PICOT and Problem Statement
Discussion
This study looked to evaluate the effectiveness of using cannabinoids as antiseizure drugs in epileptic patients by comparing the effectiveness of cannabis-based agents against that of traditional medications. The study took the form of a systemic review. In the study, the researcher looked for articles that fulfilled particular criteria and used them as a basis for the study.
The researcher reviewed six articles. Of the six articles reviewed, five directly concluded that the cannabinoids were effective in preventing epileptic seizures. Two of the articles reviewed found that cannabinoids are more effective than traditional medications on dealing with seizures that are resistant to the current antiepileptic drugs (AEDs). Moreover, other articles confirmed that cannabinoids have much lesser side effects compared to the conventional AEDs. AEDs are among the drugs that have the most side effects. In addition, one article suggested that apart from having much lesser side effects themselves, cannabinoids have the potential to relieve the side effects of the other conventional AEDs. Additionally, among the most important issues with AEDs in clinical practice is their interaction with other drugs; Geffrey et al. (2015), however, asserts that cannabinoids can interact with other drugs without causing adverse events. In their study, Geffrey et al. (2015) confirmed that clinicians could effectively combine cannabinoids with clobazam – a benzodiazepine. Two of the articles reviewed revealed that cannabinoids are highly effective as anti-seizure drugs in pediatric patients. Even though cannabinoids have a potential for misuse, regulation of the utilization of these drugs can reduce this potential for misuse hence enhancing their effectiveness as AEDs.
Suraev et al. (2017) confirmed that cannabinoids are more effective than traditional AEDs; they also compare their results with one past study to increase the validity of their study. Two of the other studies also enhance their validity by comparing their results to those of past studies (Kimberlin & Winetrstein, 2008). The studies included in this study included two cohort studies and four cross-sectional design studies. Cohort studies have a higher validity since they directly compare results and it is possible to establish causality (Kimberlin & Winetrstein, 2008). Even though cross-sectional studies are not able to establish temporality or causality, they offer a level comparative basis. Thus, such studies have relative high effectiveness and thus can be used to compare the effectiveness of the cannabinoids compared to traditional AEDs.
The studies reviewed had several limitations. Geffrey et al. (2015) did not rule out the possibility of non-compliance among patient participants. Non-compliance is an important confounding factor which could potentially limit the effectiveness of their study. The selection criteria utilized by Porter and Jacobson (2013) could not rule out the possibility that the parents of the participants were biased towards cannabinoids. The researchers used a convenience sample hence a possibility of selection bias. Suraev et al. (2017) also used a convenience sample hence a major limitation of their study; the inclusion of only participants who experienced positive outcomes with cannabinoids biased the results towards cannabinoids. In their study, Devinsky et al. (2015) used the frequency of nocturnal seizing as reported by the patients as a basis for comparing the effectiveness of AEDs; they could not, however, elaborate, on how they ascertained nocturnal seizures. Massot-Tarrus and McLachlan (2016) also had the same problem; their study could not ascertain the concentration of cannabinoids used by their participants. Press et al. (2015) also could not ascertain the various clinical features that they examined since they were reported by the participants; it is possible that the participants were subjective in their responses hence decreasing the validity of the study. Despite their various limitations, the criteria for selection of the articles ensured selection of the best articles. Thus, the results of the study are highly valid and reliable.
References
Devinsky, O., Marsh, E., Friedman, D., Thiele, E., Laux, L., Sullivan, J., … & Wong, M. (2016). Cannabidiol in patients with treatment-resistant epilepsy: an open-label interventional trial. The Lancet Neurology, 15(3), 270-278.
Geffrey, A. L., Pollack, S. F., Bruno, P. L., & Thiele, E. A. (2015). Drug-drug interaction between clobazam and cannabidiol in children with refractory epilepsy. Epilepsia, 56(8), 1246-1251. DOI: 10.1111/epi.13060
Kimberlin, C. L., & Winetrstein, A. G. (2008). Validity and reliability of measurement instruments used in research. American Journal of Health-System Pharmacy, 65(23). DOI 10.2146/ajhp070364
Massot-Tarrús, A., & McLachlan, R. S. (2016). Marijuana use in adults admitted to a Canadian epilepsy monitoring unit. Epilepsy & Behavior, 63, 73-78.
Porter, B. E., & Jacobson, C. (2013). Report of a parent survey of cannabidiol-enriched cannabis use in pediatric treatment-resistant epilepsy. Epilepsy & Behavior, 29(3), 574-577.
Press, C. A., Knupp, K. G., & Chapman, K. E. (2015). Parental reporting of response to oral cannabis extracts for treatment of refractory epilepsy. Epilepsy & Behavior, 45, 49-52.
Suraev, A. S., Todd, L., Bowen, M. T., Allsop, D. J., McGregor, I. S., Ireland, C., & Lintzeris, N. (2017). An Australian nationwide survey on medicinal cannabis use for epilepsy: History of antiepileptic drug treatment predicts medicinal cannabis use. Epilepsy & Behavior, 70, 334-340.
