Cannabinoids and Epilepsy

Epilepsy is defined as a disorder of the central nervous system characterized by a predisposition to generate seizures in an uncontrolled manner. These episodes can, in the long term, cause severe damage at a cognitive and psychological level that can limit and condition the life of the affected people [1].

The therapeutic potential of CBD (cannabidiol), an active component of the cannabis plant, has gained support in recent years due to evidence from studies that conclude its usefulness in controlling seizures in various epileptic syndromes [2] [3].

The anticonvulsive properties of CBD and its low toxicity to the body [4] make it a valuable tool to treat various epileptic syndromes resistant to conventional medication [5] [6].

Several studies accredit cannabidiol as having a neuronal protective effect meaning it reduces the excessive excitation of the neurons [7], helps to preserve cognitive capacities and reduces the progression of the damage produced in the nervous system by the repetitive convulsions. All these properties make CBD a good neuro-protective agent [8] [9], without the rates of toxicity or risk of overdose which is associated with the prolonged use of conventional antiepileptic drugs [10] [11].

Epilepsy diagnosis Kalapa Clinic

Benefits of Cannabinoids

  • Anticonvulsant
  • Neuroprotective effects
  • Anti-inflammatory properties
  • Works for refractory epilepsy
  • Treatment for serious epilepsy

Summary

The studies suggest that cannabinoids are beneficial as an adjuvant treatment for seizures suffered by people with epilepsy, and can reduce them in a large percentage.

Cannabinoids are very useful, they are a safe way to treat cases of refractory epilepsy and they lack the toxicity of conventional antiepileptic medication. One of the widely known cases is of a little girl, Charlotte Figi of the United States. This is a famous case where the effectiveness of the use of medicinal cannabis even for refractory or difficult-to-treat epilepsies was observed. Due to cases like this, the various entities and associations have called for an end to the restrictions limiting clinical trials and studies on medicinal cannabis in the treatment of this disease.

Treatments for Refractory Epilepsy using CBD Oil

We are facing a case of refractory epilepsy when the epileptic seizures are so frequent that they limit the patient’s ability to live fully in accordance with their desires and mental and physical capacity or when anticonvulsant treatment does not control the seizures and their side effects limit the normal development of the person.

In the last 10 years, the occurrence of refractory epilepsy has been high despite the emergence of new antiepileptic drugs. Epidemiological data indicate that between 20% and 40% of patients with newly diagnosed epilepsy will be refractory to treatment.

The factors that are taken into account to determine whether a patient will respond or not to treatment with antiepileptic drugs include [12]:

  • The type of epilepsy
  • The underlying syndrome
  • The aetiology and the history of the patient
  • The density and grouping of the seizures
  • The antiepileptic drug being used

Several studies have demonstrated the benefits of cannabinoids in the treatment of people with epilepsy. In refractory epilepsy a study from 2015 on the use of oral cannabis extracts in paediatric patients with epilepsy showed improvement in patients who used this treatment [13].

In addition to reducing seizures and having a neuroprotective effect, CBD also has effects on a wide range of conditions [14] that we mention below:

  • Reduces inflammation [15] [16]
  • Combats psychotic disorders [17]
  • Decreases anxiety
  • Reduces nausea and vomiting [18]
  • Improves sleep and increases the feeling of wellbeing [19]
  • Has a neuronal antioxidant effect

Bibliography for Epilepsy and Medical Cannabis

[1] Robert Fisher, and other. ILAE Official Report: A practical clinical definition of epilepsy. April 2014 Volume 55, Issue 4 Pages 471–626, e25–e33.

[2] Devinsky O and other. Cannabidiol in patients with treatment-resistant epilepsy: an open-label interventional trial. Lancet Neurol. 2016 Mar;15(3):270-8.

[3] Devinsky O and other. Cannabidiol: pharmacology and potential therapeutic role in epilepsy and other neuropsychiatric disorders. Epilepsia. 2014 Jun;55(6):791-802

[4] Bergamaschi MM, Queiroz RH, Zuardi AW, Crippa JA. Safety and side effects of cannabidiol, a Cannabis sativa constituent. Curr Drug Saf. 2011 Sep 1;6(4):237-49.

[5] Devinsky O and other. Cannabidiol in patients with treatment-resistant epilepsy: an open-label interventional trial. Lancet Neurol. 2016 Mar;15(3):270-8.

[6] Fabio Arturo Iannotti and other. Nonpsychotropic Plant Cannabinoids, Cannabidivarin (CBDV) and Cannabidiol (CBD), Activate and Desensitize Transient Receptor Potential Vanilloid 1 (TRPV1) Channels in Vitro: Potential for the Treatment of Neuronal Hyperexcitability. ACS Chem. Neurosci., 2014, 5 (11), pp 1131–1141

[7] Hampson AJ, Grimaldi M, Lolic M, Wink D, Rosenthal R, Axelrod J. Neuroprotective antioxidants from marijuana. Ann N Y Acad Sci. 2000;899:274-82.

[8] Hampson AJ, Grimaldi M, Lolic M, Wink D, Rosenthal R, Axelrod J. Neuroprotective antioxidants from marijuana. Ann N Y Acad Sci. 2000;899:274-82.

[9] Campos AC, Fogaça MV, Sonego AB, Guimarães FS. Cannabidiol, neuroprotection and neuropsychiatric disorders. Pharmacol Res. 2016 Oct;112:119-127.

[10] Bergamaschi MM, Queiroz RH, Zuardi AW, Crippa JA. Safety and side effects of cannabidiol, a Cannabis sativa constituent. Curr Drug Saf. 2011 Sep 1;6(4):237-49.

[11] Gram L, Bentsen KD. Hepatic toxicity of antiepileptic drugs: a review. Acta Neurol Scand Suppl. 1983;97:81-90

[12] Jacqueline A. French. Refractory Epilepsy: Clinical Overview. TOC Volume 48, Issue s1 March 2007 Pages 3–7

[13] Press CA, Knupp KG, Chapman KE. Parental reporting of response to oral cannabis extracts for treatment of refractory epilepsy. Epilepsy Behav. 2015 Apr;45:49-52.

[14] Zuardi AW. Cannabidiol: from an inactive cannabinoid to a drug with wide spectrum of action. Rev Bras Psiquiatr. 2008 Sep;30(3):271-80.

[15] Burstein S. Cannabidiol (CBD) and its analogs: a review of their effects on inflammation. Bioorg Med Chem. 2015 Apr 1;23(7):1377-85

[16] Costa B and other.  Oral anti-inflammatory activity of cannabidiol, a non-psychoactive constituent of cannabis, in acute carrageenan-induced inflammation in the rat paw. Naunyn Schmiedebergs Arch Pharmacol. 2004 Mar;369(3):294-9

[17] Zuardi AW, Crippa JA, Hallak JE, Moreira FA, Guimarães FS. Cannabidiol, a Cannabis sativa constituent, as an antipsychotic drug. Braz J Med Biol Res. 2006 Apr;39(4):421-9

[18] Parker LA, Rock EM, Limebeer CL. Regulation of nausea and vomiting by cannabinoids. Br J Pharmacol. 2011 Aug;163(7):1411-22

[19] Carlini EA, Cunha JM. Hypnotic and antiepileptic effects of cannabidiol. J Clin Pharmacol. 1981 Aug-Sep;21(8-9 Suppl):417S-427S.

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