The Role of Cannabidiol in Neurological Disorders.

Cannabis has been used for both recreational and medicinal purposes for more than 4 millennia. Cannabis has been studied in various medical disorders including neurological disorders. There are well-known risks of long-term use of cannabis, including low motivation, lowered cognitive capabilities, and diminished IQ and brain mass.

Effectiveness at 24 Months of Single-Source Generic Carbamazepine, Lamotrigine, or Levetiracetam in Newly Diagnosed Focal Epilepsy.

Background: Kaiser Permanente advocates using single-source generics for brand-name drugs. We compared the effectiveness of 3 different-generation generic antiepileptic drugs (AEDs) in patients with focal epilepsies.

Objective: To compare the effectiveness of the 3 most commonly used AEDs (carbamazepine [CBZ], lamotrigine [LTG], and levetiracetam [LEV]) after 24-month monotherapy.

Mechanisms of Action and Pharmacokinetics of Cannabis.

At least 100 cannabis species are compounds known as cannabinoids, a molecule with a 21-carbon terpenophenolic skeleton. Cannabinoids produce more than 100 naturally occurring chemicals, the most abundant of which are Δ-9-tetrahydrocannabinol (THC), cannabidiol (CBD), terpenes, and flavonoids. THC and CBD bind with cannabinoid receptors (CB1 and CB2), which are present in the brain and many organs.

Does Early Recognition of Treatment Failure and Changing Anti-Epilepsy Medication Regimen Improve Short-Term Seizure Remission Rates In Childhood Absence Epilepsy?

Purpose: To study the role of early serial EEGs in improving seizure freedom rates after initiation of ethosuximide or valproic acid for childhood absence epilepsy.

Methods: Retrospective data analysis study of AED naive patients with childhood absence epilepsy undergoing treatment at the community-based epilepsy clinic. Due to small sample size Fisher's exact test was used to determine two-tailed p value at less than 0.

Cannabis and Neuropsychiatric Disorders: An Updated Review.

Cannabis plant has the scientific name called Cannabis sativa L. Cannabis plant has many species, but there are three main species including Cannabis sativa, Cannabis indica and Cannabis ruderalis. Over 70 compounds isolated from cannabis species are called cannabinoids (CBN).

Neuromodulation Therapy with Vagus Nerve Stimulation for Intractable Epilepsy: A 2-Year Efficacy Analysis Study in Patients under 12 Years of Age.

To study the efficacy of vagus nerve stimulation (VNS) therapy as an adjunctive treatment for intractable epilepsy in patients under 12 years of age, we analyzed 2-year postimplant data of 35 consecutive patients. Of the 35 patients, 18 (51.4%) at 6 months, 18 (51.

Efficacy of Pinus radiata bark extract and vitamin C combination product as a prophylactic therapy for recalcitrant migraine and long-term results.

Purpose: This was the open-label study to evaluate the potential benefit of Pinus radiata bark extract and vitamin C as a treatment for migraine.

Methods: Fifty outpatients with chronic migraine refractory to at least two prophylactic medications were treated with an antioxidant formulation of 1200 mg Pinus radiata bark extract and 150 mg vitamin C daily for 3 months. Patients completed migraine disability assessment (MIDAS) questionnaires at the beginning and end of the study to assess migraine impact on work, school, domestic and social activities over the three months prior to enrollment and the three month treatment period.

Evaluation of maturation and function of visual pathways in neonates: role of flash visual-evoked potentials revisited.

The purpose of our study was to establish the guidelines for interpreting neonatal flash visual-evoked potentials (FVEPs) by examining the correlation between maturation of the waveforms and conceptual age (CA). We retrospectively analyzed 220 consecutive neonatal FVEPs performed on premature and full-term infants. The CA of the participants ranged from 28 to 52 weeks.

Acute levetiracetam overdose presented with mild adverse events.

Purpose: Overdose of levetiracetam may produce neurotoxicity.

Case Report: We reported a patient with epilepsy who took an overdose of 63 grams of levetiracetam with mild adverse events. The patient presented mild blurred vision and mild ataxia that rapidly subsided within one day with supportive care.

The mechanisms of medically refractory temporal lobe epilepsy.

The mechanisms underlying the refractory temporal lobe epilepsy (TLE) are not well understood. Several explanations for refractory TLE are (1) an overexpression of P-glycoprotein (P-gp) encoded by multiple drug resistance 1 (MDR1) gene and other efflux transporters such as multidrug resistance protein (MRP) in the cerebrovascular endothelium in or around the region of the epileptic focus may lead to drug resistance in epilepsy; (2) the loss of antiepileptic drug sensitivity at certain target sites in the brain, including the sodium ion channel and the gamma aminobutyric acid (GABA)A receptor; and (3) seizures beget seizures by means of a cascade of events that include various types of neuronal damage, sprouting of neuronal axons and new synapse formations that establish aberrant glutamatergic synapses. TLE may be a progressive neurological disorder that requires early and effective treatment.

Midline spikes.

Midline spikes are characterized by spike foci recorded at Cz, Fz, or Pz with amplitude ranging from 20 to 350 microvolts. Out of 7,929 EEGs performed at the Neurodiagnostics Laboratory, Kaiser Permanente Medical Center, Anaheim, California, between 1996 and 2006, 17 EEGs (0.21%) were identified as having interictal midline spikes with or without other epileptiform discharges.

Scalp-recorded auditory P300 event-related potentials in new-onset untreated temporal lobe epilepsy.

We studied scalp-recorded auditory event-related potentials (ERPs) of 30 untreated patients with new-onset temporal lobe epilepsy and 30 age- and sex-matched normal controls. This study was designed to eliminate the effects of intractability of seizures and chronic use of antiepileptic drugs on P300 auditory ERPs. There were no statistically significant differences in both latency and amplitude of P300 between the two groups.

Use of a pine bark extract and antioxidant vitamin combination product as therapy for migraine in patients refractory to pharmacologic medication.

Objective: To evaluate the potential benefit of a pine bark extract and antioxidant vitamin combination product in the treatment of migraine headache.

Background: This was an uncontrolled preliminary study to investigate the potential of an antioxidant formulation as therapy for migraine headache.

Methods: Twelve patients with a long-term history of migraine with and without aura who had failed to respond to multiple treatments with beta-blockers, antidepressants, anticonvulsants, and 5-hydroxytryptamine receptor agonists were selected for the study.

Screening of EEG referrals by neurologists leads to improved healthcare resource utilization.

The objective of this study was to determine if screening by a neurologist of all non-neurologist electroencephalogram (EEG) referrals prior to approval reduces the number of inappropriate requests. This retrospective survey included 600 consecutive EEG requisitions referred to the Anaheim Kaiser Permanente Neurodiagnostic Laboratory to rule out epilepsy. Patients with established epilepsy referred for a repeat EEG for management issues were excluded.

Social communication in children with epilepsy.

Background: This study examined measures of social communication that involve the use of language in formulating and organizing thoughts and its relationship with seizure-related, developmental, cognitive, and behavioral variables in 92 children with complex partial seizure disorder (CPS), 51 with primary generalized epilepsy (PGE), and 117 normal children, aged 5.1-16.9 years.

Measures of psychopathology in children with complex partial seizures and primary generalized epilepsy with absence.

Objective: This investigation examined psychopathology in 48 children with complex partial seizures (CPS), 39 children with primary generalized epilepsy with absence (PGE), and 59 nonepileptic children, aged 5 to 16 years, by comparing the Child Behavior Checklist (CBCL) and the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS).

Method: The CBCL was completed by parents and the K-SADS was administered to both parent and child.

Results: The CBCL identified psychopathology in 26% and the K-SADS in 51% of the CPS and PGE patients (kappa = 0.

Conversational repair in pediatric epilepsy.

This study examined if children with complex partial seizures disorder (CPS) and primary generalized epilepsy with absence (PGE) were impaired in the use of self-initiated repair during a conversation compared to normal children. Transcriptions of speech samples of 92 CPS, 51 PGE, and 65 normal children, ages 5-16 years, were coded for self-initiated repair according to Evans (1985). The WISC-R, a structured psychiatric interview, and seizure-related information were obtained for each child.

An unusual case of multiple cranial nerve palsies in Wegener's granulomatosis.

We describe an unusual case of Wegener's granulomatosis, which initially caused fulminant palsies affecting cranial nerves II, V, VI, VII, and VIII during a brief episode of the disease. The patient was successfully treated with immunosuppressive therapy. Wegener's granulomatosis should be suspected when multiple cranial nerves are initially affected.

Correlation of electroencephalography and the active and inactive forms of neurocysticercosis.

We studied the interictal EEG of 50 epileptic patients (28 males, 22 females) who had parenchymal neurocysticercosis, diagnosed by CAT/MRI of the brain, positive immunological reaction for cysticercosis in cerebral spinal fluid or both. Age ranged from 5 to 61 years old; the mean age of onset was 24.2 +/- 12.

Psychopathology in pediatric complex partial and primary generalized epilepsy.

Structured psychiatric interviews were administered to 60 children with complex partial seizure disorder (CPS), 40 children with primary generalized epilepsy with absences (PGE), and 48 control children, aged 5 to 16 years. Significantly more patients with epilepsy had psychiatric diagnoses compared with the control children. There were no statistically significant differences, however, in the number of patients with CPS and PGE with psychiatric diagnoses.

Formal thought disorder and psychopathology in pediatric primary generalized and complex partial epilepsy.

Objective: To examine whether formal thought disorder and psychopathology occurred in children with complex partial seizures (CPS) rather than children with primary generalized epilepsy with absences (PGE) or nonepileptic children.

Method: Formal thought disorder was coded in 30 children with CPS, 24 children with PGE, and 61 nonepileptic children, and structured interview-based psychiatric diagnoses were obtained for the epileptic subjects.

Results: The CPS subjects had significantly more illogical thinking than the PGE and nonepileptic children.

Recording of brainstem evoked potentials and their association with gentamicin in neonates.

Brainstem auditory evoked potential (BAEP) recording was used to screen presymptomatically the hearing of 200 neonates treated with ampicillin (100 mg/kg daily) and gentamicin sulfate (5 mg/kg daily). The study included 130 male and 70 female neonates; post-conceptional age ranged from 34 to 57 weeks (mean 42.36 weeks).

Somatosensory evoked potentials in acute migraine with sensory aura.

One current view of migraine pathophysiology suggests that vasospasm causes cerebral ischemia and focal symptoms during an aura and that reactive hyperemia accompanies the headaches. Eight patients with acute migraine with sensory aura were studied with somatosensory evoked potential (SEP) to examine the vascular theory of acute migraine headache. All patients had sudden onset of hemiparesthesia as an aura followed by throbbing headaches.

The usefulness of one to two hour video EEG monitoring in patients with refractory seizures.

Video EEG monitoring for 1-2 hours was performed on 100 outpatients (57 females and 43 males) with refractory seizures or frequent paroxysmal events. Patients' ages ranged from 8 days to 67 years (mean age 21). At least one clinical seizure or paroxysmal event was observed in 66 patients; 24 of these patients had subtle seizures that would be difficult to observe without videotape monitoring.

Felbamate monotherapy for partial-onset seizures: an active-control trial.

We evaluated felbamate (FBM) monotherapy in 111 patients with uncontrolled partial-onset seizures in a multicenter, double-blind, parallel-group trial. During the 56-day baseline period, patients had at least eight partial-onset seizures and received one standard antiepileptic drug (AED) at a therapeutic level; a second AED was allowed if at a subtherapeutic level. Patients received either FBM 3,600 mg/d or valproate (VPA) 15 mg/kg/d.