In their article "Pseudoseizure Dogs," Dr. Krauss and coworkers(Neurology 2007:68:308–309) look at the use of servicedogs to assist patients with epilepsy and other related conditions.The authors found that several of their patients with seizureresponse dogs did not suffer from epileptic seizures, but infact had "pseudoseizures" (now more commonly called "nonepilepticseizures").
Nonepileptic seizures can be difficult to distinguish from epilepticseizures: they may look exactly like epileptic seizures. Thedifference is that during a nonepileptic seizure, there areno abnormal electrical discharges in the brain of the type seenin epileptic seizures. Nonepileptic seizures can have many causes;however, the most common cause is a psychiatric illness. Inthese illnesses (the most common called a "conversion disorder"),psychological stresses come out as physical symptoms. Usually,the nonepileptic seizures are not under the person's control.
Seizure response dogs are animals that respond to a person havinga seizure. Usually, the dog will be helpful in some way duringthe seizure itself. The dog may respond by instinct, or it canbe trained for this purpose. Such animals may be able to alertothers that a seizure is happening or will stay with the personduring a seizure to help avoid injury. Finally, as the personis awakening from the seizure, the presence of the seizure dogcan be both reassuring and reorienting to the patient. Manypatients report feeling more confident, knowing that they havesome type of assistance for their seizures.
A seizure alert dog is one that can alert the patient or familymember before a seizure begins, or in the very early phase ofa seizure, so that appropriate steps may be taken to make surethat the patient is safe. We do not understand how dogs mightbe able to do this, and we do not know much about how good theyare at predicting seizures correctly. Mostly we know that peoplewith seizure alert dogs report feeling "better" and "more confident"and enjoy the companionship of their seizure dog.
The authors reported the stories of six patients at their centerwho had seizure dogs, and they told the stories of four of thesepeople in detail because of the interesting findings.
After careful study, the authors found that four of the patientswith seizure response dogs did not have epileptic seizures,but had "pseudoseizures" or "nonepileptic seizures" (NES). Ineach of these people, they felt that there was a psychologicalcause for the seizure-like events rather than an abnormal electricaldischarge in the brain. These patients needed different treatmentsto help control their events than people with epilepsy.
Of these four people with NES, three patients recovered fromtheir NES and one moved away (so the authors do not know whathappened to her). One person returned the dog to its trainingprogram, and the other three kept the dogs as pets.
The authors also reported limited information about two patientswith epilepsy whose dogs stay with them when a seizure happens.These patients found that the dog's responses were helpful.They also noted the benefits of companionship with the dog tohelp them deal with a medical problem that has no easy cureand lasts for a long time.
Seizure response dogs are helpful for some people with epilepsy,as reported in this and other studies. This is an area thatdeserves more study so that we can understand better how somedogs might be able to tell when a seizure is coming and seehow good they are at doing this. Dogs may also be good companionsfor people with chronic disease. Because highly trained dogsare expensive, it makes good sense to understand what they canand cannot do and where they could be best used. In this way,we may be able to assign seizure dogs to the people who wouldbenefit most.
It is important to recognize that some patients with seizureresponse dogs may not have epileptic seizures, but may be sufferingfrom a different condition (NES) that causes behavior similarto seizures, but is caused by a mental health problem. The authorssuggest that doctors should first clarify the underlying diagnosis.They feel that many people might benefit from the companionshipand emotional support of a pet, but that highly trained serviceanimals should closely match the patient's condition.
A seizure is a disruption in the normal electrical activityof the brain. Normally the brain is very active, passing electricalmessages back and forth between nerve cells. When a person hasa seizure, there is abnormal firing of nerve cells and the messagesbecome jumbled in part or all of the brain.
A seizure may cause a variety of different symptoms, such astwitching or shaking in an arm, leg, one side of the face, orthe whole body; repetitive movements or gestures; confusion;feelings of fear or other emotions; hallucinations (odd smells,tastes, sounds, or seeing things that are not there); loss ofconsciousness;and convulsions. [Adapted from Patient Page: Szabo CA. Riskof fetal death and malformation related to seizure medications.Neurology 2006;67:E6–E7.]
Epilepsy is an episodic recurrence of seizures that are notdue to fever, active infection, drug effects, or other triggeringcauses. It may be caused by a variety of conditions that injurea part or all of the brain, such as problems in developmentof the brain that occurs before birth, inherited disorders ofthe brain or nervous system, brain trauma, brain tumors, stroke,infections, and poisoning. About 70% of cases have no knowncause.
Each year there are 125,000 new cases of epilepsy. About 2.5millionpeople in the United States have some form of epilepsy. [Adaptedfrom Patient Page: Szabo CA. Risk of fetal death and malformationrelated to seizure medications. Neurology 2006;67:E6–E7.]
What are nonepileptic seizures ("pseudoseizures")?
Nonepileptic seizures are temporary disturbances of neurologicfunction. Although they may look like epileptic seizures, thereare several differences. The most important difference is thatthe brain wave activity recorded on an EEG test is normal duringa nonepileptic seizure. In other words, the event is NOT causedby an abnormal electrical discharge in the brain.
There are two types of nonepileptic seizures: physiologic andpsychogenic. Physiologic nonepileptic seizures are less common.In these events, there is a clear physical cause of the seizureevent, but it is not epileptic and there are no abnormal electricaldischarges in the brain. There are several causes of physiologicnonepileptic seizures, including fainting (also called syncope),TIAs (small strokes), sleep disorders, and migraines. For instance,it is common for an individual to experience jerking movementsof the arms or legs during a fainting episode. This can sometimesbe mistaken for a seizure, but has a different cause and differenttreatment. Psychogenic nonepileptic seizures are much more common,and these may be connected to many psychiatric illnesses. Usuallyit is felt that these events are a way that psychological stresscomes out as physical symptoms. People with this condition mayappear to lose consciousness and may have shaking or other activitythat looks very much like an epileptic seizure, but again, thereis no abnormal electrical activity in the brain. Most oftenthe patient with this condition is not aware of the connectionto psychological stresses and does not have control over theepisodes.
The treatment of nonepileptic seizures first depends on thecorrectly identifying the cause of the symptoms. Then the treatmentcan focus on the specific physical or mental health issue causingthe episodes. This may involve counseling or "talk therapy,"or use of medications to treat depression or anxiety that oftengo along with psychogenic nonepileptic seizures. Our usual epilepsymedications do not work in people with nonepileptic seizures.If a person with a diagnosis of epilepsy does not respond toantiseizure medications, the physician should always considerthe possibility of nonepileptic seizures.
For more information about seizures, epilepsy, and seizure responsedogs, please contact the Epilepsy Foundation of America: http://www.epilepsyfoundation.org
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