OBJECTIVE Literature accounts of service dogs alerting patients prior to their seizures are a mix of historically poor quality data and confounding diagnoses. In a group of epilepsy patients, Canine Assistants and Florida International University characterized a unique scent combination of volatile organic compounds present during the immediate postictal period, but never at other times. The current study was designed to confirm prospectively if this unique scent, and potential biomarker, can: (1) be detected in an epilepsy monitoring unit (EMU), (2) whether this scent is present with nonepileptic seizures, and (3) whether this scent also precedes the clinical-electrographic seizure. METHODS Following consent and approval, sweat samples taken from EMU admissions at Denver Health Medical Center were sent to Canine Assistants in Georgia. Their team of service dogs, who had been imprinted to recognize the unique scent, were then asked to process these sweat samples in a simple yes/no identification paradigm. RESULTS Sixty unique subjects were enrolled over a two-year period. In the first part of this study, a total of 298 ictal sweat samples of 680 total observations were collected. The dogs had a 93.7% (OR: 14.89, 95% CI: 9.27, 23.90) probability of correctly distinguishing between ictal and interictal sweat samples. In the nonepileptic seizure population, 18 of the 19 NES events that were accompanied by sweat sample collections were not associated with identification of the unique seizure scent. In the second part of the study, in which subjects had samples collected every hour, dogs identified the unique seizure scent presence before 78.7% of all seizures captured, at a probability of 82.2% (OR: 4.60, 95% CI: 0.98, 21.69) of a positive detection predicting a seizure. The average duration of the warning phase of the scent was 68.2 min. The average duration of the tail phase of the scent faded after 81 min. SIGNIFICANCE This study confirms the unique seizure scent identified by Canine Assistants and FIU may be collected and recognized by dogs trained to do so, in a prospective manner. A significant number of seizures appear to be associated with the unique scent presence prior to clinical-electrical onset of the seizure itself, and therefore further study of this biomarker is warranted.

中文翻译：

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犬检测人类癫痫发作特有的挥发性有机化合物

目的 服务犬在癫痫发作前提醒患者的文献记载是历史质量低劣的数据和混淆诊断的混合体。在一组癫痫患者中，Canine Assistants 和佛罗里达国际大学发现了​​一种独特的挥发性有机化合物气味组合，在发作后立即出现，但在其他时间不会出现。目前的研究旨在前瞻性地确认这种独特的气味和潜在的生物标志物是否可以：(1) 在癫痫监测单元 (EMU) 中检测到，(2) 这种气味是否存在于非癫痫发作中，以及 (3)这种气味也出现在临床电图癫痫发作之前。方法 在征得同意和批准后，从丹佛健康医疗中心 EMU 入院处采集的汗液样本被送到乔治亚州的 Canine Assistants。然后，他们的服务犬团队被要求以一种简单的是/否识别范式来处理这些汗液样本，这些服务犬已被烙印以识别独特的气味。结果 在两年的时间内招募了 60 名独特的受试者。在本研究的第一部分，共收集了 680 个观察结果的 298 个发作期汗液样本。狗有 93.7% (OR: 14.89, 95% CI: 9.27, 23.90) 正确区分发作期和间期汗液样本的概率。在非癫痫发作人群中，伴随汗液样本收集的 19 次 NES 事件中有 18 次与识别独特的癫痫发作气味无关。在研究的第二部分，受试者每小时收集一次样本，狗在 78.7% 的癫痫发作之前识别出独特的癫痫发作气味，预测癫痫发作的阳性检测概率为 82.2% (OR: 4.60, 95% CI: 0.98, 21.69)。气味警告阶段的平均持续时间为 68.2 分钟。气味尾部阶段的平均持续时间在 81 分钟后消失。意义 这项研究证实了由 Canine Assistants 和 FIU 识别的独特癫痫气味，可以被训练有素的狗以前瞻性的方式收集和识别。在癫痫发作本身的临床电学发作之前，大量癫痫发作似乎与独特的气味存在有关，因此有必要对这种生物标志物进行进一步研究。气味尾部阶段的平均持续时间在 81 分钟后消失。意义 这项研究证实了由 Canine Assistants 和 FIU 识别的独特癫痫气味，可以被训练有素的狗以前瞻性的方式收集和识别。在癫痫发作本身的临床电学发作之前，大量癫痫发作似乎与独特的气味存在有关，因此有必要对这种生物标志物进行进一步研究。气味尾部阶段的平均持续时间在 81 分钟后消失。意义 这项研究证实了由 Canine Assistants 和 FIU 识别的独特癫痫气味，可以被训练有素的狗以前瞻性的方式收集和识别。在癫痫发作本身的临床电学发作之前，大量癫痫发作似乎与独特的气味存在有关，因此有必要对这种生物标志物进行进一步研究。