Information about the use of cannabis oil for epilepsy to gain seizure control. The most well known are two cannabinoids: CBD - cannabidiol. Although CBD oil has become a trendy cure-all, treatment of epilepsy is the only use that has garnered significant scientific evidence. Galveston resident Trysten Pearson, who has epilepsy, experienced his first seizure in when he was 12 years old. But last summer, his.
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For many who have used CBD oil, the newly available treatment has provided relief when all else failed. But once an epilepsy patient has taken two different medicines without relief, the odds that a third medication will work are less than 1 percent, doctors say. That leaves other options, such as special diets, surgeries, device implementation—or CBD oil. He said the stigma associated with taking medicine derived from cannabis is fading.
But for some patients, it can help eliminate or reduce their symptoms, and it may allow them to ease off of other drugs that have serious side effects, including anemia, low platelet levels, liver failure, pancreatitis, allergic reactions and suicidal tendencies. Before the Texas law took effect, many patients were trying CBD oil on their own by visiting other states or ordering it online, which is a legal gray area.
For context, recreational marijuana might measure 20 percent THC. Those restrictions ensure Texas CBD oil makers maximize the compounds that provide symptom relief while minimizing those that can cause side effects or a high Trysten Pearson, for his part, said he experiences no side effects from CBD oil.
Perhaps the biggest hurdle of all is price. But in June, the U. Food and Drug Administration approved Epidiolex, a CBD oral solution to treat seizures associated with rare and severe forms of epilepsy. So far, the program has served 12 of its approximate customers. That has frustrated some patients and advocates, but skeptics say more research must be done to evaluate whether and how CBD oil can treat those illnesses. UTSA research designed to set student Veterans up for success https: You can be assured our editors closely monitor every feedback sent and will take appropriate actions.
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Cannabidiol significantly reduces seizures in patients with severe form of epilepsy May 17, It is important to recognize, however, that at this stage these extensive putative therapeutic benefits touted by the proponents of medical marijuana are largely unproven 8 , 9. At present, high quality medical evidence supporting the use of these agents in most of these conditions remains modest at best. Likewise, the widespread physiological effects of the cannabinoids also presuppose the potential for a broad range of toxicities.
Thus enthusiasm for therapeutic benefits needs to be tempered by the realistic appreciation of potential adverse effects Table 3 4 , 28 , The latter could include inhalational injury from smoking, inhalation of associated microorganisms or fungi, inadvertent intake of co-administered pesticides or other byproducts, and so forth. It is important to recall, again, that the cannabis plant produces a remarkably broad array of phytochemicals.
It would be anticipated that these could have varying degrees of efficacy as well as toxicity. Specifically, there is considerable evidence that suggests that of the phytocannabinoids, deltaTHC is likely to be the substance largely responsible for most of the systemic and neurotoxic effects of cannabis preparations 13 , 14 , Meanwhile, there is growing evidence that CBD may actually inhibit, reduce or moderate some of these adverse effects 27 , 31 - Obviously, from a scientific standpoint, it becomes virtually impossible to properly conduct carefully controlled studies with vernacular cannabis preparations given that these products likely contain widely disparate relative quantities of the various constituent cannabinoids.
Finally, among the potential toxicities of the cannabinoids, those of greatest concern to neurologists in particular are neurological and neuropsychiatric toxicities Table 3. Unfortunately, there is considerable high-quality data coming from various sources that indicates that long-term exposure to THC can have serious deleterious effects on neurological functioning 34 - In particular, there is strong evidence that progressive memory impairment as well as impaired executive functions results 34 , 37 , There is additional concern about a deleterious effect on neural plasticity, particularly with regard to the developing brain 39 - There is strong evidence that cannabis use results in an increased risk of psychosis in predisposed individuals 43 , Acute and chronic cannabis use have also been linked to aggravation of anxiety, mania and depression.
Consequently any future studies of cannabinoid therapy in epilepsy, and in particular in childhood epilepsy, must very carefully assess acute and long-term neurotoxicity. Authors focused on the following neurological conditions: It is enlightening to briefly review the data that supports this therapy and compare it with what exists with respect to the treatment of epilepsy with cannabis products.
Controlled trials of various pharmaceutical cannabis products for the treatment of multiple sclerosis specifically the painful spasms of MS began in the early s Initial studies did use a variety of preparations Table 4. This culminated in a series of high quality placebo-controlled trials with Sativex a These trials demonstrated a statistically significant benefit of Sativex in the management of painful MS spasms, resulting in the marketing of this agent in England and many other countries not including the United States.
However, quick perusal of Table 4 demonstrates that well over patients were studied in this fashion. In addition, published post-marketing data regarding well over 10, patient-years of experience with Sativex demonstrates relatively low toxicity and statistical absence of serious adverse events 46 - Since Sativex is a mixture of THC and CBD, these observations do provide some reassurance that CBD itself may have minimal toxicity and a low propensity to result in dangerous or serious adverse effects.
However contrast this with the published data regarding the use of medical marijuana for the treatment of epilepsy Table 5 50 - Until the last few years, the published data was minimal Table 5 and included less than 70 subjects. Very few of these were children. However this state of affairs is rapidly changing given the current climate. In , Porter and Jacobson 54 published the self-reported experience of 19 patients whose families had given their children some form of high-CBD medical marijuana product for severe intractable epilepsy.
The majority of families reported improvement: Others reported an ability to discontinue previously administered medications Though clearly this data would not be considered high quality medical evidence, the information at the time was tantalizing.
In addition, considerable preclinical evidence regarding the potential efficacy of cannabinoids for the treatment of epilepsy does exist. Some of these studies began as early as the s. Phytocannabinoids particularly CBD have been studied in a wide array of animal models of epilepsy 55 - For the most part, these have demonstrated substantial efficacy.
There is some evidence that THC itself can be pro- convulsant in some animal models More recently, efficacy in animal models of temporal lobe epilepsy and partial seizures has been demonstrated In addition there is some evidence that tolerance to the anticonvulsant effects of CBD is not a prominent feature in animal models of epilepsy Thus based on these preclinical studies, one would be excited about the potential therapeutic potential of the cannabinoids.
However, it is undeniable that the complex regulation that surrounds these schedule I substances has impeded scientific investigation of their therapeutic potential. Spurred by the widespread interest in the therapeutic potential of CBD for the treatment of intractable childhood epilepsies, GW pharmaceuticals the makers of Sativex developed a pure CBD product known as Epidiolex.
Initial reports of the experience with these children again uncontrolled were recently presented Adverse effects were modest somnolence, diarrhea, fatigue and decreased appetite. While the results remain promising, outcome data nevertheless is based on self-reported seizure frequencies, is uncontrolled and may suffer from the same methodological problems to some degree as did the Porter and Jacobson report.
However, placebo controlled trials of Epidiolex for Dravet and Lennox-Gastaut syndrome are now in process. Consequently higher quality medical evidence surrounding the use of CBD for the treatment of pediatric epilepsy syndromes will be forthcoming. Meanwhile Insys Therapeutics, Inc.
Here again the analysis of outcomes is complicated by the extraordinary variability between these products, relative lack of consistency in dosing, variable quality control, and uncertainty with respect to the presence or absence of other potentially bioactive constituents within these products i. A recent report from Colorado is intriguing in this respect 6. This could strongly suggest a significant placebo effect in the self-reported seizure outcomes.
These range from natural products to synthetic agents, substances delivered by inhalation versus those that are swallowed or even delivered by an oral-mucosal spray. Again, this makes comparison of outcomes among various studies nearly impossible. In general, as shown in Table 6 , there are clearly distinct advantages to the use of a highly purified, pharmaceutical product. Specifically according to the Controlled Substance Act of , the federal government has placed marijuana and THC under Schedule I of controlled substances.
This designation indicates that marijuana and THC are considered to have: In addition, this federal regulation specifies that all species of plants from which controlled substances in Schedule I derive are similarly controlled and subject to the same penalties.
This is despite the fact that most experts and considerable evidence now suggest that this particular phytochemical in fact does not have abuse potential and is clearly of substantial medical interest at this time 13 , 25 , In the meanwhile, state regulation of marijuana ranges from complete proscription to full legalization. Some states have enacted CBD-specific laws Utah, Georgia, others which allow families to administer CBD-rich, THC-poor marijuana products to their children with intractable epilepsy under very specific circumstances in part regulated by the respective state health departments 5.
However, it is left up to families themselves, with or without the tacit assistance of physicians, to determine how to obtain these substances, judge the quality of the available products, and determine what amount to administer 2 , 6 , Concerns have been raised with respect to increase in violent crime or delinquent behavior 66 , potential for increase in driving related accidents or deaths 8 , potential for neurotoxicity due to increased use of recreational marijuana products 62 , unintended neurotoxicity in children 65 , and the theoretical largely unproven proposition that increased access to cannabis serves as a gateway to more serious drug abuse behaviors 28 , With respect to these various public health concerns, actual data is in fact conflicting 28 , 66 and to some degree data available so far is less alarming than might be imagined by those who strongly oppose the liberalization or legalization of medicinal marijuana products.
It is an exciting time with respect to the study of phytochemicals in their application to the treatment of epilepsy and in particular intractable pediatric epilepsies. It is particularly satisfying to see that the grassroots experiences of families who have children suffering from severe intractable epilepsy have been able to move the field forward so rapidly. The upwelling of interest has already had a remarkable impact and in the space of a few years a large body of medical evidence of increasing quality has been accumulated.
Ongoing and anticipated double-blind placebo controlled trials promise the availability of high quality medical evidence in the near future. Hopefully, CBD and possibly other phytocannabinoids or combinations thereof will prove to be beneficial for at least a subset of epileptic children.
In order to foster this progress it is suggested that pediatric neurologists may wish to advocate for the following:. Furthermore, pediatric neurologists are encouraged to inform themselves on the specifics of federal and local state regulations so as to be able to best inform and advocate for their patients.
The author thanks Claire Filloux, Ph. The author has no conflicts of interest to declare. National Center for Biotechnology Information , U. Journal List Transl Pediatr v. Author information Article notes Copyright and License information Disclaimer. Received Sep 21; Accepted Oct 3. Copyright Translational Pediatrics. This article has been cited by other articles in PMC. Cannabinoids and chemistry The plant, Cannabis sativa , often referred to as hemp or marijuana, has been used for its medicinal properties for millennia 10 , Open in a separate window.
The endocannabinoid system The very existence of natural substances the cannabinoids that have such remarkable and broad effects on human behavior and function presupposes a set of target receptors or endogenous physiological processes upon which these chemicals act.
Cannabinoids for neurological disease: Table 2 Therapeutic potential of the cannabinoids. Table 3 Potential toxicities of cannabinoid preparations. Table 4 Clinical studies of cannabinoids in multiple sclerosis.
Study Product Design No. Spasticity, pain Vaney, THC 2. Table 5 Clinical studies of cannabinoids in epilepsy- pre Recommendations for the future It is an exciting time with respect to the study of phytochemicals in their application to the treatment of epilepsy and in particular intractable pediatric epilepsies.
In order to foster this progress it is suggested that pediatric neurologists may wish to advocate for the following: A change in federal regulations that would facilitate carefully conducted, scientifically driven, basic, preclinical and clinical studies of phytocannabinoids in the treatment of various neurological diseases including epilepsy. Acknowledgements The author thanks Claire Filloux, Ph.
CBD oil study shows significant improvement in patients with treatment-resistant epilepsy
CBD also interacts with some other seizure medicines. over a number of years suggest that cannabidiol (CBD) could potentially help control seizures. Published in the journal Epilepsy and Behavior, the results indicate use of CBD oil reduced adverse events and seizure severity, in addition to. Keywords: Cannabidiol (CBD), cannabis, epilepsy, medical marijuana, . Thus seizure control and/or toxicity may result from pharmacokinetic interactions as.