Cannabinoids and Epilepsy
1. Epilepsy Behav. 2017
The current status of artisanal cannabis for the treatment of epilepsy in the United States. Sulak D(1), Saneto R(2), Goldstein B(3).
(1)Integr8 Health, 170 US Rt. 1, Falmouth, ME 04105, United States.
(2)Seattle Children's Hospital/University of Washington, 4800 Sand Point Way NE, Seattle, WA 98105, United States.
(3)Canna-Centers, 15901 Hawthorne Blvd Suite #460, Lawndale, CA 90260, United States. The widespread patient use of artisanal cannabis preparations has preceded quality validation of cannabis use for epilepsy.
Neurologists and cannabinoid specialists are increasingly in a position to monitor and guide the use of herbal cannabis in epilepsy patients. We report the retrospective data on efficacy and adverse effects of artisanal cannabis in Patients with medically refractory epilepsy with mixed etiologies in Washington State, California, and Maine. Clinical considerations, including potential risks and benefits, challenges related to artisanal preparations, and cannabinoid dosing, are discussed.
Of 272 combined patients from Washington State and California, 37 (14%) found cannabis ineffective at reducing seizures, 29 (15%) experienced a 1-25% reduction in seizures, 60 (18%) experienced a 26-50% reduction in seizures, 45 (17%) experienced a 51-75% reduction in seizures, 75 (28%) experienced a 76-99% reduction in seizures, and 26 (10%) experienced a complete clinical response. Overall, adverse effects were mild and infrequent, and beneficial side effects such as increased alertness were reported. The majority of patients used cannabidiol (CBD)-enriched artisanal formulas, some with the addition of delta-9-tetrahydrocannabinol (THC) and tetrahydrocannabinolic acid (THCA). Four case reports are included that illustrate clinical responses at doses <0.1mg/kg/day, biphasic dose-response effects, the use of THCA for seizure prevention, the use of THC for seizure rescue, and the synergy of cannabinoids and terpenoids in artisanal preparations.
2. Epilepsy Behav. 2017
An Australian nationwide survey on medicinal cannabis use for epilepsy: History of antiepileptic drug treatment predicts medicinal cannabis use. Suraev AS(1), Todd L(2), Bowen MT(3), Allsop DJ(3), McGregor IS(3), Ireland C(2), Lintzeris N(4).
(1)The Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, Australia.
(2)Epilepsy Action Australia, Sydney, Australia.
(3)The Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, Sydney, Australia.
(4)Drug and Alcohol Services, South Eastern Sydney Local Health District New South Wales Ministry of Health, Sydney, Australia; Addiction Medicine, Central Clinical School, Faculty of Medicine, The University of Sydney, Sydney, Australia. Epilepsy Action Australia conducted an Australian nationwide online survey seeking opinions on and experiences with the use of cannabis-based products for the treatment of epilepsy. The survey was promoted via the Epilepsy Action Australia's main website, on their Facebook page, and by word of mouth. The survey consisted of 39 questions assessing demographics, clinical factors, including diagnosis and seizure types, and experiences with and opinions towards cannabis use in epilepsy. A total of 976 responses met the inclusion criteria. Results show that 15% of adults with epilepsy and 13% of parents/guardians of children with epilepsy were currently using, or had previously used, cannabis products to treat epilepsy. Of those with a history of cannabis product use, 90% of adults and 71% of parents reported success in reducing seizure frequency after commencing cannabis products. The main reasons for medicinal cannabis use were to manage treatment-resistant epilepsy and to obtain a more favorable side-effect profile compared to standard antiepileptic drugs. The number of past antiepileptic drugs tried was a significant predictor of medicinal cannabis use in both adults and children with epilepsy. Fifty-six percent of adults with epilepsy and 62% of parents/guardians of children with epilepsy expressed willingness to participate in clinical trials of cannabinoids. This survey provides insight into the use of cannabis products for epilepsy, in particular some of the likely factors influencing use, as well as novel insights into the experiences of and attitudes towards medicinal cannabis in people with epilepsy in the Australian community.
3. Epilepsy Behav. 2017
Strokes are possible complications of cannabinoids use. Wolff V(1), Jouanjus E(2).
(1)Stroke Unit, Strasbourg University Hospital, 1, avenue Molière, 67098 Strasbourg, France; EA3072, Federation of Translational Medicine of Strasbourg, University of Strasbourg, Strasbourg, France.
It is critically important to identify all factors that may play a role in the recent increase of the incidence of stroke among the young population. Considering the worldwide use of cannabinoids (cannabis and synthetic cannabinoids), the recent legalization of their consumption in some countries, and their supposed involvement in cardiovascular events, we evaluated their role in the occurrence of neurovascular complications among the young. Ninety-eight patients were described in the literature as having a cannabinoids-related stroke (85 after cannabis use and 13 after synthetic cannabinoids). The distribution by type of stroke was as follows: 4 patients with an undetermined type of stroke, 85 with an ischemic stroke and/or a transient ischemic attack, and 9 with a hemorrhagic stroke. The mean age of patients was 32.3±11.8years (range 15-63), and the majority of them were male with a sex ratio of 3.7:1. Cannabis was often smoked with tobacco in 66% of cases.
Most of the patients with cannabinoids-related strokes were chronic cannabis users in 81% of cases, and for 18% of them, there was a recent increase of the amount of cannabis consumption during the days before the occurrence of stroke. Even if the prognosis of stroke was globally favorable in 46% of cases, with no or few sequelae, 5 patients died after the neurovascular event. One striking element reported in the majority of the reports was a temporal relationship between cannabinoids use, whether natural or synthetic, and the occurrence of stroke.
However, a temporal correlation does not mean causation, and other factors may be involved. Cannabis may be considered as a risk factor of stroke until research shows evidence of an underlying mechanism that, alone or in association with others, contributes to the development of stroke. As of today, reversible cerebral vasoconstriction triggered by cannabinoids use may be a convincing mechanism of stroke in 27% of cases. Indeed, despite the widespread use of cannabinoids, the low frequency of neurovascular complications after their use may be due to a genetic predisposition to their neurovascular toxicity in some individuals. Further studies should focus on this point.
More importantly however, this low frequency may be underestimated because the drug consumption may not be systematically researched, neither by questioning nor by laboratory screening. Besides this vascular role of cannabinoids in the occurrence of stroke, a cellular effect of cannabis on brain mitochondria was recently suggested in an experimental study.
One of the mechanisms involved in young cannabis users with stroke may be the generation of reactive oxygen species leading to an oxidative stress, which is a known mechanism in stroke in humans. It is useful to inform the young population about the real potential risk of using cannabinoids. We suggest to systematically ask all young adults with stroke about their drug consumption including cannabinoids, to screen urine for cannabis or to include a specific diagnostic test to detect synthetic cannabinoids, and to obtain non-invasive intracranial arterial investigations (i.e. CT-angiography or cerebral MRA) in order to search for cerebral vasoconstriction. However, several questions remained unresolved and further research is still needed to assess the pathophysiological mechanisms involved in young cannabinoids users with stroke.
4. Epilepsy Behav. 2017
Social correlates of health status, quality of life, and mood states in patients treated with cannabidiol for epilepsy. Szaflarski M(1), Hansen B(2), Bebin EM(3), Szaflarski JP(4).
(1)Department of Sociology, University of Alabama at Birmingham, HHB 460H, 1720 2nd Ave South, Birmingham, AL 35294-1152, USA.
(2)Department of Sociology, University of Alabama at Birmingham, HHB 460H, 1720 2nd Ave South, Birmingham, AL 35294-1152, USA.
(3)UAB Epilepsy Center, Department of Neurology, University of Alabama at Birmingham, 312 Civitan International Research Center (CIRC 312), 1720 2nd Avenue South, Birmingham, AL 35294-0021, USA.
(4)UAB Epilepsy Center, Department of Neurology, University of Alabama at Birmingham, 312 Civitan International Research Center (CIRC 312), 1720 2nd Avenue South, Birmingham, AL 35294-0021, USA.
Social characteristics, such as socioeconomic status and race/ethnicity, play a role in the treatment and outcomes of patients with epilepsy (PWE), but little is known about how these factors affect patients receiving cannabidiol (CBD) to treat seizures. This exploratory study examined the sociodemographic profile of patients treated with CBD (n=80) and associations between social factors and patient-centered outcomes - overall health status, Quality of Life in Epilepsy-89 (QOLIE-89), and Profile of Mood States (POMS) - in this population. Associations were examined using Pearson correlations and multiple ordinary-least-squares regression (alpha=0.1). The sample was predominantly white (96%) and non-Hispanic/Latino (96%); 76% of patients had family incomes of $40,000+/year. Some patients/families reported experiencing food scarcity (13%), not being able to make ends meet (6%), or not being able to afford antiepileptic medications (8%). The patients' health ratings declined with age and income (p≤0.014), and there was a statistically significant interaction (p<0.055) between these variables: for example, a higher-income 10-year-old had a predicted health rating of 3 ("very good"), followed by a higher-income 40-year-old with a rating of 2 ("good"), a low-income 10-year-old with a rating of 1 ("fair"), and a low-income 40-year-old with a rating of 0 ("poor"). This is the first study reporting the social profile of patients taking pharmaceutical grade CBD for the treatment of epilepsy. The results suggest that despite free access to this treatment some patients may not be accessing CBD because of their socioeconomic situation or race/ethnicity. Larger, diverse samples and longitudinal data are needed to more accurately model social factors and patient-centered outcomes in PWE receiving CBD.
5. Epilepsy Behav. 2017
- Introduction. Szaflarski JP(1), Devinsky O(2).
(1)University of Alabama at Birmingham, Birmingham, AL, USA.
(2)New York University Langone Medical Center, New York, NY, USA.