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Ask The Pharmacist: Alternative treatments for seizure management

Suzy Cohen
Columnist

Epilepsy is frustrating and difficult on one’s life. It can show up many ways, from mild absence seizures, to grand mal, to cyclic vomiting and nocturnal seizures.

Medications such as gabapentin, phenytoin, valproate, topiramate, carbamazepine and others may control symptoms for a while, but they’re not a cure. No one has the answer to all types of seizures, because the origin differs. 

Knowing what raises or lowers your threshold becomes imperative to reducing frequency. For example, becoming dehydrated, upset or taking too hot a shower can trigger a seizure.

A screenshot of a patient's Fitbit activity tracker shows his heart rate spiked around the same time as his seizure earlier in the day.

Sleep deprivation, a stressful interaction with someone or too much glutamate or caffeine can all reduce your seizure threshold, causing an episode.

Here are some popular medications that reduce seizure threshold and increase seizure frequency: antihistamines, insulin and diabetes medications, oxytocin, maprotiline, clomipramine, clozapine, lithium, fluoroquinolone antibiotics, methylphenidate, metronidazole or tinidazole and schizandra herb.

Animal research suggests that impaired methylation (reduced folate, which is not folic acid by the way) can damage the hippocampus and result in post-seizure memory loss. Reduced folate transport to the brain led to seizures, cognitive impairment, immune suppression, and anemia in a 7-year old girl. When the child was given a little methylfolate (not folic acid), her condition substantially improved.
You can protect your brain from seizures naturally. Consider compounds known to raise threshold, reducing seizure incidents: magnesium, omega 3 fish oils, grape seed extract, CBD or cannibidiol, an extract from marijuana.

That last one might shock you, as it is from marijuana but CBD, a non-psychoactive hemp extract is federally legal now since President Trump recently signed the bill. That means that people in pain, and those with seizures have easier access and possibly a cure. 

Image source: Getty Images.
After years of research involving large, scientifically controlled studies, marijuana-derived medicine may be finally coming of age. If so,  GW Pharmaceuticals   (NASDAQ: GWPH)  and  Insys Therapeutics   (NASDAQ: INSY)  -- two publicly traded drugmakers that are researching marijuana medicine -- could benefit handsomely.
So far, however, it's only GW Pharmaceuticals' shares that are on the upswing. A troubled past that includes investigations into Insys Therapeutics' marketing of the opioid pain-killer Subsys has caused its shares to crash more than 50% in the past year. Meanwhile, GW Pharmaceuticals shares have more than doubled on reports that its marijuana drug, Epidiolex, successfully reduces seizures in rare forms of epilepsy.
Let's take a closer look at why these two stocks have been heading in different directions.

Image source: Getty Images.
GW Pharmaceuticals delivers wins
In 2015, GW Pharmaceuticals reported that its THC-based medicine Sativex failed to beat a placebo in phase 3 studies evaluating its use in cancer pain patients. While that failure cast doubt on the future of marijuana as medicine, a wave of success this year has ignited optimism that marijuana could reshape how doctors treat rare forms of epilepsy.
Epidiolex, a purified version of a non-psychoactive chemical cannabinoid found in marijuana known as cannabidiol, or CBD, has been proven to effectively reduce monthly seizure rates in patients diagnosed with both Dravet syndrome and Lennox-Gastaut syndrome.
GW Pharmaceuticals reported in March that patients participating in a Dravet syndrome trial saw a 39% decline in their monthly seizure rate and since then, the company has reported significant declines in seizure rates for patients diagnosed with Lennox-Gastaut syndrome participating in two separate trials.
In the first Lennox-Gastaut trial, drop seizures in Epidiolex patients declined 44%, and in the second trial, drop seizures declined by 42%.
The results are potentially transformative given that both Dravet syndrome and Lennox-Gastaut syndrome are particularly hard to treat. For example, patients participating in the second Lennox-Gastaut trial had previously tried and failed an average of seven anti-epileptic medicines.
Although the addressable patient population diagnosed with these rare forms of epilepsy is small, the wins suggest that CBD may play a significant role in the future in treating epilepsy. As a result, GW Pharmaceuticals' share price has more than doubled this year.

Image source: Getty Images.
Struggling to get back on track
In July, Insys Therapeutics' won a FDA green light to begin marketing Syndros, a liquid formulation of the long-standing marijuana medicine marinol. Marinol is used to treat anorexia in AIDS patients and chemotherapy-induced nausea and vomiting in cancer patients. Syndros' oral dosing provides dosing and bioavailability advantages that could allow it to win a significant share of the $200 million marinol market.
Despite Syndros' potential to boost sales, Insys Therapeutics shares have fallen sharply this year because of ongoing investigations into the company's marketing of Subsys, a commonly used fentanyl spray. Subsys is approved for use in breakthrough cancer pain, however, a series of revelations show that the company's sales team engaged in practices to boost Subsys' use in other pain indications.
Last November, CEO Michael Babich was shown the door following a CNBC expose on the investigations into reported kickbacks to doctors and since then, EVP and Chief Operating Officer Dan Brennan has left the company and former district sales manager Jeffery Perlman has been arrested. Last month, Insys CEO and founder John Kapoor announced he'll be stepping down as soon as a successor is found, too.
The fallout comes at a particularly tough time for the company. Rising concern over opioid abuse has led to a significant drop in demand for fentanyl drugs, including Subsys.
In the second quarter, Subsys sales tumbled 13.5% year over year to $67.1 million, reversing a long-standing trend of double-digit sales growth in previous periods. Subsys' sales decline puts additional pressure on the company to hit the ground running with Syndros and to advance other drugs in development, including a buprenorphine spray and CBD products for epilepsy -- something that may be jeopardized by the company's revolving leadership.
A big year ahead
GW Pharmaceuticals plans to file for FDA approval of Epidiolex in Dravet syndrome and Lennox-Gastaut syndrome early next year and that timeline suggests that the company could launch Epidiolex in late 2017 or early 2018. The company is also studying Epidiolex in other forms of epilepsy, and trial results from those studies could also be announced in the coming year.
Meanwhile, falling opioid prescription volume or a stumble out of the gate for Syndros could keep Insys Therapeutics back on its heels. Additional news regarding investigations into Insys' past marketing practices and trial results could cause Insys Therapeutics' shares to swing wildly in the coming year.
In both of these cases, the coming year may be pivotal. A market cap of $2.7 billion sets the bar pretty high for GW Pharmaceuticals' Epidiolex. The bar is set pretty low for Insys Therapeutics, but it needs to get leadership in place that can resolve the Subsys overhang and capitalize on its various research programs.   Todd Campbell  owns shares of Insys Therapeutics.   Todd owns E.B. Capital Markets, LLC. E.B. Capital's clients may have positions in the companies mentioned.     Like this article? Follow him on Twitter where he goes by the handle  @ebcapital      to see more articles like this.   The Motley Fool has no position in any of the stocks mentioned. Try any of our Foolish newsletter services  free for 30 days . We Fools may not all hold the same opinions, but we all believe that  considering a diverse range of insights  makes us better investors. The Motley Fool has a  disclosure policy .     The Motley Fool is a USA TODAY content partner offering financial news, analysis and commentary designed to help people take control of their financial lives. Its content is produced independently of USA TODAY.     Offer from the Motley Fool:   A secret billion-dollar stock opportunity

Fish oils are essential for cell membrane stability in trillions of your cells. They’re critical for neurological function and work by reducing nerve irritation or excitability in the brain. This means that your nerves aren’t so easily over stimulated and seizure-inducing compounds are less likely to be released.

In 2015, a case-controlled study involving 70 children was published in the New American Journal of Medical Science. The kids all had uncontrolled, chronic seizures. Thirty-five of the children were given omega 3 fish oil (containing EPA and DHA), while everyone else received a placebo. After three months, the number of children without seizure activity went from no one to 57 percent. No improvements happened in the placebo group.  

Another study confirmed omega 3’s benefits for epilepsy in adults. In this study, participants with drug-resistant seizures took about 1,000 mg omega 3 fish oils supplements every day.  This went on for three different ten-week treatment periods. There was an incredible 34% reduction in seizure frequency compared to the placebo group. 
Fish oil isn’t the only “brain food” for epilepsy. Grape seed extract is another protective compound. It protects your hippocampus which houses one of your seizure ‘switches.’ Grape seed extract turns off the seizure switch. Finally, keep in mind that chamomile, ginkgo and St. John’s wort may interact with your medication. 

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Suzy Cohen is a registered pharmacist. The information presented here is not intended to treat, cure or diagnose any condition. Visit SuzyCohen.com.