Today we discuss Epilepsy, while trying to understand more about it by interviewing Professor Pasquale Striano, Doctor in Pediatric Neurology and Muscular Diseases at the ”G.Gaslini” in Genoa.
In Italy over 500.000 individuals are affected by epilepsy with about 30.000 new cases each year, Can cannabinoids be effective in the treatment of this disorder? Have we got sufficient scientific studies? These and not only, are the topics treated with Doctor Striano.
Panorama on Epilepsies in Italy. Are there types of Epilepsy which are correlated to genetics and which role does the latter play? Is it possible to operate in terms of prevention?
Epilepsy is a "social disease" due to its high incidence of about 1% of the population. In Italy over 500.000 individuals are affected by epilepsy with about 30.000 new cases each year, one person every 17 minutes, with a peak incidence amongst small children and adolescents, in fact 60-70% of the cases appear within the age of 20.
Epilepsy can be caused by brain “damage” taking place before or immediately after birth, for example due to an oxygenation defect in the brain in the first moments of life, or a difficult birth, to malformations of the brain, a development deficiency, to infectious diseases of the nervous system (encephalitis), severe head traumas (e.g. caused by road accidents), brain tumours, strokes (especially in the elderly) and to malformation of the cerebral vessels, etc.
The importance of a family predisposition in determining the onset of the “sacred disease” is known since the days of Hippocrates.
Currently, genetic causes are considered at the basis of the larger part of those specific types of epilepsy, which up to some years ago, were defined without an apparent cause.
In the last twenty years the “molecular revolution” has had an important impact also at diagnostic level and in the treatment of epilepsies, in particular of idiopathic epilepsies, which involve about 0.4% of the general population and form a 30% of all epilepsies.
Doctor, news of the past weeks tell the story of Billy Caldwell, the 12 year old British boy affected by a severe form of Epilepsy, to whom in the first place has been denied and then given an oil with Cannabis extracts, which has contributed to the improvement of his quality of life. Disputes weren’t lacking. Can we state with certainty that Therapeutic Cannabis, intended as both referring to ‘therapy’ with a single cannabinoid (CBD) and in combination (THC e CBD), can be an effective remedy for some forms of Epilepsy?
The use of cannabinoids for medical use has always raised discussions. However, even though not officially recognized by the medical communities, there is growing evidence confirming its potential.
When CBD is involved the therapeutic effectiveness appears to be real.
Numerous scientific studies have been undertaken on CBD and with more than well-founded reasons. In fact in several occasions it has been demonstrated, both in an anecdotal and a clinical manner, that there are positive effects on a wide range of health states.
One of the medical fields in which CBD proves to have the best results are cases related to epilepsy, in its severest form.
Are there sufficient scientific studies in Italy to assert that Cannabis can be used securely by the patients?
In Italy there is still very little clinical data available. At the Gaslini Institute of Genoa, before the Regional Decree n° 271/2016, and subsequently with the purchase of the treatment at private authorized Pharmacies, 11 patients have been monitored, who had taken, in the past and under close medical surveillance, cannabinoids in different formulations.
Some patients, affected by drug-resistant epileptic disorders, had a considerable benefit from the cannabinoid treatment, in terms of improvement at EEG level with reduction of paroxysmal activity, improvement in behaviour and in sleep-wake rhythms.
These are, however, only isolated “case reports”, the issue is that at today’s date no controlled and randomized studies are available on cannabinoids and, as a consequence, it is hard to express judgements, in spite of the fact that the results obtained up to now look very promising.
On the web much information is circulating, the danger exists to encounter information which is not fully corresponding to the truth, Cannabis isn’t a “magic wand” useful in whichever case, what do you recommend to those considering Cannabis as a Therapy?
It is important to bear in mind that CBD is not yet considered an actual medicine. Although the results are more than promising, they are not yet conclusive. Hence we invite you to consult a doctor in case of doubt.
Looking at the future, how do you consider the ‘state’ of research on the Topic in Italy and which are, according to your point of view, the aspects requiring major investments?
Genetic research on epilepsy represents at the moment a highly suggestive and promising research frontier and important prospects can be glimpsed by means of the creation of new medical drugs, aimed at specific pathogenic mechanisms, or with a specific action on mutated proteins, up to a substitute gene therapy for the most severe forms (Precision Medicine).
In future, it will be fundamental to implement the integrated research platforms. Moreover, the realization of networks for clinical testing, will allow the expansion of the sample populations of patients with genetically defined epilepsy, in such a manner as to translate the new discoveries in benefits at clinical level.
Sadly enough, epilepsy is still burdened with a heavy stigma and there are still many people who erroneously believe epilepsy to be a rare disease or a mental disorder with scarce treatment possibilities and hardly compatible with a ‘normal’ life. Also, that during a seizure one becomes violent, or that one cannot drive a car, practise sports and, when a woman is involved, that she has difficulty conceiving or that it is forbidden for her to breastfeed.
Thus, a contribution to the elimination of stereotypes and prejudices is a correct language, which is expressed in a way that people suffering from epilepsy are not excluded because of a condition and that there are growing resources for the community, also at job level.
Epilepsy doesn’t necessarily preclude, in fact, normal work activities. A renowned American epileptologist, Lennox, stated: “The individual with epilepsy suffers, more than from his/her disorder, from all it brings about, especially at a social level”.
This statement, in spite of the fact that many years have passed since it was made, is still extraordinarily true!