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Taking your pet to the online “vets”

Previous studies have shown that pet owners regularly upload footage of their animal to seek help and advice from the outside world after their pet demonstrates signs of unusual and worrying behavior, for example seizure-like events – and online feedback from the public and “experts” can often be incorrect, putting your pet in danger.

Concurrently, vets are now commonly presented with these videos from pet owners looking for veterinary advice, and as such the interpretation of these videos by vets is of high importance.

How reliable is video footage for diagnosing paroxysmal events?

New research published in BMC Veterinary Research has highlighted the difficulty of diagnosing seizures in dogs and cats from videos recorded by pet owners alone.

This study, led by the Royal Veterinary College (RVC) canine epilepsy clinic working together with world-experts in the field, investigated whether vets could agree whether a cat, or dog was having an epileptic seizure when presented with a video of an animal experiencing a seizure-like event. In addition, the authors sought to investigate what kind of seizure vets thought was occurring (e.g. those involving all of the brain or only part of the brain), and which characteristics of a seizure they thought were present (e.g. particular movements or behaviors).

In order to answer this question, an online questionnaire study was conducted, where neurology specialists and non-specialist vets watched 100 videos of dogs and cats exhibiting seizure-like events, without having prior medical knowledge of the animal, and provided their feedback.

Interestingly, the study confirmed that there was a low level of agreement between observers who were not always able to interpret from the video footage whether they were observing an epileptic seizure. Differences in agreement rates were also noted between more and less experienced observers, with neurology specialists less likely to diagnose a seizure than non-specialists, instead diagnosing less common disorders such as idiopathic head bobbing or episodic falling.

In addition, vets often disagreed about the type of seizure occurring, with only a ‘moderate’ level of agreement between observers. Vets agreed most upon diagnosing ‘generalized seizures’, those where both halves of the brain are involved and dogs often lose consciousness and shake throughout their whole body. However, they mainly disagreed upon the diagnosis of ‘focal seizures’, those where only part of the brain is affected and the animal may appear to stay conscious.

The only seizure characteristic to achieve good agreement between the participant groups was whether the dog salivated or not during the episode, which vets associated with generalized seizures. In contrast, neurobehavioral signs such as aggression, fear/anxiety and hallucination were least agreed upon, with vets also disagreeing over the consciousness status of the dog.

Co-author of the study and Clinical Investigations Research Assistant at RVC, Dr Rowena Packer, added:

“In isolation, observing videos of seizure-like events appears to be unreliable way to diagnose a seizure, highlighting the importance of detailed history taking, physical examination and diagnostic testing in determining whether an epileptic seizure has occurred. Although owners may be tempted to upload videos of their pet online to ask others what is happening to them, this is no substitute for taking their pet to the vets for a full diagnostic work-up.”

Although owners may be tempted to upload videos of their pet online to ask others what is happening to them, this is no substitute for taking their pet to the vets for a full diagnostic work-up

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Rowena Packer
Royal Veterinary College, London

A need for veterinary neurologists to classify epileptic seizures

This study has highlighted that further training may be needed for these poorly agreed upon characteristics, to ensure subtle signs are recognized, with further discussions between vets to ensure that they are interpreting signs in the same way.

The authors emphasized the need for robust seizure classification systems (creating a common language used by practitioner and specialists alike), with poor agreement between observers potentially highlighting deficiencies in current classification systems.

Agreement of seizure type is of particular importance in clinical research, where certain anti-epileptic drugs may be more efficacious for particular seizure types, and thus high agreement between observers is essential in multi-centre clinical trials.

BMC Veterinary Research Section Editor, Prof Holger Volk, who is the Clinical Director of the RVC’s small animal referral clinic and specialist in Neurology and Neurosurgery said:

“Video-EEG [electroencephalogram] studies, where electrical activity in the brain is recorded alongside videos of seizure-like events are often used as a diagnostic tool in human neurology, and could be used more widely in veterinary medicine to aid characterization of episodes beyond what can be observed on a video alone, and lead to more objective, definitive diagnoses.”

Although other studies have successfully used online video clips to study neurological and behavioral problems in dogs, and the use of videos to diagnose seizure activity is becoming increasingly common, this study has highlighted that it cannot be solely relied upon, and a trip to the vets is always the best prescription.