seiures cannabinoids first seizure to treat or not to treat

1. Debate 1:
Epilepsy and Marijuana
1- Exogenous Cannabinoids Is Anti-covulsant
Verus Pro-convulsant.
2- Endocannabinoids Verus Exogenous One Is
Anti- convulsant versus psychoactive effect .

2. Conculsion: Strategies that enhance the ability to release
cannabinoids when and where needed, or to prolong the
activity of endogenous cannabinoids only where naturally
released, may hold greater promise for effectively enhancing
the brains own strategies for regulation of excitability.
Epilepsy and Marijuana

3. Epilepsy and Marijuana
CONCLUSION
The relation between marijuana and epilepsy is still controversial. Despite
limited evidences of its efficacy, some patients with epilepsy believe that it can
be an alternative therapy for their seizures. Marijuana can both have anti and
pro-convulsive actions and it has psychoactive components. Some psychotropic
substances may not be necessary for the efficacy of marijuana for controlling
seizures. Future medicinal preparations of cannabis used for epilepsy may have
other active constituent, separating psychoactivity from anticonvulsant effects.

4. With
 Wada et al.,
demonstrated that 9THC
may have a prophylactic
activity in preventing
amygdaloid kindled cats,
Cannabis also have
anticonvulsant
properties through
presynaptic expression of
GABAergic activity.
Against
 Cannabionoids seem to
be ineffective in fully
developed kindled
amygdaloid seizures.
Cannabionoids bind to
CB1 receptors and
modulate neuronal
excitability. This modulation
can be excitatory through
presynaptic expression of
glutamtergic activity.
Epilepsy and Marijuana

5. Debate 2 :
First Seizure To Treat Or Not To Treat ………is it still
the question??
High risk seizures are still debatable to treat
or not to treat depending on risk of recurrence
on long term or short term outcome versus
adverse effect of AEDs

6. First Seizure To Treat Or Not To Treat??
To date, there is a consensus that immediate or delayed treatment after a first
seizure does not impact the long-term outcome of the seizure disorder.
In contrast, immediate treatment prolongs the time to a first breakthrough
seizure and increases the percentage of patients that reach an earlier 2-year
remission.
These conclusions were obtained from one single-center study (2) and four
multicenter, randomized studies that included both children, aged 2 years and
older, and adults, including elderly people aged 60 years and older. (3–5).

7. First Seizure To Treat Or Not To Treat??
High risk seizure:

8. First Seizure To Treat Or Not To Treat??
Benefits of early versus deferred treatment
Immediate AED treatment in high risk seizure reduce
the incidence of of seizure recurrence in short term 30-
50% . Studies suggest that it has little impact on long
term out come.
However the questionnaires demonstrated significant
trade of between the adverse effects of taking AEDs
versus seizure adverse effects, suggesting that
individual patient and physician preference should be
considered.