551
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Report from a Survey of Parents Regarding the Use of Cannabidiol (Medicinal cannabis) in Mexican Children with Refractory Epilepsy. Neurol Res Int 2017; 2017:2985729. [PMID: 28392943 PMCID: PMC5368357 DOI: 10.1155/2017/2985729] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/14/2016] [Accepted: 12/15/2016] [Indexed: 11/17/2022] Open
Abstract
Structured online surveys were used to explore the experiences of the parents of children with refractory epilepsy using medicinal cannabis in Mexico during September 2016. The surveys, which were completed in full, were reviewed, and 53 cases of children aged between 9 months and 18 years were identified. Of these, 43 cases (82%) were from Mexico and 10 (18%) were from Latin American countries. Of the 43 Mexican cases, the diagnoses were as follows: 20 cases (47%) had Lennox-Gastaut syndrome (LGS); 13 cases (30%) had unspecified refractory epilepsy (URE); 8 cases (19%) had West syndrome (WS); 1 case (2%) had Doose syndrome (DS); and 1 case (2%) had Ohtahara syndrome (OS). In total, 47.1% of cases had previously been treated with 9 or more anticonvulsant therapies. The parents reported a decrease in convulsions when cannabidiol was used in 81.3% of the cases; a moderate to significant decrease occurred in 51% of cases, and 16% of cases were free from seizure. The number of antiepileptic drugs being used was reduced in 9/43 (20.9%) cases. No serious adverse effects were reported, with only some mild adverse effects, such as increased appetite or changes in sleep patterns, reported in 42% of cases.
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552
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Russo EB. Cannabidiol Claims and Misconceptions. Trends Pharmacol Sci 2017; 38:198-201. [DOI: 10.1016/j.tips.2016.12.004] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 12/12/2016] [Indexed: 11/13/2022]
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553
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Cannabidiol in Patients With Intractable Epilepsy Due to TSC: A Possible Medication But Not a Miracle. Epilepsy Curr 2017; 17:91-92. [PMID: 28490996 DOI: 10.5698/1535-7511.17.2.91] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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554
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Babalonis S, Haney M, Malcolm RJ, Lofwall MR, Votaw VR, Sparenborg S, Walsh SL. Oral cannabidiol does not produce a signal for abuse liability in frequent marijuana smokers. Drug Alcohol Depend 2017; 172:9-13. [PMID: 28088032 PMCID: PMC5361620 DOI: 10.1016/j.drugalcdep.2016.11.030] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/17/2016] [Accepted: 11/24/2016] [Indexed: 02/09/2023]
Abstract
BACKGROUND Cannabidiol (CBD) is a naturally occurring constituent of the marijuana plant. In the past few years, there has been great interest in the therapeutic effects of isolated CBD and it is currently being explored for numerous disease conditions (e.g., pain, epilepsy, cancer, various drug dependencies). However, CBD remains a Schedule I drug on the U.S. Controlled Substances Act (CSA). Despite its status, there are no well-controlled data available regarding its abuse liability. METHODS Healthy, frequent marijuana users (n=31) were enrolled in this within subject, randomized, placebo-controlled, double-blind, multisite study that administered oral cannabidiol (0, 200, 400, 800mg) alone and in combination with smoked marijuana (0.01%, 5.3-5.8% THC). Participants received one dose combination across 8 once-weekly outpatient sessions (7.5h). The primary findings on the drug interaction effects were previously reported (Haney et al., 2016). The present study is a secondary analysis of the data to examine the abuse liability profile of oral cannabidiol (200, 400, 800mg) in comparison to oral placebo and active smoked marijuana (5.3-5.8% THC). RESULTS Active marijuana reliably produced abuse-related subjective effects (e.g., high) (p<0.05). However, CBD was placebo-like on all measures collected (p>0.05). CONCLUSIONS Overall, CBD did not display any signals of abuse liability at the doses tested and these data may help inform U.S. regulatory decisions regarding CBD schedule on the CSA.
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Affiliation(s)
- Shanna Babalonis
- University of Kentucky, Department of Behavioral Science, Center on Drug and Alcohol Research, Lexington, KY, USA.
| | - Margaret Haney
- Columbia University Medical Center, Division on Substance Abuse, New York State Psychiatric Institute and the Department of Psychiatry, New York, NY, USA
| | | | - Michelle R. Lofwall
- University of Kentucky, Department of Behavioral Science, Center on Drug and Alcohol Research, Lexington, KY, USA
| | - Victoria R. Votaw
- McLean Hospital, Division of Alcohol and Drug Abuse, Belmont, MA, USA
| | | | - Sharon L. Walsh
- University of Kentucky, Department of Behavioral Science, Center on Drug and Alcohol Research, Lexington, KY, USA
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555
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Ryan SA, Ammerman SD, Gonzalez PK, Patrick SW, Quigley J, Walker LR. Counseling Parents and Teens About Marijuana Use in the Era of Legalization of Marijuana. Pediatrics 2017; 139:peds.2016-4069. [PMID: 28242859 DOI: 10.1542/peds.2016-4069] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Many states have recently made significant changes to their legislation making recreational and/or medical marijuana use by adults legal. Although these laws, for the most part, have not targeted the adolescent population, they have created an environment in which marijuana increasingly is seen as acceptable, safe, and therapeutic. This clinical report offers guidance to the practicing pediatrician based on existing evidence and expert opinion/consensus of the American Academy of Pediatrics regarding anticipatory guidance and counseling to teenagers and their parents about marijuana and its use. The recently published technical report provides the detailed evidence and references regarding the research on which the information in this clinical report is based.
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Affiliation(s)
- Sheryl A. Ryan
- Department of Pediatrics/Adolescent Medicine, Yale University School of Medicine, New Haven, Connecticut; and
| | - Seth D. Ammerman
- Department of Pediatrics/Adolescent Medicine, Stanford University School of Medicine, Stanford, California
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556
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Optimizing the Diagnosis and Management of Dravet Syndrome: Recommendations From a North American Consensus Panel. Pediatr Neurol 2017; 68:18-34.e3. [PMID: 28284397 DOI: 10.1016/j.pediatrneurol.2017.01.025] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 01/24/2017] [Accepted: 01/28/2017] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To establish standards for early, cost-effective, and accurate diagnosis; optimal therapies for seizures; and recommendations for evaluation and management of comorbidities for children and adults with Dravet syndrome, using a modified Delphi process. METHODS An expert panel was convened comprising epileptologists with nationally recognized expertise in Dravet syndrome and parents of children with Dravet syndrome, whose experience and understanding was enhanced by their active roles in Dravet syndrome associations. Panelists were asked to base their responses to questions both on their clinical expertise and results of a literature review that was forwarded to each panelist. Three rounds of online questionnaires were conducted to identify areas of consensus and strength of that consensus, as well as areas of contention. RESULTS The panel consisted of 13 physicians and five family members. Strong consensus was reached regarding typical clinical presentation of Dravet syndrome, range of electroencephalography and magnetic resonance imaging findings, need for genetic testing, critical information that should be conveyed to families at diagnosis, priorities for seizure control and typical degree of control, seizure triggers and recommendations for avoidance, first- and second-line therapies for seizures, requirement and indications for rescue therapy, specific recommendations for comorbidity screening, and need for family support. Consensus was not as strong regarding later therapies, including vagus nerve stimulation and callosotomy, and for specific therapies of associated comorbidities. Beyond the initial treatment with benzodiazepines and use of valproate, there was no consensus on the optimal in-hospital management of convulsive status epilepticus. CONCLUSIONS We were able to identify areas where there was strong consensus that we hope will (1) inform health care providers on optimal diagnosis and management of patients with Dravet syndrome, (2) support reimbursement from insurance companies for genetic testing and Dravet syndrome-specific therapies, and (3) improve quality of life for patients with Dravet syndrome and their families by avoidance of unnecessary testing and provision of an early accurate diagnosis allowing optimal selection of therapeutic strategies.
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557
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Maccarrone M, Maldonado R, Casas M, Henze T, Centonze D. Cannabinoids therapeutic use: what is our current understanding following the introduction of THC, THC:CBD oromucosal spray and others? Expert Rev Clin Pharmacol 2017; 10:443-455. [PMID: 28276775 DOI: 10.1080/17512433.2017.1292849] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The complexity of the endocannabinoid (eCB) system is becoming better understood and new drivers of eCB signaling are emerging. Modulation of the activities of the eCB system can be therapeutic in a number of diseases. Research into the eCB system has been paralleled by the development of agents that interact with cannabinoid receptors. In this regard it should be remembered that herbal cannabis contains a myriad of active ingredients, and the individual cannabinoids have quite distinct biological activities requiring independent studies. Areas covered: This article reviews the most important current data involving the eCB system in relation to human diseases, to reflect the present (based mainly on the most used prescription cannabinoid medicine, THC/CBD oromucosal spray) and potential future uses of cannabinoid-based therapy. Expert commentary: From the different therapeutic possibilities, THC/CBD oromucosal spray has been in clinical use for approximately five years in numerous countries world-wide for the management of multiple sclerosis (MS)-related moderate to severe resistant spasticity. Clinical trials have confirmed its efficacy and tolerability. Other diseases in which different cannabinoids are currently being investigated include various pain states, Alzheimer's disease, Parkinson's disease, Huntington's disease and epilepsy. The continued characterization of individual cannabinoids in different diseases remains important.
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Affiliation(s)
- Mauro Maccarrone
- a Department of Medicine , Campus Bio-Medico University of Rome , Rome , Italy.,b Laboratory of Lipid Neurochemistry, European Center for Brain Research/IRCCS Santa Lucia Foundation , Rome , Italy
| | - Rafael Maldonado
- c Laboratori de Neurofarmacologia, Departament de Ciències Experimentals i de la Salut (CEXS), Facultat de Ciències de la Salut i de la Vida , Universitat Pompeu Fabra , Barcelona , Spain
| | - Miguel Casas
- d Servicio de Psiquiatría , Hospital Universitari Vall d'Hebron , Barcelona , Spain.,e Departamento de Psiquiatría y Medicina Legal , Universitat Autònoma de Barcelona , Barcelona , Spain.,f CIBERSAM , Barcelona , Spain
| | - Thomas Henze
- g Passauer Wolf Reha-Zentrum Nittenau , Nittenau , Germany
| | - Diego Centonze
- h Multiple Sclerosis Clinical and Research Center, Tor Vergata University, Rome & Unit of Neurology , IRCCS Istituto Neurologico Mediterraneo Neuromed , Pozzilli , Italy
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558
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Sultan SR, Millar SA, England TJ, O'Sullivan SE. A Systematic Review and Meta-Analysis of the Haemodynamic Effects of Cannabidiol. Front Pharmacol 2017; 8:81. [PMID: 28286481 PMCID: PMC5323388 DOI: 10.3389/fphar.2017.00081] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 02/08/2017] [Indexed: 11/13/2022] Open
Abstract
Despite cannabidiol (CBD) having numerous cardiovascular effects in vitro, its haemodynamic effects in vivo are unclear. Nonetheless, the clinical use of CBD (Epidiolex) is becoming more widespread. The aim of this systematic review was to establish whether CBD is associated with changes in haemodynamics in vivo. Twenty-five studies that assessed the haemodynamic effects of CBD (from PubMed, Medline and EMBASE) were systematically reviewed and meta-analyzed. Data on blood pressure (BP), heart rate (HR), and blood flow (BF) were extracted and analyzed using random effects models. Twenty-two publications assessed BP and HR among 6 species (BP n = 344 and HR n = 395), and 5 publications assessed BF in 3 species (n = 56) after acute dosing of CBD. Chronic dosing was assessed in 4 publications in 3 species (total subjects BP, n = 6; HR, n = 27; BF, n = 3). Acute CBD dosing had no effect on BP or HR under control conditions. Similarly, chronic dosing with CBD had no effect on HR. In models of stress, acute CBD administration significantly reduced the increase in BP and HR induced by stress (BP, mean difference (MD) −3.54, 95% CI −5.19, −1.9, p < 0.0001; HR, MD −16.23, 95% CI −26.44, −6.02, p = 0.002). In mouse models of stroke, CBD significantly increased cerebral blood flow (CBF, standardized mean difference (SMD) 1.62, 95% CI 0.41, 2.83, p = 0.009). Heterogeneity among the studies was present, there was no publication bias except in HR of control and stressful conditions after acute CBD dosing, and median study quality was 5 out of 9 (ranging from 1 to 8). From the limited data available, we conclude that acute and chronic administration of CBD had no effect on BP or HR under control conditions, but reduces BP and HR in stressful conditions, and increases cerebral blood flow (CBF) in mouse models of stroke. Further studies are required to fully understand the potential haemodynamic effects of CBD in humans under normal and pathological conditions.
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Affiliation(s)
- Salahaden R Sultan
- Vascular Medicine, Division of Medical Sciences and Graduate Entry Medicine, Royal Derby Hospital Centre, School of Medicine, University of Nottingham Derby, UK
| | - Sophie A Millar
- Vascular Medicine, Division of Medical Sciences and Graduate Entry Medicine, Royal Derby Hospital Centre, School of Medicine, University of Nottingham Derby, UK
| | - Timothy J England
- Vascular Medicine, Division of Medical Sciences and Graduate Entry Medicine, Royal Derby Hospital Centre, School of Medicine, University of Nottingham Derby, UK
| | - Saoirse E O'Sullivan
- Vascular Medicine, Division of Medical Sciences and Graduate Entry Medicine, Royal Derby Hospital Centre, School of Medicine, University of Nottingham Derby, UK
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559
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Pisanti S, Malfitano AM, Ciaglia E, Lamberti A, Ranieri R, Cuomo G, Abate M, Faggiana G, Proto MC, Fiore D, Laezza C, Bifulco M. Cannabidiol: State of the art and new challenges for therapeutic applications. Pharmacol Ther 2017; 175:133-150. [PMID: 28232276 DOI: 10.1016/j.pharmthera.2017.02.041] [Citation(s) in RCA: 346] [Impact Index Per Article: 49.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Over the past years, several lines of evidence support a therapeutic potential of Cannabis derivatives and in particular phytocannabinoids. Δ9-THC and cannabidiol (CBD) are the most abundant phytocannabinoids in Cannabis plants and therapeutic application for both compounds have been suggested. However, CBD is recently emerging as a therapeutic agent in numerous pathological conditions since devoid of the psychoactive side effects exhibited instead by Δ9-THC. In this review, we highlight the pharmacological activities of CBD, its cannabinoid receptor-dependent and -independent action, its biological effects focusing on immunomodulation, angiogenetic properties, and modulation of neuronal and cardiovascular function. Furthermore, the therapeutic potential of cannabidiol is also highlighted, in particular in nuerological diseases and cancer.
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Affiliation(s)
- Simona Pisanti
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Italy.
| | - Anna Maria Malfitano
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Italy
| | - Elena Ciaglia
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Italy
| | - Anna Lamberti
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Italy
| | - Roberta Ranieri
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Italy
| | - Gaia Cuomo
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Italy
| | - Mario Abate
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Italy
| | - Giorgio Faggiana
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Italy
| | | | | | | | - Maurizio Bifulco
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Italy; Corporea, Fondazione Idis-Città della Scienza, Naples, Italy.
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560
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Hurd YL. Cannabidiol: Swinging the Marijuana Pendulum From 'Weed' to Medication to Treat the Opioid Epidemic. Trends Neurosci 2017; 40:124-127. [PMID: 28162799 DOI: 10.1016/j.tins.2016.12.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 12/29/2016] [Indexed: 02/05/2023]
Abstract
Epidemics require a paradigm shift in thinking about all possible solutions. The rapidly changing sociopolitical marijuana landscape provides a foundation for the therapeutic development of medicinal cannabidiol to address the current opioid abuse crisis.
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Affiliation(s)
- Yasmin L Hurd
- Friedman Brain Institute, Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, Center for Addictive Disorders, Mount Sinai Behavioral Health System, New York, NY, USA.
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561
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Abstract
This paper reviews advances in epilepsy in recent years with an emphasis on therapeutics and underlying mechanisms, including status epilepticus, drug and surgical treatments. Lessons from rarer epilepsies regarding the relationship between epilepsy type, mechanisms and choice of antiepileptic drugs (AED) are explored and data regarding AED use in pregnancy are reviewed. Concepts evolving towards a move from treating seizures to treating epilepsy are discussed, both in terms of the mechanisms of epileptogenesis, and in terms of epilepsy's broader comorbidity, especially depression.
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562
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Bialer M, Johannessen SI, Levy RH, Perucca E, Tomson T, White HS. Progress report on new antiepileptic drugs: A summary of the Thirteenth Eilat Conference on New Antiepileptic Drugs and Devices (EILAT XIII). Epilepsia 2017; 58:181-221. [PMID: 28111749 DOI: 10.1111/epi.13634] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2016] [Indexed: 01/05/2023]
Abstract
The Thirteenth Eilat Conference on New Antiepileptic Drugs and Devices (EILAT XIII) took place in Madrid, Spain, on June 26-29, 2016, and was attended by >200 delegates from 31 countries. The present Progress Report provides an update on experimental and clinical results for drugs presented at the Conference. Compounds for which summary data are presented include an AED approved in 2016 (brivaracetam), 12 drugs in phase I-III clinical development (adenosine, allopregnanolone, bumetanide, cannabidiol, cannabidivarin, 2-deoxy-d-glucose, everolimus, fenfluramine, huperzine A, minocycline, SAGE-217, and valnoctamide) and 6 compounds or classes of compounds for which only preclinical data are available (bumetanide derivatives, sec-butylpropylacetamide, FV-082, 1OP-2198, NAX 810-2, and SAGE-689). Overall, the results presented at the Conference show that considerable efforts are ongoing into discovery and development of AEDs with potentially improved therapeutic profiles compared with existing agents. Many of the drugs discussed in this report show innovative mechanisms of action and many have shown promising results in patients with pharmacoresistant epilepsies, including previously neglected rare and severe epilepsy syndromes.
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Affiliation(s)
- Meir Bialer
- Faculty of Medicine, School of Pharmacy and David R. Bloom Center for Pharmacy, Institute for Drug Research, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Svein I Johannessen
- The National Center for Epilepsy, Sandvika, Norway.,Department of Pharmacology, Oslo University Hospital, Oslo, Norway
| | - René H Levy
- Department of Pharmaceutics and Neurological Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Emilio Perucca
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.,C. Mondino National Neurological Institute, Pavia, Italy
| | - Torbjörn Tomson
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - H Steve White
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington, U.S.A
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563
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Volkow ND, Hampson AJ, Baler RD. Don't Worry, Be Happy: Endocannabinoids and Cannabis at the Intersection of Stress and Reward. Annu Rev Pharmacol Toxicol 2017; 57:285-308. [DOI: 10.1146/annurev-pharmtox-010716-104615] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Nora D. Volkow
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland 20892;
| | - Aidan J. Hampson
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland 20892;
| | - Ruben D. Baler
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland 20892;
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564
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Paediatric neurology in 2016: a year in review. Lancet Neurol 2017; 16:14-15. [DOI: 10.1016/s1474-4422(16)30348-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 10/31/2016] [Indexed: 11/17/2022]
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565
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Mandelbaum DE, de la Monte SM. Adverse Structural and Functional Effects of Marijuana on the Brain: Evidence Reviewed. Pediatr Neurol 2017; 66:12-20. [PMID: 27789118 PMCID: PMC9954727 DOI: 10.1016/j.pediatrneurol.2016.09.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 09/04/2016] [Accepted: 09/07/2016] [Indexed: 01/30/2023]
Abstract
The growing use and legalization of cannabis are leading to increased exposures across all age groups, including in adolescence. The touting of its medicinal values stems from anecdotal reports related to treatment of a broad range of illnesses including epilepsy, multiple sclerosis, muscle spasms, arthritis, obesity, cancer, Alzheimer disease, Parkinson disease, post-traumatic stress, inflammatory bowel disease, and anxiety. However, anecdotal data and the high level of interest in this treatment must not obscure objective assessments of any potential and realized short- and long-term adverse effects of cannabis, particularly with respect to age of onset and chronicity of exposure. This critical review focuses on evidence-based research designed to assess both therapeutic benefits and harmful effects of cannabis exposure and is combined with an illustration of the neuropathologic findings in a fatal case of cannabis-induced psychosis. The literature and reported case provide strong evidence that chronic cannabis abuse causes cognitive impairment and damages the brain, particularly white matter, where cannabinoid 1 receptors abound. Contrary to popular perception, there are few objective data supporting preferential use of cannabis over conventional therapy for restoration of central nervous system structure and function in disease states such as multiple sclerosis, epilepsy, or schizophrenia. Additional research is needed to determine if subsets of individuals with various neurological and psychiatric diseases derive therapeutic benefits from cannabis.
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Affiliation(s)
- David E. Mandelbaum
- Departments of Neurology and Pediatrics, Hasbro Children’s Hospital and Rhode Island Hospital, and the Alpert Medical School of Brown University, Providence, Rhode Island
| | - Suzanne M. de la Monte
- Departments of Neuropathology and Neurosurgery, Hasbro Children’s Hospital and Rhode Island Hospital, and the Alpert Medical School of Brown University, Providence, Rhode Island,Communications should be addressed to: Dr. de la Monte; Rhode Island Hospital; Pierre Galletti Research Building; 55 Claverick Street; Room 419; Providence, RI 02903.
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566
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Golyala A, Kwan P. Drug development for refractory epilepsy: The past 25 years and beyond. Seizure 2017; 44:147-156. [DOI: 10.1016/j.seizure.2016.11.022] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/30/2016] [Indexed: 01/25/2023] Open
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567
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Bonn-Miller MO, Banks SL, Sebree T. Conversion of Cannabidiol Following Oral Administration: Authors' Response to Grotenhermen et al. DOI: 10.1089/can.2016.0036. Cannabis Cannabinoid Res 2017; 2:5-7. [PMID: 28861500 PMCID: PMC5569618 DOI: 10.1089/can.2016.0038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In a commentary, Grotenhermen, Russo, and Zuardi questioned not only the clinical relevance but also the conclusions of a recently published study by Merrick et al. on the conversion of cannabidiol (CBD) to delta-8 and delta-9-tetrahydrocannabinol (THC) in simulated gastric fluid. In response, this article aims to provide a thorough review of the in vitro and in vivo studies of gastric CBD conversion as well as potential consequences resulting from such conversion. Findings highlight (1) consistent evidence over the past half century of gastric conversion of CBD, (2) evidence from human studies, indicating the importance of testing for THC metabolites as well as a number of other cannabinoids in the detection of such conversion, and (3) THC-like effects after administration of oral CBD in humans that may not only stem from CBD's conversion to THC, but also its conversion to 9α-hydroxy-hexahydrocannabinol and 8α-hydroxy-iso-hexahydrocannabinol. These findings, coupled with a number of limitations in the existing literature, point to the need for large-scale human studies, specifically designed to explore gastric conversion and potential THC-like side effects after oral administration of CBD.
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Affiliation(s)
- Marcel O Bonn-Miller
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Zynerba Pharmaceuticals, Inc., Devon, Pennsylvania
| | - Stan L Banks
- Zynerba Pharmaceuticals, Inc., Devon, Pennsylvania
| | - Terri Sebree
- Zynerba Pharmaceuticals, Inc., Devon, Pennsylvania
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568
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Grotenhermen F, Russo E, Zuardi AW. Even High Doses of Oral Cannabidol Do Not Cause THC-Like Effects in Humans: Comment on Merrick et al. Cannabis and Cannabinoid Research 2016;1(1):102-112; DOI: 10.1089/can.2015.0004. Cannabis Cannabinoid Res 2017; 2:1-4. [PMID: 28861499 PMCID: PMC5531368 DOI: 10.1089/can.2016.0036] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
This short communication examines the question whether the experimental data presented in a study by Merrick et al. are of clinical relevance. These authors found that cannabidiol (CBD), a major cannabinoid of the cannabis plant devoid of psychotropic effects and of great interest for therapeutic use in several medical conditions, may be converted in gastric fluid into the psychoactive cannabinoids delta-8-THC and delta-9-THC to a relevant degree. They concluded that “the acidic environment during normal gastrointestinal transit can expose orally CBD-treated patients to levels of THC and other psychoactive cannabinoids that may exceed the threshold for a positive physiological response.” They issued a warning concerning oral use of CBD and recommend the development of other delivery methods. However, the available clinical data do not support this conclusion and recommendation, since even high doses of oral CBD do not cause psychological, psychomotor, cognitive, or physical effects that are characteristic for THC or cannabis rich in THC. On the contrary, in the past decades and by several groups, high doses of oral CBD were consistently shown to cause opposite effects to those of THC in clinical studies. In addition, administration of CBD did not result in detectable THC blood concentrations. Thus, there is no reason to avoid oral use of CBD, which has been demonstrated to be a safe means of administration of CBD, even at very high doses.
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569
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Effects of Marijuana on Ictal and Interictal EEG Activities in Idiopathic Generalized Epilepsy. J Clin Neurophysiol 2017; 34:e1-e4. [DOI: 10.1097/wnp.0000000000000332] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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570
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Gofshteyn JS, Wilfong A, Devinsky O, Bluvstein J, Charuta J, Ciliberto MA, Laux L, Marsh ED. Cannabidiol as a Potential Treatment for Febrile Infection-Related Epilepsy Syndrome (FIRES) in the Acute and Chronic Phases. J Child Neurol 2017; 32:35-40. [PMID: 27655472 DOI: 10.1177/0883073816669450] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Febrile infection-related epilepsy syndrome (FIRES) is a devastating epilepsy affecting normal children after a febrile illness. FIRES presents with an acute phase with super-refractory status epilepticus and all patients progress to a chronic phase with persistent refractory epilepsy. The typical outcome is severe encephalopathy or death. The authors present 7 children from 5 centers with FIRES who had not responded to antiepileptic drugs or other therapies who were given cannabadiol (Epidiolex, GW Pharma) on emergency or expanded investigational protocols in either the acute or chronic phase of illness. After starting cannabidiol, 6 of 7 patients' seizures improved in frequency and duration. One patient died due to multiorgan failure secondary to isoflourane. An average of 4 antiepileptic drugs were weaned. Currently 5 subjects are ambulatory, 1 walks with assistance, and 4 are verbal. While this is an open-label case series, the authors add cannabidiol as a possible treatment for FIRES.
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Affiliation(s)
- Jacqueline S Gofshteyn
- 1 Division of Child Neurology, Pediatric Regional Epilepsy Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Angus Wilfong
- 2 Division of Child Neurology, Texas Children's Hospital, Houston, TX, USA
| | - Orrin Devinsky
- 3 NYU Comprehensive Epilepsy Center, Department of Neurology, NYU School of Medicine, New York, NY, USA
| | - Judith Bluvstein
- 3 NYU Comprehensive Epilepsy Center, Department of Neurology, NYU School of Medicine, New York, NY, USA
| | - Joshi Charuta
- 4 Division of Child Neurology, University of Iowa School of Medicine, Iowa City, IA, USA
| | - Michael A Ciliberto
- 4 Division of Child Neurology, University of Iowa School of Medicine, Iowa City, IA, USA
| | - Linda Laux
- 5 Division of Child Neurology, Northwestern University Medical School, Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Eric D Marsh
- 1 Division of Child Neurology, Pediatric Regional Epilepsy Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,6 Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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571
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Abstract
"Cannabinoid" is the collective term for a group of chemical compounds that either are derived from the Cannabis plant, are synthetic analogues, or occur endogenously. Although cannabinoids interact mostly at the level of the currently recognized cannabinoid receptors, they might have cross reactivity, such as at opioid receptors. Patients with malignant disease represent a cohort within health care that have some of the greatest unmet needs despite the availability of a plethora of guideline-driven disease-modulating treatments and pain and symptom management options. Cannabinoid therapies are varied and versatile, and can be offered as pharmaceuticals (nabilone, dronabinol, and nabiximols), dried botanical material, and edible organic oils infused with cannabis extracts. Cannabinoid therapy regimens can be creative, involving combinations of all of the aforementioned modalities. Patients with malignant disease, at all points of their disease trajectory, could be candidates for cannabinoid therapies whether as monotherapies or as adjuvants. The most studied and established roles for cannabinoid therapies include pain, chemotherapy-induced nausea and vomiting, and anorexia. Moreover, given their breadth of activity, cannabinoids could be used to concurrently optimize the management of multiple symptoms, thereby reducing overall polypharmacy. The use of cannabinoid therapies could be effective in improving quality of life and possibly modifying malignancy by virtue of direct effects and in improving compliance or adherence with disease-modulating treatments such as chemotherapy and radiation therapy.
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Affiliation(s)
- V Maida
- Division of Palliative Care, University of Toronto, Toronto, ON;; Division of Palliative Care, McMaster University, Hamilton, ON;; Supportive and Palliative Care Program, William Osler Health System, Toronto, ON
| | - P J Daeninck
- St. Boniface Unit, Cancer Care Manitoba, St. Boniface, MB;; Department of Internal Medicine and Department of Family Medicine, University of Manitoba, and; Winnipeg Regional Health Authority Palliative Care Program, Winnipeg, MB
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572
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Treat L, Chapman KE, Colborn KL, Knupp KG. Duration of use of oral cannabis extract in a cohort of pediatric epilepsy patients. Epilepsia 2016; 58:123-127. [PMID: 27859038 DOI: 10.1111/epi.13617] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Oral cannabis extracts (OCEs) are being used in the treatment of epilepsy with increasing rates in the United States following product legalization; however, no studies demonstrate clear efficacy. We evaluated the duration of use of OCEs as a measure of perceived benefit in a cohort of patients with pediatric epilepsy. METHODS Retrospective chart review was performed of children and adolescents who were given OCEs for treatment of epilepsy. RESULTS Of the 119 patients included in the analysis, 71% terminated use of their OCE product during the study period. The average length of use of OCE was 11.7 months (range 0.3-57 months). Perceived seizure benefit was the only factor associated with longer duration of treatment with OCE (p < 0.01). Relocation to Colorado was associated with perceived benefit of OCEs for seizures (65% vs. 38%, p = 0.01), but was not independently associated with longer OCE use. Factors associated with shorter use included adverse effects (p = 0.03) and a diagnosis of Dravet syndrome (p = 0.02). Twenty-four percent of patients were considered OCE responders, which was defined by a parent's report of a > 50% reduction in seizures while on this therapy. Adverse events (AEs) were reported in 19% of patients, with the most common side effects being somnolence and worsening of seizures. SIGNIFICANCE Parental report of OCE use in refractory pediatric epilepsy suggests that some families perceive benefit from this therapy; however, discontinuation of these products is common. Duration appears to be affected by logical factors, such as perceived benefit and side effect profile. Surprisingly, families of patients with Dravet syndrome terminated use of OCEs more quickly than patients with other epilepsy syndromes. Results from this study highlight the need for rigorous clinical studies to characterize the efficacy and safety of OCEs, which can inform discussions with patients and families.
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Affiliation(s)
- Lauren Treat
- Department of Pediatrics and Neurology, Children's Hospital Colorado, Anschutz Medical Campus, University of Colorado, Aurora, Colorado, U.S.A
| | - Kevin E Chapman
- Department of Pediatrics and Neurology, Children's Hospital Colorado, Anschutz Medical Campus, University of Colorado, Aurora, Colorado, U.S.A
| | - Kathryn L Colborn
- Division of Health Care Policy and Research and ACCORDS, Anschutz Medical Campus, University of Colorado, Aurora, Colorado, U.S.A
| | - Kelly G Knupp
- Department of Pediatrics and Neurology, Children's Hospital Colorado, Anschutz Medical Campus, University of Colorado, Aurora, Colorado, U.S.A
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573
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Ho KS, Wassman ER. A case for cannabidiol in Wolf-Hirschhorn syndrome seizure management. Am J Med Genet A 2016; 173:324-326. [PMID: 28102593 PMCID: PMC6585685 DOI: 10.1002/ajmg.a.37979] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 08/29/2016] [Indexed: 12/14/2022]
Abstract
Complex, and sometimes intractable, seizures affect the quality of life and cognitive development of over 90% of individuals with Wolf-Hirschhorn syndrome (WHS). Fine resolution genotype-phenotype mapping of the WHS locus recently identified a candidate gene whose probable function has led to insights into a mechanism connecting WHS seizures with those of Dravet syndrome, a distinct condition caused by mutations in SCN1A and SCN1B. In addition to this possible molecular mechanistic connection, these disorders' seizures share a strikingly similar constellation of features, including clinical presentation, seizure types, early age of onset, EEG pattern, and responses to specific anti-epileptic drugs. Based in part on these similarities, we suggest that a highly successful Phase III clinical trial of a formulation of cannabidiol for Dravet syndrome seizures may be directly translatable into possible benefits for WHS individuals with challenging seizure patterns. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Karen S Ho
- Lineagen, Inc., Salt Lake City, Utah.,Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah
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574
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575
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Schoonjans A, Paelinck BP, Marchau F, Gunning B, Gammaitoni A, Galer BS, Lagae L, Ceulemans B. Low-dose fenfluramine significantly reduces seizure frequency in Dravet syndrome: a prospective study of a new cohort of patients. Eur J Neurol 2016; 24:309-314. [PMID: 27790834 PMCID: PMC5298030 DOI: 10.1111/ene.13195] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 09/27/2016] [Indexed: 01/20/2023]
Abstract
Background and purpose Dravet syndrome (DS) is a severe, drug‐resistant epilepsy. Fenfluramine has been reported to have a long‐term clinically meaningful anticonvulsive effect in patients with DS. Methods This prospective, open‐label study assessed the safety and effectiveness of low‐dose fenfluramine in a new cohort of patients with DS. Following a 3‐month baseline period, fenfluramine was added to each patient's current antiepileptic drug regimen at a dose of 0.25–1.0 mg/kg/day (max. 20 mg/day). The incidence of major motor seizures (tonic, clonic, tonic–clonic, atonic and myoclonic seizures lasting >30 s) in both the baseline and treatment periods was assessed via a seizure diary. Periodic echocardiographic examinations during the treatment period were used to assess cardiovascular safety. Results Nine patients (aged 1.2–29.8 years) enrolled in the study and were treated with fenfluramine for a median duration of 1.5 (range, 0.3–5.1) years. Median frequency of major motor seizures was 15.0/month in the baseline period. All patients demonstrated a reduction in seizure frequency during the treatment period with a median reduction of 75% (range, 28–100%). Seven patients (78%) experienced a ≥50% reduction in major motor seizure frequency. The most common adverse events were somnolence (n = 5) and anorexia (n = 4). No evidence of cardiac valvulopathy or pulmonary hypertension was observed. Conclusions The effectiveness and safety of low‐dose fenfluramine as an add‐on therapy for DS in this new prospective cohort supports previous findings.
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Affiliation(s)
- A Schoonjans
- Department of Neurology - Paediatric Neurology, Antwerp University Hospital, University of Antwerp, Antwerp
| | - B P Paelinck
- Department of Cardiology, Antwerp University Hospital, University of Antwerp, Antwerp
| | - F Marchau
- Department of Paediatric Cardiology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - B Gunning
- Stichting Epilepsie Instellingen Nederland SEIN, Zwolle, The Netherlands
| | | | | | - L Lagae
- Department of Development and Regeneration, Section Paediatric Neurology, University Hospitals Gasthuisberg, Leuven, Belgium
| | - B Ceulemans
- Department of Neurology - Paediatric Neurology, Antwerp University Hospital, University of Antwerp, Antwerp
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576
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Gruber SA, Sagar KA, Dahlgren MK, Racine MT, Smith RT, Lukas SE. Splendor in the Grass? A Pilot Study Assessing the Impact of Medical Marijuana on Executive Function. Front Pharmacol 2016; 7:355. [PMID: 27790138 PMCID: PMC5062916 DOI: 10.3389/fphar.2016.00355] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/20/2016] [Indexed: 12/12/2022] Open
Abstract
Currently, 25 states and Washington DC have enacted full medical marijuana (MMJ) programs while 18 states allow limited access to MMJ products. Limited access states permit low (or zero) tetrahydrocannabinol (THC) and high cannabidiol (CBD) products to treat specified conditions such as uncontrolled epilepsy. Although MMJ products are derived from the same plant species as recreational MJ, they are often selected for their unique cannabinoid constituents and ratios, not typically sought by recreational users, which may impact neurocognitive outcomes. To date, few studies have investigated the potential impact of MMJ use on cognitive performance, despite a well-documented association between recreational marijuana (MJ) use and executive dysfunction. The current study assessed the impact of 3 months of MMJ treatment on executive function, exploring whether MMJ patients would experience improvement in cognitive functioning, perhaps related to primary symptom alleviation. As part of a larger longitudinal study, 24 patients certified for MMJ use completed baseline executive function assessments and 11 of these so far have returned for their first follow-up visit 3 months after initiating treatment. Results suggest that in general, MMJ patients experienced some improvement on measures of executive functioning, including the Stroop Color Word Test and Trail Making Test, mostly reflected as increased speed in completing tasks without a loss of accuracy. On self-report questionnaires, patients also indicated moderate improvements in clinical state, including reduced sleep disturbance, decreased symptoms of depression, attenuated impulsivity, and positive changes in some aspects of quality of life. Additionally, patients reported a notable decrease in their use of conventional pharmaceutical agents from baseline, with opiate use declining more than 42%. While intriguing, these findings are preliminary and warrant further investigation at additional time points and in larger sample sizes. Given the likelihood of increased MMJ use across the country, it is imperative to determine the potential impact of short- and long-term treatment on cognitive performance as well as the efficacy of MMJ treatment itself.
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Affiliation(s)
- Staci A. Gruber
- Cognitive and Clinical Neuroimaging Core, McLean Hospital Imaging CenterBelmont, MA, USA
- Department of Psychiatry, Harvard Medical SchoolBoston, MA, USA
| | - Kelly A. Sagar
- Cognitive and Clinical Neuroimaging Core, McLean Hospital Imaging CenterBelmont, MA, USA
- Department of Psychiatry, Harvard Medical SchoolBoston, MA, USA
| | - Mary K. Dahlgren
- Cognitive and Clinical Neuroimaging Core, McLean Hospital Imaging CenterBelmont, MA, USA
- Department of Psychology, Tufts UniversityMedford, MA, USA
| | - Megan T. Racine
- Cognitive and Clinical Neuroimaging Core, McLean Hospital Imaging CenterBelmont, MA, USA
| | - Rosemary T. Smith
- Cognitive and Clinical Neuroimaging Core, McLean Hospital Imaging CenterBelmont, MA, USA
| | - Scott E. Lukas
- Department of Psychiatry, Harvard Medical SchoolBoston, MA, USA
- Behavioral Psychopharmacology Research Laboratory, McLean Hospital Imaging Center, McLean HospitalBelmont, MA, USA
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577
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White CM. The Pharmacologic and Clinical Effects of Illicit Synthetic Cannabinoids. J Clin Pharmacol 2016; 57:297-304. [PMID: 27610597 DOI: 10.1002/jcph.827] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 09/07/2016] [Indexed: 11/06/2022]
Abstract
This article presents information on illicitly used synthetic cannabinoids. Synthetic cannabinoids are structurally heterogeneous and commonly used drugs of abuse that act as full agonists of the cannabinoid type-1 receptor but have a variety of additional pharmacologic effects. There are numerous cases of patient harm and death in the United States, Europe, and Australia with many psychological, neurological, cardiovascular, pulmonary, and renal adverse events. Although most users prefer using cannabis, there are convenience, legal, and cost reasons driving the utilization of synthetic cannabinoids. Clinicians should be aware of pharmacologic and clinical similarities and differences between synthetic cannabinoid and cannabis use, the limited ability to detect synthetic cannabinoids in the urine or serum, and guidance to treat adverse events.
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Affiliation(s)
- C Michael White
- University of Connecticut School of Pharmacy & Hartford Hospital Department of Pharmacy, Storrs, CT, USA
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578
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Hess EJ, Moody KA, Geffrey AL, Pollack SF, Skirvin LA, Bruno PL, Paolini JL, Thiele EA. Cannabidiol as a new treatment for drug-resistant epilepsy in tuberous sclerosis complex. Epilepsia 2016; 57:1617-1624. [DOI: 10.1111/epi.13499] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2016] [Indexed: 01/11/2023]
Affiliation(s)
- Evan J. Hess
- Massachusetts General Hospital; Boston Massachusetts U.S.A
| | | | | | | | | | | | - Jan L. Paolini
- Massachusetts General Hospital; Boston Massachusetts U.S.A
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579
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Massot-Tarrús A, McLachlan RS. Marijuana use in adults admitted to a Canadian epilepsy monitoring unit. Epilepsy Behav 2016; 63:73-78. [PMID: 27568641 DOI: 10.1016/j.yebeh.2016.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/30/2016] [Accepted: 08/01/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Epidemiologic evidence supporting antiseizure properties of cannabis is limited and controversial. We determined the prevalence of marijuana use and its perceived effects in patients with and without epilepsy. METHODS Information was collected over 14months from consecutive adult patients admitted to an epilepsy monitoring unit using a 27-item anonymous questionnaire. Patients with cognitive impairment unable to understand the questions or give informed consent and readmissions were not recruited. Subjects were divided into 4 groups, those with epileptic seizures, those with psychogenic nonepileptic seizures (PNES), those with both epileptic and PNES, and those with other nonepileptic events. Patients with exclusively epileptic seizures were compared with those with exclusively PNES. RESULTS From 310 patients, 18 undiagnosed cases were excluded leaving a cohort of 292 patients with median age 35 (range: 27-49) years; 57.2% female. Epilepsy was documented in 190 (65.1%), PNES in 64 (21.9%), and both types of seizures in 26 (8.9%). Median duration of seizure disorder was longer (2 [1-9] vs. 13 [5.7-25] years; p<0.001) and seizure frequency lower (daily or weekly in 62.3% vs. 44.9%; p=0.03) in patients with epilepsy compared with those in patients with PNES. Overall, 166 (57%) had tried marijuana, and 36.2% used it over the past year. Utilization was 57.1% in sole epilepsy and 64.1% in sole PNES, but daily use was more likely in epilepsy (59% vs. 33.3%). Estimated mean dose was 1g/day. Marijuana use was associated with tobacco smoking (p<0.001) but not alcohol use. Eight patients used other street drugs. Improvement in seizures was perceived by 84% in those with epilepsy and 72.7% in those with PNES. In the 2 groups, stress was decreased in 84.9% and 88%, sleep improved in 77.3% and 88%, and memory/concentration was better in 32% and 28%, respectively. Antiepileptic drug side effects were decreased in 53.2% of marijuana users. Perceived effect on epileptic seizures correlated with effect on stress (r=0.35, p=0.004). Adverse effects of marijuana were mild and reported in 30.7% but included possible seizure precipitation in 5 patients with epilepsy. SIGNIFICANCE Patients with uncontrolled epilepsy or nonepileptic events had a high rate of marijuana use with associated perceived improvements in seizure control, stress, sleep, and drug side effects. Stress reduction may contribute to the perceived impact of marijuana on seizures and nonepileptic events in adults.
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Affiliation(s)
- Andreu Massot-Tarrús
- Epilepsy Program, Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
| | - Richard S McLachlan
- Epilepsy Program, Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada.
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580
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Crippa JAS, Crippa ACS, Hallak JEC, Martín-Santos R, Zuardi AW. Δ9-THC Intoxication by Cannabidiol-Enriched Cannabis Extract in Two Children with Refractory Epilepsy: Full Remission after Switching to Purified Cannabidiol. Front Pharmacol 2016; 7:359. [PMID: 27746737 PMCID: PMC5043219 DOI: 10.3389/fphar.2016.00359] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 09/20/2016] [Indexed: 11/13/2022] Open
Abstract
Animal studies and preliminary clinical trials have shown that cannabidiol (CBD)-enriched extracts may have beneficial effects for children with treatment-resistant epilepsy. However, these compounds are not yet registered as medicines by regulatory agencies. We describe the cases of two children with treatment-resistant epilepsy (Case A with left frontal dysplasia and Case B with Dravet Syndrome) with initial symptom improvement after the introduction of CBD extracts followed by seizure worsening after a short time. The children presented typical signs of intoxication by Δ9-THC (inappropriate laughter, ataxia, reduced attention, and eye redness) after using a CBD-enriched extract. The extract was replaced by the same dose of purified CBD with no Δ9-THC in both cases, which led to improvement in intoxication signs and seizure remission. These cases support pre-clinical and preliminary clinical evidence suggesting that CBD may be effective for some patients with epilepsy. Moreover, the cases highlight the need for randomized clinical trials using high-quality and reliable substances to ascertain the safety and efficacy of cannabinoids as medicines.
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Affiliation(s)
- José A S Crippa
- Department of Neuroscience and Behavior, University of São Paulo Ribeirão Preto, Brazil
| | - Ana C S Crippa
- Department of Clinical Medicine, Federal University of Paraná Curitiba, Brazil
| | - Jaime E C Hallak
- Department of Neuroscience and Behavior, University of São Paulo Ribeirão Preto, Brazil
| | - Rocio Martín-Santos
- Department of Neuroscience and Behavior, University of São PauloRibeirão Preto, Brazil; Institute of Neuroscience, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute - Center for Biomedical Research in Mental Health Network and Department of Medicine - University of BarcelonaBarcelona, Spain
| | - Antonio W Zuardi
- Department of Neuroscience and Behavior, University of São Paulo Ribeirão Preto, Brazil
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581
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Russo EB. Current Therapeutic Cannabis Controversies and Clinical Trial Design Issues. Front Pharmacol 2016; 7:309. [PMID: 27683558 PMCID: PMC5022003 DOI: 10.3389/fphar.2016.00309] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 08/30/2016] [Indexed: 12/12/2022] Open
Abstract
This overview covers a wide range of cannabis topics, initially examining issues in dispensaries and self-administration, plus regulatory requirements for production of cannabis-based medicines, particularly the Food and Drug Administration "Botanical Guidance." The remainder pertains to various cannabis controversies that certainly require closer examination if the scientific, consumer, and governmental stakeholders are ever to reach consensus on safety issues, specifically: whether botanical cannabis displays herbal synergy of its components, pharmacokinetics of cannabis and dose titration, whether cannabis medicines produce cyclo-oxygenase inhibition, cannabis-drug interactions, and cytochrome P450 issues, whether cannabis randomized clinical trials are properly blinded, combatting the placebo effect in those trials via new approaches, the drug abuse liability (DAL) of cannabis-based medicines and their regulatory scheduling, their effects on cognitive function and psychiatric sequelae, immunological effects, cannabis and driving safety, youth usage, issues related to cannabis smoking and vaporization, cannabis concentrates and vape-pens, and laboratory analysis for contamination with bacteria and heavy metals. Finally, the issue of pesticide usage on cannabis crops is addressed. New and disturbing data on pesticide residues in legal cannabis products in Washington State are presented with the observation of an 84.6% contamination rate including potentially neurotoxic and carcinogenic agents. With ongoing developments in legalization of cannabis in medical and recreational settings, numerous scientific, safety, and public health issues remain.
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Döring JH, Lampert A, Hoffmann GF, Ries M. Thirty Years of Orphan Drug Legislation and the Development of Drugs to Treat Rare Seizure Conditions: A Cross Sectional Analysis. PLoS One 2016; 11:e0161660. [PMID: 27557111 PMCID: PMC4996488 DOI: 10.1371/journal.pone.0161660] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 08/09/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Epilepsy is a serious chronic health condition with a high morbidity impairing the life of patients and afflicted families. Many epileptic conditions, especially those affecting children, are rare disorders generating an urgent medical need for more efficacious therapy options. Therefore, we assessed the output of the US and European orphan drug legislations. METHODS Quantitative analysis of the FDA and EMA databases for orphan drug designations according to STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) criteria. RESULTS Within the US Orphan Drug Act 40 designations were granted delivering nine approvals, i.e. clobazam, diazepam viscous solution for rectal administration, felbamate, fosphenytoin, lamotrigine, repository corticotropin, rufinamide, topiramate, and vigabatrin. Since 2000 the EMA granted six orphan drug designations whereof two compounds were approved, i.e. rufinamide and stiripentol. In the US, two orphan drug designations were withdrawn. Orphan drugs were approved for conditions including Lennox-Gastaut syndrome, infantile spasms, Dravet syndrome, and status epilepticus. Comparing time to approval for rufinamide, which was approved in the US and the EU to treat rare seizure conditions, the process seems faster in the EU (2.2 years) than in the US (4.3 years). CONCLUSION Orphan drug development in the US and in the EU delivered only few molecular entities to treat rare seizure disorders. The development programs focused on already approved antiepileptic drugs or alternative pharmaceutical formulations. Most orphan drugs approved in the US are not approved in the EU to treat rare seizures although some were introduced after 2000 when the EU adopted the Orphan Drug Regulation.
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Affiliation(s)
- Jan Henje Döring
- Pediatric Neurology and Metabolic Medicine, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
- Center for Rare Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
| | - Anette Lampert
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- Cooperation Unit Clinical Pharmacy, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Georg F. Hoffmann
- Pediatric Neurology and Metabolic Medicine, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
- Center for Rare Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
| | - Markus Ries
- Pediatric Neurology and Metabolic Medicine, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
- Center for Rare Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
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Abstract
Purpose of review Technological advance has revolutionized epilepsy management recently. Herein, we review some recent developments. Recent findings Responsive neurostimulation (Food and Drug Administration [FDA]-approved 2013) works by continuous analysis of brain rhythms and direct brain stimulation on detecting patterns thought to be epileptogenic, thereby aborting seizures. Cardio-responsive vagus nerve stimulation (FDA-approved 2015) is an improvement over traditional vagus nerve stimulation systems, taking advantage of the fact that 80% of seizures are associated with tachycardia. Automated tachycardia detection leads to vagus nerve stimulation to abort seizures. In MRI-guided stereotactic laser ablation (developed 2012), a directed laser emitting fiberoptic catheter is used to ablate epileptogenic lesions. The procedure can be completed in 3 to 4 hours, potentially under local anesthesia and with next-day discharge. Perampanel (FDA-approved 2012) is a promising new class of AMPA (α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid)-antagonist antiseizure therapy. Meanwhile, a millennia-old remedy for epilepsy, cannabis, is staging a comeback with recent legal and social permissiveness accelerating research into this use. Summary The coming years will demonstrate how these recent advances in device and drug management will improve the care of epilepsy.
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Affiliation(s)
- Chutima Saipetch
- Baylor College of Medicine (CS), Houston, TX; Emory University (ES), Atlanta, GA; and Baylor College of Medicine and the VA Medical Center (ZH), Houston, TX
| | - Ezekiel Sachs
- Baylor College of Medicine (CS), Houston, TX; Emory University (ES), Atlanta, GA; and Baylor College of Medicine and the VA Medical Center (ZH), Houston, TX
| | - Zulfi Haneef
- Baylor College of Medicine (CS), Houston, TX; Emory University (ES), Atlanta, GA; and Baylor College of Medicine and the VA Medical Center (ZH), Houston, TX
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585
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Andrzejewski K, Barbano R, Mink J. Cannabinoids in the treatment of movement disorders: A systematic review of case series and clinical trials. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.baga.2016.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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586
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Breuer A, Haj CG, Fogaça MV, Gomes FV, Silva NR, Pedrazzi JF, Del Bel EA, Hallak JC, Crippa JA, Zuardi AW, Mechoulam R, Guimarães FS. Fluorinated Cannabidiol Derivatives: Enhancement of Activity in Mice Models Predictive of Anxiolytic, Antidepressant and Antipsychotic Effects. PLoS One 2016; 11:e0158779. [PMID: 27416026 PMCID: PMC4945002 DOI: 10.1371/journal.pone.0158779] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 06/21/2016] [Indexed: 12/31/2022] Open
Abstract
Cannabidiol (CBD) is a major Cannabis sativa constituent, which does not cause the typical marijuana psychoactivity. However, it has been shown to be active in a numerous pharmacological assays, including mice tests for anxiety, obsessive-compulsive disorder, depression and schizophrenia. In human trials the doses of CBD needed to achieve effects in anxiety and schizophrenia are high. We report now the synthesis of 3 fluorinated CBD derivatives, one of which, 4'-F-CBD (HUF-101) (1), is considerably more potent than CBD in behavioral assays in mice predictive of anxiolytic, antidepressant, antipsychotic and anti-compulsive activity. Similar to CBD, the anti-compulsive effects of HUF-101 depend on cannabinoid receptors.
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Affiliation(s)
- Aviva Breuer
- Institute for Drug Research, Medical Faculty, Hebrew University, Jerusalem, Israel
| | - Christeene G. Haj
- Institute for Drug Research, Medical Faculty, Hebrew University, Jerusalem, Israel
| | - Manoela V. Fogaça
- Departments of Pharmacology, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Felipe V. Gomes
- Departments of Pharmacology, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Nicole Rodrigues Silva
- Departments of Pharmacology, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - João Francisco Pedrazzi
- Neuroscience and Behavior, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Elaine A. Del Bel
- Department of Morphology, Physiology and Pathology, School of Odontology of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Jaime C. Hallak
- Neuroscience and Behavior, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - José A. Crippa
- Neuroscience and Behavior, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Antonio W. Zuardi
- Neuroscience and Behavior, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Raphael Mechoulam
- Institute for Drug Research, Medical Faculty, Hebrew University, Jerusalem, Israel
- * E-mail: (RM); (FSG)
| | - Francisco S. Guimarães
- Departments of Pharmacology, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
- * E-mail: (RM); (FSG)
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587
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Maternal marijuana use has independent effects on risk for spontaneous preterm birth but not other common late pregnancy complications. Reprod Toxicol 2016; 62:77-86. [DOI: 10.1016/j.reprotox.2016.04.021] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 04/08/2016] [Accepted: 04/21/2016] [Indexed: 11/21/2022]
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588
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Affiliation(s)
- Carl E. Stafstrom
- Division of Pediatric Neurology, John M. Freeman Pediatric Epilepsy Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Eric H. Kossoff
- Division of Pediatric Neurology, John M. Freeman Pediatric Epilepsy Center, Johns Hopkins University School of Medicine, Baltimore, MD
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589
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Patel RR, Barbosa C, Brustovetsky T, Brustovetsky N, Cummins TR. Aberrant epilepsy-associated mutant Nav1.6 sodium channel activity can be targeted with cannabidiol. Brain 2016; 139:2164-81. [PMID: 27267376 DOI: 10.1093/brain/aww129] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 04/15/2016] [Indexed: 11/12/2022] Open
Abstract
Mutations in brain isoforms of voltage-gated sodium channels have been identified in patients with distinct epileptic phenotypes. Clinically, these patients often do not respond well to classic anti-epileptics and many remain refractory to treatment. Exogenous as well as endogenous cannabinoids have been shown to target voltage-gated sodium channels and cannabidiol has recently received attention for its potential efficacy in the treatment of childhood epilepsies. In this study, we further investigated the ability of cannabinoids to modulate sodium currents from wild-type and epilepsy-associated mutant voltage-gated sodium channels. We first determined the biophysical consequences of epilepsy-associated missense mutations in both Nav1.1 (arginine 1648 to histidine and asparagine 1788 to lysine) and Nav1.6 (asparagine 1768 to aspartic acid and leucine 1331 to valine) by obtaining whole-cell patch clamp recordings in human embryonic kidney 293T cells with 200 μM Navβ4 peptide in the pipette solution to induce resurgent sodium currents. Resurgent sodium current is an atypical near threshold current predicted to increase neuronal excitability and has been implicated in multiple disorders of excitability. We found that both mutations in Nav1.6 dramatically increased resurgent currents while mutations in Nav1.1 did not. We then examined the effects of anandamide and cannabidiol on peak transient and resurgent currents from wild-type and mutant channels. Interestingly, we found that cannabidiol can preferentially target resurgent sodium currents over peak transient currents generated by wild-type Nav1.6 as well as the aberrant resurgent and persistent current generated by Nav1.6 mutant channels. To further validate our findings, we examined the effects of cannabidiol on endogenous sodium currents from striatal neurons, and similarly we found an inhibition of resurgent and persistent current by cannabidiol. Moreover, current clamp recordings show that cannabidiol reduces overall action potential firing of striatal neurons. These findings suggest that cannabidiol could be exerting its anticonvulsant effects, at least in part, through its actions on voltage-gated sodium channels, and resurgent current may be a promising therapeutic target for the treatment of epilepsy syndromes.
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Affiliation(s)
- Reesha R Patel
- 1 Program in Medical Neuroscience, Neuroscience Research Building, 320 West 15th St, Indianapolis, IN, 46202, USA 2 Paul and Carole Stark Neurosciences Research Institute, 320 West 15th St, Indianapolis, IN, 46202, USA
| | - Cindy Barbosa
- 3 Department of Pharmacology and Toxicology, Indiana University School of Medicine, 635 Barnhill Drive, Indianapolis, IN, 46202, USA
| | - Tatiana Brustovetsky
- 3 Department of Pharmacology and Toxicology, Indiana University School of Medicine, 635 Barnhill Drive, Indianapolis, IN, 46202, USA
| | - Nickolay Brustovetsky
- 1 Program in Medical Neuroscience, Neuroscience Research Building, 320 West 15th St, Indianapolis, IN, 46202, USA 2 Paul and Carole Stark Neurosciences Research Institute, 320 West 15th St, Indianapolis, IN, 46202, USA 3 Department of Pharmacology and Toxicology, Indiana University School of Medicine, 635 Barnhill Drive, Indianapolis, IN, 46202, USA
| | - Theodore R Cummins
- 1 Program in Medical Neuroscience, Neuroscience Research Building, 320 West 15th St, Indianapolis, IN, 46202, USA 2 Paul and Carole Stark Neurosciences Research Institute, 320 West 15th St, Indianapolis, IN, 46202, USA 3 Department of Pharmacology and Toxicology, Indiana University School of Medicine, 635 Barnhill Drive, Indianapolis, IN, 46202, USA
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590
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Abstract
Dravet syndrome (DS) is an intractable pediatric epilepsy syndrome, starting in early childhood. This disorder typically manifests with febrile status epilepticus, and progresses to a multifocal epilepsy with febrile and non-febrile seizures with encephalopathy. Most cases are due to a mutation in the SCN1A gene. This article reviews treatments for DS, with an emphasis on pharmacotherapy. While many medications are used in treating the seizures associated with DS, these patients typically have medically refractory epilepsy, and polytherapy is often required. First-line agents include valproate and clobazam, although there are supportive data for topiramate, levetiracetam, stiripentol and the ketogenic diet. Other agents such as fenfluramine are promising therapies for Dravet syndrome. Sodium channel-blocking anticonvulsants such as carbamazepine and lamotrigine are generally contraindicated in this syndrome. Nonpharmacologic therapies (such as neurostimulation or surgery) are understudied in DS. Because DS is a global encephalopathy, pharmacologic treatment of non-epileptic manifestations of the disease is often necessary. Attention-deficit hyperactivity disorder is often encountered in patients with DS, and psychostimulants can be helpful for this indication. Other psychoactive drugs are less studied in this context. Extrapyramidal and gait disorders are often encountered in DS as well. While DS is a severe epileptic encephalopathy with a high (up to 15 %) mortality rate in childhood, careful pharmacologic management can improve these patients' clinical picture and quality of life.
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591
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Abstract
In this article, we review the treatment options for the pediatric epileptic encephalopathies and provide an update on the new and emerging therapies targeted at the underlying pathophysiology of many of these syndromes. We illustrate how the identification of the specific genetic and autoimmune causes has made possible the evaluation and development of novel, better targeted therapies, as and at times, avoidance of potentially offending agents.
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592
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Cannabidiol in patients with treatment-resistant epilepsy. Lancet Neurol 2016; 15:544-5. [DOI: 10.1016/s1474-4422(16)00122-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 01/10/2016] [Accepted: 03/08/2016] [Indexed: 11/24/2022]
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593
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Abstract
The medical management of the epilepsy syndromes of early childhood (eg, infantile spasms, Dravet syndrome, and Lennox-Gastaut syndrome) is challenging; and requires careful evaluation, classification, and treatment. Pharmacologic therapy continues to be the mainstay of management for these children, and as such it is important for the clinician to be familiar with the role of new antiepileptic drugs. This article reports the clinical trial data and personal experience in treating the severe epilepsies of childhood with the recently Food and Drug Administration-approved new antiepileptic drugs (vigabatrin, rufinamide, perampanel, and clobazam) and those in clinical trials (cannabidiol, stiripentol, and fenfluramine). Genetic research has also identified an increasing number of pediatric developmental and seizure disorders that are possibly treatable with targeted drug therapies, focused on correcting underlying neural dysfunction. We highlight recent genetic advances, and how they affect our treatment of some of the genetic epilepsies, and speculate on the use of targeted genetic treatment (precision medicine) in the future.
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594
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Devinsky O, Marsh E, Friedman D. Cannabidiol in patients with treatment-resistant epilepsy – Authors' reply. Lancet Neurol 2016; 15:545-6. [DOI: 10.1016/s1474-4422(16)00120-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 03/08/2016] [Indexed: 10/22/2022]
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595
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Bauer PR, Sander JW. Cannabidiol in patients with treatment-resistant epilepsy. Lancet Neurol 2016; 15:544. [DOI: 10.1016/s1474-4422(16)00118-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 03/08/2016] [Indexed: 11/30/2022]
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596
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Cannabidiol and epilepsy: Rationale and therapeutic potential. Pharmacol Res 2016; 107:85-92. [PMID: 26976797 DOI: 10.1016/j.phrs.2016.03.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/07/2016] [Accepted: 03/08/2016] [Indexed: 12/30/2022]
Abstract
Despite the introduction of new antiepileptic drugs (AEDs), the quality of life and therapeutic response for patients with epilepsy remains still poor. Unfortunately, besides several advantages, these new AEDs have not satisfactorily reduced the number of refractory patients. Therefore, the need for different other therapeutic options to manage epilepsy is still a current issue. To this purpose, emphasis has been given to phytocannabinoids, which have been medicinally used since ancient time in the treatment of neurological disorders including epilepsy. In particular, the nonpsychoactive compound cannabidiol (CBD) has shown anticonvulsant properties, both in preclinical and clinical studies, with a yet not completely clarified mechanism of action. However, it should be made clear that most phytocannabinoids do not act on the endocannabinoid system as in the case of CBD. In in vivo preclinical studies, CBD has shown significant anticonvulsant effects mainly in acute animal models of seizures, whereas restricted data exist in chronic models of epilepsy as well as in animal models of epileptogenesis. Likewise, clinical evidence seems to indicate that CBD is able to manage epilepsy both in adults and children affected by refractory seizures, with a favourable side effect profile. However, to date, clinical trials are both qualitatively and numerically limited, thus yet inconsistent. Therefore, further preclinical and clinical studies are undoubtedly needed to better evaluate the potential therapeutic profile of CBD in epilepsy, although the actually available data is promising.
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