News in brief: Medical cannabis pain protocols; More pregnancy data required on epilepsy surgery; Subcutaneous EEG looks promising

15 Jul 2021

Medical cannabis pain protocols available

Consensus-based recommendations have been developed to guide dosing and administration of medical cannabis for the treatment of patients with chronic pain.

The panel of 20 experts from around the world included Australian pain medicine specialists Dr Peter Georgius and Associate Professor Malcolm Hogg.

The panel developed three protocols for medical cannabis – a routine protocol for most patients, a conservative protocol for clinically frail patients or those with complex comorbidities, and a rapid protocol for urgent management of severe pain, palliation or for patients with a significant prior use of cannabis.

Safety considerations rule out patients with psychotic disorders, unstable cardiovascular disorders and pregnant or breastfeeding women.

There was no consensus regarding minimum or maximum age limits for CBD use or minimum age for THC use.

Journal of Cannabis Research

More data required on epilepsy surgery ahead of pregnancy

Previous epilepsy surgery does not appear to guarantee better seizure-control during subsequent pregnancies, according to an Australian registry study.

The study compared 74 pregnancies in women with surgically treated focal epilepsy and 1,013 pregnancies in women with medically treated epilepsy.

Seizures of all types, and also convulsive seizures, were less well controlled during pregnancy in the previously surgically treated cases.

The findings were inconsistent with an Indian study which had previously found seizures increased more often during pregnancy in the non-surgically managed women than in the post-surgery ones (39.6% v 14.9%).

“Until larger data sets become available, the above analysis suggests that it may be premature to conclude that previous epilepsy surgery will necessarily be associated with a better chance for a subsequent seizure-free, or seizure- well-controlled, pregnancy, a highly desirable outcome though that be,” the Australian investigators concluded.

Acta Neurol Scand

Subcutaneous electroencephalography looks promising

Ultra long-term subcutaneous electroencephalography (sqEEG) has been shown to deliver signal stability and consistent impedance measurements and frequency band power.

The study comprised 14 adults with refractory epilepsy and 12 healthy controls using the 24/7 EEG SubQ system for up to 41 months.

“This represents a major technological advance in EEG monitoring, overcoming a significant limitation of scalp electrodes which require regular attention by EEG technologists,” the study said.

“The consistency of sqEEG recordings highlights their potential usefulness for other clinical applications, including, for example, as a brain-computer interface (BCI) system.”


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