Treatment-Refractory Epilepsy Alimentary Therapy (TREAT): A canine case study.

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.