Epilepsy in companion animals
Researchers and clinicians at the RVC have devoted more than a decade of work to improving our understanding of epilepsy in dogs, as well as cats.
Epilepsy in the most common chronic neurological disease in dogs, affecting around 0.6% of the 8.9 million dogs in the UK, which amounts to 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.
There are different types of seizures dogs (and other species) have. Despite epilepsy and non-epileptic seizures affecting so many dogs, seizure activity can easily be misinterpreted – and vets have not always classified seizures in the same way. RVC research illustrated a lack of consistency among vets in the diagnoses of epilepsy. Because classifications, definitions, therapeutic outcome measures, neuroimaging and neuropathological standards have historically differed between studies, it was difficult to draw comparisons. This has limited their scientific and clinical impact.
Consequently, the RVC has driven international consensus on the research, diagnosis and treatment of canine and feline epilepsy. The consensus was facilitated by the establishment of an international body composed of veterinary practitioners and neuropharmacology, neuropathology and neurology experts. The International Veterinary Epilepsy Task Force, which was established and first chaired a RVC professor, produced seven ‘consensus statements’ outlining recommendations and classifications on all aspects of the condition. The guidelines established a framework and standards for future trials.
Ongoing RVC epilepsy research is improving the characterisation of this chronic disorder and its comorbidities, develops technology to aid its long-term management for vets and owners, and identifies fresh new ways to manage this age-old disorder.
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 diets) ensures these findings can be implemented by the widest possible patient base.
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.
As well as offering medical expertise in epilepsy management at RVC Small Animal Referrals and our Beaumont Sainsbury Animal Hospital, the RVC is now using the latest technologies to advance healthcare in pets globally. RVC epilepsy research involves collaborations with researchers nationally and internationally.
These includes 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 further transformations in the care of epilepsy patients in the future.
RVC researchers recently conducted an international study of general practice vets, specialist veterinary neurologists and caregivers of dogs with epilepsy 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 push the field forward.
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.
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