Dravet syndrome is a type of severe epilepsy that develops during the first year of childhood and is characterized by frequent febrile seizures. Studies have. Trial of Cannabidiol for Drug-Resistant Seizures in the Dravet Syndrome Beneficial effects of CBD have been reported in reducing psychotic symptoms, anxiety, Another study demonstrated that cannabinoids abolished seizures in rats. Cannabis oils are used to treat seizures in drug‐resistant epilepsy (DRE). . and was subject to Health Canada review prior to study initiation.
Syndrome: CBD Research Overview and Dravet Cannabinoids
This trial is one of the many being launched by pharmaceutical companies and researchers; United Kingdom-based drug developer GW Pharmaceuticals announced in that they reduced epileptic seizures in a clinical trial with their drug, Epidiolex, a pure extract of CBD. Many standard treatments for pediatric epilepsy are expensive, high-risk, and simply ineffective in a substantial minority of patients, says Hussain. Hormonal treatments such as intramuscular injection of adrenocorticotropic hormone ACTH or oral prednisolone post risk of potentially lethal infection due to their immunosuppressive effects, as well as hypertension, which can lead to heart failure.
Vigabitrin, known by the brand name Sabril in the United States, is another option, but has been linked to irreversible vision loss. Since ancient history, the supposed anticonvulsant effects of cannabis have been well documented in the medical literature. As early as BCE, Sumerian and Akkadian tablets referenced a plant that is most likely cannabis for various ailments, including nocturnal convulsions.
In the 11 th century, Arabic physician al-Mayusi specifically recommended use of cannabis extracts for epilepsy. In the case of epilepsy, the cannabinoid receptor system within the brain, specifically cannabinoid receptor 1 CB1R , where THC and CBD act upon, has been shown to be implicated in seizures in animal models, including that hippocampal CB1R expression is protective against acutely induced seizures.
CB1R activity affects clinical seizures by inhibition of adenyl cyclase activity, which in turn by decreasing cAMP induces potassium efflux and decreases calcium reflux. Nevertheless, liver enzymes are routinely measured by most participants regardless of comedication. Purified CBD preparations increase serum levels in a dose-dependent manner However, pharmacokinetics of different CBD preparations or different routes of application and correlations between CBD serum level and anti-seizure effects or side effects have not been fully established 36 , Accordingly, almost none of the participants measure CBD serum levels.
There are several surveys of patients' or parents' opinions regarding CBD treatment for epilepsy 38 — 41 , but only one that is including health care professionals. This may indicate a change of attitude concerning a cannabinoid-based treatment for epilepsy among practitioners treating children and adolescents for epilepsy.
According to our survey, most participants receive inquiries about CBD treatment on a regular basis. In our experience, families searching for alternative treatment options are burdened by a long history of seizures, side effects and complications. In an Australian nationwide survey on medicinal cannabis use for epilepsy, a significant proportion of children and adults with epilepsy were commencing cannabis-based products without medical supervision, even resulting in unsupervised reduction of concomitant antiepileptic treatment Therefore, according to our survey some participants would rather commence a CBD treatment even if not convinced about its efficacy than having patients using it without medical supervision.
However, decision to commence CBD treatment is mainly made on individual case-by-case basis and most patients of our participants are treated outside of clinical trials. Interestingly, a substantial number of answers about their country specific availability and regulations concerning reimbursement of CBD were contradictory. This is in line with the results of an US survey about the use of medical cannabis in cancer patients. This may indicate a further need for providing adequate information to health care providers given the striking differences between European countries in regulation, availability and covering of costs of medical cannabinoids in general and CBD in particular Given the widely differing practice concerning indications and limitations, choice of preparation, dosing and monitoring revealed by our survey, official guidelines for the use of CBD for epilepsy treatment appear to be advisable to harmonize and potentially improve its use.
There are several limitations concerning our survey. Since this was an open-access survey we cannot generate a response rate. We relied onto the participants to reply truthfully and thoroughly. Numbers and percentages of CBD prescribers may be overestimated by a participation bias, that may be indicated by a substantial variation of responses between countries.
Furthermore, we were not able to relate the numbers of participants to the total number of physicians that are treating children and adolescents with CBD in participating countries.
Therefore, we cannot to draw a representative picture for the extent of CBD use in participating countries. These aspects need to be considered when interpreting our findings. Nevertheless, we presented a broad overview of certain aspects of CBD use by European experts of childhood epilepsy and highlighted several limitations for its use in clinical practice.
CBD appears to be increasingly used by the participants of our survey, but the individual experience remains limited. There are diverse opinions about the use of CBD to treat epilepsy in children and adolescents and widely differing views on several aspects in managing the CBD treatment.
KK conceptualized and designed the questionnaire, collected contact data, performed the survey, analyzed data and drafted the initial manuscript. VA-A contributed to data collection, and revised the manuscript. AS-B contributed to the design of the questionnaire and revised the manuscript. JJ contributed to the design of the manuscript, contributed to the collection of contact data and revised the manuscript. All authors gave final approval of the version to be published. All authors agree to be accountable for the content of the work.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The Supplementary Material for this article can be found online at: Cannabinoids in the treatment of epilepsy: Cannabidiol exerts anti-convulsant effects in animal models of temporal lobe and partial seizures. Evaluation of cannabidiol in animal seizure models by the epilepsy therapy screening program ETSP.
Parental reporting of response to oral cannabis extracts for treatment of refractory epilepsy. Epilepsy Behav EB Duration of use of oral cannabis extract in a cohort of pediatric epilepsy patients. CBD-enriched medical cannabis for intractable pediatric epilepsy: Cannabidiol in patients with treatment-resistant epilepsy: Cannabidiol as a new treatment for drug-resistant epilepsy in tuberous sclerosis complex. Trial of cannabidiol for drug-resistant seizures in the Dravet syndrome.
N Engl J Med. Eur J Pain Lond Engl. Assessment of Israeli physicians' knowledge, experience and attitudes towards medical cannabis: PubMed Abstract Google Scholar. Fewer specialists support using medical marijuana and CBD in treating epilepsy patients compared with other medical professionals and patients: Gloss D, Vickrey B.
Cochrane Database Syst Rev. Cannabidiol as a potential treatment for febrile infection-related epilepsy syndrome FIRES in the acute and chronic phases. Epilepsy Behav EB 8: Therapeutic effects of cannabinoids in animal models of seizures, epilepsy, epileptogenesis, and epilepsy-related neuroprotection. Development of outcome criteria to measure effectiveness of antiepileptic therapy in children.
Phytochemistry of Cannabis sativa L. Prog Chem Org Nat Prod. Cannabinoids concentration variability in cannabis olive oil galenic preparations. Antiepileptic and prophylactic effects of tetrahydrocannabinols in amygdaloid kindled cats. The influence of cannabidiol and delta 9-tetrahydrocannabinol on cobalt epilepsy in rats.
Single and combined effects of plant-derived and synthetic cannabinoids on cognition and cannabinoid-associated withdrawal signs in mice. Lifts federal barriers to cannabis and CBD research, and protects individuals in states with medical cannabis programs. Individuals who have daily multiple seizures and their care team may consider cannabis as a treatment option when others have failed.
People living with uncontrolled seizures have reported beneficial effects from medical cannabis, especially CBD oil. Medical cannabis use is legal in 23 states and the District of Columbia. Share your voice to get all 50 states on board. Urge Congress to support the CARERS Act to facilitate cannabis research and help the epilepsy community gain safe, legal access to this treatment option. Removes therapeutic hemp from the Controlled Substances Act, expands the availability of this treatment option and makes extracting CBD oil legal at the federal level.
The reality is bleak for those living with uncontrolled seizures, which can lead to disability, injury and even death. Nothing should stop patients from gaining access to this potentially lifesaving treatment. Contact your Congressional leaders and tell them how important it is to reintroduce this act for the future of epilepsy treatment.
Researchers Review Cannabis-Based Therapies for Epilepsy, Dravet Syndrome
Researchers Review Cannabis-Based Therapies for Epilepsy, for the treatment of seizures: cannabidiol (the active ingredient of Epidiolex. The review focused on 36 studies of cannabinoids as adjunctive treatment for treatment-resistant epilepsy. It included six randomized controlled trials that. What does the research say about the use of medicinal marijuana for epilepsy? • Treatment over 14 weeks with cannabidiol (medicinal marijuana) was effective.