Cannabidiol in the Treatment of Epilepsy: A Focused Review of Evidence and Gaps.

Guilherme Diogo Silva,Maira De Oliveira Lelis,Lécio Figueira Pinto,Felipe Borelli Del Guerra

doi:10.3389/fneur.2020.531939

Abstract

Approximately one third of epilepsy patients do not become seizure free with antiseizure medications. This treatment gap motivates research for new therapeutic options, such as cannabidiol (CBD). CBD differs from other cannabis derivatives because of its consistent efficacy and lack of a psychoactive effect. CBD can be recommended as adjunctive therapy in patients with Dravet and Lennox-Gastaut syndromes. The most common adverse effects (AEs) are drowsiness, reduced appetite, diarrhea, and vomiting. Transaminase elevation is the most common AE that leads to CBD discontinuation. Coadministration with valproate may increase the risk of hepatotoxicity. The combination of CBD and clobazam may increase both the effectiveness and the risk of AEs associated with these drugs. The most striking gaps in knowledge are the efficacy and optimal dose of CBD for adults with focal epilepsies, the long-term safety of CBD use, and strategies to improve access to CBD for people living with epilepsy.

Highlights

Tetrahydrocannabinol (THC) and cannabidiol (CBD) are two of the most prominent cannabinoids found in the Cannabis
Double-blind, placebo-controlled phase 3 trial investigated the efficacy of CBD as an add-on therapy for drop seizures in patients with treatment-resistant LennoxGastaut syndrome
The results confirmed the efficacy of CBD with a median percentage reduction in monthly drop seizure frequency from a baseline of 43.9% in patients treated with 20 mg/kg of CBD compared to 21.8% in the placebo group

Summary

INTRODUCTION

This treatment gap motivates research on new ASMs, such as cannabidiol (CBD). The medical use of marijuana has gained considerable interest in the press in the last two decades Three reasons for this are (a) the appeal of being a “natural” alternative treatment [3]; (b) the discovery of a complex cell-signaling system responsive to cannabis, the endocannabinoid system [4]; and (c) prominent public cases, such as Charlotte Figi in the United States [5]. Tetrahydrocannabinol (THC) and cannabidiol (CBD) are two of the most prominent cannabinoids found in the Cannabis. CBD is a cannabinoid that lacks psychoactive effects It has a more consistent antiepileptic efficacy than THC [17, 18]. Transient receptor potential vanilloid type 1 (TRPV1)-mediated signaling may be the most relevant pathway in the anticonvulsant effect of CBD [19,20,21]

EVIDENCE ON EFFECTIVENESS

PHARMACOKINETICS AND DRUG INTERACTIONS

Findings

CONCLUSION