Medical. Marijuana and Epilepsy: Based on the data collected from 12 studies, here's how cannabis is being used to treat seizures The ECS helps to maintain homeostasis through the body's own cannabinoids (called. A recent analysis of published studies indicates that the use of cannabinoids for active chemicals in cannabis or marijuana -- for the treatment of epilepsy in children. 12/htm>. FDA grants fast track designation to cannabidiol for Dravet syndrome. Marijuana and other cannabis products with high content in Δ(9) In these studies, CBD was found to be superior to placebo in reducing the frequency of Keywords: Cannabis, Cannabidiol, Epilepsy, Seizures, Review .. at least 12 weeks of follow-up–this included 33 patients with Dravet syndrome and.
Epilepsy: Studies) Seizures Cannabis (12 Stops How Here’s and Marijuana
Concentrated in peripheral immune tissues i. In the context of seizures and epilepsy, although it seems CB1 would be a likely target, that does not appear to be the case. Cannabis contains more than unique compounds called phytocannabinoids, which are quite similar to lipophilic endocannabinoids—differentiated only by the origin of synthesis ie, plants.
There are mixed reports of seizure treatment success and seizure exacerbation. Some believe this is a benefit as it may have less potential for abuse. CBD is highly lipophilic and becomes distributed in the brain rapidly.
Much remains to be ascertained regarding cannabis and its precise mechanism s of action in epilepsy. Overall, most side effects were well tolerated. This is significant both clinically and statistically as positive perception may positively affect patient outcomes. Both groups of patients treated had larger reductions in drop seizures Patients experienced statistically significant decreases in convulsive seizures per month after 12 weeks; this was sustained through week 48 of the study.
The largest effects were seen for tonic-clonic seizures Side effects were similar to previous reports ie, drowsiness, ataxia, diarrhea. A large analysis of expanded access to pharmaceutical-grade CBD included patients and 25 institutions. Data are lacking for nonconvulsive seizures, which are more difficult to quantify; the studies discussed in this article were not designed to assess this endpoint. The majority of studies described in this article involve a single, standardized formulation of CBD created with cannabis grown and CBD extracted under extremely strict conditions, as would be required for any drug approved for human consumption.
There are a number of artisanal CBD products available from dispensaries and online retailers, many touting their efficacy for epilepsy and other conditions. Unlike the recently FDA-approved formulation, artisanal CBD products are considered supplements and do not have the same regulatory oversight. As a result, these products cannot be labeled to state claims of health benefit.
The consumer must be aware these products may vary widely in contents and purity. A study examined the accuracy of CBD labeling on artisanal products and found that of 84 different CBD extracts reviewed. This is not to say that artisanal cannabis products may not be efficacious for epilepsy. Practitioners simply need to be aware of the differences. Although there is good evidence for safety and efficacy of CBD, many artisanal products may contain high amounts of other cannabinoids for which research is lacking.
Consequently, patient response and potential adverse effects are unknown and should be taken into consideration when discussing the risks and benefits of this type of therapy. The recommended starting dose of pharmaceutical-grade CBD is 2. Milder side effects included somnolence, fatigue, diarrhea, and reduced appetite. Hepatotoxicity has emerged as an adverse effect of CBD treatment of particular concern. Many antiepileptic drugs AEDs carry some risk of hepatotoxicity, but with a clear monitoring plan, this concern could be reduced.
Elevation of LFTs appears to be most common in the first 2 months of treatment but has also been observed in later stages of treatment. Liver monitoring is recommended at months 1, 3, and 6 after initiating treatment with pharmaceutical-grade CBD or monthly after dose changes or addition of another AED that interacts with CBD.
The hepatotoxicity risk of pharmaceutical-grade CBD appears to be more common if there is polypharmacy with valproic acid products or clobazam, although LFT elevation has also been shown to occur without these concomitant drugs.
Varying reports of alterations in serum concentration of rufinamide, topiramate, zonisamide, and eslicarbazepine have also been noted. Close monitoring may be encouraged or even required. Alone, CBD has no schedule designation, but as a component of marijuana, it has been listed as a schedule I drug—defined by the Drug Enforcement Administration DEA as a substance having high potential for abuse with no medical efficacy. This will occur imminently in the US prior to expected release of pharmaceutical-grade CBD in late How this will affect the legality of artisanal CBD products is less clear, as many may contain unacceptable amounts of THC and other cannabinoids which are likely to remain schedule I until there is more evidence for safety and efficacy.
Cannabis law varies widely across the US from state to state, further complicating procurement for patients choosing not to use the FDA-approved product. CBD and marijuana laws vary internationally as well. Several countries allow utilization of cannabis for medical purposes, but the cultivation and possession of marijuana for recreational use remains largely illegal.
In the United Kingdom, once pharmaceutical-grade CBD is approved, lawmakers plan to re-examine current laws to allow for legal utilization of this CBD product. The cost of treatment is another factor that warrants discussion. Currently, CBD oils procured from dispensaries are not covered by health insurance as they lack accepted evidence of efficacy.
Cannabis and CBD have a long history of use for medical purposes throughout human history. Until recently, standardized studies with large datasets have been lacking. Now, with the change in social climate and attitude towards the potential of cannabis and CBD, data are amassing to provide much-needed insight into the practical application of CBD in patients with seizures and epilepsy.
More studies are needed to determine the exact mechanism of therapeutic efficacy ie direct antiepileptic target vs. Practitioners still must be cognizant of individual patient factors because CBD is not a benign entity.
Vigilance for concomitant hepatotoxic antiepileptics, potential interactions, and side-effects must be maintained and cost and variability between different formulations considered. New options are on the horizon and expanding potential medical treatment with CBD. Governmental acceptance of a CBD-based product is helping to open doors for many families and patients with previously limited options.
The CBD safety and efficacy profiles combined with the great need for better treatment options in refractory epilepsy make this a promising therapy for patients and practitioners alike.
We are likely experiencing the first among many therapies to be derived from the cannabis plant in the coming years. Friedman D, Sirven JI. Historical perspective on the medical use of cannabis for epilepsy: Current status and prospects for cannabidiol preparations as new therapeutic agents. J Cli Phar Ther. The legal status of cannabis marijuana and cannabidiol CBD under U.
Together, they decrease convulsive activity. In models of temporal lobe and partial seizures, CBD was therapeutic in reducing ictal frequencies. In the acute pilocarpine model of temporal lobe seizures, administration of CBD lowered the incidence of convulsions mediated by influence on the NMDA receptor.
In the popular press, there are a plethora of uncontrolled clinical utilizations reporting medical marijuana as a treatment of epilepsy. Most of them claim rather positive outcomes in decreasing seizure frequencies. The discussed person, Charlotte, had intractable Dravet syndrome epilepsy and her parents said that using this type of marijuana in their child attenuated her seizures; that led to the popularity of medical marijuana.
It sparked interest in cannabinoids as a treatment for epilepsy, even despite the lack of scientifically proven evidence for safety or effectiveness. For legal access to it, her family moved to Colorado, heightening publicity, even though marijuana remains inconsistently legal elsewhere.
Marijuana was documented as protective against a first-onset seizure in men. Anecdotal evidence in a survey revealed that 21 percent of patients with seizures in a tertiary epilepsy center admitted to utilizing marijuana in the past year.
A pilot study of CBD versus placebo was conducted in eight normal volunteers and 15 patients with refractory generalized epilepsy. Those with epilepsy continued their previous anticonvulsant medication.
There were no adverse effects reported. Four subjects with epilepsy claimed to be almost seizure free, three experienced decreased frequency of partial seizures, and one remained unchanged.
Among seven placebo-treated individuals, six of them did not improve and one claimed better seizure control. However, cannabidiol-enriched cannabis induces fewer such problems; yet, it still may provide benefits in mood, sleep, and alertness. However, marijuana abuse can be a concern. It is not universally legal. A year-old man suffered seizures after consuming synthetic, purchased-online, cannabinoids.
Despite positive reviews in the popular press, there is little support about the efficacy of medical marijuana by physician epilepsy specialists. Still awaited are well-designed investigations to establish the risk-to-benefit ratio, safety, and efficacy of medical marijuana for someone with epilepsy. General interest and anecdotal claims should be subservient to scientific scrutiny.
Until then, great caution is advised for everyone considering its use and even greater concern by physicians who might recommend it to patients. For those whose seizures remain uncontrolled without alternative conventional interventions available, medical marijuana has received anecdotal support, but only on an empirical basis. Any clinical trial is appropriate only in selected refractory cases and only when strictly monitored by a physician.
Being illegal in many jurisdictions remains a concern. There is a dearth of controlled scientific investigations reported on cannabidiol as an epilepsy control medication. Reportedly, there is no evidence for interactions between CBD and approved anticonvulsant drugs. CBD fraction preparations, lack of controlled double-blind studies, and unapproved indications for medical marijuana compromises understanding, research, and clinical applications.
This makes prescribing such products by a physician complicated for medical and ethical reasons. An additional concern has to do with potential risk that marijuana might induce adverse consequences on the developing brain of children and adolescents. No funding was provided for the preparation of this article. The authors have no conflicts of interest relevant to the content of this article. National Center for Biotechnology Information , U. Journal List Innov Clin Neurosci v.
Author information Copyright and License information Disclaimer. Kolikonda and Sagi are from the Department of Neurology, Dr. This article has been cited by other articles in PMC. Abstract Treatment-refractory epilepsy remains an important clinical problem. Medical marijuana for epilepsy: On-demand activation of the endocannabinoid system in the control of neuronal excitability and epileptiform seizures.
The pharmacologic and clinical effects of medical cannabis. Elphick MR, Egertova M. The neurobiology and evolution of cannabinoid signaling. Philosophical Transactions of the Royal Society B: Gordon E, Devinsky O.
Pharmacology of cannabinoid CB1 and CB2 receptors. Lakhan SE, Rowland M.
Cannabis, Cannabidiol, and Epilepsy
Cannabis-derived substances, such as medical marijuana, are studies of subjects with epilepsy has more CBD and a low THC receptor-independent mechanisms., These include the regulation of The discussed person, Charlotte, had intractable Dravet syndrome epilepsy and her parents said that. Publication status and date: New search for studies and content updated (no change to conclusions), published in Issue In epilepsy, drug resistance is defined as failure to stop all seizures This review will assess the ingestion of marijuana, THC or syn- . type for either 12 months or three times the longest ( pre-interven-. While the majority of those with epilepsy are able to obtain seizure control through Marijuana is known by many names including 'cannabis' – the Latin name favoured cannabidiol in children across the US and Europe with Dravet Syndrome – a people received oral cannabidiol over a week treatment period.