For a small group of persons with epilepsy, seizures persist on a regular basis despite having tried available treatments. These persons have severe refractory epilepsy. Seizure dogs have gained attention as a potential solution to help address the seizure-related risks and emotional challenges faced by these individuals. Seizure dogs undergo specialised training to recognise and respond to the unique characteristics of their owner's seizures. The aim of a seizure dog partnership is to enhance safety and provide emotional support during episodes. Anecdotal reports and exploratory studies hint at the potential of seizure dogs to improve quality of life and reduce seizure frequency in their owners. Yet, there is no robust, scientific evidence on the benefits of seizure dogs and this has been a barrier to their inclusion in reimbursed care packages. The goal of this thesis, embedded in the EPISODE (EPIlepsy SuppOrt Dog Evaluation) study, was to conduct an extensive evaluation of the potential of seizure dogs as an assistive care service for adult PSREs. The chapters of this thesis describe the results of studies into the burden of illness of adults with severe refractory epilepsy and the clinical effectiveness, cost-effectiveness, and broader impacts of this intervention.The Chapters of this thesis illustrated the multifaceted potential of seizure dogs for a severely burdened population. It demonstrated seizure dogs reduce seizure frequency and enhance the quality of life of persons with severe refractory epilepsy and their informal caregivers, and that it very likely concerns a cost-effective complement to usual care in the Netherlands. Yet, not all adults with severe refractory epilepsy benefit equally, as evidenced by considerable variation in outcomes, mixed experiences, and a significant rate of discontinuation of seizure dog trajectories. These insights assist stakeholders with balancing the considerations of clinical effectiveness, cost-effectiveness, and broader impacts when appraising the potential of seizure dogs. Additionally, the EPISODE study serves as an illustrative case study of the application of established methods for economic evaluations to non-pharmacological interventions and episodic conditions.<br/
