Cannabinoids in the Treatment of Epilepsy: Hard Evidence at Last?
TLDR
There is now class 1 evidence that adjunctive use of CBD improves seizure control in patients with specific epilepsy syndromes, for the first time, according to currently available information.Abstract:
The interest in cannabis-based products for the treatment of refractory epilepsy has skyrocketed in recent years. Marijuana and other cannabis products with high content in Δ(9) - tetrahydrocannabinol (THC), utilized primarily for recreational purposes, are generally unsuitable for this indication, primarily because THC is associated with many undesired effects. Compared with THC, cannabidiol (CBD) shows a better defined anticonvulsant profile in animal models and is largely devoid of adverse psychoactive effects and abuse liability. Over the years, this has led to an increasing use of CBD-enriched extracts in seizure disorders, particularly in children. Although improvement in seizure control and other benefits on sleep and behavior have been often reported, interpretation of the data is made difficult by the uncontrolled nature of these observations. Evidence concerning the potential anti-seizure efficacy of cannabinoids reached a turning point in the last 12 months, with the completion of three high-quality placebo-controlled adjunctive-therapy trials of a purified CBD product in patients with Dravet syndrome and Lennox-Gastaut syndrome. In these studies, CBD was found to be superior to placebo in reducing the frequency of convulsive (tonic-clonic, tonic, clonic, and atonic) seizures in patients with Dravet syndrome, and the frequency of drop seizures in patients with Lennox-Gastaut syndrome. For the first time, there is now class 1 evidence that adjunctive use of CBD improves seizure control in patients with specific epilepsy syndromes. Based on currently available information, however, it is unclear whether the improved seizure control described in these trials was related to a direct action of CBD, or was mediated by drug interactions with concomitant medications, particularly a marked increased in plasma levels of N-desmethylclobazam, the active metabolite of clobazam. Clarification of the relative contribution of CBD to improved seizure outcome requires re-assessment of trial data for the subgroup of patients not comedicated with clobazam, or the conduction of further studies controlling for the confounding effect of this interaction.read more
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Helen Andrew,Gemma Gossedge,Julie Croft,Neil Corrigan,Julia Brown,Nicholas West,Philip Quirke,Damian Tolan,Ronan A. Cahill,David Jayne +9 more
TL;DR: Trimetazidine is indicated in adults as add-on therapy for the symptomatic treatment of patients with stable angina pectoris who are inadequately controlled by or intolerant to first-line antianginal therapies.
Journal ArticleDOI
A Review of Human Studies Assessing Cannabidiol's (CBD) Therapeutic Actions and Potential.
TL;DR: Cannabidiol (CBD) is a highly touted product for many different disorders among the lay press, but in those diseases with evaluable human data, it generally has weak or very weak evidence.
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Coadministered cannabidiol and clobazam: Preclinical evidence for both pharmacodynamic and pharmacokinetic interactions.
Lyndsey L. Anderson,Nathan L. Absalom,Sarah V. Abelev,Ivan K. Low,Peter T. Doohan,Lewis J. Martin,Mary Chebib,Iain S. McGregor,Jonathon C. Arnold +8 more
TL;DR: The present study aimed to address the nature of the interaction between CBD and clobazam to address speculation that the anticonvulsant efficacy of CBD may simply reflect CBD augmenting clobzam exposure.
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Pharmacological and Therapeutic Properties of Cannabidiol for Epilepsy.
Valentina Franco,Emilio Perucca +1 more
TL;DR: Preliminary results from a recently completed controlled trial indicate that efficacy of CBD extends to the treatment of seizures associated with the tuberous sclerosis complex and to precipitation of some adverse effects, particularly somnolence.
Journal ArticleDOI
Cannabis for the Treatment of Epilepsy: an Update
TL;DR: Understanding of CBD’s efficacy and safety in the treatment of TRE has expanded significantly in the last few years, and data from both open-label expanded access programs (EAPs) and randomized placebo-controlled trials (RCTs) of a highly purified oral preparation of CBD are presented.
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Summary of product characteristics
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