Noted experts critically evaluate benefits of medical marijuana for treatment of epilepsy

Although cannabis had been used for many centuries for treatment of seizure disorders, medical use became prohibited in the 20th century. However, with the loosening of laws regarding medical marijuana, research and clinical use of marijuana-derived substances are increasing. This has prompted the editors of Epilepsy & Behavior to produce a special issue that presents an in-depth assessment of the potential of cannabinoids for the effective treatment of epilepsy. Cannabinoids are components of the cannabis plant.

Guest Editors Jerzy Szaflarski, MD, PhD, Director of the Epilepsy Center, University of Alabama at Birmingham, and Orrin Devinsky, MD, Director, Epilepsy Center, New York University Langone Medical Center, New York, comment that, "There is an enormous dissociation between the widespread use of cannabis-based therapies to treat diverse epilepsies and our understanding about the efficacy and safety of different cannabinoids in treating different epilepsy syndromes." Because much of the political pressure to allow for medical marijuana use came from patients and lay groups, the goal of this special issue is "to evaluate the concerns and gaps in cannabinoid knowledge and medical education, and to create a curriculum as a first step in building a broader Education Roadmap."

This special issue provides an overview for general neurologists and epileptologists, including historical aspects of cannabis use for epilepsy, overview of cannabis botany, general aspects of the endocannabinoid system as it pertains to epilepsy, pharmacology of cannabinoids, available anecdotal and clinical trial data of cannabinoid use for the treatment of epilepsy, safety data, discussion of possible effects of cannabinoids on the brain including neuroimaging data, and the legal aspects of cannabis production, distribution, and use for the treatment of epilepsy.

Raphael Mechoulam, PhD, Head of the School of Pharmacy and Director of the Institute for Drug Research at Hebrew University, provides an insightful historical perspective. He notes that non-psychoactive cannabidiol (CBD) is officially approved for the treatment of intractable pediatric epilepsy in Israel, but it took over 35 years to conduct the studies and obtain the results. "I expect that over the next decade we shall see major advances both in the medical-scientific and the treatment aspects of epilepsy with the help of CBD and related cannabinoids," explains Dr. Mechoulam.

To move a plant-based drug from research studies to clinical use is a particular challenge for pharmaceutical companies. Suman Chandra, PhD, Senior Research Scientist at the University of Mississippi, and co-authors review how the United States and United Kingdom have addressed the problem of securing uniform supplies of medically pure and potent cannabinoids. They review cultivation and processing of marijuana at two institutions with extensive experience, GW Pharmaceuticals in the U.K. and the University of Mississippi in the U.S.

Because both media coverage of cannabis use in epilepsy and inconsistent classification of medical marijuana usage in different U.S. states have short-circuited the rigorous scientific protocols of the U.S. Food and Drug Administration (FDA), quality validation may be lacking. Dustin Sulak, DO, Integr8 Health (Falmouth, ME) and co-investigators review how "artisanal" cannabis preparations, not subject to state regulatory controls, are being used in Washington and California. They also relate four case studies of pediatric epilepsy patients that illustrate the complexities of treatment due to variability of these preparations.

As an example of how interest in medical use of cannabis can be driven by social media and word-of-mouth, Anastasia S. Suraev, The Lambert Initiative for Cannabinoid Therapeutics, The University of Sydney, and co-authors surveyed the Australian epilepsy community. This online survey was promoted by Epilepsy Action Australia, a national non-profit organization that provides education and services to people with epilepsy and their families. There were 976 responses, about 60% from adults with epilepsy and the remainder from children with epilepsy. Overall, 14% reported currently using or having previously used cannabis products to treat epilepsy. Of the 389 children with epilepsy included in the survey, 13% had a reported history of cannabis product use for epilepsy. Of these, 71% of parents/guardians rated cannabis products as successful in helping them manage their child's seizures. Furthermore, 51% of parents/guardians reported reduced use of anti-epileptic drugs by their child after commencing use of cannabis products.

Although cannabis is currently legal for medical purposes in half of the states and another seventeen states allow products that are high in cannabidiol (CBD) and low in THC (tetrahydrocannabinol) for medical use, none of these products has been approved by the FDA. Alice Mead, JD, LLM, GW Pharmaceuticals, Inc. (Carlsbad, CA) provides an overview of the legal aspects of cannabis and cannabidiol, including cultivation, manufacture, distribution, and use for medical purposes.

"We hope these articles help stimulate greater understanding and more importantly, stimulate more studies to scientifically define the potential benefits and harms of cannabis-based therapies for epilepsy," note Dr. Szaflarski and Dr. Devinsky. "We need to develop a curriculum to address the rapidly changing scientific and regulatory landscape surrounding the medical use of cannabis and cannabinoids."

Epilepsy & Behavior, May 2017 Volume 70, Part B, p277-370, Cannabinoids and Epilepsy

  • The current status of artisanal cannabis for the treatment of epilepsy in the United States
    Sulak, Dustin et al.
    Epilepsy & Behavior , Volume 70 , 328 - 333
  • Cannabinoids and epilepsy - Introduction
    Szaflarski, Jerzy P. et al.
    Epilepsy & Behavior , Volume 70 , 277
  • Social factors in marijuana use for medical and recreational purposes
    Szaflarski, Magdalena et al.
    Epilepsy & Behavior , Volume 70 , 280 - 287
  • Cannabis and epilepsy: An ancient treatment returns to the fore
    Russo, Ethan B.
    Epilepsy & Behavior , Volume 70 , 292 - 297
  • Pharmacology of cannabinoids in the treatment of epilepsy
    Gaston, Tyler E. et al.
    Epilepsy & Behavior , Volume 70 , 313 - 318
  • Social correlates of health status, quality of life, and mood states in patients treated with cannabidiol for epilepsy
    Szaflarski, Magdalena et al.
    Epilepsy & Behavior , Volume 70 , 364 - 369
  • Historical perspective on the medical use of cannabis for epilepsy: Ancient times to the 1980s
    Friedman, Daniel et al.
    Epilepsy & Behavior , Volume 70 , 298 - 301
  • Cannabinoids in treatment-resistant epilepsy: A review
    O'Connell, Brooke K. et al.
    Epilepsy & Behavior , Volume 70 , 341 - 348
  • Cannabis and epilepsy
    Mechoulam, R.
    Epilepsy & Behavior , Volume 70 , 278 - 279
  • Cannabis cultivation: Methodological issues for obtaining medical-grade product
    Chandra, Suman et al.
    Epilepsy & Behavior , Volume 70 , 302 - 312
  • Neuroimaging studies towards understanding the central effects of pharmacological cannabis products on patients with epilepsy
    Allendorfer, Jane B. et al.
    Epilepsy & Behavior , Volume 70 , 349 - 354
  • Therapeutic effects of cannabinoids in animal models of seizures, epilepsy, epileptogenesis, and epilepsy-related neuroprotection
    Rosenberg, Evan C. et al.
    Epilepsy & Behavior , Volume 70 , 319 - 327
  • An Australian nationwide survey on medicinal cannabis use for epilepsy: History of antiepileptic drug treatment predicts medicinal cannabis use
    Suraev, Anastasia S. et al.
    Epilepsy & Behavior , Volume 70 , 334 - 340
  • Strokes are possible complications of cannabinoids use
    Wolff, Valérie et al.
    Epilepsy & Behavior , Volume 70 , 355 - 363
  • The legal status of cannabis (marijuana) and cannabidiol (CBD) under U.S. law
    Mead, Alice
    Epilepsy & Behavior , Volume 70 , 288 - 291

Most Popular Now

Novartis rises to second place in 2018 Access to M…

Novartis ranked second in the 2018 Access to Medicine Index (ATMi), up from 3rd place in 2016, in recognition of its long-standing efforts to improve worldwide access to ...

Sanofi builds focus on rare blood disorders and ca…

Some of the most serious unmet patient needs today are in the field of hematology. Rare blood disorders and blood-related cancers continue to be a major focus of research...

MSD is looking for a digital health solution to em…

MSD Lebanon is looking for an external partner to co-create a digital solution that helps oncologists to stay updated with relevant clinical content about cancer. The sol...

FDA approves new treatment for patients with acute…

The U.S. Food and Drug Administration today approved Daurismo (glasdegib) tablets to be used in combination with low-dose cytarabine (LDAC), a type of chemotherapy, for t...

Lilly submits New Drug Application to the FDA for …

Eli Lilly and Company (NYSE: LLY) has announced the submission of a New Drug Application (NDA) to the U.S. Food and Drug Administration (FDA) for lasmiditan for the acute...

New study reveals probiotics do not help children …

Probiotics are a multibillion-dollar industry with marketing claims of being an effective treatment for a multitude of ailments, including diarrhea. However, findings fro...

Merck and Pfizer provide update on avelumab in pla…

Merck and Pfizer Inc. (NYSE: PFE) today announced that the Phase III JAVELIN Ovarian 200 trial evaluating avelumab* alone or in combination with pegylated liposomal doxor...

U.S. FDA approves Larotrectinib, the first TRK inh…

The U.S. Food and Drug Administration (FDA) has approved larotrectinib, the first oral TRK inhibitor, under the brand name Vitrakvi®. The approval is for the treatment of...

FDA approves first treatment for Lambert-Eaton mya…

The U.S. Food and Drug Administration today approved Firdapse (amifampridine) tablets for the treatment of Lambert-Eaton myasthenic syndrome (LEMS) in adults. LEMS is a r...

Bristol-Myers Squibb awards "Golden Tickets…

Bristol-Myers Squibb Company (NYSE: BMY) and LabCentral, an innovative, shared laboratory space designed as a launchpad for life-sciences and biotech startups, today anno...

Alcon to highlight its vision, strategy and benefi…

Alcon, the eye care division of Novartis, will today hold its first Capital Markets Day for investors and analysts in relation to the previously-announced intention of No...

FDA grants breakthrough device designation to arti…

Bayer announced today that the U.S. Food and Drug Administration (FDA) granted Breakthrough Device Designation to the Artificial Intelligence Software for Chronic Thrombo...