One in 26. That’s the number of people who will develop epilepsy in their lifetime. Each November, Cook Children’s Comprehensive Epilepsy Program creates original T-shirt designs to raise epilepsy awareness. This year’s theme is “Lights, camera, take action!”

Megan was the “one.” She was born in 1997. Her mom, Mary Overfield, had a healthy full-term pregnancy. However, shortly after birth, Megan began experiencing infantile spasms and was later diagnosed with a rare form of epilepsy, Lennox-Gastaut Syndrome (LGS), at 4 years old. At 16, genetic testing revealed that Megan also had a rare genetic anomaly known as PURA Syndrome.

“Megan was included in the first genetic study of this particular anomaly at Baylor College of Medicine in 2014 which became identified as PURA syndrome,” Mary said.

Sadly, Megan passed away earlier this year at the age of 26. Despite her struggles with LGS and other medical complexities, Mary said Megan was a bright light in her life – as well as the lives of her husband, Dane, and their older daughter, Emily.

“She always showed the strongest spirit,” Mary said, “Megan taught all three of us many important life lessons without ever saying a word.”

While Megan never received care at Cook Children’s, her family had a special bond with Cook through the annual epilepsy awareness T-shirt campaign. This year’s design celebrates that connection and Megan’s story.

Parenting a child with special health care needs

Being a specialized caregiver around the clock can be very isolating and take a toll on one’s health. Mary said she joined Twitter (now X) shortly after its launch when Megan’s health care team recommended social media as a way to connect with other families facing similar challenges.

“I found a great deal of support on Twitter, connecting with foundations, epileptologists, medical professionals and other families like ours,” Mary said. “I started feeling less isolated in my parenting journey. Our family connected with the LGS Foundation and found Executive Director Tracy Dixon-Salazar, among others there, to be an amazing source of helpful information, understanding and support.”

Discovering Cook Children’s and raising epilepsy awareness

Mary and Emily have been raising epilepsy awareness for many years. They came across M. Scott Perry, M.D., a pediatric epileptologist and head of Neurosciences at the Jane and John Justin Institute for Mind Health at Cook Children’s, on social media. Dr. Perry's annual T-shirt fundraiser each fall raises epilepsy awareness and support for Cook Children’s Comprehensive Epilepsy Program. 

“We purchased Dr. Perry’s first epilepsy awareness T-shirts years ago and every fall we eagerly await to learn the unique themes and designs for his annual T-shirt fundraiser with Cook Children’s,” Mary said.

International LGS Awareness Day

November is National Epilepsy Awareness Month and November 1^st is International LGS Awareness Day and Illuminate for LGS Awareness. Mary and her family illuminate their home with purple lights all month to educate and raise awareness for epilepsy and LGS.

“Megan always had purple string lights hung above her bed for the month of November and we have purple outdoor lights as well as our LGS awareness yard sign for the whole month,” Mary said. “Emily wears—and Megan also wore—the annual T-shirts designed by Dr. Perry and the LGS Foundation. Emily has always been a fierce advocate for her sister, including her in as much of life as possible and continues raising awareness for rare epilepsies.”

Mary and her family live in Rochester, New York, and she said the city also lights up for LGS in purple and green lights on November 1.

“We feel it is important to raise awareness as the experts work towards a cure for rare epilepsies,” Mary said.

LGS clinical studies

With Megan experiencing LGS and PURA syndrome, she has contributed to a handful of clinical studies.  

“Megan participated in multiple clinical trials for new antiseizure medications (ASMs) over the years as we feel both research and seizure cessation are integral to ending rare epilepsies,” Mary said.

At Cook Children's, Cynthia Keator, M.D., Medical Director of Neurology at the Justin Institute, was recently awarded an Endowed Chair from the W.I. Cook Foundation for her proposal to establish a Lennox-Gastaut Syndrome Center of Excellence.

Through this clinical program, Dr. Keator aims to create a natural history study to better define the course of epilepsy and other non-seizure symptoms of LGS. She’s also working with the Pediatric Epilepsy Research Consortium (PERC) to develop a national consensus on LGS treatment and care. The goal is to bring attention to health care decisions and co-existing conditions, or comorbidities, not targeted by current therapies in LGS as well as support needs for preventative intervention to develop new guidelines, treatments and protocols.

Advice for other families

Reaching out to organizations like the LGS Foundation and staying educated can help families feel connected and understood in their own journeys. Mary also encourages families to take life one day at a time and to enjoy the “infrequent, but happy moments when they occur.”

“Megan enjoyed numbers and counting, reading books, playing her chimes and many other simple joys in life,” Mary said. “She always reminded us to enjoy the little things, especially when she was powering through a particularly hard seizure day. Dane and I agree that we would all be very different people had Megan not been born into our lives.”

Remembering Megan

Mary and her family feel fortunate that they had 26 more years with Megan than they were promised when she was born.

“Although her time on earth was short in quantity, we tried our best to ensure it was long in quality,” Mary said.

Mary believes her family is fortunate they met so many amazing people throughout Megan’s life including gaining “extended family members” for whom they care deeply.

“If it weren’t for Megan, we would not have crossed paths with amazing humans like Dr. Perry and many others in the rare epilepsy realm. For that gift from Megan alone, we are especially grateful.”

Connect with Mary

To connect with others who have experience living with LGS in their families, consider following Mary on X (Twitter) and Instagram.

Support Cook Children's Epilepsy Awareness

To purchase a Cook Children’s 2024 epilepsy awareness T-shirt, please visit Under the Peaks retail shop at Cook Children’s Medical Center - Fort Worth, or call 682-885-7325. If you live outside of the area, you may order your T-shirt online here: https://www.customink.com/fundraising/1in26-2024

Cook Children’s recently participated in multicenter studies of the drug in treatment of patients with Dravet syndrome and is currently enrolling patients in a study for Lennox Gastaut Syndrome.

The research trials sponsored by Zogenix focus on a low-dose, liquid solution of fenfluramine, which was previously used in “fen-phen” for obesity and ultimately taken off the market following evidence it was related to adverse effects on heart valves.

Dravet syndrome affects an estimated 20,000 patients in the United States. Dravet results in a severe epilepsy with seizures typically resistant to treatment with currently available therapies.

The trial found that fenfluramine reduced the frequency of convulsive seizures by a median 62.7 percent, compared with a 1.2 percent median reduction in patients taking placebo, meeting the main goal of the trial.

Dr. M. Scott Perry, medical director of Neurology and Director of the Genetic Epilepsy Clinic at Cook Children’s said, “This drug is a game-changer for patients suffering from Dravet Syndrome. Rarely do we get a treatment for epilepsy which reduces seizures so significantly, especially in an epilepsy syndrome that is this refractory to therapy. I can’t wait to see if the results are as remarkable for Lennox Gastaut Syndrome.”

Thus far, no significant cardiac valvulopathy or pulmonary hypertension has been noted in trials for epilepsy, possibly due to the lower dosing used in these trials.

Zogenix will now focus on submitting applications for a marketing approval of its drug in the U.S. and Europe in the fourth quarter of 2018.

Not a day goes by that Scott Perry, M.D., doesn’t hear that question from parents desperate to help their child. Dr. Perry says he probably discusses the pros and cons of marijuana use for intractable epilepsy at least three or four times a day.

Those questions may increase with the news an experimental cannabis-based drug has successfully treated children with a rare form of severe epilepsy, known as Dravet syndrome broke today.

GW Pharmaceuticals announced positive results from a 120-patient trial on Monday, March 14, 2016. The study shows that patients who took the drug known as Epidiolex saw a monthly reduction of convulsive seizures of 39 percent, compared to a reduction of 13 percent in patients on placebo.

Cook Children’s did not participate in this particular study, but Dr. Perry is leading a team studying the same drug with the same company in three additional trials of Dravet syndrome and Lennox Gastaut Syndrome.

“Many parents of children with epilepsy are interested in considering marijuana, but are afraid of the response they will get from their doctor when they ask,” said Dr. Perry, medical director of the Epilepsy Monitoring Unit and Genetic Epilepsy Clinic at Cook Children’s. “While providers are increasingly more open to the idea that marijuana has some place in medicine, many others continue to regard it as nothing more than an illegal drug with no health benefit.”

Cook Children’s is involved in two studies that examine cannabidiol (CBD) as a treatment for severe cases of epilepsy. The studies, the largest of its kind, are being conducted nationwide in an effort to gather data to see if CBD is an effective form of treatment for two uncontrollable forms of epilepsy – Lennox-Gastaut syndrome and Dravet syndrome.

For Dr. Perry, taking part in a study of this magnitude is the conclusion of more than a decade of his life’s work. It’s also been a passion of his, testifying in front of politicians and lawmakers. Not serving so much as an advocate for CBD, but more so as a scientist and caregiver. He wants to know is this works.

“Without doubt, there is a lot we don’t yet know about how marijuana can be used as a medical treatment, which diseases is it best for, at what doses, at what risks, etc.,” Dr. Perry said. “But to simply ignore the potential health benefits of this plant because of its popular use as a psychoactive drug is short-sighted.”

The experimental drug

The use of an experimental drug isn’t an uncommon practice at most major hospitals, including at Cook Children’s.

An experimental drug is a substance which may be useful to diagnose or treat disease or preserve or enhance health, but has not yet been approved by the U.S. Food and Drug Administration for the specific purpose of treating a patient.

“The drug might or might not be approved for one or a number of conditions, but it becomes ‘experimental’ when used to systematically investigate treatment for an unapproved condition,” said James Marshall, M.D.,Chief Research Officer at Cook Children’s.

The experimental drugs are used, most often, in two situations at Cook Children’s.

Most commonly, experimental drugs are used during the course of an investigation of the drug’s safety, effectiveness and/or how it impacts a patient’s system and well-being. During this time, the drugs are administered under careful supervision and the children are monitored at all times.

Another important, if not as common, use of experimental drugs occurs at hospitals such as Cook Children’s. Once a drug has been approved by the U.S. FDA, experimental drugs, known to be safe and effective in adults, may be used to help children under specific guidelines. This occasion is known as “expanded access” or “compassionate use.”

“In this case, a physician believes that the experimental drug may help his or her patient’s condition for which the drug has not been investigated or approved, but the data seems to indicate a chance it will benefit the child,” Dr. Marshall said.

The data obtained from the use of experimental drugs can be useful to future patients as doctors can see how beneficial they are the next time they are treating a patient with a similar condition.

At Cook Children’s, children participate voluntarily in all experimental drug investigation. Patients and their families, particularly in the case of minor children, must volunteer to participate in any experimental investigation through a process called, “informed consent.”

Informed consent for children is regulated heavily by the U.S. and international governments. This type of consent is managed by a local board concerned only for the safety of research subjects, and far more comprehensive than the normal treatment consent process. Informed Consent for children has several key elements:

• Education by the investigator and his/her team regarding all aspects of the research.
• Informed consent or actually signing a legal document by a minor child’s parent or legally authorized representative.
• Assent or documenting that a minor child understands and agrees to participation, and a continuous, open and welcome ongoing conversation between the participant/family and the investigational team to assure understanding through all phases of the research.

The initial consent/assent process can take several hours, and investigators never really consider the conversation to be closed. Patients and their families often learn more about their condition during the consent/assent process than they would by receiving treatment only. Patients and families can decide to stop participation even before the experimental drug is administered.

However, many patient families see the importance of participating in these experimental drugs and the benefit it may bring to not only their child, but to patients in the future.

“At Cook Children’s, we believe that all children deserve the best, evidence-based treatment strategies available to manage their illnesses and maintain good health,” Dr. Marshall said. “Cook Children’s patients have the opportunity to contribute to the health of other children through safe and ethical clinical research. We treasure the fact that clinical research is the essence of people voluntarily caring for the future of mankind.”

Why a study of the use of Cannabidiol is needed

To prove a therapy is effective the following is needed:

• Controlled trials - studies where all the patients enrolled have similar conditions and in the process eliminate many variables that may affect the outcome other than use of the drug.
• Blinded studies - studies where neither the doctor nor the patient know what treatment they are on, to avoid bias.
• Placebo controls - some patients get the medicine and some get a “sugar pill” to make sure the improvement in seizures is not related to chance alone.

While early reports from families suggest CBD is well tolerated in most patients, standardized evaluation of side effects and long-term data will be very important. There is considerable concern about what impact CBD may have on the developing brain of a child and no trials in children have been sufficient yet to answer this question.

Finally, there is not yet adequate standardization of CBD production. Numerous states have CBD laws, all slightly different in their requirements, their oversight, and the conditions which can be legally treated.

“When you get a drug at the pharmacy, it is required by law to have certain standard properties to insure that each pill is similar to the next,” Dr. Perry said. “Families are often concerned about getting generic over brand name drugs – but even generic drugs have rules to insure they are very similar to their brand-name equivalent. Marijuana plants may have varied amounts of CBD and THC depending on the plant species, the growing conditions, and the extraction of the medication from the plant.”

Dr. Perry said the take home point is not whether or not CBD is a treatment for epilepsy, but is it ready to be used just as any other seizure medication now. Adequate evidence suggest that it warrants further investigation as a therapy, but there is inadequate evidence to wholeheartedly support it for more common use until the research is done.

The misconceptions of medical marijuana

The first question people often ask is “will it get my kid high?” Marijuana plants contain a number of substances which may hold potential to treat disease. There are two main chemicals in marijuana – the first and best known is THC. THC is the psychoactive part of marijuana – or the part that makes you “high.”

Cannabidiol (CBD) is another component and the one most people are interested in as a treatment for epilepsy. CBD has no psychoactive properties, so it doesn’t produce a “high.”

The second question is often “won’t smoking marijuana be bad for my child?” CBD is not administered by children smoking. It is typically formulated into an oil based liquid, so it can be given by mouth.

The next logical question is whether there is any evidence that CBD is effective at treating epilepsy – and this is where the research that Dr. Perry and his team are participating in comes into play.

“While the medical community is encouraged by the favorable reports from patients using CBD in other states, we understand that this type of ‘self-reported’ data is not adequate to prove a treatment works,” he said. “Often when a child improves with a medical treatment, the family will sing the praises of the miracle medication they found. We rarely ever hear from those people that tried yet another treatment that failed – as they simply have moved on looking for another potential cure. Therefore, while many people have reported success with CBD, we don’t know how many have failed using the same treatment.”