Cannabidiol modifies the seizure expression and effects of antiseizure drugs in a rat model of recurrent severe seizures

Cannabinoid treatments in epilepsy and seizure disorders

Cannabis has been used to treat convulsions and other disorders since ancient times. In the last few decades, preclinical animal studies and clinical investigations have established the role of cannabidiol (CBD) in treating epilepsy and seizures and support potential therapeutic benefits for cannabinoids in other neurological and psychiatric disorders. Here, we comprehensively review the role of cannabinoids in epilepsy. We briefly review the diverse physiological processes mediating the central nervous system response to cannabinoids, including Δ9-tetrahydrocannabinol (Δ9-THC), cannabidiol, and terpenes. Next, we characterize the anti- and proconvulsive effects of cannabinoids from animal studies of acute seizures and chronic epileptogenesis. We then review the clinical literature on using cannabinoids to treat epilepsy, including anecdotal evidence and case studies as well as the more recent randomized controlled clinical trials that led to US Food and Drug Administration approval of CBD for some types of epilepsy. Overall, we seek to evaluate our current understanding of cannabinoids in epilepsy and focus future research on unanswered questions.

Cannabidiol: metabolism and clinical efficacy in epileptic patients

INTRODUCTION

The landscape of epilepsy treatment has undergone a significant transformation with the emergence of cannabidiol as a potential therapeutic agent. Epidiolex, a pharmaceutical formulation of highly purified CBD, garnered significant attention not just for its therapeutic potential but also for being the first cannabis-derived medication to obtain approval from regulatory bodies.

AREA COVERED

In this narrative review the authors explore the intricate landscape of CBD as an antiseizure medication, deepening into its pharmacological mechanisms and clinical trials involving various epileptic encephalopathies. This exploration serves as a comprehensive guide, shedding light on a compound that holds promise for individuals contending with the significant challenges of drug-resistant epilepsy.

EXPERT OPINION

Rigorous studies highlight cannabidiol's efficacy, safety profile, and potential cognitive benefits, warranting further exploration for its approval in various drug-resistant epilepsy forms. As a promising therapeutic option, cannabidiol not only demonstrates efficacy in seizure control but also holds the potential for broader enhancements in the quality of life, especially for patients with epileptic encephalopathies.

Therapeutic and clinical foundations of cannabidiol therapy for difficult-to-treat seizures in children and adults with refractory epilepsies

Novel and effective antiseizure medications are needed to treat refractory and rare forms of epilepsy. Cannabinoids, which are obtained from the cannabis plant, have a long history of medical use, including for neurologic conditions. In 2018, the US Food and Drug Administration approved the first phytocannabinoid, cannabidiol (CBD, Epidiolex), which is now indicated for severe seizures associated with three rare forms of developmental and epileptic encephalopathy: Dravet syndrome, Lennox-Gastaut syndrome, and tuberous sclerosis complex. Compelling evidence supports the efficacy of CBD in experimental models and patients with epilepsy. In randomized clinical trials, highly-purified CBD has demonstrated efficacy with an acceptable safety profile in children and adults with difficult-to-treat seizures. Although the underlying antiseizure mechanisms of CBD in humans have not yet been elucidated, the identification of novel antiseizure targets of CBD preclinically indicates multimodal mechanisms that include non-cannabinoid pathways. In addition to antiseizure effects, CBD possesses strong anti-inflammatory and neuroprotective activities, which might contribute to protective effects in epilepsy and other conditions. This article provides a succinct overview of therapeutic approaches and clinical foundations of CBD, emphasizing the clinical utility of CBD for the treatment of seizures associated with refractory and rare epilepsies. CBD has shown to be a safe and effective antiseizure medicine, demonstrating a broad spectrum of efficacy across multiple seizure types, including those associated with severe epilepsies with childhood onset. Despite such promise, there are many perils with CBD that hampers its widespread use, including limited understanding of pharmacodynamics, limited exposure-response relationship, limited information for seizure freedom with continued use, complex pharmacokinetics with drug interactions, risk of adverse effects, and lack of expert therapeutic guidelines. These scientific issues need to be resolved by further investigations, which would decide the unique role of CBD in the management of refractory epilepsy.

Advances and Challenges of Cannabidiol as an Anti-Seizure Strategy: Preclinical Evidence

The use of Cannabis for medicinal purposes has been documented since ancient times, where one of its principal cannabinoids extracted from Cannabis sativa, cannabidiol (CBD), has emerged over the last few years as a promising molecule with anti-seizure potential. Here, we present an overview of recent literature pointing out CBD's pharmacological profile (solubility, metabolism, drug-drug interactions, etc.,), CBD's interactions with multiple molecular targets as well as advances in preclinical research concerning its anti-seizure effect on both acute seizure models and chronic models of epilepsy. We also highlight the recent attention that has been given to other natural cannabinoids and to synthetic derivatives of CBD as possible compounds with therapeutic anti-seizure potential. All the scientific research reviewed here encourages to continue to investigate the probable therapeutic efficacy of CBD and its related compounds not only in epilepsy but also and specially in drug-resistant epilepsy, since there is a dire need for new and effective drugs to treat this disease.

Cannabidiol Reduces Short- and Long-Term High Glutamate Release after Severe Traumatic Brain Injury and Improves Functional Recovery

This study aimed to determine if orally administered cannabidiol (CBD) lessens the cortical over-release of glutamate induced by a severe traumatic brain injury (TBI) and facilitates functional recovery. The short-term experiment focused on identifying the optimal oral pretreatment of CBD. Male Wistar rats were pretreated with oral administration of CBD (50, 100, or 200 mg/kg) daily for 7 days. Then, extracellular glutamate concentration was estimated by cortical microdialysis before and immediately after a severe TBI. The long-term experiment focused on evaluating the effect of the optimal treatment of CBD (pre- vs. pre- and post-TBI) 30 days after trauma. Sensorimotor function, body weight, and mortality rate were evaluated. In the short term, TBI induced a high release of glutamate (738% ± 173%; p < 0.001 vs. basal). Oral pretreatment with CBD at all doses tested reduced glutamate concentration but with higher potency at when animals received 100 mg/kg (222 ± 33%, p < 0.01 vs. TBI), an effect associated with a lower mortality rate (22%, p < 0.001 vs. TBI). In the long-term experiment, the TBI group showed a high glutamate concentration (149% p < 0.01 vs. SHAM). In contrast, animals receiving the optimal treatment of CBD (pre- and pre/post-TBI) showed glutamate concentrations like the SHAM group (p > 0.05). This effect was associated with high sensorimotor function improvement. CBD pretreatment, but not pre-/post-treatment, induced a higher body weight gain (39% ± 2.7%, p < 0.01 vs. TBI) and lower mortality rate (22%, p < 0.01 vs. TBI). These results support that orally administered CBD reduces short- and long-term TBI-induced excitotoxicity and facilitated functional recovery. Indeed, pretreatment with CBD was sufficient to lessen the adverse sequelae of TBI.

Effects of chronic cannabidiol in a mouse model of naturally occurring neuroinflammation, neurodegeneration, and spontaneous seizures

Cannabidiol (CBD) has gained attention as a therapeutic agent and is purported to have immunomodulatory, neuroprotective, and anti-seizure effects. Here, we determined the effects of chronic CBD administration in a mouse model of CLN1 disease (Cln1^-/-) that simultaneously exhibits neuroinflammation, neurodegeneration, and spontaneous seizures. Proteomic analysis showed that putative CBD receptors are expressed at similar levels in the brains of Cln1^-/- mice compared to normal animals. Cln1^-/- mice received an oral dose (100 mg/kg/day) of CBD for six months and were evaluated for changes in pathological markers of disease and seizures. Chronic cannabidiol administration was well-tolerated, high levels of CBD were detected in the brain, and markers of astrocytosis and microgliosis were reduced. However, CBD had no apparent effect on seizure frequency or neuron survival. These data are consistent with CBD having immunomodulatory effects. It is possible that a higher dose of CBD could also reduce neurodegeneration and seizure frequency.

Determination of the Chemical Composition and Antimicrobial Activity of Lavatera thuringiaca L. Medicinal Herb Material Extracted under Subcritical Conditions by the Liquid Carbon Dioxide Method

This article presents the composition of the components of Lavatera thuringiaca L. (Malvaceae Juss. family), which has a certain antibacterial effect. The plant collection was carried out in the Shamalgan gorge of Mountain Range of the Trans-Ili Alatau in the territory of the Karasay district of the Almaty region, in the flowering phase. A CO₂ extract of the aboveground part of the medicinal plant Lavatera thuringiaca L. was obtained under subcritical conditions and, for the first time, studied for its component composition and antimicrobial activity. Determination of the chemical composition of the extract was carried out by gas chromatography/mass spectrometry (GC/MS). To identify the obtained mass spectra, we used the Wiley 7^th edition and the NIST'02 data library. To determine the antimicrobial and antifungal activity, standard test strains of microorganisms were used: Staphylococcus aureus ATCC 6538-P, Escherichia coli ATCC 8739, Pseudomonas aeruginosa ATCC 9027, Candida albicans ATCC 10231, Streptococcus pneumonia ATCC 660, Klebsiella pneumoniae ATCC 700603, Staphylococcus haemolyticus, and Staphylococcus saprophyticus. In the composition of thick CO₂Lavatera thuringiaca L. extract, the content of 31 components was proven: spathulenol 6.97%, pulegone 5 08%, cis-β-farnesene 7.63%, verbenone 1.93%, α-bisabolol oxide B 9.65%, bisabolol oxide A 8.26%, α-bisabolol 1.36%, linolenic acid, ethyl ether 3.15%, phytol 2.49%, herniarin 5.61%, linolenic acid 9.38%, linoleic acid 6.95%, myristic acid 2.33%, and elaidic acid 2.57%. Antimicrobial activity studies have shown that the CO₂ extract of Lavatera thuringiaca L. has a pronounced effect against clinically significant microorganisms: Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Candida albicans, Streptococcus pneumonia, Klebsiella pneumoniae, Staphylococcus haemolyticus, and Staphylococcus saprophyticus. During testing, the method of serial dilutions proved that the extract of Lavatera thuringiaca L. has a bactericidal effect on Staphylococcus aureus at a concentration of 0.83 μg/μl, on Escherichia coli at a concentration of 3.33 μg/μl, on Pseudomonas aeruginosa at a concentration of 0.83 μg/μl, on Streptococcus pneumoniae at a concentration of 1.67 μg/μl, on a clinical isolate of Staphylococcus haemolyticus at a concentration of 26.65 μg/μl, on Staphylococcus saprophyticus at a concentration of 6.67 μg/μl, and against Klebsiella pneumoniae at a concentration of 13.36 μg/μl. The test result showed that the extract also has fungicidal activity against the test culture of Candida albicans at a concentration of 0.21 μg/μl. At tests, the disc diffusion method proved that the extract has antimicrobial activity with high values of the growth suppression zone exceeding 15 mm. The zones of growth retardation of the test strains were 19.33 ± 1.15 for Staphylococcus aureus; 17.33 ± 3.21 for Escherichia coli; 15.67 ± 0.57 for Pseudomonas aeruginosa; 20.0 ± 1.0 for Streptococcus pneumoniae; 16.0 ± 2.64 for Klebsiella pneumoniae; 15.0 ± 1.0 for Staphylococcus saprophyticus, and 22.0 ± 1.73 for Candida albicans. In relation to the clinical isolate of Staphylococcus haemolyticus, the extract has a bacteriostatic effect.