Abstract
A significant number of epilepsy patients are refractory to conventional antiepileptic drugs. These patients experience considerable neurocognitive impairments that impact their quality of life and ability to function independently. This need for alternative treatment has generated increased interest in cannabis use as a therapeutic option in these patients. This review seeks to analyze data presented on the pharmacology, safety, and efficacy of cannabis use in patients with drug-resistant epilepsy (DRE) and to propose any future recommendations regarding its use. PubMed was used to retrieve all published studies and articles which evaluated the use of cannabis in epilepsy. The two foremost phytocannabinoids of cannabis showing anticonvulsant properties are tetrahydrocannabinol (THC) and cannabidiol (CBD). Due to the psychoactive properties of THC, most studies focused on CBD use in these patients. The use of CBD as an adjunct resulted in decreased seizure frequency, and secondary benefits observed included improvement in mood, alertness and sleep. Adverse events (AEs) reported were drowsiness, diarrhea, increased transaminases and worsening of seizures. It can safely be concluded that there is a significant benefit in DRE patients using CBD as adjunctive therapy. However, further controlled and adequately powered studies are needed to assess the pharmacokinetics and impact of the long-term use of cannabis.
Highlights
BackgroundApproximately 70 million people worldwide are affected by epilepsy [1]
This review seeks to analyze data presented on the pharmacology, safety, and efficacy of cannabis use in patients with drug-resistant epilepsy (DRE) and to propose any future recommendations regarding its use
The anticonvulsant properties of cannabis have been reported for several years; its use as adjunctive therapy in DRE has increased in recent years
Summary
70 million people worldwide are affected by epilepsy [1]. Its prevalence ranges from 0.5% to 1% in developed countries and even higher in developing countries [2]. More than 25% of seizure reduction was found in 66% of patients with epileptic encephalopathies, while only 45% of other study participants had a comparable result [36] While these studies and others showed some therapeutic effect of cannabis in epilepsy, they lacked control groups, consistent dose administration and were inadequately powered. The benefit of cannabis use in patients with DRE has been clearly demonstrated in these studies, the outcome of which was the achievement of more than 50% seizure reduction This use was primarily noted with highly purified CBD, which led to FDA approval of its use as an adjunct and its reclassification by the Drug Enforcement Agent as a schedule V agent [19]. Most studies gave a cursory report of these benefits, reiterating the need for more double-blind RCT focusing on the quality of life in DRE patients taking CBD
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