Epilepsy Survey Epilepsy Survey - Only enter your dog if they have had at least one seizure. Name* First Last Email* Full/Registered Name of Dog*My dog is a Belgian Shepherd:*Belgian Sheepdog/GroenendaelTervuren/TervuerenMalinoisLaekenoisMy dog is not a Belgian ShepherdIs your dog (gender)*Select an OptionFemaleSpayed Female (has had uterus and/or ovaries removed)MaleNeutered Male (castrated, has had testicles removed)Does your dog have official papers – recognized by a registry associated with the FCI or AKC (in the US)?*If "No", skip the Registration Information section below.Select an OptionYesNoRegistration InformationCountry of RegistrationSelect an OptionUSAFranceGermanyBelgiumNetherlandsFinlandCzech RepublicAustriaOther - please specifyCountry of Registration - OtherIf you selected Country of Registration - Other please specify which country.What is their registration number?Do not include the registry (AKC, SCC, etc) or any dashes or slashes. IE a dog registered with the AKC, with registration number DN123456/01 should be entered as DN12345601End Registration InformationWho is the father of your dog*Full/registered name only, no titles please. Enter "N/A" if you don’t know.Who is the mother of your dog*Full/registered name only, no titles please. Enter "N/A" if you don’t know.Have you already done an Embark DNA test on your dog?*If No, skip the Embark section below.Select an OptionYesNoEmbark InformationPlease enter your dog’s Embark swab code. Enter N/A if you don’t know it.This information can be looked up on the Embark website at https://embarkvet.com/. After logging in, click on the dog, then Full Report and go to page 2.Do you consent to sharing your dog’s raw data from the Embark test in a study on the genetics of epilepsy?Select an OptionYesNoEnd Embark InformationDoes your dog have idiopathic epilepsy?*Idiopathic epilepsy means that there has never been a cause identified for your dog’s seizures. Some causes might include - brain tumor, brain injury from an accident, seizures secondary to another disease or condition, etc. a. Yes, my dog has been diagnosed by a veterinarian as having idiopathic epilepsy.b. My dog has been examined thoroughly by a veterinarian who could find no cause for the seizures.c. My dog has seizures but I’m not sure if it is idiopathic epilepsy or not.d. No, my dog has seizures and a veterinarian has determined the cause of those seizures.Idiopathic Epilepsy - Choice A, B or DAt approximately what age was your dog diagnosed?Select an OptionLess than 6 months oldOlder than 6 months but less than 1 year oldBetween 1 and 2 years oldOlder than 2 but less than 3 years oldOlder than 3 but less than 5 years oldOlder than 5 but less than 8 years old8 years old or olderNot sure/Can't rememberWhich diagnostic tools or tests were performed on your dog as part of the diagnosis?Please choose all that are appropriate Select All General Exam & discussion of seizure history Blood test Full blood panel or Blood test with chemistry panel Urinalysis X-rays MRI Other, please describe Diagnostic Tools - OtherPlease list any other tools or tests used to diagnose your dogs seizures.End Idiopathic Epilepsy - Choice A or CHow old was your dog when you noticed his/her first seizure?*Select an OptionLess than 6 months oldOlder than 6 months but less than 1 year oldBetween 1 and 2 years oldOlder than 2 but less than 3 years oldOlder than 3 but less than 5 years oldOlder than 5 but less than 8 years old8 years old or olderNot sure/Can't rememberApproximately how many times have you observed your dog have a seizure?*Select an OptionLess than 1010-2425-100100 plusPlease choose among the following characteristics to describe a typical seizure for your dog.*Select all that apply. Loses consciousness Does not lose consciousness but is altered, unable to respond normally/ disoriented/ confused Entire body is involved A specific area of the body is involved Loses control of their bowels Seems to be oblivious to everything around them Occurs on only 1 side of the body Occurs on both sides of the body Jerking movements of the body Drops suddenly as if the muscles turned to jelly Performs a ritualized or involuntary behavior repeatedly Excessive drooling stumbling/swaying when walking (appears drunk) Other Characteristics of a typical seizure for your dogAre the seizures of your dog generally the same?*Select an OptionAlways the sameMostly the same, with some minor differencesHave changed significantly over timeAlways differentHas only had 1 seizureAre you aware of any things that seem to trigger seizures in your dog?* Hormonal changes, like heat cycle in female dogs High temperatures High arousal activity Specific foods or treats Stress Loud noises, like fireworks or gunshots Vaccinations - Rabies or other Other veterinary treatments Other, please identify No, have never been able to identify any trigger(s) Seizure Triggers - OtherHow many times in the last year have you taken your dog to the vet because of his/her epilepsy?*This could be for routine monitoring or emergency treatment.Select an Option0 times1 times2 times3 times4 times5 or more timesHow would you judge the impact of the seizures on your dog?*Select an OptionMinimal – they don’t occur often and s/he has a good quality of life and is able to participate in all activitiesMinor – not able to participate in all activities that we would like to because of the seizures or the treatment to control themMajor – Unable to participate in many activities because of the seizures or the treatment to control themAre you aware of any dogs related to your dog that also have epilepsy?* Yes, 1 or more of his/her parents also has epilepsy Yes, 1 or more his/her littermates also has epilepsy Yes, 1 or more of his/her half-siblings also has epilepsy Yes, 1 or more distantly related dogs also has epilepsy No, to the best of my knowledge, I do not believe that there is epilepsy in any of the relatives No, I don't know much about the relatives of my dog On which side of the pedigree are the epileptic relatives?Select an OptionOn the father’s side (paternal)On the mother’s side (maternal)On both the father’s and mother’s sidesIs your dog on regular treatment to control the seizures?*Select an OptionYesNoPlease describe the treatment that your dog receives to control his/her seizures.There has been some discussion among owners and breeders about the role of vaccinations in epilepsy. So, we would like to know how you vaccinate your dog. Please choose the answer that most closely corresponds with your approach to vaccinations:Select an OptionI vaccinate my dog according to scheduleI check my dog’s titer levels and vaccinate only when they indicate a need for itI titer for most vaccines but give rabies on scheduleI no longer vaccinate my dog, on the advice of my veterinarianWould one of your veterinarians be willing to certify that your dog has idiopathic epilepsy, in his or her professional opinion?*Select an OptionYesNoI don't knowWould you be willing to submit a sample from your dog to Embark for genetic testing to help identify genetic regions that might lead to a test for epilepsy someday?*Select an OptionYesNoPlease feel free to share any additional information regarding your dog and the impact of epilepsy on his/her life, if you would like.Please tell us how you would like to handle the information from you regarding your dog:*Please feel free to analyze and share all the information provided in this survey, INCLUDING the names of me and my dogPlease feel free to analyze and share all the information provided in this survey, EXCLUDING the names of me and my dogThank you for your participation in our epilepsy study. We hope that the information that you and others provide will help us more fully understand the impact of epilepsy on the breed and the individual owners of affected dogs. If we conduct follow up surveys for this project would you be willing to participate?*Select an OptionYesNoCAPTCHA
