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Medical cannabis ‘safe’ for severe childhood epilepsy

Australian Study Shows – A small but significant group had a notable reduction in their seizures lmost all of the first 40 children given cannabidiol for severe epilepsy in Australia had an adverse event within three months — although most were mild and unrelated to the therapy, according to a study. Although four children withdrew from the NSW study, more than half of the cohort showed at least some improvement in the eyes of their treating doctors and carers, say the authors of the paper published in the Medical Journal of Australia. Paediatric neurologists tracked tolerability, adverse events and the subjective impressions of caregivers and treating neurologists among the first group of children with drug-resistant epilepsy and uncountable daily seizures enrolled in the ongoing NSW government-funded Compassionate Access Scheme. The children, aged between 19 months and 16 years, received increasing doses of the non-psychotropic oral cannabis extract Epidiolex (GW Pharmaceuticals) to a target dose of 25mg/kg/day, on top of their normal epilepsy treatments, over 12 weeks from August 2016. Parents and carers of the children had specifically requested the drug, which has been shown in recent human trials to reduce seizures in patients with certain forms of epilepsy. Among the cohort, two children were forced to withdraw early because their rate of seizures increased with cannabidiol. Two others were taken off the treatment because of poor liver function test results and significant somnolence resulting in respiratory depression. Another 14 experienced increased seizures that were considered unrelated to the treatment. All up, 39 out of 40 reported at least one adverse event, and 23 of these were serious enough to result in hospital admission or an increased stay — but only eight were believed linked to cannabidiol. Lead author Dr John Lawson says the trial demonstrates that medical cannabis can be relatively safe in the short term. “But you have to remember that this is a very sick patient group with a generally poor prognosis, so the balance between risk and benefits would favour taking a risk,” said Dr Lawson, a paediatric neurologist at Sydney Children’s Hospital, Randwick. None of the children became completely free of seizures during the trial but doctors assessed seven as “much” or “very much” improved in overall health. “A small but significant group had an 80% or 90% reduction in their seizures,” Dr Lawson said. He stressed the results were not conclusive and more research would be required to properly demonstrate efficacy and long-term risk. “Some children had more seizures, which is part of the message,” he said. “There is huge demand for cannabis right now and some of it is driven by desperation among the families, and hope, but there is also big money behind this, too. “There is no question that there are other motivations here that are much bigger than just the care of children — it is about a multibillion-dollar business.” Source: PharmacyNews.com/au READ FULL STUDY HERE   Related posts: Zynerba’s cannabis-based epilepsy gel fails in phase 2 trial Medical cannabis for epilepsy approved in FDA first Cannabis compound quells seizures in severe epilepsy syndrom Cannabis compound may halve seizures for patients with severe epilepsy

Causes and effects of traumatic brain injury (TBI)

Traumatic brain injury can happen when a sudden, violent blow or jolt to the head results in damage to the brain. In the United States and elsewhere, it is a major cause of disability and death. As the brain collides with the inside of the skull, there may be bruising of the brain, tearing of nerve fibers and bleeding. If the skull fractures, a broken piece of skull may penetrate the brain tissue. Causes include falls, sports injuries, gunshot wounds, physical aggression, and road traffic accidents. The Centers for Disease Control and Prevention (CDC) define a TBI as “a disruption in the normal function of the brain that can be caused by a bump, blow, or jolt to the head, or penetrating head injury.” The severity of symptoms will depend on which part of the brain is affected, whether it is in a specific location or over a widespread area, and the extent of the damage. In mild cases, temporary confusion and headache may occur. Serious TBI can result in unconsciousness, amnesia, disability, coma, and death or long-term impairment. The CDC estimate that, in 2013, TBI contributed to the deaths of some 50,000 people. In 2012, 329,290 people aged under 19 years sought emergency treatment for a TBI resulting from a sporting or recreational activity. Parents, guardians, and teachers should ensure that children are properly supervised and that they wear appropriate safety equipment during sporting and other activities. A head injury or suspected TBI needs medical attention. Fast facts on traumatic brain injury The effect of a TBI, such as concussion, depends on the severity of the injury and where it occurs. It is a major cause of death and disability in the United States and worldwide. Causes include falls, road traffic accidents, and sports injuries. Symptoms include confusion, persistent headaches, convulsions, and memory loss. Anyone who receives a head injury, however mild, should consider seeking medical attention. Symptoms A head injury can lead to cognitive impairment. Signs and symptoms may appear at once, within 24 hours, or they may emerge days or weeks after the injury. Sometimes the symptoms are subtle. A person may notice a problem but not relate it to the injury. Some people will appear to have no symptoms after a TBI, but their condition worsens later. The effects can be physical and psychological. The initial physical effects include bruising and swelling. Increased pressure in the brain can cause: damage to brain tissue, as it presses against the skull or as one part of the brain pushes into another pressure on blood vessels, reducing their ability to supply the brain cells with oxygen and essential nutrients Internal bleeding Signs of internal bleeding include bruising behind the ears (battle sign) or around the eyes (raccoon eyes). These can potentially indicate a severe or life-threatening injury. They need immediate medical attention. Other signs that may indicate severe injury include: a loss of consciousness convulsions or seizures repeated vomiting slurred speech weakness or numbness in the arms, legs, hands, or feet agitation loss of coordination dilated pupils inability to wake up from sleep severe headache weakness and numbness in hands, feet, arms or legs The following signs and symptoms can also indicate a need for urgent attention: confusion changes in mood memory problems inability to remember what happened before or after the incident fatigue (tiredness) and lethargy getting lost easily persistent headaches persistent pain in the neck slowness in thinking, speaking, reading or acting moodiness, for example, suddenly feeling sad or angry for no apparent reason sleep pattern changes, such as sleeping more or less than usual, or having trouble sleeping light headedness, dizziness becoming more easily distracted increased sensitivity to light or sounds loss of sense of smell or taste nausea tinnitus, or ringing in the ears These may appear at once, within hours, or later. A person who has received a TBI but who appears to have no symptoms should be closely monitored for 24 hours, as signs of injury may not be immediate. Anyone who experiences the above symptoms even days or weeks after a TBI should see a doctor. A child with a TBI may become irritable and listless. Children will have the same signs and symptoms, but they may be less likely to let others know how they feel. If an infant has received a blow or jolt to the head and any of the following signs or symptoms occur, call a doctor: changes in sleeping patterns irritability and crying listlessness loss of balance loss of newly acquired skills, such as toilet training changes in playing behavior changes refusal to eat loss of interest in favorite activities or toys tiredness unsteady walking vomiting If these signs are noticed, the child should see a doctor. In sport, the participant should leave out the game and not play again until the doctor gives permission to return, whether or not they lose consciousness. Not every TBI or concussion involves a loss of consciousness. Repeated head injuries in rapid succession can be particularly harmful to the brain in the long term. It is important to monitor a person who has had a TBI because their condition can deteriorate rapidly and symptoms that appear mild can become severe. Long-term effects There is growing evidence that a TBI or repeated TBIs can have long-term effects on health, including an increased risk of dementia and other neurological and neurodegenerative disorders. Football players with high scores on tests for depression have also been found to have a larger number of concussions. Treatment Swelling of the brain within the skull can put undue pressure on the surrounding tissues. In a mild case of TBI, symptoms normally go away without treatment. However, repeated, mild TBIs can be dangerous or fatal. This is why it is essential to rest and avoid further exposure until a doctor gives the go-ahead. More severe cases will require hospitalization, possibly with intensive care. Emergency care aims to stabilize the patient’s condition and prevent any worsening of brain damage. This will involve ensuring the airway is open, providing ventilation and oxygen, and maintaining blood pressure. Medications may be used to help control symptoms. Sedation: This can help prevent agitation and excess muscle activity and contribute to pain relief. Examples include profanol. Pain relief: Opioids may be used. Diuretics: These increase urine output and reduce the amount of fluid in tissue. These are administered intravenously. Mannitol is the most commonly used diuretic for TBI patients. Anti-seizure medication: A person who has experienced moderate to severe TBI may have seizures for up to a week after the incident. Medication may help prevent further brain damage that may result from a seizure. Coma-inducing medications: During a coma, a person needs less oxygen. Sometimes, a coma may be deliberately induced coma if the blood vessels are unable to supply adequate amounts of food and oxygen to the brain. Surgery Surgery may be necessary in some cases. Removing a hematoma: Internal bleeding can cause partly or fully clotted blood to pool in some part of the brain, worsening the pressure on the brain tissue. Emergency surgery can remove a hematoma from between the skull and the brain, reducing pressure inside the skull and preventing further brain damage. Repairing a skull fracture: Any part of the skull that is fractured and pressing into the brain will need to be surgically repaired. Skull fractures that are not pressing into the brain normally heal on their own. The main concern with a skull fracture is that forces strong enough to cause it may have caused further, underlying damage. Creating an opening in the skull: This can relieve the pressure inside the skull if other interventions have not worked. Long-term treatment A person who experiences a severe TBI may need rehabilitation. Depending on the extent and type of their injury, they may need to relearn how to walk, talk, and carry out other everyday tasks. This may include treatment in a hospital or in a specialized therapy center. It can involve a physical therapist, an occupational therapist, and others, depending on the type of injury. Tips for recovery Tips that can aid recovery: Avoid activities that could cause another blow or jolt to the head. Follow the instructions of healthcare professionals. Do not take drugs that the physician has not approved. Do not return to normal activities, including driving and sports participation, until the doctor agrees. Get plenty of rest. It is important to follow the doctor’s instructions after a TBI, because the impact of a brain injury can be severe, and it is not always immediately apparent. Types There are two major types of TBI: open and closed. In open TBI, the skull is broken. In a close TBI, it is not. Further classifications include: Concussion: A direct impact trauma that may or may not involve a loss of consciousness. This is the most common type of TBI. It is often mild, but it can be fatal. Contusion: When a direct blow causes localized bleeding in the brain, possibly resulting in a blood clot. Diffuse axonal injury: When tears occur in the brain structure due to shearing by the skull. Penetrating injury: When a sharp object enters the brain. Causes TBIs can result from a range of incidents, from falls to collisions in sport. TBI is caused by a severe jolt or blow to the head, or a head injury that penetrates and disrupts normal brain function. The human brain is protected from jolts and bumps by the cerebrospinal fluid around it. The brain floats in this fluid inside the skull. A violent blow or jolt to the head can push the brain against the inner wall of the skull, which can lead to the tearing of fibers and bleeding in and around the brain. According to the CDC, the leading causes of TBI in the U.S. in 2013 were: Falls: Responsible for 47 percent of reported cases, notably in children aged up to 14 years and adults aged over 65 years Motor vehicle accidents: These accounted for 14 percent of cases, especially in the 15 to 19-year age group. Being struck by or colliding with an object: 15 percent of TBIs resulted from a collision with either a moving or stationery object. Other causes include domestic violence and work-related and industrial accidents. Complications Apart from the immediate dangers, a TBI can have long-term consequences and complications. Seizures: These may occur during the first week after the injury. TBIs do not appear to increase the risk of developing epilepsy, unless there have been major structural brain injuries. Infections: Meningitis can occur if there is a rupture in the meninges, the membranes around the brain. A rupture can allow bacteria to get in. If the infection spreads to the nervous system, serious complications can result. Nerve damage: If the base of the skull is affected, this can impact the nerves of the face, causing paralysis of facial muscles, double vision, problems with eye movement, and a loss of the sense of smell. Cognitive problems: People with moderate to severe TBI may experience some cognitive problems, including their ability to: focus, reason, and process information communicate verbally and nonverbally judge situations multitask remember things in the short term solve problems organize their thoughts and ideas Personality changes: These may occur during recovery and rehabilitation. The patient’s impulse control may be altered, resulting in inappropriate behavior. Personality changes can cause stress and anxiety for family members, friends, and caregivers. Problems with the senses: These may lead to: tinnitus, or ringing in the ears difficulty recognizing objects clumsiness, due to poor hand-eye coordination double vision and blind spots sensing bad smells or a bitter taste Coma: Patients who enter a coma and remain in a comatose state for a long time may eventually wake up and resume normal life, but some people will wake up with long-term problems and disabilities. Some people do not wake up at all. Long-term neurological problems: A growing body of evidence has linked TBI with depression, Alzheimer’s, Parkinson’s disease, and other cognitive and neurological conditions. Diagnosis A severe TBI is a medical emergency. Rapid diagnosis and treatment can prevent potentially life-threatening complications. The Glasgow Coma Scale The Glasgow Coma Scale (GCS) is commonly used to assess the likelihood and severity of brain damage following a head injury. Scores are given according to verbal responses, physical responses and how easily the person can open their eyes. Eyes: do not open open in response to pain open in response to voice open spontaneously Verbal response: makes no response makes incomprehensible sounds utters words or phrases speaks but is confused and disoriented communicates normally Motor or physical response makes no movement extends arm in response to pain flexes arm in response to pain moves away in response to pain can pinpoint where the pain is obeys commands to move a part of the body The score will be added together, and brain injury will be classified as follows: Coma, if the score is 8 or less Moderate, if the score is from 9 to 12 Minor, if the score is 13 or more People who score 13 to 15 on the scale when they enter the hospital are normally expected to have a good outcome. Imaging scans MRI or CT imaging scans of the brain will help determine whether there is any brain injury or damage, and where. Brain imaging is essential for assessing the internal damage. Angiography may be used to detect any blood vessel problems, for example, after a penetrating head trauma. Electroencephalography (EEG) measures the electrical activity within the brain. The results can show if a patient is having non-convulsive seizures. Intracranial pressure monitoring enables the doctor to measure the pressure inside the skull. It can reveal any swelling of brain tissue. Neurocognitive tests can help assess any loss of memory or ability to process thoughts. Patients or caregivers should ensure that health providers know of any medications the person normally takes, especially blood thinners, such as warfarin (Coumadin), as these can increase the risk of complications. Prevention Some tips can reduce the risk of a TBI. Never drink and drive. Always use a seat belt when driving or traveling in a car Children should use a suitable restraint for their age and size Never drive after drinking alcohol Use a helmet when playing sports or using a vehicle where an incident could involve a head injury Instal grab bars in a bathroom that is used by older people Use nonslip mats on floors that can get wet Remove trip hazards, such as loose carpets and trailing wires Install window guards and safety gates on stairs if there are children around Ensure that play areas are made of a shock-absorbing surface, such as wood mulch Store any firearms, unloaded, in a locked safe or cabinet, and keep the bullets in a different location Special care should be taken when supervising young children or older adults. Household adaptations, such as ramps and window guards, may be necessary. The American Academy of Family Physicians recommends that everyone should go to a doctor after a blow to the head. If someone else hits their head and is behaving in an unusual way, the person who notices it should contact a doctor. The Heads Up project offers advice and training on how to prevent or deal with a TBI and its effects.   Source: MedicalNewsToday.com By C. Nordqvist Reviewed by S. Han, MD Related posts: Immediate Treatment of Traumatic Brain Injury Finding unseen damage of traumatic brain injury Promising Therapeutic Target For The Treatment Of Traumatic Brain Injury Experimental drug candidate may aid traumatic brain injury patients

Signs of concussion in children and toddlers

Concussion is an injury to the brain caused by either a blow to the head or body. A child’s developing brain is more at risk than an adult’s, so parents and caregivers may want to know the signs of concussion in children. A survey published in 2017, looking at more than 13,000 adolescents in the United States, found that almost one-fifth reported having had a concussion at least once. In this article, we will look at the warning signs and how to spot concussion in a child, plus what to do if you think a child has concussion. What is concussion? Concussion is a type of brain injury that happens when a blow to the head or body causes the brain to move in its surrounding fluid. The brain can twist or knock against the skull, temporarily affecting how a child thinks and acts. Concussion is a mild form of traumatic brain injury or TBI. Signs and symptoms of concussion in children A child with concussion may have a headache and feel dizzy. It may not be a hard hit that causes a concussion. In most cases, the child does not lose consciousness. Signs of concussion may not be obvious. They can be physical such as a headache, but may also show in the way the child acts or feels. People should look for the following warning signs of concussion in children: headache sleepiness feeling like they are in a fog feeling sick or vomiting sensitivity to noise or light seeming irritable sleeping more or less than usual feeling depressed or sad feeling dizzy or having problems with balance unable to think properly or concentrate The signs of concussion do not necessarily develop right after impact. Some can take hours or even days to appear. Parents and caregivers must, therefore, keep a watchful eye on the child for some time after they hit their head. The child or teen may not always be aware of their symptoms, and so adults need to watch for signs that the child may not report. When checking for signs of concussion, people can ask questions, such as, does the child: seem confused or dazed struggle to answer questions have no memory of what happened before or after the knock move clumsily remember the score or the game if injured during sport Concussion in babies and toddlers Babies and very young children may not be able to tell you what is wrong. As well as all of the signs above, people should also watch for a young child who is: unable or unwilling to nurse or eat crying and will not be comforted losing interest in toys losing new skills, such as toilet training What to do if you think your child has concussion If the child is playing in a sport and someone or something hits their head, immediately stop them from playing any more and observe them. Many states in the U.S. have laws to make sure this happens, and all states have some concussion law. If a person is unsure whether a child has got a concussion, the CDC recommend they should avoid returning to the game, including the slogan “When in doubt, sit them out” in their advice. People must call a doctor if the child reports or shows any of the above symptoms or signs. These can happen at the time of the injury or several hours or days later. When to go to the emergency room In rare cases, a head injury can cause a hematoma in a child’s brain. A hematoma is a collection of blood that forms in the brain and squeezes it against the skull. Doctors view a hematoma as a medical emergency. People should either go to the emergency room or call an ambulance if a child has: lost consciousness when hit loss of memory for more than 24 hours seizures, which could mean shaking or twitching one pupil larger than the other slurred speech been unable to wake up vomited repeatedly symptoms that suddenly get worse Treatment The primary treatment for concussion is rest. Rest helps the brain to heal. The American Academy of Neurology, the American Academy of Pediatrics and the Child Neurology Foundation, as well as other experts, all recommend rest for children who have had a concussion. What can you do at home? A child with concussion may sleep more than usual. What people do at home to help a child recover from concussion is vital. Steps to take include: make sure the child has physical rest and avoids sports or physical activity. allow the child to rest mentally, too. They should not do anything that needs a lot of concentration, such as school work. Limit their screen time, such as video games and television. Many children experience disturbed sleep after a concussion. They may sleep more than usual or find it hard to fall asleep or to sleep through the night. Caregivers can help by: removing distractions from the bedroom encouraging regular sleep routines, with no sleepovers or late nights Headaches are the most common problem after a concussion. Simple analgesics can help, but people should check with their doctor. How can a child’s school help? The child’s school can help by: providing rest breaks during or between classes allowing a shorter school day giving more time for homework and assignments postponing tests providing a quiet area if a child is sensitive to noise After a few days of rest, the child can gradually return to their usual activities. Typically, they should not return to sports or vigorous physical activity until they have no symptoms at rest. How long will my child take to recover? According to the CDC, most children will feel better within a couple of weeks. But for some children, symptoms can last for months or even longer. A 2014 study found that nearly a quarter of children still complained of a headache one month after injury. About a fifth suffered from tiredness, and almost 20 percent said that they still took longer to think than they did before their injury. People should talk to their doctor if the child’s symptoms get worse or do not go away. If a child is involved in sports, their doctor should be consulted to help develop a plan for safe return to play. Some children may get post-concussive syndrome, causing their symptoms to linger. This is especially likely in children who have had more than one concussion. Who is at risk of concussion? Playing football may put a child at an increased risk of concussion. Any child or adult can have a concussion, though some groups are more likely to experience concussion than others, and for various reasons. According to the Centers for Disease Control and Prevention (CDC), falls are the most likely cause of TBI diagnosed in the emergency room in infants aged 4 years and under. Children aged 5–14 years old are prone to TBI from both falling and being struck by something or against something. Young athletes seem to face an exceptionally high risk of concussion, especially those playing certain sports, including women’s soccer, football, basketball, and ice hockey. Dangers of another concussion Many states have concussion laws preventing people from returning to sports until doctors have given them medical clearance. Children are at greater risk of receiving another injury to the brain during the period after a concussion. The brain is particularly vulnerable during childhood and adolescence. A second concussion during this period is much more dangerous than the first. Chemical changes in the brain make it more sensitive to stress or another injury while it is recovering. Outlook Most children will recover fully from a concussion. But for some, the effects can be serious and long-lasting. The risk of severe complications is why people should always take a concussion in a child or teenager seriously, and the more adults who are aware of the signs, the better. Source: MedicalNewsToday.com by A. Fisher Reviewed by K. Gill, MD     Related posts: New FREE App by American Academy of Neurology: Concussion Quick Check Sports Concussion: Now There Are Guidelines TBI: Athletes may experience long-term brain changes after sports-related concussion New Evidence-Based Guidelines Identify 4 Signs of Concussion

Early Treatment Failure More Likely With Carbamazepine vs Lamotrigine in Epilepsy

In patients with epilepsy, moderate-quality evidence indicates that treatment failure for any reason related to therapy or adverse events (AEs) occurs significantly earlier with carbamazepine than with lamotrigine, although the results for time to first seizure imply that carbamazepine may be superior to lamotrigine for seizure control. Results of the review were published in the Cochrane Database of Systematic Reviews. The current analysis was an individual participant data review. The primary outcome was time to treatment failure, and secondary outcomes included time to first seizure postrandomization; time to 6-month, 12-month, and 24-month remission; and incidence of AEs. Among the 14 trials included in this review, individual participant data were available for 2572 of 3787 eligible patients from 9 of 14 trials — 68% of the potential data. In terms of remission outcomes, a hazard ratio (HR) of <1 indicated an advantage for carbamazepine. For first seizure and treatment failure outcomes, an HR of <1 indicated an advantage for lamotrigine. Lamotrigine showed an advantage over carbamazepine in time to treatment failure for any reason related to treatment (pooled HR adjusted for seizure type: 0.71; 95% CI, 0.62-0.82; moderate-quality evidence) and time to treatment failure because of AEs (pooled HR adjusted for seizure type: 0.55; 95% CI, 0.45-0.66; moderate-quality evidence); however, there was no difference between the 2 therapies for time to treatment failure because of lack of efficacy (pooled HR for all participants: 1.03; 95% CI, 0.75-1.41; moderate-quality evidence). However, time to first seizure (pooled HR adjusted for seizure type: 1.26; 95% CI, 1.12-1.41; high-quality evidence) and time to 6-month remission (pooled HR adjusted for seizure type: 0.86; 95% CI, 0.76-0.97; high-quality evidence) demonstrated a significant advantage for carbamazepine over lamotrigine for first seizure and 6-month remission. No difference was observed between the 2 agents for time to 12-month remission (pooled HR for all participants: 0.91; 95% CI, 0.77-1.07; high-quality evidence) or time to 24-month remission (HR for all participants: 1.00; 95% CI, 0.80-1.25; high-quality evidence). Because only 2 trials followed participants for >1 year, however, evidence was limited. The results of this review are applicable primarily to persons with focal onset seizures, with 88% of included participants experiencing this type of seizure at baseline. Moreover, seizures in up to 50% of persons who were classified as experiencing generalized onset seizures at baseline may have been misclassified. Rates of AEs were similar between the 2 agents. The investigators concluded that although the methodologic quality of the included trials was generally good, some evidence suggests that the design choice of masked or open-label treatment may have influenced the treatment failure or withdrawal rates reported in these studies. They recommend that future trials be designed to the highest quality possible, taking into account masking, selection of patient population, classification of seizure type, choice of outcomes and analysis, duration of follow-up, and presentation of results. Reference Nevitt SJ, Tudur Smith C, Weston J, Marson AG. Lamotrigine versus carbamazepine monotherapy for epilepsy: an individual participant data review. Cochrane Database Syst Rev. 2018;6:CD001031. Source: NeurologyAdvisor.com Related posts: First-Line Treatment With Carbamazepine in Neonatal Epilepsy Treatment of New-Onset Epilepsy: AAN, AES Update Practice Guidelines Intravenous Carbamazepine Accepted for Review by FDA Early promise for cannabis extract treatment in epilepsy

Here’s how cannabis harms the brain

It is already known that heavy, regular cannabis use increases the risk of developing mental health problems including psychosis and schizophrenia. The long-term use of either cannabis or cannabis-based drugs harms the brain, impairing memory, a new study has found. The study, led by Ana Sebastiao in collaboration with Neil Dawson and his team at the University of Lancaster, showed how long-term use of either cannabis or cannabis-based drugs impairs memory. It also revealed the implications for both recreational users and people who use the drug to combat epilepsy, multiple sclerosis and chronic pain. Through the legalisation in several countries of cannabis or cannabis-based drugs, there is an increased number of long-term users and more potent varieties are available for recreational users. It is already known that heavy, regular cannabis use increases the risk of developing mental health problems including psychosis and schizophrenia. However, there is still little understanding of the potential negative side effects of long-term cannabinoid exposure. Researchers studied the effects of a specific cannabinoid drug and found that mice exposed for long-term to the drug had “significant memory impairments” and could not even discriminate between a familiar and novel object. Also, brain imaging studies showed that the drug impairs function in key brain regions involved in learning and memory. Moreover, the long-term exposure to the drug impairs the ability of brain regions involved in learning and memory to communicate with each other, suggesting that this underlies the negative effects of the drug on memory. Sebastiao added, “Our work clearly shows that prolonged cannabinoid intake, when not used for medical reasons, does have a negative impact in brain function and memory. It is important to understand that the same medicine may re-establish equilibrium under certain diseased conditions, such as in epilepsy or multiple sclerosis, but could cause marked imbalances in healthy individuals.” “This work offers valuable new insight into the way in which long-term cannabinoid exposure negatively impacts on the brain. Understanding these mechanisms is central to understanding how long-term cannabinoid exposure increases the risk of developing mental health issues and memory problems; only its understanding will allow to mitigate them”, said Dawson. The full findings are present in the Journal of Neurochemistry. Source: TimesNowNews.com Related posts: Long-Term Cannabis Use May Lead To Serious Memory Impairments Prenatal Cannabis Exposure May Affect Kids’ Brain Development Cannabis Harms Brain, Imaging Shows Cannabis Classroom: The Role Of Cannabis In Epilepsy And Seizure Disorders

Girl who takes medical cannabis to treat seizures attends her first day of kindergarten but school not sure she can have it there!

Sad a school is in the way.  EpilepsyU Santa Rosa family fights for girl’s medical cannabis use in school “A Santa Rosa girl who relies on cannabis-based oil to treat a rare form of epilepsy started kindergarten Monday under a court order that allows her to attend class while a judge decides whether the Rincon Valley Union School District can ban the medication from school grounds. Brooke Adams, 5, has Dravet syndrome, a lifelong disorder that causes frequent and prolonged seizures. Her family treats the genetic disease using daily doses of THC oil and cannabidiol, a marijuana compound also known as CBD. Brooke must carry the oil with her at all times because larger doses of the medication, which is applied to her gums, stops the seizures when they strike, mother Jana Adams said. The medication — and whether Brooke can take it with her to Village Elementary School — is at the center of a dispute between the Rincon Valley school district and the Adams family. The district refused to let Brooke bring her medication on campus, citing state and federal barriers prohibiting medical marijuana in schools. Attorneys representing her family say the district’s stance violates rules that protect disabled students. The judge in the case, Charles Marson, granted a temporary order allowing Brooke to start kindergarten Monday and bring her THC medication to class until he issues a final ruling. Under the order, the school district will provide a nurse to administer the THC medication if Brooke suffers a seizure in class. Both parties have until Aug. 27 to submit their written arguments to Marson, who will then have 45 days to make a decision.” Source: PressDemocrat.com By Staff Writer N. Chavez Photo Courtesy of Jana Adams Related posts: Israel Approves Medical Cannabis Licensees for Children with Epilepsy Cannabis Research Journal Supports Obama’s Statement On Medical Cannabis School forbids 8-year-old girl with severe epilepsy from taking service dog to class Medical cannabis for epilepsy approved in FDA first

CBDs Enabling Improvements In Treatment Resistant Epilepsy

Evidence has been just been released revealing that CBD oils can significantly improve seizure frequency, symptoms and other measures of efficacy in patients suffering with treatment resistant epilepsy, as published in the journal Epilepsy and Behavior. Results of this study from researchers at the University of Alabama indicate use of CBD oil reduced adverse events and seizure severity along with decreases in overall seizure frequency. 132 patients were included in this study: 60 adults and 72 children with intractable epilepsy who did not respond to traditional therapies. Subject data was analyzed at baseline and again from visits at 12, 24, and 48 weeks. Frequency of seizures decreased from mean of 144 seizures every 2 weeks at baseline to 52 seizures over 2 weeks, decreases remained stable the course of the 48 week study period of nearly a two thirds reduction across the entire population with some experiencing even greater reductions. Patients were scored on adverse events profile or AEP scores which decreased from 40.8 at baseline of CBD therapy to 33.2 at the 12 week visit for all subjects; and Chalfont Seizure Severity Scale was used to assess overall severity of seizures, with decreases from 80.7 baseline to 39.2 at 12 weeks: decreases in scores from both measures remained stable at the 48 week mark. Improvements of 10+ points on the CSS Scale are clinically significant; improvements were observed of 30-40 points at the 12 week mark for each group from baseline, and as much as 50-60% improvements demonstrating results are statistically and clinically significant. Parallel decreases in seizure severity and frequency were noted indicating for many patients use of CBD oil led to fewer seizures and less intense seizures in adult and children patients with intractable epilepsy who did not respond to traditional therapies. Oil used in this study was pharmaceutical grade Epidiolex CBD oil produced by Greenwich Biosciences. Epidiolex has been shown in observational and randomized controlled studies to confirm tolerability and safety; data analysis showed significant decrease in overall side effects reported by patients. AEP scores remained stable throughout the study despite increases in CBD dosing and decreases in other anti-seizure medication. Only 2 subjects were noted in the pediatric group and 2 in the adult group withdrew from the study due to adverse events alone. Results of the open label safety study indicate significant improvements in seizure severity, frequency, and adverse effects at 12 weeks, with maintained response over duration of therapy for 48 weeks. Enrollment of patients with specific diagnosis of all ages with various treatment resistant epilepsy indicates that CBD oil may be effective across the spectrum of epileptic conditions. Epidiolex was approved by the US FDA on June 25, 2018 for seizures associated with Lennox-Gastaut syndrome and Dravet syndrome making it the first FDA approval of a purified cannabis derived drug, paving way for future additional efficacious well tolerated treatment options. Materials provided by: Note: Content may be edited for style and length. https://www.uab.edu/news/research/item/9665-cbd-oil-study-shows-significant-improvement-in-patients-with-treatment-resistant-epilepsy Source: WorldHealth.net Related posts: Study: Medtronic deep brain stimulation therapy for treatment-resistant epilepsy shows significant and sustained seizure reduction at five year Patients with Drug-resistant Epilepsy Need Better Research and Treatment, Study Says Cannabidiol reduces seizures in treatment-resistant epilepsy Cannabidiol Is Effective Pediatric Add-On for Treatment-Resistant Epilepsy

Flexible drug delivery microdevice to advance precision medicine

A Korea Advanced Institute of Science and Technology (KAIST research team has developed a flexible drug delivery device with controlled release for personalized medicine, a step toward theragnosis. Theragnosis, an emerging medical technology, is gaining attention as key factor to advance precision medicine with simultaneous diagnosis and therapeutics. Photo: The flexible drug delivery device for controlled release fabricated via inorganic laser lift off. Credit: KAIST Theragnosis devices including smart contact lenses and microneedle patches integrating physiological data sensors and drug delivery devices. The controlled drug delivery has fewer side effects, uniform therapeutic results, and minimal dosages compared to oral ingestion. Recently, some research groups conducted in-human applications of bulky, controlled-release microchips for osteoporosis treatment. However, they failed to demonstrate successful human-friendly flexible drug delivery systems for controlled release. For this microdevice, the team under Professor Daesoo Kim from the Department of Biological Science and Professor Keon Jae Lee from the Department of Materials Science and Engineering, fabricated a device on a rigid substrate and transferred a 50 μm-thick active drug delivery layer to the flexible substrate via inorganic laser lift off. The device shows mechanical flexibility with the capability of precise administration of exact dosages at desired times. The core technology is a freestanding gold capping layer directly on top of the micro-reservoir containing the drugs, previously regarded as impossible in conventional microfabrication. The flexible drug delivery device for controlled release attached on a glass rod. Credit: KAIST This flexible drug delivery system can be applied to smart contact lenses or the brain disease drug delivery implants. In addition, when powered wirelessly, it will represent a novel platform for personalized medicine. In animal experiments, the team treated epilepsy by releasing anti-epileptic medication through the device. Professor Lee believes the flexible microdevice will further expand the applications of smart contact lenses, therapeutic treatments for brain disease, and subcutaneous implantations for daily healthcare. This study “Flexible Wireless Powered Drug Delivery System for Targeted Administration on Cerebral Cortex” was published in the June issue of Nano Energy. Source and Photo Credits –  Provided by: The Korea Advanced Institute of Science and Technology (KAIST)   Related posts: Breaching Blood-Brain Barrier Offers Safe And Noninvasive Drug Delivery For Alzheimer’s, Parkinson’s, ALS, Epilepsy And More New Direction for Precision Medicine in Epilepsy Antidepressant may enhance drug delivery to the brain Common drug may advance epilepsy treatment

Treatment of New-Onset Epilepsy: AAN, AES Update Practice Guidelines

The American Academy of Neurology (AAN) and the American Epilepsy Society (AES) have provided new recommended practice guidelines for the management of new-onset and treatment-resistant epilepsy with anti-epileptic drugs (AEDs).1,2 The new guidelines highlight the evidence supporting the use of lamotrigine, vigabatrin, levetiracetam, pregabalin, gabapentin, and zonisamide for reducing the frequency of seizures in new-onset focal epilepsy and treatment-resistant epilepsy. An expert subcommittee was formed consisting of members of the AAN and AES to update the 2004 evidence-based guidelines on epilepsy treatment with AEDs. Based on recent evidence, the investigators recommend the use of gabapentin and topiramate in adults and children with newly diagnosed epilepsy. Class I and II studies support the use of rufinamide, ezogabine, clobazam, perampanel, and immediate-release pregabalin as add-on therapy in adults with treatment-resistant focal epilepsy; however, the adverse events associated with these therapies warrant careful consideration prior to prescribing. Other studies (class I, II, and III) suggest eslicarbazepine at 800 mg/day and 1200 mg/day may possibly be effective in treatment-resistant adult epilepsy. For monotherapy recommendations in adults with new-onset epilepsy with either focal epilepsy or unclassified tonic-clonic seizures, lamotrigine should be considered over gabapentin or immediate-release carbamazepine due to better tolerability, according to class II evidence. In addition, class II evidence appears to demonstrate no difference between controlled-release carbamazepine and levetiracetam or zonisamide in terms of reducing seizure frequency in patients with focal epilepsy or unclassified tonic-colonic seizures. Lamotrigine is recommended over pregabalin in reducing secondarily generalized tonic-clonic seizures within a 6-month period. In adults with treatment-resistant focal epilepsy, class II evidence points to eslicarbazepine as a possibly effective monotherapy for reducing seizure frequency. Comparatively, levetiracetam, oxcarbazepine, and zonisamide may be an effective add-on therapy in pediatric patients with treatment-resistant focal epilepsy. According to the guideline authors, there is a need for future studies which “use doses commonly used in clinical practice and use flexible-dosing regimens” in order to develop more definitive treatment recommendations. References Kanner AM, Ashman E, Gloss D, et al. Practice guideline update summary: Efficacy and tolerability of the new antiepileptic drugs I: Treatment of new-onset epilepsy: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society [published online June 13, 2018]. Neurology. doi:10.1212/WNL.0000000000005755 Kanner AM, Ashman E, Gloss D, et al. Practice guideline update summary: Efficacy and tolerability of the new antiepileptic drugs II: Treatment-resistant epilepsy: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Epilepsy Society [published online June 13, 2018]. Neurology. doi:10.1212/WNL.0000000000005756 Source: Neurology Advisor By B. May Related posts: PRESS RELEASE: A Pharmacist-Focused Review on Epilepsy: Improving Treatment Outcomes in Partial-Onset Seizures New AAN Guidelines on Vagus Nerve Stimulation for Epilepsy PRESS RELEASE: Sunovion Pharmaceuticals Inc. Presents Phase 3 Pooled Analysis of Once-Daily Aptiom® (eslicarbazepine acetate) as Adjunctive Treatment for Partial-Onset Seizures What are the symptoms of partial (focal onset) seizures? Types, causes, and treatment

Epilepsy: New findings ‘could change textbooks’

New research finds that two key brain proteins are involved in the neuronal misfiring that characterizes epilepsy. The findings “could potentially change textbooks” on epilepsy, according to the researchers, as well as pave the way for new therapies. The World Health Organization (WHO) estimate that 50 million people worldwide have epilepsy, making it one of the most widespread neurological conditions in the world. In the United States, 3.4 million people — or 1.2 percent of the population — live with the condition. Related posts: Cause of Neuron Death in Neurological Disease Researched Findings suggest novel target for seizure-blocking medicines Pocket Change for Epilepsy – Epilepsy Ontario Collects Change at 620 locations! New findings may lead to new treatment for epilepsy.