Epilepsy Warriors - Ask A Doc - Epilepsy and Medical Marijuana
This week I’ve had a number of questions about the use of
medical marijuana for epilepsy. It’s
not a common question, so I did some research.
Obviously, talking about illicit substances can cause a significant amount of emotion...its a hot topic... But we cannot hide from the topic since its an active area of published research. Your typical kids "Mary or Jane" can look it up in the school libary.
Some background ... Many medications are "controlled" by government regulations. Some chemicals can be used therapeutically but if bought and sold by lay-people they are illicit. Besides marijuana, other "controlled" substances are commonly used as medications. Ophthalmologists use cocaine for examination. Amphetamine is commonly prescribed for ADHD. Narcotics are essential for pain control. Gamma hydroxybutyrate is used for narcolepsy. What would I use to treat methanol poisoning in a child? IV Ethanol ... Don't try to buy phenobarbital or lorazepam on the street...
Some background ... Many medications are "controlled" by government regulations. Some chemicals can be used therapeutically but if bought and sold by lay-people they are illicit. Besides marijuana, other "controlled" substances are commonly used as medications. Ophthalmologists use cocaine for examination. Amphetamine is commonly prescribed for ADHD. Narcotics are essential for pain control. Gamma hydroxybutyrate is used for narcolepsy. What would I use to treat methanol poisoning in a child? IV Ethanol ... Don't try to buy phenobarbital or lorazepam on the street...
However, we should focus on the data supporting or refuting
the use of cannabinoids for a therapeutic end.... in this case seizures.
The National Library of Medicine sponsors a free search
engine (pubmed) that lists medical articles published by peer-reviewed journals. The
peer review process is meant to ensure a certain amount of academic integrity.
Let me roll-up the papers that I have found:
Basically, almost all research in this area has been done on rodents. There were 2 small studies of adults published in 1979 in 1980 a total of 16 individuals that appeared to show some promise with the use of cannabanoids for generalized epilepsy. Despite the apparent positive response, this is not very strong data.
Basically, almost all research in this area has been done on rodents. There were 2 small studies of adults published in 1979 in 1980 a total of 16 individuals that appeared to show some promise with the use of cannabanoids for generalized epilepsy. Despite the apparent positive response, this is not very strong data.
Regardless of
the therapeutic modality, I would not recommend treatment based on studies
performed on 16 individuals, especially when the research was performed by one
group and has not been replicated.
More importantly, there is no therapeutic data information for people under 18. For children the effects of calmly available cannabinoids on neurodevelopment are highly likely to be negative.
More importantly, there is no therapeutic data information for people under 18. For children the effects of calmly available cannabinoids on neurodevelopment are highly likely to be negative.
To shed little a
light on this hot and smokey topic, allow me to refer readers to 3 recent articles that review the topic of cannabinoids in epilepsy.
Dr. Smith
writes this matter than I can ”Since the action of cannabinoids is complex, and there is a dearth of clinical
trial data, it is currently unclear whether cannabinoids might be both
efficacious and safe in the treatment of epilepsy.”
While I respect an individual’s claims (no pot-shots from me), any reports of a positive effect must be kept in that category: interesting anecdote.
But, science moves forward with anecdote. The research possibilities may be promising, I would not recommend the use of this substance to prevent seizures. I look forward to more
research producing medications that may use bring out a therapeutic use for the cannabinoid receptor.
I hope I added some insight and a little needed levity,
I hope I added some insight and a little needed levity,
Dr.
Rotenberg
Curr Opin Investig Drugs. 2005 Jul;6(7):680-5.
Source
Department
of Pharmacology and Toxicology, School of Medical Sciences, University of
Otago, Dunedin, New Zealand. paul.smith@stonebow.otago.ac.nz
Abstract
Cannabinoids
have long been recognized as having the potential for both anticonvulsant and
proconvulsant effects. The increased understanding of the cannabinoid receptors
and their endogenous ligands over the last decade has provided a potential
mechanism of action for these apparently paradoxical effects. Although the
anticonvulsant effects of cannabinoids appear to be mediated by their action at
presynaptic cannabinoid receptors, which inhibit the release of excitatory
neurotransmitters such as glutamate, it is clear that they are also capable of
producing proconvulsant effects through the activation of cannabinoid receptors
on terminals releasing inhibitory neurotransmitters, such as
gamma-amino-butyric acid. In the brain, the activation of cannabinoid receptors
is carefully controlled by the rapid synthesis and degradation of
endocannabinoids in a way that targets the endogenous ligands to specific sets
of cannabinoid receptors. The potential problem in delivering a cannabinoid
drug to treat epilepsy is the inability to control its actions at different
cannabinoid receptors regulating the release of different neurotransmitters.
Since the action of cannabinoids is complex, and there is a dearth of clinical
trial data, it is currently unclear whether cannabinoids might be both
efficacious and safe in the treatment of epilepsy.
PMID: 16044663 [PubMed - indexed for MEDLINE]
Publication Types, MeSH Terms, Substances
3.
Epilepsia. 2009 Jul;50(7):1657-69. Epub 2009
Jul 1.
Source
Department
of Anatomy and Neurobiology, University of California, Irvine, California, USA.
cmarmstr@uci.edu
Abstract
There
are essentially two potential treatment options for any acquired disorder:
symptomatic or prophylactic. For acquired epilepsies that follow a variety of
different brain insults, there remains a complete lack of prophylactic
treatment options, whereas at the same time these epilepsies are notoriously
resistant, once they have emerged, to symptomatic treatments with antiepileptic
drugs. The development of prophylactic strategies is logistically challenging,
both for basic researchers and clinicians. Nevertheless, cannabinoid-targeting
drugs provide a very interesting example of a system within the central nervous
system (CNS) that can have very different acute and long-term effects on
hyperexcitability and seizures. In this review, we outline research on
cannabinoids suggesting that although cannabinoid antagonists are acutely
proconvulsant, they may have beneficial effects on long-term hyperexcitability
following brain insults of multiple etiologies, making them promising
candidates for further investigation as prophylactics against acquired
epilepsy. We then discuss some of the implications of this finding on future
attempts at prophylactic treatments, specifically, the very short window within
which prevention may be possible, the possibility that traditional
anticonvulsants may interfere with prophylactic strategies, and the importance
of moving beyond anticonvulsants-even to proconvulsants-to find the ideal
preventative strategy for acquired epilepsy.
PMID: 19552655 [PubMed - indexed for MEDLINE] PMCID: PMC2894282 Free PMC Article
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Full article here...
...Can we target therapy to the critical circuits in the forebrain? Smoking marijuana is obviously is not an appropriate therapy; in addition to the psychoactive effects, the inhalation of smoke poses obvious health risks. To this end, drug companies have already isolated the active ingredients in cannabis and produced them in the form of a pill or a spray. However, most synthetic cannabinoids still have psychoactive effects and are undesirable for therapeutics. It may be more beneficial to target cannabinoid transport or degradation systems to increase the levels of endogenous cannabinoids. Enhancing the cannabinoid system may prove to be an effective treatment for epilepsy, especially in cases in which standard drugs fail to control seizures.
Cannabinoids: Defending the Epileptic Brain
Full article here...
...Can we target therapy to the critical circuits in the forebrain? Smoking marijuana is obviously is not an appropriate therapy; in addition to the psychoactive effects, the inhalation of smoke poses obvious health risks. To this end, drug companies have already isolated the active ingredients in cannabis and produced them in the form of a pill or a spray. However, most synthetic cannabinoids still have psychoactive effects and are undesirable for therapeutics. It may be more beneficial to target cannabinoid transport or degradation systems to increase the levels of endogenous cannabinoids. Enhancing the cannabinoid system may prove to be an effective treatment for epilepsy, especially in cases in which standard drugs fail to control seizures.
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