Improving the use of IT in the NHS
Authors: Phil Leonard
Journal: BMJ (2009)

<h3>Objective:</h3> To investigate changes in brain temperature (T<sub>CRE</sub>) in patients with treatment resistant epilepsy (TRE) who receive Cannabidiol (CBD). <h3>Background:</h3> CBD’s efficacy in TRE may stem from targeting neuroinflammation. Brain temperature elevations (T<sub>CRE</sub>=−102.61(Δ<sub>H20−CRE</sub>)+206.1°C) may be considered a proxy for neuroinflammation and can be non-invasively mapped using magnetic resonance spectroscopic imaging and thermometry (MRSI-t). Although MRSI-t studies have documented T<sub>CRE</sub> elevations in TRE patients’ seizure onset zones (SOZs), no study has investigated if T<sub>CRE</sub> are affected by a treatment that has anti-inflammatory effects (CBD). <h3>Design/Methods:</h3> Five adults aged 20 – 43 years (3 females) with TRE were imaged at 3T before (baseline) and after 12-weeks of CBD (on-CBD). Data were processed within the Metabolite Imaging and Data Analysis System software package. Voxelwise brain temperature calculations generated 3D T<sub>CRE</sub> maps; voxelwise subtraction maps visualized each participants’ baseline vs. on-CBD T<sub>CRE</sub> changes. Mean T<sub>CRE</sub> was also estimated for 47 atlas-defined brain regions and evaluated using repeated measures t-tests. The Chalfont Seizure Severity Scale (CSSS) evaluated CBD efficacy and medical records provided seizure frequency. Mood was assessed using the Total Mood Disturbance (TMD) score on the Profile of Mood States (POMS). Repeated measures t-tests computed changes in seizure symptoms and mood. <h3>Results:</h3> Baseline T<sub>CRE</sub> elevations (&gt;37.5°C) were localized to clinically implicated seizure generation and/or propagation sites. All participants’ seizure severity (<i>p</i>=0.015) and brain temperature (<i>p</i>&lt;0.0001) decreased from baseline to on-CBD. There was also a non-significant decrease in POMS TMD. <h3>Conclusions:</h3> MRSI-t documented T<sub>CRE</sub> decreases in patients treated with CBD for treatment-resistant epilepsy. The observed effects may be related to CBD exposure, decreased seizure frequency/severity, or both. T<sub>CRE</sub> derived from MRSI-t may be a promising imaging-based biomarker for tracking neuroinflammation in patients with neurological conditions including epilepsy. Future findings from this on-going study will provide critical insights into CBD’s effects in the human brain. <b>Disclosure:</b> Mrs. Sharma has nothing to disclose. Dr. Szaflarski has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for UCB Pharma. Dr. Szaflarski has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for SK Life Sciences. Dr. Szaflarski has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for LivaNova Inc. Dr. Szaflarski has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Serina Therapeutics. Dr. Szaflarski has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for GW Biosciences. An immediate family member of Dr. Szaflarski has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for GW Biosciences. Dr. Szaflarski has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Szaflarski has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Law Firm. Dr. Szaflarski has stock in AdCel Biopharma, LLC. Dr. Szaflarski has stock in iFovea.