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intractable epilepsy

Will epileptic seizures be cured?

Epilepsy is said to be the most familiar and frequent neurological disorder, but it is still not well known, and many people are suffering from it because they cannot get the understanding of society in their daily lives.

There are various types of epilepsy, but it is a disease that suffers from its symptoms from children to adults. For example, in the case of children attending school, if there is no adult who understands them, even if they have few epileptic seizures, they may be harassed as “unpleasant” or “uncontrollable at school”. It may be rejected by teachers. I think there are many people who are not worried about whether they can get a job properly even after their student life is over, or whether they will get sick because of a seizure during work. In addition, epilepsy may develop after adulthood,

Such people are always anxious about not knowing when a seizure will occur, such as “What if I have a seizure here now?”

Regarding the treatment of epilepsy, it can be said that the treatment method is well systematized as shown in the epilepsy clinical practice guidelines. However, the treatment method differs not a little depending on the type and age of the seizure, brain wave, head imaging test, motor function, mental symptoms, etc., and for children, the type of seizure and the findings of the brain wave change as they grow up. Coming complicates epilepsy treatment. In addition, “compatibility with drugs” and “did you remember to take it?” Are also greatly involved in the suppression of epileptic seizures. Therefore, it may take some time to control the seizures, and as a result, the seizures may not subside even after repeated treatments, but it is necessary to continue the treatment patiently.

Medical cannabis is used to treat epilepsy overseas

Epilepsy is a common chronic disorder in the world, and it is said that there are 65 million people suffering from epilepsy in the world. And while many people have been able to control their symptoms with treatment, one-third of them are said to have seizures that are currently being treated optimally. Therefore, new therapeutic drug options are desired in the world, and medical cannabis has come to be used in it.

You may be reluctant to see the word cannabis, but many components can be extracted from the plant cannabis, and tetrahydrocannabinol (THC) and cannabidiol (CBD) are mainly used as medicines. It has been. In particular, cannabidiol (CBD) is said to have no euphoric or psychological side effects (so-called high mood-like effects) associated with the word cannabis, and has recently become a new genre of epilepsy treatment. It is attracting attention. The actual expected effect is a reduction in seizure development, and in fact cannabidiol (CBD) has been approved for the treatment of refractory epilepsy (Dravet syndrome, Lennox-Gastaut syndrome) in the United States and Europe. .. The detailed mechanism of action of cannabidiol will be described later, but there is also research on inhibiting the function of nerves that cause seizures, and it may be applied to various epilepsy in the future.

Treatment of cannabis components in the treatment of epilepsy in Japan

Currently, cannabis ingredients are not used in the treatment of epilepsy in Japan. The reason is that the cannabis control law enacted in 1948 prohibits the manufacture of pharmaceuticals containing cannabis raw materials (excluding dried stems and seeds), as well as research such as clinical trials in Japan. Because of that. This is regulated regardless of the presence or absence of psychotropic effects (effects that make you feel high), so the Japan Epilepsy Association is requesting a review. According to the association, a request for approval of the drug “ Epidiolex” using cannabidiol was submitted to the Minister of Health, Labor and Welfare on September 5, 2019, led by a group of patients suffering from intractable epilepsy. Seems to be there. As science is advancing day by day, I hope it will be reviewed as soon as possible, but it may take some time before the cannabis component can be used as a treatment for epilepsy in Japan due to the need to change the law.

Effect of medical cannabis on epilepsy

Drugs have various effects on the body, and when a drug acts to promote a certain reaction, it is called an agonist, and when it acts to suppress a certain reaction, it is called an antagonist. Although the site of action of cannabidiol is still unknown, it excites nerves by acting as an agonist or antagonist on ion channels in the brain and other receptors involved in neurotransmission, rather than cannabinoid receptors. It has been found to be effective in suppressing it. According to Mohammad-Reza Ghovanloo et al. (2018), it has been reported that it has an action of inhibiting sodium channels in the brain, and phenytoin, carbamazepine, lamotrigine, zonisamide, etc. are also antiepileptic drugs having a strong action of inhibiting sodium channels. However, cannavidiol is thought to have a more complex effect because it is not the only one.

Examining the effects of cannabidiol based on papers, cannabidiol is more intractable than placebo in the meta-analysis of Lattanzi, Simona et al. (2018) (the one with the highest level of evidence in the study). It reports that it significantly reduced the incidence of seizures in epilepsy. I think that side effects are of concern here, but the rate of side effects is about 15% higher in the cannabidiol-administered group than in the placebo group. However, the side effects that have occurred do not seem to be worse than existing treatments such as drowsiness, loss of appetite, and diarrhea.

Epilepsy treatment available in Thailand

So far, I’ve mentioned that medical cannabis is certainly effective and does not have the psychotropic side effects (high mood effects) that you might imagine from the word cannabis. We also paid attention to the fact that the effect has already been noticed overseas and it has been put into practical use, but it is not possible to use it in Japan even though the demand is increasing.

Here, I focused on Thailand, which can be treated with medical cannabis and is focusing on medical tourism. It seems that there are 50,000 Japanese residents in Bangkok, Thailand, and especially Bangkok Hospital accepts as many as 27,000 Japanese patients annually. In addition, a Thai doctor who graduated from Japanese medical school is working.

When considering treatment overseas, I think that the “language barrier” and the “relationship between spending and quality of medical care” are the major concerns. However, I think that this anxiety will be resolved if I can not only explain my worries and symptoms in Japanese but also receive treatment from a doctor who trained in Japan.

reference

Simona Lattanzi, Francesco Brigo, Eugen Trinka, Gaetano Zaccara, Claudia Cagnetti, 

Cinzia Del Giovane et al. Efficacy and Safety of Cannabidiol in Epilepsy: A Systematic Review and Meta-Analysis

Mohammad-Reza Ghovanloo, Noah Gregory Shuart, Janette Mezeyova, Richard A. Dean, Peter C. Ruben, and Samuel J. Goodchild. Inhibitory effects of cannabidiol on voltage-dependent sodium currents

Epilepsy Information Center “What is Epilepsy Syndrome?”

Japan Epilepsy Association

Japan Epilepsy Association “Epidiolex ® CBD: Request for Cannabidiol Drug Approval”

Japan External Trade Organization JETRO “Opening a highly specialized international hospital, expecting an increase in medical tourism”

 

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