[DIAGNOSIS AND TREATMENT OF A GIRL SUFFERING FROM DRUG RESISTANT EPILEPSY WITH AN INNOVATIVE MINIMALLY INVASIVE APPROACH].

INTRODUCTION: About one percent (over 81,000 patients) of the Israeli population suffer from epilepsy. The main treatment for this condition is medication, but about a third of the patients suffer from drug-resistant epilepsy (DRE). Each year about 5,000 new patients are diagnosed with epilepsy, of whom 3,000 are children. For these patients, an evaluation in designated centers is required in order to diagnose possible foci and propose neurosurgical treatment alternatives. BACKGROUND: A model for diagnosis and treatment of the epileptic network in a minimally invasive approach is presented through the description of a case study. Phase I: includes diagnosis of the semiology, neuropsychological assessment, video EEG recording and performing a PET-MRI-FMRI-EEG synchronized examination. Phase II: involves stereo-electroencephalography (SEEG) minimally invasive diagnosis to target the epileptic area and accurately map adjacent functional areas and assessment of cortical redundancy. Phase III: includes radiofrequency ablation of the foci without any further surgery. This procedure is performed under clinical monitoring (the patient is awake during treatment) and continuous EEG monitoring. CONCLUSIONS: This case study demonstrates the multi-dimensional model performed by a multidisciplinary team, combining innovative technologies. This model is essential for the precision of the diagnosis and treatment methods of focal epilepsy and allows preservation of function based, among other factors, on the identification of cortical redundancy. DISCUSSION: The preoperative assessment identified focal epilepsy adjacent to the motor area dominating the right hand. A combined PET-FMRI-MRI-EEG examination enabled detecting redundancy of motor functions beyond the epileptic focus. Based on this information, a targeted implantation of depth electrodes (SEEG) was performed, the epileptic foci were identified and targeted ablations were performed during clinical monitoring and continuous EEG. This resulted in the cessation of seizures in parallel with the disappearance of the pathological signal in the EEG, all while preserving the patient's hand function.

CBD-enriched medical cannabis for intractable pediatric epilepsy: The current Israeli experience.

PURPOSE: To describe the experience of five Israeli pediatric epilepsy clinics treating children and adolescents diagnosed as having intractable epilepsy with a regimen of medical cannabis oil. METHODS: A retrospective study describing the effect of cannabidiol (CBD)-enriched medical cannabis on children with epilepsy. The cohort included 74 patients (age range 1-18 years) with intractable epilepsy resistant to >7 antiepileptic drugs. Forty-nine (66%) also failed a ketogenic diet, vagal nerve stimulator implantation, or both. They all started medical cannabis oil treatment between 2-11/2014 and were treated for at least 3 months (average 6 months). The selected formula contained CBD and tetrahydrocannabinol at a ratio of 20:1 dissolved in olive oil. The CBD dose ranged from 1 to 20mg/kg/d. Seizure frequency was assessed by parental report during clinical visits. RESULTS: CBD treatment yielded a significant positive effect on seizure load. Most of the children (66/74, 89%) reported reduction in seizure frequency: 13 (18%) reported 75-100% reduction, 25 (34%) reported 50-75% reduction, 9 (12%) reported 25-50% reduction, and 19 (26%) reported <25% reduction. Five (7%) patients reported aggravation of seizures which led to CBD withdrawal. In addition, we observed improvement in behavior and alertness, language, communication, motor skills and sleep. Adverse reactions included somnolence, fatigue, gastrointestinal disturbances and irritability leading to withdrawal of cannabis use in 5 patients. CONCLUSIONS: The results of this multicenter study on CBD treatment for intractable epilepsy in a population of children and adolescents are highly promising. Further prospective, well-designed clinical trials using enriched CBD medical cannabis are warranted.