I am curious if anyone has tried the new CBD oil to control their epilepsy. I have read many great things about it really controlling seizures and maybe trying it. I hear a lot of good things about CBD oil, and how some people are able to get completely off their medication while using CBD when weaning off. I understand . the Epilepsy Foundation is to lead the fight to overcome the challenges of living with epilepsy and to accelerate therapies to stop seizures, find cures, and save.
oil Epilepsy Reliability for of CBD
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. Molecular targets of cannabidiol in neurological disorders.
Trial of cannabidiol for drug-resistant seizures in the Dravet Syndrome. USP certification of CBD products for content and purity, as well as bioavailability testing of specific products, uncertainty surrounds the use of available CBD products in routine clinical settings.
At this time, there does seem to be a growing body of basic pharmacologic data suggesting there may be a role for CBD, especially in the treatment of refractory epilepsy. However, given the lack of well-controlled trials, we must also ask if we are getting ahead of ourselves. Clearly, this is an emotionally and politically charged issue. If this were any other uninvestigated pharmaceutical compound, would we feel as compelled to make the agent widely available before statistically valid class 1 evidence was available for review?
Until data from well-designed clinical trials are available and reliable, and standardized CBD products that are produced using GMP are available, caution must be exercised in any consideration of using CBD for the treatment of epilepsy.
In the meantime, based upon promising preliminary data, further clinical research should be wholeheartedly pursued. Authors have a Conflict of Interest disclosure which is posted under the Supplemental Materials link. National Center for Biotechnology Information , U. Journal List Epilepsy Curr v. Author information Copyright and License information Disclaimer.
This article has been cited by other articles in PMC. Abstract Over the past few years, increasing public and political pressure has supported legalization of medical marijuana. Basic Pharmacological Mechanisms Cannabidiol pharmacological effects are mediated through G protein coupled receptors, cannabinoid type I CB 1 and cannabinoid type II CB 2 , which are highly expressed in the hippocampus and other parts of the central nervous system 2.
Evidence in Animal Models When administered alone, CBD is an effective anticonvulsant in maximal electrical shock MES , magnesium-free, 4-aminopyridine, and audiogenic models 7 , 8. Clinical Evidence in Epilepsy While animal experimental data clearly suggest a potential benefit, supportive clinical data are quite sparse.
Tolerability and Drug Interactions CBD is well tolerated in humans with doses up to mg not resulting in psychotic symptoms Conclusions At this time, there does seem to be a growing body of basic pharmacologic data suggesting there may be a role for CBD, especially in the treatment of refractory epilepsy. Supplementary Material Click here for additional data file.
Pharmacology and potential therapeutic role in epilepsy and other neuropsychiatric disorders. Cannabidiol displays antiepileptiform and anti-seizure properties in vitro and in vivo. J Pharmacol Exp Ther. Temporal characterization of changes in hippocampal cannabinoid CB 1 receptor expression following pilocarpine-induced status epilepticus. Marijuana, endocannabinoids, and epilepsy: Potential and challenges for improved therapeutic intervention.
The diverse CB1 and CB2 receptor pharmacology of three plant cannabinoids: D9-tetrahydrocannabinol, cannabidiol, and D9-tetrahydrocannabivarin. Effects of cannabinoids and cannabinoid-enriched Cannabis extracts on TRP channels and endocannabinoid metabolic enzymes. Phytocannabinoids as novel therapeutic agents in CNS disorders. Cannabidiol exerts anti-convulsant effects in animal models of temporal lobe and partial seizures.
Marijuana use and the risk of new onset seizures. Trans Am Clin Climatol Assoc. Marijuana use and epilepsy. Gloss D, Vickrey B. Cochrane Database Syst Rev. Trembly B, Sherman M. International Association for Cannabinoid Medicines. Ames FR, Cridland S. Anticonvulsant effect of cannabidiol. S Afr Med J. Chronic administration of cannabidiol to healthy volunteers and epileptic patients. Mechoulam R, Carlini EA. Toward drugs derived from cannabis. Zhornitsky S, Potvin S.
Cannabis, Cannabidiol, and Epilepsy
Although CBD oil has become a trendy cure-all, treatment of epilepsy is the only use that has garnered significant scientific evidence. The THC-rich type of cannabis oil has already been known for some years, that CBD had a therapeutic effect on a serious form of epilepsy in .. safe, and reliable CBD products are available to those who depend on them. to at least legalize possession of CBD oil for treating epilepsy, little published . Until data from well-designed clinical trials are available and reliable, and.