Scientists have responded with a focus on research into how the endocannabinoid system may be a target of treatment for these patients.  There is scientific evidence that people with epilepsy may have an endocannabinoid deficiency, leading to overexcitation of the flow of neurotransmitters in the brain, which leads to abnormal firing of the brain cells. Evidence also points to significant neuroinflammation in the seizuring brain.  The way that CBD works to reduce and stop seizures is being researched and so far, this is what we know:  CBD enhances the brain’s own endocannabinoid levels, enhancing the endocannabinoid system; CBD modulates the flow of calcium and potassium in neurons, thereby stabilizing these cells, and CBD works as an antiinflammatory, blocking formation of pro-inflammatory compounds and reducing toxic substances, resulting in a brain that is less inflamed.  As you can see, CBD, with its multiple mechanisms of action, acts at multiple targets in the brain. This is why we think it works well for epilepsy. Since CBD does not activate the cannabinoid receptor the way THC does, it does not cause tolerance, and as it is not psychoactive, it is an ideal compound for pediatric patients.

In most cases, the oil is administered under the tongue, swallowed by mouth, or given through a gastrostomy tube.  I insist that my patients use laboratory tested solvent- and pesticide-free cannabis oil.  Adjustments in dosing and the CBD:THC ratio are often required after periods of observation, and sometimes different strains of CBD-rich cannabis must be tried before seeing a clinical response.

“Cannabis for Pediatric Epilepsy” is the second installment of a five-part series on Children and Cannabis Medicine.

Part 1: Cannabis Medicine in Practice

Part 2: Cannabis for Pediatric Epilepsy


References:

Hampson AJ, Grimaldi M, Axelrod J, and Wink D (1998) Cannabidiol and (-)delta9-tetrahydrocannabinol are neuroprotective antioxidants. Proc Natl Acad Sci USA 95: 8268-8273 (CBD reduces glutamate and has antioxidant effects)

Vezzani A. Inflammation and epilepsy. Epilepsy Curr. 2005 Jan-Feb;5(1):1-6.

Lozovaya N, Min R, Tsintsadze V, Burnashev N. Dual modulation of CNS voltage-gated calcium channels by cannabinoids: Focus on CB1 receptor-independent effects. Cell Calcium. 2009 Sep;46(3):154-62

Izzo AA, Borrelli F, Capasso R, Di Marzo V, Mechoulam R. Non-psychotropic plant cannabinoids: new therapeutic opportunities from an ancient herb. Trends Pharmacol Sci. 2009 Oct;30(10):515-27.

De Petrocellis L, Ligresti A, Moriello AS, Allarà M, Bisogno T, Petrosino S, Stott CG, Di Marzo V. Effects of cannabinoids and cannabinoid-enriched Cannabis extracts on TRP channels and endocannabinoid metabolic enzymes. Br J Pharmacol. 2011 Aug;163(7):1479-94.

Mechoulam R. Plant cannabinoids: a neglected pharmacological treasure trove. Br J Pharmacol. 2005 December; 146(7): 913–915.

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