January 16, 2019

Dietary Supplement Use in Canine Epilepsy

Many owners change their dog’s diet after a diagnosis of idiopathic epilepsy—without veterinarian supervision.
 
By Rebecca A. Packer, MS, DVM, DACVIM (Neurology/Neurosurgery)
Owners of newly diagnosed epileptic dogs often introduce dietary supplements or changes in diet in an effort to reduce seizure frequency or severity and/ or to prevent or reduce the adverse effects of antiepi­leptic drugs (AEDs). In a recently published study, clinicians evaluated the frequency with which owners administered dietary supplements, which supplements were commonly given, and the owners’ rationale for or against using those supplements. The authors also presented a review of current evidence for potential benefit and potential drug interactions for the most common supplements reported.

STUDY DESIGN
Data were collected through a prospective survey of owners of epileptic dogs, administered online from April to June 2017. To be included in the analyses, dogs must have met the criteria for tier 1 evidence for diagnosis of idiopathic epilepsy based on the Inter­national Veterinary Epilepsy Task Force guidelines. Once surveys were complete, owners were categorized as having recently used, previously used, or never used supplements as part of the management plan for their pet’s idiopathic epilepsy. For those who used dietary supplements, the questionnaire also included the type of supplement administered, how and why the supplement was chosen, the reason for stopping the supplement, and any perceived adverse effects.

RESULTS AND DISCUSSION
Of the 547 responses, 297 met the inclusion criteria and were used in the analyses. Respondents were from the United Kingdom, United States, Canada, Germany, and Australia. Seventy-one percent of the dogs included in the study had generalized seizures, and 87.8% received concurrent AEDs. The most frequently administered AED was phenobarbital (n = 207), either alone (n = 61) or in combination with other AEDs (n = 146). Dogs receiving dietary supplements were significantly more likely to have been prescribed multiple AEDs, either in the past or currently (P = .012); however, the number of seizures was not associated with the use of dietary supplements (P = .064). Cluster seizures were also not associated with the use of dietary supplements (P = .714), but dogs that had experienced a status epilepticus event were more likely to have received dietary supplements (P = .004).

Two-thirds of respondents (67.7%) changed their dog’s diet after the idiopathic epilepsy diagnosis. The various diets included dry food only (60.6%), dry food combined with wet food (25.6%), raw food (21.9%), and home cooked food (17.8%). When asked where they sought advice for new diet choices, 27.6% asked their veterinarian, 13.8% used online informa­tion, and 37.5% cited “other” as the source of their recommendation. The most commonly administered dietary supplements were coconut oil (77.3%), fish oil (77.3%), milk thistle (42.7%), and cannabis oil (42.0%). The most common sources of advice for selection of dietary supplements were online support groups (38.2%), other online information (20.6%), and their veterinarian (17.5%).

Owners cited the most common reasons for administering dietary supplements as reduction of seizure frequency (88.2%), protection against adverse effects related to AEDs (62.5%), reduction of seizure severity (61.8%), improved postictal recovery (42.6%), reduc­tion of AED adverse effects (41.2%), or reduction of comorbidities (30.1%). Of respondents who gave their pets dietary supplements, 21 stopped administering them for the following reasons: no recognizable benefit (33.3%), concern regarding potential adverse effects (9.5%), and refusal of the dog to take the supplement (9.5%). Forty-seven percent of respondents had never given their dog dietary supplements. Reasons cited were lack of awareness that dietary supplements were available (57.8%), feeling uncomfortable giving supplements without veterinary supervision (32.1%), and lack of scientific evidence (11.4%). The majority of owners (92.5%) who had stopped or not previously administered dietary supplements would consider doing so when more scientific evidence was available.
Adverse effects of dietary supplements, as reported by owners, included sedation (9.7%), increased water consumption (8.0%), and weight gain (7.4%).

CLINICAL IMPACT
Owners of dogs with idiopathic epilepsy commonly provide dietary supplements and nutritional changes to their pet, most commonly without veterinary supervision. Although adverse effects are reported infre­quently by owners, there is evidence of interactions with commonly used AEDs, including lowering plasma levels of drugs (eg, with high chloride or sodium intake increasing excretion and lowering plasma levels of bromide and lower protein intake decreasing plasma levels of phenobarbital). Further, it would be prudent to monitor triglyceride levels or pancreas-specific lipase in patients administered additional oils as dietary supplements. Given that dietary supple­ments are commonly administered by owners, it is important to a patient’s well-being for veterinarians to engage owners in conversations, ensure dietary consistency, and monitor for adverse effects and potential AED interactions.

Berk BA, Packer RMA, Law TH, Volk HA. Investigating owner use of dietary supplements in dogs with idiopathic epilepsy. Res Vet Sci. 2018;119:276-284. doi: 10.1016/j.rvsc.2018.07.004.

Dr. Packer is an associate professor of neurology/ neurosurgery at Colorado State University College of Veterinary Medicine and Biomedical Sciences in Fort Collins, and is board certified in neurology by the American College of Veterinary Internal Medicine. She is active in clinical and didactic training of veterinary students and residents and has developed a comparative neuro-oncology research program at Colorado State University.
 

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