The risk of sudden and unpredictable seizures can severely impact how much we can do and how safe we feel going about our day. The Mayo Clinic defines epilepsy as “a central nervous system (neurological) disorder in which brain activity becomes abnormal, causing seizures or periods of unusual behavior, sensations, and sometimes loss of awareness”.
There are different factors that can lead to the development of seizures and anyone can become epileptic, at any age. Epilepsy can, for instance, be due to genetic reasons or a brain infection, a head injury, a stroke or a tumor and can have many different forms. Some seizures might cause confusion, while others will trigger staring or uncontrollable jerking movements and loss of consciousness.
Historically, some dogs have alerted to seizures on their own. There have been many reports of dogs that would suddenly start staring intensely at their human, or pacing, or whining, or licking their human excessively, etc. This sudden change of behavior from their dog would let the person know that a seizure was coming, and they could put themselves in a safe spot. Many service dog organizations have been training seizure response dogs, in other words, dogs that could perform certain tasks meant to help a person during and immediately after a seizure. Dogs can be taught that when their person drops on the floor, they need to get help, press a button connected to 911 and/or lie next to the person. As the person recovers, the dog can get something to drink, get medication, get a phone, and can help the person get up from the floor. With time and repetition of the event, some seizure response dogs develop the ability on their own to pick up on cues that their person is about to have a seizure and start showing changes in their behavior. Those dogs will become seizure alert dogs. Dogs are after all extremely good at picking up certain patterns or sequences leading up to certain events. That’s why they can get anxious as soon as we put our shoes on or grab our keys. The next step is that we’ll put our coat on and leave. With so many individual variations, it seemed quite impossible that there would be a single sign that dogs could pick up leading up to a seizure. Some speculated that subtle movements might be noticed by the dog.
What does science tell us?
As I was training Diabetes Alert Dogs in a women’s prison, I got reports that a few dogs had suddenly stopped everything they were doing to focus intensely on a person. In one instance they knew the person, but a few other times, the dogs had never met the person. This only happened after the dogs had been trained to recognize samples from diabetic patients. Could there be a similar smell released by a person whether their glucose levels get out of range or whether they’re about to have a seizure? Could the dogs be picking up on a particular scent before the seizure?
Those observations led me to start collecting samples from people right after they had a seizure and training the dogs to alert to that smell. At Medical Mutts, we have trained seizure alert dogs using scent since we started in 2013 and have taught other service dog groups both in the US and abroad, how to do so. In 2019, we decided to share our findings and teamed up with a research group from the University of Rennes (in France). We were able to prove, without a doubt, that dogs do indeed recognize a scent that epileptic patients release when they have a seizure. For this study, 5 dogs were trained to find samples collected from patients having a seizure. During the test, the dogs had to find a seizure sample amongst other samples from the same patient, either right after physical exercise or when they were just resting. The samples collected were from different people, with different types of seizures. Not only were the dogs able to find the right sample, but their level of accuracy (sensitivity and specificity) was very high.
Since then, a second study came out early 2021, from Florida International University and Canine Assistance, that confirmed our findings. Their results also proved that the smell is released before a seizure happens (Maa & al. 2021). How soon, will depend on each individual person. The smell can be released just a few minutes before, to up over an hour before the seizure.
Training a seizure alert dog
At this point, we don’t know what smell is produced before and during a seizure, only that there is a smell that dogs can detect. With that, we can teach the dogs to react to that smell by offering a specific behavior.
Here’s how it works. Since the dogs can smell millions of different molecules in their environment, the very first step is to make the seizure smell very special and meaningful. We know that a dog’s brain, like ours, will focus on what is meaningful and ignore what isn’t. We start by pairing the scent with food. With repetition, this will trigger an emotional reaction in the dog whenever they detect the scent (classical conditioning). The scent acquires significance to the dog.
We then place the scent in a container and teach the dog to perform a particular behavior anytime they detect it. This behavior, called the identification behavior, will allow us to then increase our criteria and little by little, add more identical containers (with different samples), until the dog is capable to find the right smell amongst others. This is the discrimination stage.
After the dog is strongly conditioned to finding the scent, we pair it with the alert behavior. At Medical Mutts, we chose to teach the dog to give multiple pokes with their nose. We believe best to give our dogs a distinct way to alert their person, without getting too much attention from others. If the person is at church or a restaurant or in class, for instance, and only needs to sit down or get to a couch, it’s much less obvious for all around that something is going on. This is a behavior that allows the dog to insist and will get a person’s attention.
The alert and the response behaviors will need to be practiced with the dog’s person until they become easy and are performed by the dog seamlessly. All the training is done with positive reinforcement. In other words, the dogs get rewarded when they offer the right behavior and are never forced or punished for making a mistake. This is critically important to get a dog that reacts without hesitation and has to take initiative when their person is unresponsive.
We have trained many seizure alert dogs with great results, both service dogs that we have placed but also owner dogs that we helped train through our board and train program or private and group coaching. Click here to find out about our training services.
I will never forget the day I got a report about one of the dogs recently placed by another organization that I coached. The woman had just received the dog. She was bathing her baby, when her dog came running into the bathroom and started poking her. With many doubts about the alert, as she wasn’t yet trusting her new service dog, she still figured best to get her baby out of the water and place him on the floor. Seconds later, she had a grand mal seizure.
Some of our clients have been able to go back to work, when before they had a seizure alert dog, they were too afraid to get out of the house. Simple tasks like cooking, changing a baby, crossing a street, or going down a flight of stairs, could end in tragedy, when at any time, without notice, a seizure can occur. A dog is never 100% accurate of course as they will be subject to fatigue or distraction, but they can make a significant difference in the life of a person with epileptic seizures.
For more information about our seizure alert service dogs, visit https://www.medicalmutts.org/seizure-alert-dogs