The Effects of Medical Marijuana

Therapy vs. Traditional Therapy to

Reduce Seizures in Pediatric
Epilepsy Patients
By: Kyle Gulling, Jenna Matheny, Shannon Troy, Ethan Thomas,
Valerie Kinsey
Introduction of Problem

 Epilepsy affects overall quality of life if not

treated properly
 Treatments are not 100% effective, and have
harmful side effects

 Is there a better option than the traditional

treatments for these patients?
Research Question

What is the effect of medical marijuana

therapy vs. traditional therapy to
reduce seizures in pediatric epilepsy
patients?
What is Epilepsy?
 Seizures:
 Sudden burst of neurons in the brain
 Clinical Manifestations of Seizures:
 Changes in level of consciousness
 Movement changes
 Behavior/emotional changes
 Affects cognitive function
 Epilepsy
 Chronic, recurrent, unprovoked seizures
 No underlying medical reasoning
Epilepsy continued…
 Most common treatable neurological disorder in childhood
 Long Term Affects:
 Morelikely to develop comorbidities
 Depression
 Anxiety
 Attention Deficit Hyperactivity Disorder (ADHD)
 Learning Disabilities
 Developmental Delay
Symptoms of Epilepsy
 Temporary confusion
 Staring spells
 Uncontrollable jerking movements of arms/legs
 Loss of consciousness
 Psychiatric problems
 Fear
 Anxiety
 Déjà vu
Types of Seizures
 Stereotypic
 Happen the same way every time

 Episodic
 Come and go

 Unpredicted
 No warning signs
Causes of Seizures

 Electrolyte imbalances
 Dehydration
 Hypoglycemia
 Infection
 Traumatic injury
Traditional Therapy Types

 Antiepileptic Drugs (AED)

 Vagus Nerve Stimulation
 Dietary Modifications
 Surgical Intervention
Antiepileptic Drugs

 Commonly used medications:

 Carbamazepine (Tegretol)
 Phenytoin (Dilantin)
 Valproic Acid (Depakote)
 Levetiracetam (Keppra)
Side Effects of AED
 Angioedema  CV collapse/arrest
 Steven-Johnson’s Syndrome  Purple glove syndrome
 Arrhythmias  Tissue necrosis
 Syncope  Hallucinations
 AV block  Psychosis
 Pancytopenia  Encephalopathy
 Hepatotoxicity  Cerebral pseudoatrophy
 Pancreatitis  Renal failure
 Suicidality  Rhabdomyolysis
 Toxic epidermal necrolysis***
Vagus Nerve Stimulation

 “Technique used to treat epilepsy that involves

implanting a pacemaker-like device into the chest
that generates pulses of electricity to stimulate
the vagus nerve”
 Approved for patients >4 years of age, not
successfully treated with two or three AEDs
 Not a cure!
 50-75% reduction in seizures
VNS continued…

 Helps stop seizure before it happens

 Auras (warning sign)

 As the nurse, if you notice aura:

 Hold special magnet against implant to trigger device
 Sends shock and stimulates patients
The lead connects to the
vagus nerve, which then
carries this stimulation the
rest of the way to the brain

A pacemaker-like device
(called a generator) sends
stimulation through the
flexible lead
Dietary Modifications
 Ketogenic Diet
 Mainly fats/no carbohydrates
 Beneficial: ketones are anticonvulsants
 50% reduction in seizures
 Modified Adkin’s Diet
 Restricts carbs to 10g/day
 30-45% reduction in seizures
 Low Glycemic Index
 Limits carbs to 40-60g/day
 32% reduction in seizures
Dietary Modifications
continued…
 Challenging to follow!

 Cooperation between families, schools, and children

themselves

 Stressful for school nurses especially

Surgical Intervention

 Temporal Lobe Resection

 Removes part of temporal lobe where seizures
originate – invasive
 75-85% reduction in seizure activity
 Diagnostic Testing before surgery
 Only qualify if AED and other therapies fail
 Last resort option
Medical Marijuana

 Two components to marijuana

 THC
Higher chance of children having cognitive
impairment and psychiatric problems
 CBD
 Common Side Effects:
 Somnolence (sleepiness), nausea/vomiting,
food interactions
Clinical Study #1

 1-20 years of age with refractory epilepsy

 Prior to study:
 Participants took AED for 4 weeks
 Treatment:
 Oil high in CBD, low in THC (20:1)
 Conclusion:
 Showed greater reduction in seizure activity
 CBD dose was increased/AED dose was tapered
Clinical Study #2

 Two case studies: 10 y.o. female and 7 y.o. male

 Before study:
 Female took 7 AEDs
 Male took 8 AEDs
 During study:
 Both started on CBD extract oil
Clinical Study #2 continued…
 Findings:
 10 y.o. female
 Complete remission after taking CBD for 4 weeks
 Tapered medications down to 3 AEDs
 Minor side effects
7 y.o. male
 Seizure free when taking CBD in combination with 2 AEDs
 Also had improvements with communication, social
interactions, was also able to get involved with
extracurricular activities
Before

After
Clinical Survey

 Survey completed by parents of children with

epilepsy
 Patients were taking 9 or more medications prior
to CBD treatment
 Overall, parents reported a decrease in
convulsions when CBD treatment was used
 No serious side effects reported
Clinical Survey continued…

 Findings:
 4.6% - worsened
 11.6% - no change
 83% - slight to significant change
 16% - completely seizure free
 Conclusion:
 The use of “add on” MMJ in treatment of epilepsy
showed a significant decrease in convulsions in 81.3% of
cases surveyed.
Clinical Study #4

 74 patients ranging from 1-18 years of age

 Treated for minimum of 3 months with traditional
AED, average treatment was 6 months prior to
study
 Patients were NOT being treated with any other
form of medication during study, just CBD
 Doses of CBD used: 1-20mg/kg/day
Clinical Study #4 continued…

 Findings:
 Significantdecrease in seizure activity
 18% reported – 75-100% reduction
 Only 7% reported – worsening symptoms
 Conclusion:
 CBD was shown to be effective for epilepsy
patients who were not able to be controlled with
AED
 Conclusion
 Positive results for pediatric
epilepsy patients
 Safer method of treatment
with less harmful side
effects
 Showed decrease in number
of seizures/day as well as
severity
 Unfortunately, laws restrict
treatment and there is a
stigma associated with using
marijuana as a type of
medication
Questions?