Key Things You Should Know in 2026 

Based on a lecture by Dr Holger Volk at Zoomies: The Online Veterinary Conference 2026  

The Central Paradigm Shift 

There is a fundamental rethinking of how we approach epilepsy and cognitive dysfunction in dogs. The key message is that these are not isolated brain diseases, but systemic conditions deeply influenced by the gut-brain axis, nutrition, and the microbiome. The patient with epilepsy, cognitive dysfunction, behavioural changes, and gastrointestinal issues may be viewed as having separate issues – but they may be connected in a very real and scientifically proven pathway. 

Key Conceptual Framework 

Epilepsy as a Multifactorial Disease: Rather than viewing epilepsy as a single condition requiring only antiseizure medications, a holistic model is emerging where many factors influence seizure threshold – including dietary factors, microbiome factors, concurrent disease, genetics, and concurrent illness. This reframes epilepsy management as a multimodal endeavour. 

The Interictal Period Matters: Perhaps most significantly, epilepsy’s impact extends far beyond seizures themselves. The interictal period is frequently associated with anxiety, cognitive dysfunction, memory problems, and behaviour changes similar to ADHD. These are not merely medication side effects but part of the disease process itself. Owners have long recognized this, with 70% of epileptic dogs showing increased fear and anxiety in their pets. 

The Gut-Brain Axis in Neurologic Disease 

Microbiome-Immune-Brain Connection: The gut contains over 500 million neurons and influences brain function through multiple pathways. The microbiome produces neurotransmitters, influences inflammation, and can even affect behaviour. Studies in animals show that transplanting faeces from anxious or depressed individuals transfers those behavioural traits to the recipients. This broadens our understanding of why gastrointestinal health and neurologic disease are so intimately connected. 

Evidence from Clinical Studies: 

• Dogs on phenobarbital show increased amounts of short-chain fatty acids (particularly butyrate) in their faeces – with responder dogs having higher butyrate levels than nonresponders 
• Faecal microbiota transplantation in epileptic dogs reduces ADHD-like behaviours, fear, and anxiety in the inter-ictal period 
• Faecal transplanted dogs show increased GABA/glutamate ratios, suggesting improved inhibitory neurotransmission 

Dietary Interventions: Practical Applications 

Medium Chain Triglyceride (MCT) Diets: A cornerstone of the new approach to canine cognitive dysfunction – and potentially epilepsy control is dietary supplementation with MCTs at 6.5% of caloric intake. Clinical trials show that approximately one-third of drug-resistant epileptic dogs respond well to MCT supplementation, with some becoming seizure-free. Benefits also extend to cognitive function, with improved trainability and spatial working memory. 

Mechanisms of Action: MCTs provide an alternative energy source (ketones) for metabolically compromised brain regions, increase GABA/glutamate ratios (particularly in limbic systems), and have direct effects on glutamatergic neurotransmission by blocking AMPA receptors. 

Cognitive Dysfunction Syndrome (CDS): The same metabolic principles apply to CDS, which shares key features with human Alzheimer’s disease including amyloid plaques, tau pathology, and neuroinflammation. Diets enriched with MCTs, antioxidants, and B vitamins support cognitive function in aging dogs. Notably, a Western-style diet (high in processed foods) increases amyloid-β42 markers in dogs within just two weeks, demonstrating the rapid impact of nutrition on neurodegenerative processes. 

The Practical Clinical Approach Utilising the Gut-Microbiome-Brain Axis 

Step 1: Comprehensive Assessment 

• Use WSAVA-endorsed dietary questionnaires 
• Evaluate gastrointestinal health (faecal scoring, frequency) 
• Assess vitamin B status 
• Document behaviour using validated tools 

Step 2: Anti-Seizure Medications 

• Initiate phenobarbital, potassium bromide, or levetiracetam as appropriate 
• Monitor serum concentrations and adjust dosing 
• Consider the patient’s comorbidities and owner factors in drug selection 

Step 3: Nutritional Interventions 

• Begin with a hypoallergenic diet if gastrointestinal signs are present 
• Consider adding psyllium or other fibre sources to increase butyrate production 
• Supplement with omega-3 fatty acids for anti-inflammatory effects 
• Consider MCT-enriched diets or MCT oil supplementation (approximately 6.5% of daily caloric intake) 
• Monitor vitamin B levels and supplement if needed 

Step 4: Recognise the Interconnectedness 

• Treat behaviour, cognition, and seizures as related issues 
• Consider faecal microbiota transplantation for refractory behavioural comorbidities (emerging therapy) 
• Address stress and anxiety through environmental management 

Key Takeaways for Practice 

1. Listen to Owners:The link between diet and behaviour has long been recognised, and its impact on epilepsy isemerging as an important management tool. Note gastrointestinal symptoms and behaviour in the inter-ictal period – as abnormalities in this period may support the need for management strategies in addition to antiepileptic therapy.  
2. Diagnose Proactively: Cognitive dysfunction screening should begin at age 7 using validated tools like the DISHAA questionnaire. MRI and CSF analysis can improve diagnostic certainty whenindicated.
3. Think Holistically: Epilepsy and cognitive dysfunction are whole-body diseases. Gastrointestinal health,behaviour, cognition, and seizure control are intimately connected through the gut-brain axis.
4. Accessible Interventions Work: MCT oil supplementation on existing food was as effective as specialised diets, making this approach accessible to more owners. A relativelysmall changein diet can significantly impact seizure control and behaviour. 
5. The Future Is Bright: Emerging therapies includingfaecal matter transplant (FMT)and precision nutrition offer hope for previously refractory seizure patients. These could provide a useful complement to proven medical therapies. 

Closing Perspective 

The well-being triangle of physical health, nutrition, and mental/cognitive health provides a framework for comprehensive patient care. By looking beyond the brain to the entire body – including the gastrointestinal system – veterinary practitioners can offer more effective, compassionate care for dogs with epilepsy and cognitive dysfunction. The evidence base continues to grow, and the future of veterinary neurology lies in embracing this holistic, multimodal approach.