PBG GLOBAL

Epilepsy

Epilepsy is a condition defined by recurrent, unprovoked seizures. It has numerous causes, each reflecting underlying brain dysfunction[1]. According to the World Health Organization, epilepsy affects more than 50 million people worldwide and is one of the most common, chronic, neurological disorders. Patients with epilepsy can suffer from a diminished quality of life, family function, and social support compared to other patients who are chronically ill[2]. Epilepsy comes in several forms: generalized, focal, combined generalized and focal, or unknown epilepsy[3]. Up to 70% of epilepsy cases can be successfully treated, and the pharmacological treatment options use drugs with different mechanisms of action. These include sodium and calcium channel blockers, potassium channel function enhancers, inhibitors of excitation mediated by glutamate, and enhancement of GABA receptors activity. About 30% of the cases though are treatment-resistant epilepsies (TREs), which have even shown resistance to newer antiepileptics[4]. TREs are defined as disorders with unsuccessful prolonged remission after treatment of at least two regimens of antiepileptic therapy[5].

CBD and epilepsy

CBD can play an important role in overcoming this resistance as its action mechanism differs from all the antiepileptic drugs available. Scientific studies suggest that CBD may be effective against several TREs stemming from Dravet syndrome [6], Lennox-Gastaut syndrome[7], Tuberous sclerosis complex [8], [9], Febrile infection-related epilepsy syndrome [10], focal seizures, and others [11], [12]. Experimental data shows that it can further increase the action of other anti-epilepsy drugs when used in combination [13].

Additionally, the use of CBD in the treatment of TREs could be justified from another point of view. The current guidelines for TREs suggest that the patient undergoes surgical treatment (if possible) [14], and CBD could be used as a painkiller for post-operative pain management.

The U.S. Food and Drug Administration (FDA) now officially recognizes the 10% CBD in sesame seed oil oral solutions as a standard adjuvant treatment for several TREs in patients one year of age and older.

Dosing recommendations for epilepsy patients

Is CBD safe?

Yes. CBD is considered safe for epilepsy.

What is the recommended daily dose?

Start with 1 mg/kg/day and titrate to effect - possibly as high as 30 mg/kg/day. Consult higher doses with your doctor. Read General recommendations for more information.

Should I take it before or after a meal?

CBD should be taken before or after a meal.

How many times a day should I take CBD?

Take your dose twice a day. Half of it in the morning and the other half in the evening.

Are there any known drug interactions?

Some. Read Side effects for more information.

Bibliography

1. Shorvon S, Guerrini R, Schachter S and Trinka E: The Causes of Epilep- sy: Common and Uncommon Causes in Adults and Children. Cambridge University Press, Cambridge, 2019.

2. Wiebe S, Bellhouse DR, Fallahay C and Eliasziw M: Burden of epilepsy: the Ontario Health Survey. The Canadian journal of neurological sciences Le journal canadien des sciences neurologiques 26: 263-270, 1999.

3. Scheffer IE, Berkovic S, Capovilla G, et al: ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia 58: 512-521, 2017.

4. French JA, White HS, Klitgaard H, et al: Development of new treatment approaches for epilepsy: Unmet needs and opportunities. Epilepsia 54: 3-12, 2013.

5. Kwan P, Arzimanoglou A, Berg AT, et al: Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia 51: 1069-1077, 2010.

6. Koubeissi M: Anticonvulsant Effects of Cannabidiol in Dravet Syndrome. Epilepsy Curr 17: 281-282, 2017.

7. Thiele E, Marsh E, Mazurkiewicz-Beldzinska M, et al: Cannabidiol in patients with Lennox-Gastaut syndrome: Interim analysis of an open-label extension study. Epilepsia 60: 419-428, 2019.

8. Nickels K: Cannabidiol in Patients With Intractable Epilepsy Due to TSC: A Possible Medication But Not a Miracle. Epilepsy Curr 17: 91-92, 2017.

9. Hess EJ, Moody KA, Geffrey AL, et al: Cannabidiol as a new treatment for drug-resistant epilepsy in tuberous sclerosis complex. Epilepsia 57: 1617-1624, 2016.

10. Gofshteyn JS, Wilfong A, Devinsky O, et al: Cannabidiol as a Potential Treatment for Febrile Infection-Related Epilepsy Syndrome (FIRES) in the Acute and Chronic Phases. Journal of Child Neurology 32: 35-40, 2017.

11. Silvestro S, Mammana S, Cavalli E, Bramanti P and Mazzon E: Use of Cannabidiol in the Treatment of Epilepsy: Efficacy and Security in Clinical Trials. Molecules 24: 1459, 2019.

12. Laux LC, Bebin EM, Checketts D, et al: Long-term safety and efficacy of cannabidiol in children and adults with treatment resistant Lennox- Gastaut syndrome or Dravet syndrome: Expanded access program results. Epilepsy research 154: 13-20, 2019.

13. Consroe P and Wolkin A: Cannabidiol--antiepileptic drug comparisons and interactions in experimentally induced seizures in rats. The Journal of pharmacology and experimental therapeutics 201: 26-32, 1977.

14. Engel J, Jr., Wiebe S, French J, et al: Practice parameter: temporal lobe and localized neocortical resections for epilepsy. Epilepsia 44: 741-751, 2003.