Annual Meeting Abstracts: View
(Abst. 2.104), 2014
RESOLUTION OF SEIZURES AND NORMALIZATION OF EEG AFTER INITIATION OF CBD IN A PATIENT WITH DOOSE SYNDROME
Authors: Jeffrey Gold, Shifteh Sattar, Sonya Wang and Mark Nespeca
Content: Rationale: Our goal is to expand the knowledge of the epilepsy community regarding cannabinoid derivative treatment of epilepsy. Methods: This is a case report of a child with Doose Syndrome and intractable epilepsy whose family initiated cannabinoid treatment through a family interest group. Multiple EEGs, clinical evaluations, blood tests, and laboratory tests on the cannabinoid derivative were performed. Results: Patient ST presented as a developmentally normal male who began having seizures ("suddenly falls to the ground") at 3.5 years. Over the next year of life he developed multiple seizure types including staring spells, drop attacks, and myoclonic jerks up to 30 times per day. Keppra worsened his spells. Valproic acid stopped spells for two weeks and then spells returned despite levels up to 166 mg/dl. He sought care from two pediatric neurologists and a pediatric epileptologist who felt he likely had Doose Syndrome. 24 hour video EEG in October 2013 showed at least 10 atonic and myoclonic seizures in wake and sleep, and frequent 1-8 second runs of 2.5-4.5 Hz generalized spike-and-wave discharges in both wake and sleep. Additional medications were offered, as was the ketogenic diet, but the family preferred to pursue other therapies. The family instead started a cannabinoid (CBD) oil treatment regimen through a family interest group in December 2013, without initial benefit (continued 10-18 seizures/day). Valproic acid level increased from 116 mg/dl to 178 mg/dl (53%) without increasing the dose; when the dose was reduced by 25% the level normalized. Over the next 4 months seizures decreased and then disappeared. The family has had extensive independent testing of the CBD performed. Repeat routine EEG in May 2014 was normal in wake and sleep. Conclusions: We report this case to expand the literature of patients receiving CBD. We cannot recommend CBD treatment based on the limited evidence available at this time. However, for patients who choose to initiate CBD therapy on their own and also receive valproic acid, we recommend checking valproic acid levels frequently. We also recommend repeating EEG if clinical seizures resolve to assess for electroencephalographic improvement.