Whole-plant cannabis is associated with a significant reduction in seizures in children with severe treatment resistance epilepsyEarly research suggests.
In a small case series, children with severe epilepsy resistant to treatment with a combination of cannabinoid whole plant extracts (CBMPs) reported an 86% reduction in monthly seizures.
All participants had no improvement with conventional Anti-epileptic drugs (AED).
The study adds to a small but growing body of research looking at whole-plant cannabis medications containing THC in pediatric epilepsy.
“Although we have previously observed The superior efficacy of whole botanical medicinal cannabis is a previous group of children, to find that the effect of the treatment resulted in an average reduction of seizures by 86% which is remarkable and testifies to the clear clinical value of this intervention,” lead author Ryan Raja Zafar, PhD student at the Center for Research in Anesthetic and Neuropsychopharmacology, Imperial College London, UK, said Medscape Medical News.
The results were Posted online December 14 in Pediatrics BMJ Open.
Superior to CBD?
The retrospective case series included 10 children under 18 years of age recruited through MedCann Support and End Our Pain, two charities representing children who use medical cannabis to treat intractable epilepsy. Data were collected from patients’ parents or caregivers between January and May 2021.
Patients presented with a range of epilepsy etiologies and reported a mean of 7 (±4.58) dirhams before starting the CBMPs. Two patients experienced no improvement in symptoms after taking purified Epidyolex cannabidiol (CBD) approved by the European Commission in 2019 for the treatment of rare forms of epilepsy. formula accepted by the US Food and Drug Administration in 2018 under the name Epidiolex.
All participants received CBMPs, including Bedrolite (<1% THC and 9% CBD), Bedica (14% THC and <1% CBD), Celixir 20 (<1% THC and 20% CBD), Sweet Pink CBD (<1% THC and <1% CBD) 1% THC and 10.6% CBD), and Althea 100 (<1% THC and 10% CBD). Medicines were prescribed to patients by doctors in the National Health Service or by private medical clinics.
Patients consumed an average of 5.15 (±6.8) mg of THC per day and an average of 171.8 (±153.3) mg of CBD per day.
All patients reported fewer seizures, ranging from a decrease in monthly seizure activity of 62.5% to 100%. The average decrease was 86%.
“Whole cannabis seems to be better than CBD alone, and the reasons for this are speculative,” Dhofar said.
“THC is known to have independent anticonvulsant activity; however, little is known about the role that cannabinoids and other minor terpenes play in the cannabis plant,” Zafar added.
“There have been some preclinical tests suggesting that they also have anti-seizure activity, so it appears that the combined effects of whole plant products work better than isolating.”
Comment on the results for Medscape Medical News, Tyler Allison, MD, assistant professor of pediatrics at Children’s Mercy Kansas City, Missouri, noted that researchers selected patients based on their long-term use of whole-plant medicinal cannabis oils, which introduced a selection bias.
“The response remains interesting, and I think it needs further study with better criteria to reduce bias, but I don’t think it is fair to assess the amount of reduction in seizure frequency when only the studied population were patients in which Allison responded to treatment.”
“How many patients have tried whole hemp oil and did not find it effective, or at least more effective than other anti-epileptic treatments?” Asked. “This information is missing and could significantly affect the significance of the study.”
Allison added that selection bias and the small study group also make it difficult to compare the results with previous isolated CBD studies that included a larger number of patients.
He noted that a randomized, intent-to-treat study design comparing a control group treated with a type of CBD isolate product and a placebo group that received whole cannabis plant oils would remove this bias. “Then they can analyze the frequency of seizures in the same way they did and compare the groups to see if whole plant hemp oil shows a reduction in the frequency of seizures compared to a similar drug,” he said.
This is a design that Zafar notes that he and his colleagues are interested in pursuing.
“We started the research to understand the role of cannabinoids and small terpenes in treating this condition, because we wanted to understand more why we see a superior clinical effect in whole plant medicines,” he said.
He added that they also plan to partner with academic and commercial collaborators on additional retrospective and prospective studies on these issues.
The study was unfunded. Zafar has not reported any relevant financial relationships. Other authors’ disclosures are listed in the original article. Allison report no relevant conflict of interest.
BMJ Pediatric is open. Posted online December 14, 2021. full text
Source: Medscape Neurology news
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