Abigayle Williams wears a helmet all day. She is nine years old. Abigayle Williams has neurofibromatosis, a genetic disorder that causes tumors to form on nerves anywhere in the body at any time. She experiences several types of seizures, lasting from a few seconds to hours, and has a hard time keeping her balance while she walks. Her helmet protects her when she falls.

But Abigayle Williams has help, because Abigayle has Katya.

Katya is a three-year-old German Shepherd. She comforts Abigayle, who lives in Goose Creek, South Carolina, while Abigayle is in a seizure and helps her familiarize herself with the surroundings as she comes out of it. Katya has broken falls and steadies Abigayle as she walks. Katya also alerts to Abigayle’s seizures minutes before they begin, in time for her parents to give her medicine and get her in a safe position.

Katya is one of the hundreds of seizure alert/assist dogs that have been trained and placed over the last decade to help seizure victims. The waiting list to obtain an alert dog, can stretch for years and the demand is growing as more people learn about them. Whether this demand can be met depends on a key question: can the dogs be trained to alert or is this ability innate?

Currently, there are approximately 120 organizations in the United States that train service dogs. Fewer than 20 work with seizure alert/assist.

Not all seizure dogs are alert dogs. Some, called seizure response or seizure assist dogs to distinguish them from alert dogs, help during and after the seizure but do not actually alert before the seizure comes. They do anything from simply staying close to the person and stabilizing them to fetching medications or a caretaker. They nudge the person toward a seat, open refrigerators to get the person food, bring telephones, or even push a button to call 911.

Dogs that do alert can sense an oncoming seizure anywhere from a minute to almost an hour before the onset. There is no conclusive scientific evidence to explain how dogs alert to seizures. Ideas on the subject include the theory that dogs can sense electric or chemical changes taking place in the body before a seizure.

Brenna Kneynsberg, a nursing student who has worked with and trained dogs for nine years, said that not one seizure alert dog works for everyone because the chemicals are different in different people and with different seizures. “You might have a year of training and then find out they can’t work as they should,” she said.

“You don’t have to have a pure breed,” Kneynsberg said, but it is preferred and safer to see the parents and have an idea of the temperament and know the genetics. Size and temperament have more to do with it than breed, however. “Some seizure dogs are little,” she explained, so they are not “overwhelming” when they lie on or beside the person. The dog’s personality is observed as well: “Sometimes you get a dog who is a psychopath.”

Most experts say the ability to alert is innate: either the dog is born with it or not. It cannot be trained into them. Some trainers, however, believe you can recognize and reinforce the instinct at an early age.

Murray Craft, who trained and placed Katya, was not sure at first if Katya would alert to Abigayle’s seizures. “Mostly what I do is obedience training,” he said. He uses the obedience training as a foundation for seizure training.

Craft has been training dogs for 30 years, founded Crafty K9 in Columbia, South Carolina, and has worked with many people who have disabilities. Katya is the first seizure dog he trained completely.

The Crafts’ interest in seizure alert has deeply personal roots. In 2003, their ten-month-old son, Josiah, began having between twenty and one hundred seizures a day. He was cured through brain surgery, but “the emotional, physical, and psychological strain was very intense,” said Mrs. Craft. “We will never forget how it feels to be so helpless as parents.”

During Josiah’s illness, friends took care of the Crafts’ many dogs and one was accidentally bred. Craft’s voice smiled as he said. “One of those [unintended] puppies was Katya.”

“It doesn’t take a special breed to do this work, only a very special dog,” Mrs. Craft said.. “It takes all the intelligence of a typical service dog, but there has to be another factor that makes the dog likely to alert to seizures before they occur. No one can guarantee that they will alert, but if you choose wisely, you can make it more likely than not that the dog will alert.”

The Crafts get many of their German Shepherds straight from Germany. “The quality of control is unbelievable,” said Craft. This can be more expensive, but they reduce costs by importing unwanted dogs. Thus, they can “import a good dog that has the necessary traits and have the dog ready in at least a third the time it would take to rehabilitate and train a shelter dog,” said Mrs. Craft.

At least one organization believes it is possible to do more than simply recognize and reinforce innate ability. Michele Reinkemeyer, of Heaven Scent Paws in St. Elizabeth, Missouri, says alerting can be trained.

In 2000, the Reinkemeyers’ 7-year-old son, Joseph, was diagnosed with type I diabetes. Though not a death sentence, the disease leads to comas, seizures, or blackouts (which then lead to comas or seizures). They were not warned about these symptoms, however, until the seizures began.

Reinkemeyer searched for anything that could help her son. At 5:45 one morning she found a story about a seizure alert dog. She believed this was the answer for Joseph, but he needed it fast and did not have time to try out many dogs to find one that worked.

Everyone told her a dog could not be trained to alert, but “when you run out of options you start making your own,” she said. “We didn’t really find the training, we developed the training.”

Their training uses a “scent discrimination technique” as the key. It is “similar in some ways to drug or explosive tracking,” Reinkemeyer said. “It was a guess, it wasn’t brilliant. I have worked with search and rescue dogs a bit in the past. I didn’t know what else to do and I noticed there was a smell [Joseph] had when he was low or had a seizure.”

Because of the distinct smell, Reinkemeyer hoped a dog’s keener senses would be able to detect the smell before it got to the point of a seizure. They invested $1000 in a ten-week-old German Shepherd puppy, named Delta, and began training with clothes that had the seizure scent on them. Two weeks into the training, Delta alerted them to Joseph’s low blood sugar.

A person who is low cannot always think straight, Reinkemeyer explained. Some people become “almost violently cranky” and it is “very much like a drunken stupor.” Reinkemeyer trains the dogs to first alert the person by licking their hand, then go to the fridge and bring them some food, and then find a parent. “Even though [the person having the low] knows they need to do something about the low, they can’t always think what. If food is put in front of them, they’ll probably eat it,” she said.

Joseph has only had one seizure since Delta came, and that was when she had to spend a night at the vet. Joseph’s 13-year-old sister, Alice, who also developed type I diabetes, got a Labrador named Lance who alerts to seizures every day 49-51 minutes before its onset. Alice has never experienced a diabetic seizure.

“When you hear that your child is diabetic, a lot of hopes and dreams are lost,” Reinkemeyer said. Now, “[Joseph] does everything he used to and then some.”

The Reinkemeyer’s’ Heaven Scent Paws, with the help of their seven children and volunteers, have trained 79 dogs and are helping many more people train their own through a course and manual they developed. Judy Merriman, a juvenile onset diabetic who is now a grandmother, is using the program to train an 11-week-old Labrador for herself. “Waiting to find one that will self-train just takes too long,” she said. “It is truly amazing to me that [the dog] is learning to alert after such a short time.”

Mike and Tiffany Stacy acquired a dog for their 4-year-old daughter, MacKenzie, through Heaven Scent Paws. MacKenzie became epileptic after surgery complications and had seizures that lasted between three and five hours. “We had finally run out of hope,” Mrs. Stacy said. Then Heaven Scent Paws contacted them and MacKenzie was given “another chance at life.”

Though they were not able to match MacKenzie’s desire for a pink, female dog named “Precious,” they did find a girl dog named “Happy.” On the Stacy’s’ second meeting with the Reinkemeyer’s, Happy alerted and MacKenzie was medicated. “The dog worked! It alerted to a seizure that we would have never known was coming,” Mrs. Stacy said.