Huizenga MN, Fureman BE, Soltesz I, Stella N. Epilepsy & Behavior, 85 (2018): 237-242.
In October 2017, the Epilepsy Foundation helped host the Cannabinoids in Epilepsy Therapy workshop. This workshop brought together researchers, clinicians, and advocates for people with epilepsy to discuss the science on how cannabinoids¬†control seizures and identify knowledge gaps.¬†
The purpose of this workshop was to better understand how cannabidiol (CBD) and potentially other cannabinoids control seizures, and what we still don’t know.
What are cannabinoids?
- Cannabinoids are a class of molecules that act on cannabinoid receptors in the brain¬†
- Our own body can produce certain types of cannabinoids known as endocannabinoids.¬†
- Marijuana is derived from the plant cannabis sativa, which contains more than 100 different pharmacologically active compounds referred to as cannabinoids. The two most well-known cannabinoids are¬†CBD¬†and THC.¬†
Cannabis-based treatment options are of great interest to the epilepsy community.¬†This is due to increased access to medical cannabis products in selected states and the FDA‚Äôs recent approval of Epidiolex for the treatment of seizures associated with two rare and severe forms of epilepsy, Lennox-Gastaut syndrome and Dravet syndrome, in people two years of age and older. Epidiolex is a drug derived from cannabis plant in the U.S. that is 98% made of CBD.
Summary of Workshop Discussions
Importance of Regulation
- The same cannabis brand¬†taken from five different dispensaries had CBD content ranging from 0% to 75%
- The lack of regulation about how artisanal cannabinoid products are manufactured can produce a lot of variability in what the product actually contains. This is of great concern when using a product for seizure control, as we know that different levels of CBD can interfere with the safety and/or efficacy of other medications.
CBD Interacts with Other Anti-Seizure Medications
- CBD can interact with other anti-seizure drugs by changing their overall levels in the blood.
- For example, CBD can alter the metabolites of clobazam (n-desmethyl clobazam) and possibly valproic acid.
CBD and Epilepsy
- CBD treatment reduces seizure frequency and severity in many, but not all, epilepsy animal models. This suggests that CBD might work for some but not all people with epilepsy.¬†
- CBD interacts with the receptors GPR44 and the TRPV family.¬†
- How CBD reduces seizures is still not completely clear. For example, it could be a multi-pronged approach through the cannabinoid receptors and other receptor types.¬†
- Recent data shows efficacy and safety of CBD in various epilepsy populations. Learn more about recent research here.¬†¬†
Advances in Technology
- Recently, there have been a couple of promising technologies that would allow us to track the activity of millions of cells in an awake, behaving mouse.¬†
- Being able to visualize brain networks in animal models would allow us to better understand how cannabinoids can change brain activity.
- The reports on the success of CBD in treatment-resistant epilepsy and¬†the FDA approval of the first CBD-based therapy for two rare epilepsies highlights the need to understand how CBD is working in the brain and how CBD can interact with other medications
- More research is needed to understand whether other cannabinoids, in addition to CBD, can also be safe and effective therapeutic options
The workshop was supported by the Epilepsy Foundation, the Tuberous Sclerosis Alliance, and an unrestricted educational grant from Greenwich Biosciences.¬†¬†
Article published in Epilepsy & Behavior, August 2018.¬†