What about: MEDICAL MARIJUANA AND EPILEPSY

There is NO data to support using marijuana for epilepsy. And its illegal. 

Anecdotes are interesting. 

Observation is the basis for medical progress, after all.  But there is a 13% placebo response rate in epilepsy trials. -  JR

From the AES....

MEDICAL MARIJUANA AND EPILEPSY

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Summary:

Nearly 3 million people in the United States live with epilepsy, a neurological problem that includes recurring seizures. While 6 in 10 people with epilepsy may respond to medical treatment, over 1 million people live with uncontrolled seizures. Some of these people may be helped by surgery or other non-drug treatments, but for many, no answers have been found yet. People with uncontrolled epilepsy live with the continued risk of seizures, side effects of medication, injuries and other medical problems.

Recently CNN's chief medical correspondent, Dr. Sanjay Gupta, hosted a special report on medical marijuana. One of the families profiled was the Figis of Colorado. Their daughter, Charlotte, lives with Dravet Syndrome – a rare and severe form of epilepsy with seizures that cannot be controlled by medication. Matt and Paige Figi, after many failed treatments, turned to medical marijuana as a potential treatment for their 5-year-old daughter. The Epilepsy Foundation is excited to hear the results for Charlotte were very positive.

The Epilepsy Foundation is open and committed to exploring and advocating for all potential treatment options for epilepsy -- assuming they are proven safe and effective. This includes medical marijuana (cannabis). However, research into medical marijuana and seizure control is not complete. We are in favor of research that evaluates cannabis's effectiveness so as to better inform and help the millions of individuals who live with epilepsy. We need to help the many children and adults with epilepsy who have no other options but to resort to cannabis.

Introduction:

What to do about the medical use of marijuana (cannabis) as a potential treatment for a number of neurologic conditions, including epilepsy, is a hotly debated issue. There are legal issues surrounding its dispensing and prescription, as well as a lack of scientific research on the usefulness and safety of marijuana as a treatment for seizures. Here are four commonly asked questions about this dilemma:

Does marijuana help seizures?

Evidence from laboratory studies, anecdotal reports, and a small clinical study from a number of years ago suggests that cannabidiol, a non-psychoactive compound of cannabis, could potentially be helpful in controlling seizures. However, there are conflicting reports in the literature. So far, no clear, definitive, solid evidence exists to show marijuana helps seizures.

Does marijuana have side effects on seizures?

Marijuana has a number of effects depending on how it is ingested:

• If smoked, the risk factors associated with smoking apply to marijuana.
• If one takes marijuana preparations that are not smoked, side effects are similar to ones that would be seen with inhaled varieties of the drug. These include appetite stimulation and memory problems.
• It is difficult to assess the adverse effects of the drug since there is no controlled amount of the medication that has been studied. Therefore, other side effects could occur that are simply not known yet to practicing physicians.

What are the laws governing medical marijuana?

A number of states in the U.S. have statutes allowing for dispensation and prescription of this substance. However, the federal government also has a law that is contradictory and fundamentally criminalizes its use. Therefore, if physicians choose to follow the state laws on the medical use of marijuana, it does not guarantee that they will be immunized against federal prosecution for prescribing the medication if the federal government were to decide to enforce these laws. Therefore, physicians must be aware of both federal and state laws and the potential implications. A clearer understanding of the laws governing this issue is needed.

Should one pursue medical marijuana if all other medications do not work?

The goal of epilepsy treatment is to stop seizures with minimal or no side effects. There are receptors in the brain for marijuana, otherwise known as cannabinoid receptors, in areas that are commonly known to cause seizures (such as the hippocampus and amygdala). There is very little understanding as to what roles these receptors play in seizures. Given the legal issues, the lack of clarity on side effects, and risks associated with the use of the medication, there are better options one could try for epilepsy before resorting to marijuana.

Perhaps a clinical drug trial for a new medication or alternatively a new device may be more appropriate and—to some degree— a bit safer. For new medicines or devices, there are federal governing agencies monitoring the safety of the compound and/or device.

To date, there is very little to no monitoring of street-based marijuana. Therefore, one takes risks into their own hands and sometimes this can lead to terrible consequences. But since medical marijuana is now legal in many states, suppliers are working hard to develop dependable branded product, even mixes carefully controlled to offer specific percentages of THC or CBD.

The Epilepsy Foundation supports research on the potential antiepileptic effects of CBD or other marijuana.  While there is experimental evidence that CBD can work to stop seizures in animal models and that there are reports that it may be effective in patients with epilepsy, there is a lack of scientific data in humans.  The Epilepsy Foundation urges anyone exploring  epilepsy treatments, as permitted under their state law, to work with their treating physician to make the best decisions for their own care

More about the studies on marijuana and epilepsy:

There are current ongoing trials involving cannabis for epilepsy such as one at NYU which is sponsored by the Epilepsy Foundation.

While there are no studies finding that either marijuana or its active metabolite, tetrahydrocannabinol, may worsen seizures, there is no scientific basis to justify such studies.

One case-controlled study was designed to evaluate illicit drug use and the risk of a first seizure. Investigators concluded that marijuana is protective against the first-time seizure in men but not women.

• This study compared 308 individuals who had been admitted to a hospital after their first seizure with a control group of 294 patients. The control group was made up of patients who had not had seizures and were admitted for emergency surgery such as appendicitis, etc.
• Compared to men who did not use marijuana, the odds of a first seizure for men who had used marijuana within 90 days of hospital admission were roughly 3.6 out of 10.
• The results for women were not statistically significant. Nevertheless, the study was weak, because it did not include measures of health status prior to hospital admission for the patients' serious conditions.

The potential anti-epilepsy activity of marijuana and its metabolites has been investigated, but so far, the data has not been promising.

• There have been 3 controlled trials in which marijuana substances were given orally to patients who had had generalized grand mal seizures or focal seizures. These studies were small and the largest study involved 12 patients. One study was a double-blind, placebo-controlled trial in which 8 patients with epilepsy were given marijuana in addition to their standard therapy. Another was a double-blind, placebo-controlled trial in which 12 patients with epilepsy were given marijuana along with their standard anti-epileptic therapy, and then a third one was a double-blind, placebo-controlled add-on crossover trial with 10 patients.
• In two of the studies, marijuana had no effect on seizure frequency; however, in one of the studies, four of eight patients had significant improvement.
• Two of the studies were never published and one was presented as an abstract. The studies are so small that one cannot make any definite conclusion about the effect of marijuana as a seizure treatment.

Febrile Seizures - a beginners guide

From Dr. Rotenberg (www.txmss.com)...

Many parents need information on febrile seizures. Please note that there is no data that "temperature" management prevents febrile seizures.

Simple febrile seizures are well-managed by general pediatricians. Please develop a seizure action plan for school. JR

Febrile Seizures

Link here

A febrile seizure is a convulsion in a child triggered by a fever. These convulsions occur without any brain or spinal cord infection or other nervous system (neurologic) cause.

Causes

About 3 - 5% of otherwise healthy children between ages 9 months and 5 years will have a seizure caused by a fever. Toddlers are most commonly affected. Febrile seizures often run in families.

Most febrile seizures occur in the first 24 hours of an illness, and not necessarily when the fever is highest. The seizure is often the first sign of a fever or illness

Febrile seizures are usually triggered by fevers from:

• Ear infections
• Roseola infantum (a condition with fever and rash caused by several different viruses)
• Upper respiratory infections caused by a virus

Meningitis causes less than 0.1% of febrile seizures but should always be considered, especially in children less than 1 year old, or those who still look ill when the fever comes down.

A child is likely to have more than one febrile seizure if:

• There is a family history of febrile seizures
• The first seizure happened before age 12 months
• The seizure occurred with a fever below 102 degrees Fahrenheit

Symptoms

A febrile seizure may be as mild as the child's eyes rolling or limbs stiffening. Often a fever triggers a full-blown convulsion that involves the whole body.

Febrile seizures may begin with the sudden contraction of muscles on both sides of a child's body -- usually the muscles of the face, trunk, arms, and legs. The child may cry or moan from the force of the muscle contraction. The contraction continues for several seconds, or tens of seconds. The child will fall, if standing, and may pass urine.

The child may vomit or bite the tongue. Sometimes children do not breathe, and may begin to turn blue.

Finally, the contraction is broken by brief moments of relaxation. The child's body begins to jerk rhythmically. The child does not respond to the parent's voice.

A simple febrile seizure stops by itself within a few seconds to 10 minutes. It is usually followed by a brief period of drowsiness or confusion. A complex febrile seizure lasts longer than 15 minutes, is in just one part of the body, or occurs again during the same illness.

Febrile seizures are different than tremors or disorientation that can also occur with fevers. The movements are the same as in a grand mal seizure.

Exams and Tests

The health care provider may diagnose febrile seizure if the child has a grand mal seizure but does not have a history of seizure disorders (epilepsy). In infants and young children, it is important to rule out other causes of a first-time seizure, especially meningitis.

In a typical febrile seizure, the examination usually shows no abnormalities other than the illness causing the fever. Typically, the child will not need a full seizure workup, which includes an EEG, head CT, and lumbar puncture (spinal tap).

To avoid having to undergo a seizure workup:

• The child must be developmentally normal.
• The child must have had a generalized seizure, meaning that the seizure was in more than one part of the child's body, and not confined to one part of the body.
• The seizure must not have lasted longer than 15 minutes.
• The child must not have had more than one febrile seizure in 24 hours.
• The child must have a normal neurologic exam performed by a health care provider.

Treatment

During the seizure, leave your child on the floor.

• You may want to slide a blanket under the child if the floor is hard.
• Move him only if he is in a dangerous location.
• Remove objects that may injure him.
• Loosen any tight clothing, especially around the neck. If possible, open or remove clothes from the waist up.
• If he vomits, or if saliva and mucus build up in the mouth, turn him on his side or stomach. This is also important if it looks like the tongue is getting in the way of breathing.

Do NOT try to force anything into his mouth to prevent him from biting the tongue, as this increases the risk of injury. Do NOT try to restrain your child or try to stop the seizure movements.

Focus your attention on bringing the fever down:

• Insert an acetaminophen suppository (if you have some) into the child's rectum.
• Do NOT try to give anything by mouth.
• Apply cool washcloths to the forehead and neck. Sponge the rest of the body with lukewarm (not cold) water. Cold water or alcohol may make the fever worse.
• After the seizure is over and your child is awake, give the normal dose of ibuprofen or acetaminophen.

After the seizure, the most important step is to identify the cause of the fever.

Outlook (Prognosis)

The first febrile seizure is a frightening moment for parents. Most parents are afraid that their child will die or have brain damage. However, simple febrile seizures are harmless. There is no evidence that they cause death, brain damage, epilepsy, mental retardation, a decrease in IQ, or learning difficulties.

A small number of children who have had a febrile seizure do go on to develop epilepsy, but not because of the febrile seizures. Children who would develop epilepsy anyway will sometimes have their first seizures during fevers. These are usually prolonged, complex seizures.

Nervous system (neurologic) problems and a family history of epilepsy make it more likely that the child will develop epilepsy. The number of febrile seizures is not related to future epilepsy.

About a third of children who have had a febrile seizure will have another one with a fever. Of those who do have a second seizure, about half will have a third seizure. Few children have more than three febrile seizures in their lifetime.

Most children outgrow febrile seizures by age 5.

Possible Complications

• Biting oneself
• Breathing fluid into the lungs
• Complications if a serious infection, such as meningitis, caused the fever
• Injury from falling down or bumping into objects
• Injury from long or complicated seizures
• Seizures not caused by fever
• Side effects of medications used to treat and prevent seizures (if prescribed)

When to Contact a Medical Professional

Children should see a doctor as soon as possible after their first febrile seizure.

If the seizure is lasting several minutes, call 911 to have an ambulance bring your child to the hospital.

If the seizure ends quickly, drive the child to an emergency room when it is over.

Take your child to the doctor if repeated seizures occur during the same illness, or if this looks like a new type of seizure for your child.

Call or see the health care provider if other symptoms occur before or after the seizure, such as:

• Abnormal movements
• Agitation
• Confusion
• Drowsiness
• Nausea
• Problems with coordination
• Rash
• Sedation
• Tremors

It is normal for children to sleep or be briefly drowsy or confused right after a seizure.

Prevention

Because febrile seizures can be the first sign of illness, it is often not possible to prevent them. A febrile seizure does not mean that your child is not getting the proper care.

Occasionally, a health care provider will prescribe diazepam to prevent or treat febrile seizures that occur more than once. However, no medication is completely effective in preventing febrile seizures.

Alternative Names

Seizure - fever induced

References

Johnston MV. Seizures in childhood. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 593.

Update Date: 2/11/2010

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 1997-2011, A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Sleep and Epilepsy

As part of a comprehensive approach to treating epilepsy and preventing seizures, sleep disorders should be addressed.

Watch this short video by Dr Rotenberg on the topic

http://www.youtube.com/watch?v=Fll_WIxqy9s&feature=related

November is Epilepsy Awareness Month - Get the Seizure Facts

Get the facts about seizures and epilepsy!!

Here is a great one page resource on the facts about seizures. JR

Seizure First Aid Do you know what to do?

From Dr. Rotenberg, Child & Adolescent Neurologist
Board Certified Epileptologist
Member American Epilepsy Society 
www.txmss.com - 714-464-4107

Do you know what to do?
Find out How Seizure Smart You Are and Take the Quiz!

This November, for National Epilepsy Awareness Month, the Epilepsy Foundation is asking everyone to Get Seizure Smart about seizure first aid, recognition and types. Epilepsy affects people of all ages and races, and represents one percent of the population in this country—nearly 3 million people.

Review Seizure First Aid (convulsive, generalized tonic-clonic)

http://www.epilepsyfoundation.org/neam/

Absence Epilepsy - Which medication is best?

Big news from the New England Journal on absence epilepsy - ethosuximide is more effective than valproate or lamotrigine in Childhood Absence Epilepsy. Dr. Josh Rotenberg

http://www.nejm.org/doi/full/10.1056/NEJMoa0902014

2010 Mar 4;362(9):790-9.

Ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy.

Glauser TA, Cnaan A, Shinnar S, Hirtz DG, Dlugos D, Masur D, Clark PO, Capparelli EV, Adamson PC; Childhood Absence Epilepsy Study Group.

Collaborators (157)

Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital, 3333 Burnet Ave., MLC 2015, Cincinnati, OH 45229, USA. tracy.glauser@cchmc.org

Comment in:

• J Neurol. 2010 Apr;257(4):683-5.
• N Engl J Med. 2010 Mar 4;362(9):843-5.

Abstract

BACKGROUND: Childhood absence epilepsy, the most common pediatric epilepsy syndrome, is usually treated with ethosuximide, valproic acid, or lamotrigine. The most efficacious and tolerable initial empirical treatment has not been defined.

METHODS: In a double-blind, randomized, controlled clinical trial, we compared the efficacy, tolerability, and neuropsychological effects of ethosuximide, valproic acid, and lamotrigine in children with newly diagnosed childhood absence epilepsy. Drug doses were incrementally increased until the child was free of seizures, the maximal allowable or highest tolerable dose was reached, or a criterion indicating treatment failure was met. The primary outcome was freedom from treatment failure after 16 weeks of therapy; the secondary outcome was attentional dysfunction. Differential drug effects were determined by means of pairwise comparisons.

RESULTS: The 453 children who were randomly assigned to treatment with ethosuximide (156), lamotrigine (149), or valproic acid (148) were similar with respect to their demographic characteristics. After 16 weeks of therapy, the freedom-from-failure rates for ethosuximide and valproic acid were similar (53% and 58%, respectively; odds ratio with valproic acid vs. ethosuximide, 1.26; 95% confidence interval [CI], 0.80 to 1.98; P=0.35) and were higher than the rate for lamotrigine (29%; odds ratio with ethosuximide vs. lamotrigine, 2.66; 95% CI, 1.65 to 4.28; odds ratio with valproic acid vs. lamotrigine, 3.34; 95% CI, 2.06 to 5.42; P<0.001 p="">

CONCLUSIONS: Ethosuximide and valproic acid are more effective than lamotrigine in the treatment of childhood absence epilepsy. Ethosuximide is associated with fewer adverse attentional effects.