Abstracts

Rationale: One third of epilepsy patients suffer from medically refractory epilepsy (MRE) characterized by frequent seizures unresponsive to medical intervention, neurodevelopmental delays, and impaired quality of life. Patients with treatment-resistant epilepsies often face numerous comorbidities associated with their condition further impacting their quality of life. New developments in anti-epileptic drugs (AEDs) have not significantly reduced the number of medically refractory patients nor significantly improved quality of life for these patients. Previous studies have suggested cannabidiol (CBD) to be an effective and well-tolerated treatment option for MRE patients. Methods: From our large, multi-site regional epilepsy program, 33 MRE patients were registered for the New York Medical Marijuana program in the past year and were entered into our study. Of the 33 registered patients, 27 patients (81%) were successfully contacted (age range 3-48, 19M, 8F). The average number of previously used AEDs was 5.43 for this cohort. The patients in this program were registered for use of a select formula of CBD and tetrahydrocannabinol at a 20:1 ratio.Patients were contacted and given a questionnaire pertaining to the effect of medical marijuana (MMJ) on change in overall quality of life, epilepsy, mood, sleep, appetite, stress, sedation, anxiety, and aggression. Patients were also asked to compare the cost and convenience of obtaining MMJ to previous AEDs. Each response was quantified on a scale of 1 to 5: 1 indicating that the use of MMJ had made the condition much worse, 3 indicating a neutral response, and 5 indicating that MMJ made the condition much better. The average response score were calculated for each category presented on the survey. An ongoing follow-up study will qualify their responses based on normative tests for each parameter, i.e. the QOLIE/QOLCE.   Results: Of the 27 patients successfully contacted, 17 indicated they had used MMJ for more than a month, 4 indicated that they were not using MMJ because they could not afford it, 4 declined to answer the survey, 1 patient indicated they had recently begun treatment and were exempt from the study, and 1 patients contact information had changed. The majority reported an improvement in overall quality of life (n=13, 76%, avg score of 4.24), epilepsy (n=12, 70%, avg score of 4.12), mood (n=12, 70%, avg score of 4.06), quality of sleep (n=12, 70%, avg score of 4.00), and appetite (n=12/17, 70%, avg score of 3.94). Less than half reported an improvement in stress (n=8, 47%, avg score of 3.71) and sedation (n=8, 47%, avg score of 3.65).  A  smaller group noted improvement in anxiety (n=4, 23%, avg score of 3.35) and aggression (n=2, 11%, avg score of 3.12). The majority reported that MMJ was more expensive than other AEDs (n=15, 88%, avg score of 1.59). More than half reported that obtaining MMJ was  difficult (n=10, 58%, avg score of 2.29). 1 patient discontinued use due to lack of efficacy. Conclusions: The results of this study suggest that MMJ may be a promising candidate for the treatment of epilepsy and its associated comorbidities when used in conjunction with AEDs in MRE patients. This study suggests MMJ may improve overall quality of life, epilepsy, and comorbidities associated with epilepsy. The high out-of-pocket costs and lack of insurance coverage associated with this treatment has been a major concern and deterring factor in patients participating in this study. Although this study lacks controls and is based on self-reporting, it serves as a pilot study for a larger study to quantify the effects of MMJ treatment on MRE and its comorbidities.  Funding:  Internal research funding ( J. Paolicchi) and Binghamton University Summer Research Grant (A. Papalia)