Peer-reviewed veterinary case report
Treatment-Refractory Epilepsy Alimentary Therapy (TREAT): A canine case study.
- Journal:
- The Canadian veterinary journal = La revue veterinaire canadienne
- Year:
- 2025
- Authors:
- Frankel, Grace et al.
- Affiliation:
- Pembina Veterinary Hospital
- Species:
- dog
Plain-English summary
This case study discusses a dog with epilepsy that didn't respond to standard medications, meaning the seizures continued despite treatment. The dog was having cluster seizures, which are multiple seizures occurring close together, and it was found that changes in its gut health might be contributing to the problem. The researchers suggest that looking into the dog's gastrointestinal health and considering a special diet that is low in carbohydrates, along with adding medium-chain triglycerides (MCTs) and probiotics, could help improve the situation. They believe these dietary changes might be important before trying more medications or considering more drastic options. In this case, the treatment approach focused on diet and gut health could potentially help dogs with similar epilepsy issues.
Abstract
Half of all epilepsy cases in both humans and canines are identified as idiopathic. Of these cases, 30 to 40% remain treatment-refractory to antiepileptic medications. Several human and dog studies have demonstrated low-carbohydrate diets and dietary medium-chain triglyceride (MCT) supplementation are effective for seizure reduction, with some patients achieving a seizure-free status. Recent evidence suggests the gut-brain axis has an important role in the pathology of neurological disease among both humans and dogs. Altered gut microbiota may have a major role in treatment-refractory epilepsy. This case report describes a dog with treatment-refractory epilepsy experiencing cluster seizures triggered by an altered gut microbiome despite therapeutic drug concentrations of multiple agents. Consideration of an underlying gastrointestinal disorder should be investigated in patients with treatment-refractory epilepsy, despite therapeutic concentrations of several antiepileptic medications. Dietary and gastrointestinal health-promoting interventions for epilepsy should also be considered before add-on pharmacotherapy or euthanasia. For difficult epilepsy cases, we suggest exploring the role of a limited-ingredient, low-carbohydrate diet, MCT supplementation, and/or pre/probiotics to augment pharmacotherapeutic strategies. This information may be critically valuable in designing high-quality, diet-based therapies for epileptic dogs. Key clinical message: Gastrointestinal workup, dietary changes to a low-carbohydrate diet, supplementation with MCTs, and addition of pre/probiotics could be considered to augment pharmacotherapeutic strategies in treatmentrefractory epilepsy cases in dogs.
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Search related cases →Original publication: https://pubmed.ncbi.nlm.nih.gov/40170936/