RVC’s Epilepsy Journey
Clinical Connections – Spring 2021
Rowena Packer, Lecturer in Companion Animal Behaviour and Welfare Science and BBSRC Research Fellow, reflects on the contributions of RVC research to the care of pets with epilepsy, including several important milestones, and looks to the future.
Researchers and clinicians at the RVC have devoted over a decade of work to improving our understanding of epilepsy in dogs and cats, including better characterisation of this chronic disorder and its comorbidities, developing technology to aid its long-term management for vets and owners, and identifying fresh new ways to manage this age-old disorder.
Epilepsy in the most common chronic neurological disease in dogs, affecting around 0.6% of the 8.9 million dogs in the UK (around 53,000 dogs). Dogs with epilepsy experience recurrent seizures, which are most commonly managed by anti-seizure drugs (ASDs) with the aim of reducing how often, and how severely, affected dogs have seizures.
Unfortunately, around a third of these dogs will continue to seizure despite medical treatment, sparking a quest for ‘adjunctive’ non-drug therapies to improve the quality of life of the hardest-to-treat dogs, while also effectively supporting owners’ managing dogs with this often-distressing disease.
Detailed in the timeline below, the RVC has been pivotal in reframing both the wider understanding of epilepsy as a brain disease, and in pioneering new approaches to its treatment. We now know that epilepsy is not only a seizure disorder, and instead, seizures are just one clinical sign in a complex network of brain changes, including behavioural comorbidities such as anxiety, and cognitive changes such as impaired learning ability. Based on these findings, behavioural and cognitive outcome measures are now embedded in epilepsy clinical trial design, alongside traditional measures of seizure frequency and severity, and the impact of existing anti-seizure therapies on behaviour and cognition are being considered.
RVC has been pivotal in the game-changing development of dietary therapies for canine epilepsy, providing an evidence base for medium-chain triglyceride (MCT) enriched or supplemented diets. RVCs groundbreaking clinical trials have demonstrated the positive effects of MCTs on not only seizure frequency, but also on behaviour and cognition. Robust clinical trials of both commercially available complete diets (developed based on RVC research) and of MCT dietary supplements (added to a dog’s existing diet) ensures these findings can be implemented by the widest possible patient base.
RVC’s pioneering epilepsy research has been enabled by a range of sources including the BBSRC, American Kennel Club Canine Health Foundation, Animal Care Trust, UFAW, and a number of industrial partners, including Boehringer Ingelheim and Nestlé Purina Pet Care.
In addition to clinical research at the RVC, our understanding of canine and feline epilepsy has benefited from RVC’s VetCompass project, which has identified how common epilepsy and seizures are in the general population, while identifying a number of important risk factors for epilepsy, including breed predispositions.
RVC’s epilepsy research has a tradition of acknowledging the importance of the owner (or ‘caregiver’) in the long-term management of epilepsy patients, both in terms of the success of treatment (for example, studying owner factors associated with owner compliance to treatment) but also their own wellbeing. RVC research has taken a multidisciplinary approach to understanding the effect of epilepsy on human caregivers: from measuring their stress response to their dog having a seizure, to more recently undertaking in-depth owner interviews to qualitatively explore how their own lives have been impacted by their dog’s epilepsy. These findings will inform future efforts to more effectively support canine caregivers.
As well as offering medical expertise in epilepsy management at RVC Small Animal Referrals and the Beaumont Sainsbury Animal Hospital, the RVC is now using the latest technologies to advance healthcare in pets. RVC epilepsy research involves collaborations with researchers nationally and internationally, including developing seizure detection and prediction technology with Newcastle University, using electroencephalographic (EEG) technology to better characterise epilepsy with Ontario Veterinary College, and collaborating with the human charity Epilepsy Society to produce smartphone technologies to help owners and vets better record and manage epilepsy. We anticipate that this exciting work, including the development of “wearable tech”, will lead to transformations in the care of epilepsy patients in the future.
What does the future hold for epilepsy research?
RVC researchers recently conducted an international study of general practice vets, specialist veterinary neurologists and caregivers of dogs with epilepsy (accepted for publication in the Journal of Veterinary Internal Medicine) which identified the areas of epilepsy research these stakeholders prioritised for future epilepsy research.
The research areas ranked as the highest priorities were the development of new antiepileptic medication, identifying the genetic causes of idiopathic epilepsy, and non-drug management of epilepsy. Within non-drug therapies, those therapies rated to have the highest potential to positively impact epilepsy management included behavioural management and dietary supplementation, including MCT oil and cannabidiol oil (CBD) supplementation.
With RVC world-leaders in research on the dietary management of epilepsy, and the research team’s newest clinical trial focusing on behavioural therapies for epilepsy management, it is likely that RVC epilepsy research will continue to be world-leading for years to come.
Timeline of RVC contributions to epilepsy research and treatment
|2008||RVC research describes the efficacy and tolerability of levetiracetam, a human epilepsy drug, in the treatment of drug-resistant canine epilepsy patients. This drug is now commonly used for drug-resistant dogs with epilepsy as an adjunctive therapy.|
|2011||RVC publishes the first findings indicating that dog with epilepsy experience behavioural changes following their epilepsy diagnosis, mirroring psychiatric comorbidities such as anxiety seen in people with epilepsy|
|2013||RVC uses VetCompass ‘Big Data’ to identify the prevalence and risk factors for idiopathic epilepsy in the UK, finding 0.6% of the canine population are affected|
|2014||Pivotal systematic review is published defining the evidence base for antiepileptic drug efficacy|
|2014||First large-scale quantitative study describing the impact of epilepsy on canine quality of life is published (the EpiQOL) by RVC and collaborators|
|2014||RVC publishes a key report identifying clinical features of dogs with drug-resistant epilepsy, highlighting the importance of high seizure density rather than high seizure frequency per se as a risk factor for drug-resistance|
|2015||Landmark publication of International Veterinary Epilepsy Task Force (IVETF) consensus papers on canine epilepsy, including epilepsy classification, diagnostic approaches, treatment and outcomes|
|2015||RVC publishes the first paper demonstrating positive effects of a medium-chain triglyceride (MCT) enriched diet on seizure frequency in dogs with epilepsy|
|2015||RVC launches the smartphone app Pet Epilepsy Tracker, the first app to facilitate owner monitoring and improvement of the lives of their epileptic pets, which is now used in >80 countries and has been downloaded >30,000 times|
|2015||RVC host an owner education event “21st Century Management of Canine Epilepsy”, with speakers including human neurologists and people with epilepsy, as well as internationally renowned neurologists|
|2015||RVC publishes the first review to explore the concept of “Epilepsy beyond seizures”, reviewing the impact of epilepsy and its comorbidities on health-related quality of life in dogs|
|2016||Publication of American College of Veterinary Internal Medicine (ACVIM) consensus statement on seizure management in dogs, where >10% of original papers cited providing the evidence for these recommendations were co-authored by the RVC group|
|2016||The RVC publishes findings indicating that dogs with epilepsy may also experience ADHD-like behaviour (as seen in people with epilepsy and rodent models), which may be improved with a medium-chain triglyceride enriched diet|
|2016||Systematic review on the adverse effects of antiepileptic drugs published by RVC and collaborators|
|2017||The Big Brainy Border Collie study is launched, exploring the interplay between brain health and behaviour in this popular breed, including analysis of behavioural, cognitive, EEG and MRI data|
Three landmark papers published by RVC researchers describing cognitive impairments in dogs with epilepsy for the first time - an effect long described in human medicine but never before explored in veterinary medicine
|2018||Publication of the first findings to indicate the potential mechanisms of MCT enriched diets in dogs with epilepsy, describing changes in their metabolic profiles|
|2018||First systematic review published on antiepileptic drugs safety and effectiveness in feline epilepsy patients by RVC and collaborators|
|2019||RVC publishes first clinical trial study protocol in BMC Veterinary Research, a practice commonplace in human medicine but previously absent from veterinary medicine|
|2020||RVC uses VetCompass ‘Big Data’ to characterise the epidemiology of seizures in both dogs and cats in primary veterinary care|
|2020||RVC publishes evidence from a clinical trial demonstrating that medium-chain triglyceride supplementation (in addition to a variable base diet) reduces seizure frequency and improves cognitive abilities in dogs with epilepsy|
|2020||RVC publishes the first-ever qualitative exploration of the impact of epilepsy on the lives of owners, describing the wide-ranging and often severe impacts of being a caregiver for a dog with epilepsy|
|2021||The first ever clinical trial is launched to investigate the impact of behavioural interventions on seizure frequency and quality of life in dogs with epilepsy, funded by RVCs charity the Animal Care Trust|
|2021||Research is ongoing with a wide range of academic and industrial collaborators across a variety of canine epilepsy topics, including behaviour, cognition, quality of life, caregiver impacts, seizure detection technology, nutrition, metabolomics and microbiomics|