The National Institute of Neurological Disorders and Stoke defines epilepsy as a brain disorder that causes recurring seizures . Seizures are caused by sudden and abnormal electrical activity in the brain . While seizures can be seen as convulsive activity, some seizures are localized to one part of the brain, causing milder symptoms . Epilepsy can be caused by illness, brain injury, and abnormal brain development, though in some cases the cause is unknown .
Multiple sclerosis (MS) is a disease of the nervous system affecting the brain and spinal cord . It causes damage to the myelin sheath, the protective material around nerve cells, slowing or blocking messages between the brain and the body . Symptoms can include visual disturbances, muscle weakness, trouble with coordination and balance, thinking and memory problems . Depression is also another common feature of the disease . There are few options for therapy and medications to treat MS .
Cerebral palsy refers to a group of disorders that disrupts a person’s movement and ability to maintain balance and posture . People with cerebral palsy may have difficulty walking, writing, and may have other medical conditions including seizures and/or mental impairment . The disease is caused by an abnormality or disruption in brain development, though the initial trigger cause is unknown. While there is no cure for cerebral palsy, treatment may improve the quality of life (QOL) for those who have it. Treatments may include medicine, various braces, and therapies including occupational and speech therapy.
Epilepsy, multiple sclerosis, and cerebral palsy are all non-affective disorders of the brain. The diseases are resistant to typical medicinal treatments. Research involving the human-animal bond is being conducted into the efficacy of mitigating and lessening the symptoms and improving the QOL for those with these diseases. Some research has suggested that specially trained dogs may be able to detect the onset of seizures for persons with epilepsy. Hippotherapy is being used to help those with cerebral palsy and MS improve overall motor function. Much of the research is preliminary with calls being made by researchers and practitioners for more rigorous investigations with larger sample sizes .
State of Current Research
There is a distinction between seizure alert dogs (SAD) and seizure response dogs (SRD). SADs are supposed to be able to predict when their charge is about to experience a seizure. The SAD then alerts their owner with a specific behavior. SRDs do not predict seizures, rather they act after the seizure happens. These dogs help their owners in a particularly useful way , in some cases engaging in nonaggressive but protective behavior such as helping hold the person down or alerting family .
Adam Kirton, Elain Wirrell, James Zhang, and Lorie Hamiwka (2004) investigated the effectiveness of SADs and SRDs living with families with epileptic children. Participants were chosen through a Refractory Epilepsy Clinic. All children were between one and eighteen years of age and experienced at least one serious seizure a month (Kirton). Data was collected via interviews. Of the 238 families surveyed, 48 had lived with a dog for one year while having seizures. Twenty of those families (42%) reported specific seizure related behavior from their dogs . The behaviors varied by dog. Some alerting behavior included not allowing their owner up prior to a drop attack, licking the toddler’s feet, and attachment to the child prior to a seizure . The authors claim that the accuracy of alerting behavior was high, 80%, and that anticipatory behavior was never performed without a following seizure. They argue that, against a prior report, seizure sensitive dogs are not only safe to have in the family, but also they may improve QOL for family members.
While much of the investigation and evidence for seizure alert dogs comes from anecdotal accounts and interviews, a study by Rafael Ortiz and Joyce Liporace (2005) used inpatient video/EEG monitoring to evaluate the detection abilities of SADs. The study focused on two individuals who owned SADs. The first patient had 5 to 14 seizures daily that did not respond to three antiepileptic drugs (AEDs) . During the 4-day monitoring period, patient 1 had eight complex partial seizures, four while awake and four while asleep. The dog alerted the patient before one of the episodes by sitting up and staring at the patient two seconds prior to the seizure. For the other seven, the dog was asleep and did not predict the seizures. However, the dog did wake up a few seconds after the seizures began and barked to alert the family and walked around the bed of the patient. The second patient had 5 seizures during the monitoring period. Her SAD was present during one of her seizures. The SAD alerted her seven minutes prior to her seizure. There was no EEG change with her seizure, leading to a diagnosis of nonepileptic seizures.
For patient 1, though his dog did not predict all his seizures, the dog was helpful in alerting the family. For patient 2, who had frontal lobe epilepsy, the authors believe that the SAD actually contributed to the frequency of her seizures . However, the authors note that specially trained dogs would be helpful as seizure assist (also called seizure response) dogs, alerting the family or caregivers when seizures occur and aiding the patient by being a comforting presence. People with epilepsy sometimes feel withdrawn and disconnected from a larger social community because of their illness (. The presence of an animal companion might “have a positive effect, at least subjectively, on epilepsy patients and their families” . While work is still ongoing, studies seem to agree that “some dogs can be trained both to respond to and provide useful premonitory signals to human seizures following specific individual training” .
John Sterba (2007) compiled a review of eleven quantitative studies measuring the effectiveness of instructor directed recreational horseback riding therapy (HBRT) and licensed-therapist directed hippotherapy for people with cerebral palsy to improve gross motor function. HBRT is conducted by non-therapists who have knowledge of the rider’s disabilities and access to therapy-trained horses. The rider will perform activities while touching various parts of the horse. Experiences are designed to stretch the rider’s ability to move while maintaining balance and posture. In contrast, hippotherapy is conducted by licensed therapists utilizing occupational, speech-language, and physical therapies using the “movement of the horse as a therapeutic intervention tool” . The therapists target impairments, functional limitations, and disabilities in people with neuromuscular dysfunction, including cerebral palsy.
Of the eleven articles chosen for their higher methodological quality, six investigated HBRT and five covered hippotherapy. Five articles concluded HBRT was an effective treatment for improving gross motor function and all five articles on hippotherapy as an intervention reported positive improvement. Most studies concluded that children with cerebral palsy had improvements in balance, coordination, strength, and sitting posture  after the interventions. One of the studies observed that “dual sinusoidal frequency of movement of horseback riding subjected all riders to a more complicated pattern of pelvic and truncal displacement, placing a greater demand on the riders’ automatic postural responses and, thereby, simulating a normal walking pattern” . Such activities can be helpful in improving balance and coordination.
Bronson, Brewerton, Ong, Palanca, and Sullivan (2010) reviewed three studies investigating the effect of hippotherapy on balance for people with MS. The studies were chosen out of a pool of thirteen studies and articles after selecting for various criteria, such as published or translated into English, comparing pre and post balance scores, and hippotherapy interventions. Hippotherapy is used as an intervention because it “uses the movement of the horse to promote a dissociation of the pelvis and trunk, which is though to elicit righting and balance reactions” . The authors also cite the work done with HBRT and hippotherapy for children with cerebral palsy and the gains the children experienced as reason to pursue hippotherapy for those with MS. In the three studies the authors reviewed, all reported positive gains in balance for people with MS. Participants who had more severe MS had the greatest gains in balance at the end of the trials. Those with milder MS, higher pre intervention balance scores, had smaller gains, suggesting to the authors that there is a possible ceiling for improvement . The review also notes psychosocial gains for the participants, suggesting that in addition to gains in balance, hippotherapy also can contribute to QOL.
Areas for Investigation
John Sterba notes that studies involving HBRT and hippotherapy often lack control groups, elements important to a rigorous study. What kinds of therapy might act as appropriate controls for further investigation of the benefits of HBRT and hippotherapy for children with cerebral palsy? (Sterba 2007)
How might a control group be designed for testing the efficacy of seizure alert and response dogs when the obvious control group, untrained dogs, has been deemed hazardous? What other control group design might be workable without jeopardizing both animal and human safety? (Brown)
Ortiz and Liporace note that larger population samples will be needed to study the ability of SADs to predict seizures in a video inpatient/EEG unit. The authors also noted that the dogs might have been distracted by other seizures happening around them. How might a study be designed to include a larger sample size, but limit possible detection by multiple dogs?
Bronson, C., Brewerton, K., Ong, J., Palanca, C.,SJ. (2010). Does hippotherapy improve balance in persons with sclerosis: A systematic review. European Journal of Physical and Rehabilitation Medicine. 46(3).
The article reviewed studies that investigated the effect of hippotherapy on balance for people with multiple sclerosis (MS). Three studies were reviewed and after meeting the selection criteria were evaluated. The studies suggest that hippotherapy has a positive effect on the balance of individuals with MS. The authors theorize that the disassociation between torso and pelvis due to the horse’s motion requires the rider react and maintain balance in a beneficial way. The authors note limitations in this area of research, namely small sample sizes, studies published in non-peer reviewed journals, and nonstandard measuring tools (standard tools like the Berg Balance Scale).
Brown, S., Goldstein, L. (2011). Can seizure-alert dogs predict seizures? Epilepsy Research. 97.
Stephen Brown and Laura Goldstein’s (2011) article is a review of the evidence for seizure-alert dogs. They report that many studies rely on anecdotal evidence based on surveys and owner/trainer responses. They note current studies have provided a basis for describing the benefits of seizure alert and response dogs, though the next step is to do a large randomized and controlled trial to rigorously test those claims. The article also includes a description of the training process for the SADs and SRDs, as well as some of the controversy that surrounds the canines.
Kirton, A., Wirrell, E., Zhang, J., Hamiwka, L. (2004). Seizure-alerting and –response behaviors in dogs living with epileptic children. Neurology. 62.
The authors surveyed families with children (1-18 years old) through the Refractory Epilepsy Clinic who had lived with a dog for one year while experiencing at least one seizure per month. The authors report that alert and response behavior was specific to the animal and family with no family reporting the same collect of dog behaviors. The article also covers the difference between seizure alerting and response dogs. Different behaviors as reported for the different types of seizure dogs. Quality of life is reported as higher in families who have a seizure-sensitive dog than with families that did not.
Ortiz, R., Liporace, J. (2005). Seizure-alert dogs: Observations from an inpatient video/EEG unit. Epilepsy & Behavior. 6.
Rafael Ortiz and Joyce Liporace’s (2005) article describes two patients who experience seizures and have trained seizure alert dogs. The cases were investigated to discover the accuracy and effectiveness of the seizure alert dogs in predicting when the person would experience a seizure. The study, following one 17-year-old man and a 20-year-old woman, found that in the first case, the dog predicted the seizure 1 out of 8 times. In the second case, the dog was present for 1 of the 5 seizures experienced will in the EEG unit. The dog predicted the seizure, though the researchers believe that the results are misleading. The authors note that a larger sample size would be required for conclusive results.
Sterba, J. (2007). Does horseback riding therapy or therapist-directed Hippotherapy rehabilitate children with cerebral palsy? Developmental Medicine & Child Neurology. 49.
John Sterba’s article reviews the literature covering recreational horseback riding therapy (HBRT) and hippotherapy for children with cerebral palsy. The intent of the equine assisted therapy and activities is to help children with CP improve overall motor function. The review investigates whether there is evidence for physiological benefits from HBRT and hippotherapy. While the review notes that some studies have small sample size and lack of control groups, the evidence indicates HBRT and hippotherapy can have a positive effect on a child’s motor skills.
^ a b c Multiple sclerosis. (7 August, 2012). In !MedlinePlus. Retrieved from: http://www.nlm.nih.gov/medlineplus/multiplesclerosis.html
^ a b Multiple sclerosis. (1 August, 2012). In National Institute of Neurological Disorders and Stroke. Retrieved from: http://www.ninds.nih.gov/disorders/multiple_sclerosis/multiple_sclerosis.htm
^ a b Cerebral Palsy. (7 March 2012). In !MedlinePlus. Retreived from: http://www.nlm.nih.gov/medlineplus/cerebralpalsy.html
^ Ortiz, R., Liporace, J. (2005). Seizure-alert dogs: Observations from an inpatient video/EEG unit. Epilepsy & Behavior. 6. 620-22.
^ Spencer, D. (2007). Understanding seizure dogs. Neurology. 68(2). 1-4.
^ a b Bronson, C., Brewerton, K., Ong, J., Palanca, C.,SJ. (2010). Does hippotherapy improve balance in persons with sclerosis: A systematic review. European Journal of Physical and Rehabilitation Medicine. 46(3). 347-353.