has been documented. Reported outcomes include improved seizure anticipation, decrease seizure rates and improved psychosocial status. This abstract is a description of highly sensitive and specific detection of simple and complex partial seizures by a family dog.Methods: The patient is now a 16 year old boy who has chronic localization-related epilepsy symptomatic to a cryptogenic neonatal stroke in the left frontal-parietal lobes and early life seizures. The semiology of seizure recurrence in adolescence are auras of presyncope, with subsequent aphasia, perioral automatisms and occasional secondary generalization to generalized tonic-clonic (GTC) seizures with right head version. Seizures were refractory to pharmacological polytherapy and the ketogenic diet. Cortical mapping, electrocorticography and functional MRI localized the seizure focus to include the language center. Focal cortical resection and MST led to a marked reduction in seizure frequency and GTC seizures, but seizure frequency remained at 3 to 4/ month. The patient family purchased an untrained Belgian Malinois puppy at 12 weeks of age in the hope that it would detect seizures. There was no specific seizure detection training offered to the dog but for allowing the dog to socialize with the patient.Results: The dog rapidly and spontaneously detected simple and complex partial seizures, as well as GTC. The range of anticipation time was 10 to 60 minutes. The accuracy by self-report has been high, with sensitivity of 100% with no known false alerts. This has been confirmed by prolonged ambulatory video EEG. In the first 6 months, there has been no change in seizure frequency. Patient independence has increased with an improved QOL. Response behavior includes face licking and protective actions continuing until patient s post ictal confusion resolves.Conclusions: A Belgian Malinois seizure alerting dog can spontaneously learn to accurately detect seizures with and without motor seizure semiology. Quality of life improved for patient and caregivers. Further study of the mechanism of dog s seizure alerting could identify novel epilepsy biomarkers.