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Marijuana and Cannabis Extracts Treating Epilepsy: The full story

Epilepsy, Infant and Children | August 28, 2014 | Author: The Super Pharmacist


Marijuana and Cannabis Extracts Treating Epilepsy: The full story

Epilepsy refers to a common chronic neurological disorder characterised by recurrent unprovoked seizures. Seizures are caused by a disruption in electrical activity among neurons in the cerebral cortex, the most highly developed part of the human brain. Seizures can cause disturbance of consciousness and/or body movements. Seizures are also known as fits, turns or convulsions.

A child may have epilepsy if he or she has had two or more unprovoked seizures. About two percent of the general population are known to have epilepsy, approximately 400,000 Australians. Of these, over 60 percent have had their first seizure before the age of 12 and there are approximately 50,000 students with epilepsy in Australia. In 40 percent of cases the cause of epilepsy is unidentified.

Known causes in childhood 

  • Genetic cause
  • Congenital brain abnormality
  • Perinatal brain injury
  • Other brain trauma
  • Central nervous system infections (e.g. meningitis, encephalitis)
  • Metabolic disorders (e.g. low blood sugar)

The condition is typically managed, though not cured, with anti-seizure medication. Unfortunately, almost one-third of sufferers do not achieve seizure control even with the best available drugs. Until now, the only other option has been surgery, and surgery has only been indicated in a select number of medication-resistant cases. In children, the ketogenic diet may also be considered.
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Can Marijuana Control Childhood Epilepsy?

Can Marijuana Control Childhood Epilepsy?On August 7th, 2013, Cable News Network (CNN) in the U.S.A. aired a sensational documentary by Dr. Sanjay Gupta detailing the journey of a little Colorado girl named Charlotte Figi, who suffers from a rare genetic form of epilepsy called Dravet Syndrome. From the time Charlotte was two years old, she was having over 300 seizures a week. By 2012, she had lost the ability to walk, talk, and eat, and her parents had said their goodbyes on several occasions.

Doctors had her on seven different potent, addictive medications and a special diet, but with each intervention, benefits were only temporary, and side effects were overwhelming.

Charlotte’s mother, Paige Figi, had voted against the Colorado medical marijuana ballot initiative that passed in 2000. But after doing some research, she and her husband changed their minds. They found a video online of a young boy in California, also with Dravet Syndrome, who was successfully being treated with cannabis. The Figis called doctor after doctor to find two who would sign off on a medical marijuana card for their five-year-old daughter.

Eventually, they found a Harvard-trained physician who treated other medical marijuana patients. He found a strain similar to the one used by the little boy in California – low in the concentration of tetrahydrocannabinol or THC (the main psychoactive component of marijuana) and high in the concentration of another compound called cannabidiol or CBD (a non-psychoactive constituent of marijuana).

Charlotte began taking it in liquid form, twice a day.

Charlotte's Web

Today, Charlotte, now 7 years old, is thriving.

Charlotte's WebHer seizures only happen two to three times per month, almost solely in her sleep. Not only is she walking, she can ride her bicycle. She feeds herself and is talking more and more each day. The marijuana strain has been named "Charlotte's Web"– in her honour.

Desperate Australian families are resorting to giving their children medical cannabis in a bid to stop dangerous epileptic seizures. In Australia, a girl named Tara O’Connell has become Australia's 'Charlotte Figi.' She too was diagnosed with Dravet syndrome and suffered throughout most of her life, having as much as 20,000 seizures a year.

After a year on cannabis tincture, Tara is now seizure-free and showing other signs of improvement, including mobility. Dozens of other children are also using tincture with positive results throughout Australia.

Unlike the high-CBD oil being used in Colorado, the type of cannabis extract mentioned above is tincture with high concentrations of tetrahydrocannabinolic acid (THCA). THCA is the non-decarboxylated, raw form of tetrahydrocannabinol (THC). Like CBD, it is non-psychoactive and offers a wide range of potential benefits.

How Do Cannabis Extracts Differ?

There are over 480 natural components found within the Cannabis sativa plant, of which 66 have been classified as "cannabinoids," chemicals unique to the plant. The most well known and researched of these, delta-9-tetrahydrocannabinol (Δ9-THC), is the substance primarily responsible for the psychoactive effects of cannabis. This is the part of the plant that gives the ‘high.’                                                                                                                       The cannabinoids are separated into subclasses. These are as follows:

  • Cannabigerols (CBG)
  • Cannabichromenes (CBC)
  • Cannabidiols (CBD)
  • Tetrahydrocannabinols (THC)
  • Cannabinol (CBN) and cannabinodiol (CBDL)
  • Other cannabinoids (such as cannabicyclol (CBL), cannabielsoin (CBE), cannabitriol (CBT) and other miscellaneous types)

The major differences between the cannabinoids are determined by the extent to which they are psychologically active.

Three classes of cannabinoids, the CBG, CBC and CBD are not known to have a psychoactive effect. THC, CBN, CBDL and some other cannabinoids on the other hand are known to be psychologically active to varying degrees.

Tetrahydrocannabinolic acid (THCA) is the main constituent in raw cannabis.

THCA converts to tetrahydrocannabinol (THC), the main psychoactive component in Cannabis, when burned, vaporised, or heated for a period of time at a certain temperature.

THCA is the non-activated, non-psychotropic acid form of THC. THCA not only has anti-proliferative abilities that are crucial in helping inhibit the growth of cancerous cells, but also, it has anti-spasmodic abilities that helps subdue muscle spasms and therefore has potential use among epileptic patients.

What Is the Current Evidence for Use of Cannabis Extracts for Epilepsy?

Although the above mentioned stories provide scope into the capacity for effective treatment of epilepsy, in the medical, evidence based world, larger scaled, controlled and preferably double-blind studies are the benchmark for medical significance.

Cannabidiol (CBD) is one of at least 60 cannabinoids found in cannabis. It is the principal non-psychoactive cannabinoid in cannabis. It is a major constituent of the plant, second only to tetrahydrocannabinol (THC), and represents up to 40% of its extracts. Compared with THC, cannabidiol is not psychoactive in healthy individuals and is considered to have a wider scope of medical applications than THC, one of which is epilepsy. CBD has been shown to have anti-convulsant properties in numerous studies of rodent models of epilepsy. 

In one study, cannabidiol (CBD) or placebo was given in a double-blind fashion to 16 healthy human volunteers at a dose of 3 mg/kg daily for 30 days. In phase 2 of the same study, 15 patients suffering from secondary generalised epilepsy with temporal focus were randomly divided into two groups. Each patient received, in a double-blind procedure, 200-300 mg daily of CBD or placebo for as long as 4 1/2 months. The patients continued to take the anti-epileptic drugs prescribed before the experiment, although these drugs no longer controlled their seizures.

All patients and volunteers tolerated CBD very well and showed no signs of toxicity or serious side effects. Four of the 8 CBD patients remained almost seizure-free throughout the experiment and 3 other patients demonstrated partial improvement. CBD was ineffective in 1 patient. The clinical condition of 7 of the 8 placebo patients remained unchanged, and one patient improved.

As of late February 2014, according to the Stanley's Realm of Caring Foundation, 187 paediatric and 27 adult patients with epilepsy are taking Charlotte’s Web. (There is an extensive waiting list.) Among the initial cohort of 27 children with epilepsy who have received Charlotte’s Web,  (85%) have experienced a reduction of 50% or more in seizure frequency.

Severe childhood epilepsies are characterised by frequent seizures, neurodevelopmental delays, and impaired quality of life. In these treatment-resistant epilepsies, families often seek alternative treatments.

Can Marijuana Control Childhood Epilepsy?A survey was presented to parents of children with severe epilepsy about the use of cannabidiol (CBD)-enriched cannabis to treat their child's seizures. Nineteen responses met the inclusion criteria for the study: a diagnosis of epilepsy and current use of cannabidiol-enriched cannabis. Sixteen (84%) of the 19 sets of parents reported a reduction in their child's seizure frequency while taking cannabidiol-enriched cannabis.

Of these, two (11%) reported complete seizure freedom, eight (42%) reported a greater than 80% reduction in seizure frequency, and six (32%) reported a 25-60% seizure reduction. Other beneficial effects included increased alertness, better mood, and improved sleep. Side effects included drowsiness and fatigue.

Although less well studied than cannabidiol (CBD), tetrahydrocannabnoic acid or THCA appears to have significant anti-convulsant properties as well and has been anecdotally successful in treating severe pediatric epilepsy. Tara O'Connell, from Victoria, is but one of a number of pediatric epilepsy patients who have benefited from this cannabis extract.

How Safe Is Cannabidiol (CBD)?

Safety studies of CBD were required before human tests. CBD was extensively investigated in laboratory animals to detect possible side effects or toxic effects. Acute CBD administration by the oral, inhalatory or intravenous route did not induce any significant toxic effect in humans. In addition, chronic administration of CBD for 30 days to healthy volunteers, at daily doses ranging from 10 to 400 mg, failed to induce any significant alteration in neurological, psychiatric or clinical exams.

What Is the Status of Cannabis Extracts in Australia?

Although cannabis is the most widely used illicit drug in Australia, with a reported one-third of all Australians aged 14 or older having tried cannabis -  it remains illegal in Australia.

Commonwealth, state and territory governments have used existing laws or passed specific laws to allow the prescribing and dispensing of medicinal cannabis products, as well as cannabis cultivation and manufacture for medicinal purposes. 
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Legally, drug scheduling in Australia is a state issue, however, all states abide by the federal government’s scheduling of cannabis as a Schedule nine drug, as per the Standard for the Uniform Scheduling of Medicines and Poisons.
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