Cannabinoid treatments in epilepsy and seizure disorders.

Cannabis has been used to treat convulsions and other disorders since ancient times. In the last few decades, preclinical animal studies and clinical investigations have established the role of cannabidiol (CBD) in treating epilepsy and seizures and support potential therapeutic benefits for cannabinoids in other neurological and psychiatric disorders. Here, we comprehensively review the role of cannabinoids in epilepsy. We briefly review the diverse physiological processes mediating the central nervous system response to cannabinoids, including Δ9-tetrahydrocannabinol (Δ9-THC), cannabidiol, and terpenes. Next, we characterize the anti- and proconvulsive effects of cannabinoids from animal studies of acute seizures and chronic epileptogenesis. We then review the clinical literature on using cannabinoids to treat epilepsy, including anecdotal evidence and case studies as well as the more recent randomized controlled clinical trials that led to US Food and Drug Administration approval of CBD for some types of epilepsy. Overall, we seek to evaluate our current understanding of cannabinoids in epilepsy and focus future research on unanswered questions.

Freehand external ventricular drain insertion - is there a learning curve?

BACKGROUND: Accuracy of freehand insertion of external ventricular drains (EVDs) is influenced by many factors including etiology and presence of midline shift. We sought to assess if junior neurosurgical trainees' performance in accurately inserting EVDs improves with experience, using a radiological grading system. METHODS: EVD insertion procedures from the first 3 years of training were identified from the operative logbooks of three trainees. Postoperative CT head scans were graded for accuracy of placement and intraventricular catheter length. RESULTS: 40 frontal EVDs performed primarily by the trainees were identified, after 34 assists, revision surgeries, parietal, or occipital insertions were excluded from the study. The mean number (±1 SD) of procedures was 7.7 ± 4.5 at ST3, 4.7 ± 2.5 at ST2, and 1 ± 1 at ST1. About 80% of EVDs were optimally inserted. There was no statistically significant difference in placement accuracy between the three training grades (P = 0.669), nor any difference in intraventricular catheter length (P = 0.697). There were no statistically significant differences between surgeons' accuracy at each grade. CONCLUSION: We report good accuracy of EVDs tip position inserted by junior neurosurgery trainees. Trainees perform more procedures independently as they progress in their career. Further studies including senior years of training performance, other procedure factors and outcome should be considered.