Medical marijuana for epilepsy 2014

Marijuana in
Philippe Douyon, MD
Northeast Regional Epilepsy Group
• Objectives:
• Brief overview of seizures/epilepsy
• Endocannabinoid System
• Mechanism of Action
• Impact on the Brain/Theoretical role in Epilepsy
• Politics of Marijuana
A sudden surge of electrical activity
in the brain
Epilepsy: 2 or
Epilepsy is the fourth most common
neurological disorder and affects people
of all ages
Epilepsy means the same thing as "seizure
Epilepsy is characterized by unpredictable
seizures and can cause other health
Epilepsy is a spectrum condition with a
wide range of seizure types and control
varying from person-to-person
Medically Intractable
• No single step in treatment defines
• After each drug failure, the statistical
probability of seizure control by the next drug
becomes lower, but it never approaches zero
• Dravet Syndrome
• Lennox-Gastaut Syndrome
• West Syndrome
• Landau-Kleffner Syndrome
Howard compares his seizures to
electricity and lightning. He asks,
"What is it like to be split open
from the inside by lightning?”
He provides one answer: "The
actual seizure was when the bolt
touched flesh, and in an instant so
atomic, so nearly immaterial, nearly
incorporeal, that there was almost
no before and after . . . and Howard
became pure, unconscious energy"
• Endogenous
• CB1 regulates neuronal
• Neuronal
hyperexcitability is
associated with seizures
• No studies –endogenous
cannabinoid system in an
intact model of epilepsy
• CB1 receptors are
concentrated in the
hippocampus, association
cortices, basal ganglia,
cerebellum, spinal cords,
and peripheral nerves
• CB1 receptors are notably
absent from the thalamus
and brainstem
• Systematic review: Efficacy and safety of
medical marijuana in selected neurologic
disorders: Report of the Guideline
Development Subcommittee of the American
Academy of Neurology
Barbara S. Koppel, MD, FAAN, John C.M. Brust, MD, FAAN, Terry Fife, MD, FAAN,
Jeff Bronstein, MD, PhD, Sarah Youssof, MD, Gary Gronseth, MD, FAAN and David
Gloss, MD
• Spasticity in patients with MS
• Central pain and painful spasms in MS
• Bladder dysfunction in MS
• Involuntary movements, including tremor, in MS
• Dyskinesias of Huntington disease, levodopa induced dyskinesias
in PD, cervical dystonia, and tics of Tourette syndrome
• Seizure frequency in epilepsy
• Analytic Process
• Searched Medline, EMBASE, PsychINFO, Web of
Science, and Scopus
• 1,729 abstracts
• Surveys, case reports/series, non placebocontrolled trials were excluded
• Reviewed the full text of 63 articles
• 33 articles met inclusion criteria
• Do cannabinoids decrease seizure frequency?
• No Class I-III studies
• 2 Class IV studies that did not demonstrate a
significant benefit and did not show adverse
effects over 3-18 weeks of treatment
• Conclusion: “data is insufficient to supports or
refute the efficacy of cannabinoids for reducing
The AAN review also concluded that
there is not enough information to
show if medical marijuana, including
smoked medical marijuana, is safe or
effective in these neurologic diseases:
•Motor symptoms in Huntington’s
•Tics in Tourette syndrome
•Cervical dystonia (abnormal neck
•Seizures in epilepsy
There are safety concerns with medical
marijuana use. Side effects reported in
at least two studies were nausea,
increased weakness, behavioral or
mood changes, suicidal thoughts or
hallucinations, dizziness or fainting
symptoms, fatigue, and feelings of
intoxication. There was one report of a
seizure. Mood changes and suicidal
thoughts are of special concern for
people with MS, who are at an increased
risk for depression or suicide. The
studies showed the risk of serious
psychological effects is about 1 percent,
or one in every 100 people. In general,
medical marijuana is prescribed as a
treatment for use only when standard
treatment has not helped.
“Don’t let my daughter die”
• NJ Senate Bill 2842
• Prohibits limitations on number of strains of
medical marijuana cultivated, and expands
available means of packaging and distribution
• Approved September 10th 2013
Alternative Treatment Centers (ATC) NJ
Compassionate Care
100 Century Drive Egg
Harbor Twp, NJ
(609) 277-7547
Compassionate Center
395 Bloomfield Ave
Montclair, NJ
(973) 337-5670
Garden State
U.S. Highway 1 North
Woodbridge NJ
Alternative Treatment Centers (ATC) NJ
Breakwater Alternative
Treatment Center
Location Pending
Operations Pending
(732) 703-7300
Foundation Harmony
Location Pending
Operations Pending
(201) 840-5800
Sciences, Inc.
111 Coolidge Avenue
Bellmawr, NJ
(856) 933-8700
Operations Pending
• N.Y. / Region |NYT Now
Connecticut Allows Medical Marijuana, but
Sellers Encounter Hurdles
• Medical marijuana could be legalized in New
York this spring: advocates
“Proponents of medical pot say newly revised legislation could be approved in
Albany this year, which would make New York the 22nd state to legalize medical
marijuana. Gov. Cuomo has hinted at his support, but opposition remains in the
state Senate.”
Published: Sunday, April 27, 2014, 7:44 PM
• Medical Marijuana Refugees
• American Academy of Neurology (April 2014)
“…..scientific research on the use of medical
marijuana in brain diseases finds certain forms of
medical marijuana can help treat some symptoms
of multiple sclerosis (MS), but do not appear to be
helpful in treating drug-induced (levodopa)
movements in Parkinson’s disease. Not enough
evidence was found to show if medical marijuana
is helpful in treating motor problems in
Huntington’s disease, tics in Tourette syndrome,
cervical dystonia and seizures in epilepsy.”
• American Epilepsy Society (February 2014)
“The recent anecdotal reports of positive effects of
the marijuana derivative cannabidiol for some
individuals with treatment-resistant epilepsy give
reason for hope. However, we must remember that
these are only anecdotal reports, and robust scientific
evidence for the use of marijuana is lacking. The lack
of information does not mean that marijuana is
ineffective for epilepsy. It merely means that we do
not know if marijuana is a safe and effective treatment
for epilepsy, which is why it should be studied using
the well-founded research methods that all other
effective treatments for epilepsy have undergone.”
• The Epilepsy Foundation supports the rights of
patients and families living with seizures and
epilepsy to access physician directed care,
including medical marijuana.
• The Epilepsy Foundation calls for an end to Drug
Enforcement Administration (DEA) restrictions
that limit clinical trails and research into medical
marijuana for epilepsy.
• The Epilepsy Foundation believes that an end to
seizures should not be determined by one’s zip

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