Refractory Epilepsy: Full Remission after Switching to Purified that cannabidiol (CBD)-enriched extracts may have beneficial effects for. Two children achieved full remission of Refractory Epilepsy after switching from an extract of intoxicating?9-THC to pure CBD extract. Purified CBD can lead the full remission of seizures in those with epilepsy. The study, which was published online by the National Institute of.
Purified with CBD REMISSION COMPLETE EPILEPSY:
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TheWeedBlog Editor Nov 26, I still use this…. Thank you for this valuable information about Cannabis oil and I am so glad by read this post. Leah Maurer Editor 5 days. Cannabis Nurses Network looks amazing! Beyond attempting to establish the safety and efficacy of such products, we also investigated if there is enough evidence to assume any difference in efficacy between CBD-rich extracts compared to purified CBD products. The qualitative assessment resulted in 11 valid references, with an average impact factor of 8.
The categorical data of a total of patients were analyzed by Fischer test. Patients treated with CBD-rich extracts reported lower average dose 6. CBD-rich extracts seem to present a better therapeutic profile than purified CBD, at least in this population of patients with refractory epilepsy. The roots of this difference is likely due to synergistic effects of CBD with other phytocompounds aka Entourage effect , but this remains to be confirmed in controlled clinical studies.
Derivative products from the Cannabis sativa plant have historically been used for a number of neurological disorders, as broad as pain and appetite stimulation in oncological and HIV patients 1. The delicate balance between therapeutic and adverse effects in medicinal Cannabis yields controversial discussions in the literature 2 — 4 , where the main psychoactive cannabinoid compound—deltatetrahydrocannabinol THC is the major protagonist.
More recently, another non-psychoactive cannabinoid—cannabidiol CBD —has received a lot of attention, since its promising pharmacological profile suggests a broader therapeutic index compared to THC. CBD has been described as a potential therapeutic compound to control seizures in humans in the 80's 5 and since then, several other studies have extended this data 6 — Hemp extracts became an internet buzz 19 , with several anecdotal descriptions of therapeutic effects in children with treatment-resistant epilepsies, especially Dravet syndrome, starting to appear since 11 , 20 , Preclinical evidence support anti-convulsant properties of CBD [reviewed in Hill et al.
Furthermore, a number of observational papers suggested good tolerability and therapeutic benefits in seizure control, with patients experiencing low frequency of side effects 6 — The first CBD-based product was just recently registered for the treatment of treatment-resistant epilepsies These products are not considered controlled substances at the production countries and are being distributed in many countries via exceptional import mechanisms.
Some observational studies are available on scientific literature, but there is a scarcity of clinical data acquired within the logic, rigor and organization necessary to the conduction of clinical studies destined to the registration of a pharmaceutical product. The objective of the present study is to conduct a meta-analysis to investigate the available data about the clinical use of CBD-rich products for patients with treatment-resistant epilepsy. Main focus was on cannabidiol CBD and CBD-rich Cannabis extracts, whose use has been disseminated among infant and juvenile patients of treatment-resistant forms of epilepsy.
The search was limited to papers published in English, with results obtained from human beings in parent surveys and proper medical records. Pre-print servers like PeerJ and BioRxiv were also used for the search, but did not reveal any forthcoming useful clinical study. The titles, abstracts and full texts of all search results had their eligibility analyzed, considering inclusion and exclusion criteria.
Review and opinion papers, case studies, studies with no measurable data, and studies with no accessible numerical data. Papers describing studies in prospective and retrospective design were considered eligible, regardless of the kind and duration of treatment.
Papers presenting partial data example: Classical objective clinical outcomes in the research field of epilepsy were used to group the articles. Data were pooled together in categorical variable format proportion of patients for combined analysis. In two cases, the authors were contacted for additional information that could not be inferred from the paper. The transformed data were analyzed statistically by the Fischer test for categorical variables.
The data of every paper was organized in tables and plotted in RawGraphs http: Direct comparisons were performed among different epileptic encephalopathies Lennox-Gastaut patients vs. As clinical safety outcomes, all reported outcomes of adverse events were considered and grouped afterwards by similarity. From these, were duplicates and were removed. The remained 61 records were screened and 42 of these studies were excluded.
Nineteen 19 papers were assessed for eligibility and 6 papers were excluded due to lack of observational clinical data ex: The qualitative assessment of 13 articles resulted in 11 valid references for analysis, with an average impact factor of 8. All the studies included are fairly recent, published between and , showing how vivid this subject is in the scientific literature worldwide.
Information about the clinical studies included as valid reference in the current meta-analysis. From the selected studies, six 6 show a retrospective design with a total of patients and 5 show a prospective design with a total of patients. The quality of evidence reported in the papers is a relevant variable: As for the type of treatment, five 5 studies report data from patients who used purified CBD patients and 6 studies report data from patients who used Cannabis extracts with high CBD content, whose composition is not standardized patients.
Noteworthy, these variables don't seem to constitute an obvious bias compromising interpretation of data, since the groups are relatively well balanced. The only remarkable difference is that all studies using purified CBD had a prospective design, while the studies using CBD-rich extracts had a retrospective design. All studies were conducted by medical centers experienced in conducting this type of study, at universities or internationally reputed research centers.
Curiously, nine 9 out of the 11 studies were conducted or lead by universities or research centers in the United States patients. One study was conducted in Israel 74 patients and another in Mexico 43 patients. The majority of the studied population consisted of children and adolescents, between 1 one and 18 eighteen years old with treatment-resistant epilepsy refractory epilepsy , who tried between 4 four and 12 twelve other medications for 3 three years before trying CBD-based treatments.
Needless to say, this population constitutes a very hard-to-treat population, diagnosed with treatment-resistant epileptic syndromes. Roughly, this affects one-third of the total population of epileptic patients. The results of efficacy in the studied population suggest that treatment with CBD-based products significantly reduces seizure frequency, even for this otherwise treatment-resistant population.
Efficacy of treatments in the reduction of convulsive seizures heterogeneous population. The dotted line is the average, regardless of treatment. Each type of treatment Purified CBD vs. CBD-rich extracts is coded with a different color, according to the legend.
The mean dose, regardless of treatment was The average daily dose reported for purified CBD was Moreover, there was no difference among subtypes of epileptic encephalopathies Dravet and Lennox-Gastaut syndromes , although the data implies that patients from these two genetic-related epileptic syndrome are more sensitive to CBD treatment Supplementary Table 1.
They shall not be negligible, since they provide a significant improvement in quality of life for the patients and their family members. Secondary endpoints were reported for patients in the selected papers.
Unfortunately, not all studies considered such endpoints during their development. Arguably, these effects occurred as a consequence of the seizures reduction, but in many cases they occurred before or even in the absence of significant reductions of epileptic seizures considering each case individually.
There were no reports of secondary health aspects in studies of purified CBD 6 — However, it's impossible to conclude that no improvements on secondary endpoints occurred with this type of treatment; rather, it is more likely that the study didn't focus on this clinical phenomenon.
This is true, at least, for the effects in mood improvement, awareness, sleep quality, and self-control. Although treatment with CBD products is regarded as at least equally safe in comparison to regular anti-epileptic drugs, CBD is not devoid of adverse effects Importantly, in this case, we are considering only patients of studies that mentioned the occurrence of adverse effects.
To improve accuracy, if the study did not mention adverse events, we considered that it was not reasonable to assume that there were no adverse events and, therefore, the whole study was excluded of the analysis. Two studies containing only 20 patients were excluded according to this criterion 7 , 8. Counter-intuitively, there is also an advantage of CBD-rich extracts in relation to purified CBD regarding the occurrence of adverse events. Negative secondary effects of treatment with CBD-rich Cannabis extracts and purified CBD described as secondary endpoints in the clinical studies.
The present meta-analysis study confirms the anecdotal evidence that CBD treatment improves seizure control in patients with treatment-resistant epilepsy. Pooled together, the data from 11 studies provide strong evidence in support of the therapeutic value of high-CBD treatments, at least as far as this population of patients is regarded.
Important to say, not every study reported all the clinical parameters e. The difference in the quality of the studies is also an important limitation that should be taken into consideration. With the observational non-blinded design, it's impossible to quantify how much of this response would be due to placebo effect. More objective physiological measures would help to improve accuracy and are welcome in cannabinoid-related clinical studies.
The interpretation of higher potency of CBD in combination with other minor compounds is in line with previous reports of synergistic effects between cannabinoid and even non-cannabinoid compounds For instance, King et al. Similar examples of pharmacological interaction between these cannabinoids were summarized in Russo and Guy Another interesting aspect of cannabinoid pharmacology is that CBD tends to block some of adverse events of THC, like anxiety and paranoia Modern pharmacology suggests that these effects are due to allosteric modulation of CB1 cannabinoid receptors by CBD 39 , Noteworthy, the original description of the physiology of allosteric modulation of these receptors was performed by the main author of the current paper When it comes to adverse events, the same pattern was true: This is counter-intuitive, and we believe that it might be secondary to the dose.
Since patients taking CBD-rich extracts reported lower CBD dose, it's reasonable to expect lower side effects, including those related with the oil vehicle itself, like gastrointestinal discomfort or abdominal pain. Uncommon or rare adverse events include thrombocytopenia, respiratory infections, and alteration of the liver enzymes. There was a worsening of the seizure burden in some cases, but this is uncommon and cannot be necessarily attributed to the treatment. Uncommon or rare events reported occurred in combination with other anti-epileptic medication, particularly valproic acid and clobazam, and may be related to drug interaction, and not due to direct CBD toxicity.
Cannabinoids in the Treatment of Epilepsy: Hard Evidence at Last?
The categorical data of a total of patients were analyzed by Fischer test. . syndrome patients vs. whole epileptic population) and between “purified CBD” .. epilepsy: full remission after switching to purified cannabidiol. Clarification of the relative contribution of CBD to improved seizure outcome epilepsy: full remission after switching to purified cannabidiol. All participants received an oral formulation of highly purified CBD in with adjustments made based on seizure response and tolerability (in some adult and completed study questionnaires including the Chalfont Seizure.