·¬ÇÑapp

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