Patients taking a milligram (mg) daily dose of pharmaceutical grade and cannabidiol will be available for children and adults with these two Although CBD oil has become a trendy cure-all, treatment of epilepsy is the. Parents, who hoped that their child might respond to cannabis oil, have . that was listed for this med as well as having seizures every night for the pas 10 days. Only certain patients have access to the cannabis-based oil under . for anything beneficial to prevent their kids from having seizures,” Watkins said. patients' medicine must contain at least 10 percent CBD oil and no more.
and with Helps CBD Epilepsy Seizures 10.) Children Oil
A different substance in the plant, tetrahydrocannabinol, or THC, is responsible for the high associated with cannabis. In June , Gov. Greg Abbott signed into law the Texas Compassionate Use Act after it passed both chambers of the state legislature by wide, bipartisan margins. Meanwhile, doctors have been slow to sign up for the program as they navigate the new law.
As of late June, just 42 physicians across Texas were registered with the state to become CBD oil prescribers, including 12 in Harris County, though not all are prescribing CBD oil at this point. According to the Epilepsy Foundation of Texas, approximately , Texans have been diagnosed with the form of epilepsy that would make them eligible for the program. For many who have used CBD oil, the newly available treatment has provided relief when all else failed.
But once an epilepsy patient has taken two different medicines without relief, the odds that a third medication will work are less than 1 percent, doctors say.
That leaves other options, such as special diets, surgeries, device implementation—or CBD oil. He said the stigma associated with taking medicine derived from cannabis is fading. But for some patients, it can help eliminate or reduce their symptoms, and it may allow them to ease off of other drugs that have serious side effects, including anemia, low platelet levels, liver failure, pancreatitis, allergic reactions and suicidal tendencies.
Before the Texas law took effect, many patients were trying CBD oil on their own by visiting other states or ordering it online, which is a legal gray area. For context, recreational marijuana might measure 20 percent THC. Those restrictions ensure Texas CBD oil makers maximize the compounds that provide symptom relief while minimizing those that can cause side effects or a high Trysten Pearson, for his part, said he experiences no side effects from CBD oil.
Perhaps the biggest hurdle of all is price. But in June, the U. Food and Drug Administration approved Epidiolex, a CBD oral solution to treat seizures associated with rare and severe forms of epilepsy. So far, the program has served 12 of its approximate customers. That has frustrated some patients and advocates, but skeptics say more research must be done to evaluate whether and how CBD oil can treat those illnesses.
UTSA research designed to set student Veterans up for success https: Eluesky Hi Elue, thank you for your question! Denominators are based on the number of answers for any given individual question. Cannabinoids used by participants for treatment of childhood epilepsy. Multiple answers were possible.
Fourteen participants refer to a maximum permissible CBD dose per day. CBD is usually given in two to three single doses per day and dosage is gradually increased by all respondents.
Remarkably, the primary objective appears to be improving the patient's quality of life. If treatment goals are not achieved, participants would discontinue the CBD treatment after a median IQR of 12 12—20 weeks. However, most responders would not use CBD for treating patients with genetic epilepsies other than Dravet syndrome, structural epilepsy with the exemption of Lennox-Gastaut syndrome or for less retractable epilepsies.
Fifty-six percent of the participants with previous CBD expertise acknowledge that data are limited but still may be sufficient to justify the use of CBD. The lack of convincing evidence to support the use of CBD, the lack of personal experience and the restricted availability for legal reasons in some countries was cited as the main reason therefore Supplementary Table 1.
According to those participants who are using CBD, this cannabinoid is available for medical purposes in Spain, Germany, France, Austria, Switzerland and the Netherlands and not available in Belgium with missing data from Italy. However, contradictory statements concerning availability and reimbursement are given by practitioners from three countries. According to our survey, almost half of the participants have used or are using CBD for treatment of epilepsy in children and adolescents. The rising CBD prescription rate within the last years found in our survey corelates with a growing interest in medical cannabis in general and CBD in particular 1.
However, the clinical evidence to support its use is scarce and the individual experience is mostly limited to a few patients per practitioner. Interestingly, even practitioners outside of specialized epilepsy centers und neuropediatric departments are using CBD in their patients. Given the lack of individual in depth experience in treating children and adolescents with CBD, a more centralized treatment approach may be suggested and treatment data should be prospectively collected.
CBD has been proven to be effective in acute and chronic seizure models in rodents 2 , 3. However, sound clinical data to prove the efficacy of CBD, depending on the epilepsy type, are limited Results of two randomized controlled trials on CBD as add-on anticonvulsant in patients with Dravet and Lennox-Gastaut syndrome have been published recently.
In both trials CBD was efficient to reduce convulsive or drop seizures frequency respectively 10 , Open label 8 , 9 , observational 16 and retrospective studies 5 — 7 indicate that other forms of intractable epilepsies may also respond to CBD. However, these observations are limited for various reasons 1. Consistently, structural or genetic epilepsies other than Dravet and Lennox-Gastaut syndrome were not considered to be treatable with CBD by most respondents of our survey.
Unsurprisingly, given the limited data, survey participants would rather treat only patients with proven pharmacoresistancy, when other treatment options are exhausted or do not appear appropriate. Randomized controlled trials primarily focus on seizure control as a main outcome criteria, implicating seizure control to be the primary treatment goal 10 , However, parental surveys and case reports suggest that from the patient's perspective, other treatment effects of CBD, e.
Aforementioned aspects may impair the quality of life as much as the seizures themselves 17 and may be responsive to a CBD treatment Interestingly therefore, in our participants opinion, improving the patient's quality of life was even more important than seizure reduction when initiating a CBD treatment. However, this may be in part due to the limited practitioner's expectation concerning seizure control in the respective patient population and we cannot provide information about decision making based on individual patient data.
Nevertheless, increasing patient's quality of life appears to be a major motive for initiating a CBD treatment and should be included as outcome criteria in future CBD trials The two major neuroactive components of the cannabis plant out of more than hundred different cannabinoids are delta9-tetrahydrocannabinol THC and CBD The latter cannabinoid is used by most participants.
While the approval of the European Medicines Agency EMA is pending for a purified CBD pharmaceutical, purified CBD is currently only available as an individual pharmacy-dispensed preparation in some European countries or even prohibited in others.
This may be the rationale to use over-the-counter preparations as reported by some participants, however, the reasons therefore are not elucidated by our survey. CBD enriched hemp oils are mixtures of cannabis extracts, presumably with a higher CBD content, and are freely available as dietary supplement. However, CBD concentrations in those preparations are not standardized. Quality controls revealed low CBD concentrations, potentially impacting anticonvulsive efficacy of the preparation, and revealed increased concentrations of THC in a large proportion of hemp oil samples Therefore, when intending to initiate a CBD based treatment, there is currently no alternative available for individually dispended purified CBD preparations.
Preclinical data on THC prove anticonvulsant 22 , as well as proconvulsive 23 and adverse effects on neurocognitive functioning Clinical data show adverse structural and functional effects resulting from long term THC use 25 , Nevertheless, the use of THC containing preparations is still reported in our survey.
This may facilitate its utilization and the approval of reimbursement from health care providers. Since clinical data concerning the safety and efficacy of THC or hemp oils for treatment of childhood epilepsy are not available, these preparations cannot be recommended.
However, dosing may depend on several factors, e. Long term data of the use of CBD are equally limited Therefore, there is no defined timeframe that qualifies as CBD treatment failure and this is reflected by the participant's divergent opinions about when to discontinue a CBD treatment. The majority of participants in our survey would reduce clobazam when initiating a CBD treatment.
While cytochrome P inhibiting CBD has shown relevant interactions with other anticonvulsant drugs in preclinical studies 30 — 32 , the only clinically relevant interaction consists of increasing plasma concentrations of the active clobazam metabolite N-desmethyl-clobazam 8 , 33 — This interaction is claimed to be partially accountable for the anticonvulsant effect of CBD but also for increased sedation 8 , 27 , Elevated aminotransferase levels during CBD treatment are reported to result almost exclusively from a concomitant valproate therapy 10 , 33 , Nevertheless, liver enzymes are routinely measured by most participants regardless of comedication.
Purified CBD preparations increase serum levels in a dose-dependent manner However, pharmacokinetics of different CBD preparations or different routes of application and correlations between CBD serum level and anti-seizure effects or side effects have not been fully established 36 , Accordingly, almost none of the participants measure CBD serum levels.
There are several surveys of patients' or parents' opinions regarding CBD treatment for epilepsy 38 — 41 , but only one that is including health care professionals.
This may indicate a change of attitude concerning a cannabinoid-based treatment for epilepsy among practitioners treating children and adolescents for epilepsy. According to our survey, most participants receive inquiries about CBD treatment on a regular basis. In our experience, families searching for alternative treatment options are burdened by a long history of seizures, side effects and complications.
In an Australian nationwide survey on medicinal cannabis use for epilepsy, a significant proportion of children and adults with epilepsy were commencing cannabis-based products without medical supervision, even resulting in unsupervised reduction of concomitant antiepileptic treatment Therefore, according to our survey some participants would rather commence a CBD treatment even if not convinced about its efficacy than having patients using it without medical supervision.
However, decision to commence CBD treatment is mainly made on individual case-by-case basis and most patients of our participants are treated outside of clinical trials. Interestingly, a substantial number of answers about their country specific availability and regulations concerning reimbursement of CBD were contradictory.
This is in line with the results of an US survey about the use of medical cannabis in cancer patients. This may indicate a further need for providing adequate information to health care providers given the striking differences between European countries in regulation, availability and covering of costs of medical cannabinoids in general and CBD in particular Given the widely differing practice concerning indications and limitations, choice of preparation, dosing and monitoring revealed by our survey, official guidelines for the use of CBD for epilepsy treatment appear to be advisable to harmonize and potentially improve its use.
There are several limitations concerning our survey. Since this was an open-access survey we cannot generate a response rate. We relied onto the participants to reply truthfully and thoroughly. Numbers and percentages of CBD prescribers may be overestimated by a participation bias, that may be indicated by a substantial variation of responses between countries. Furthermore, we were not able to relate the numbers of participants to the total number of physicians that are treating children and adolescents with CBD in participating countries.
Therefore, we cannot to draw a representative picture for the extent of CBD use in participating countries. These aspects need to be considered when interpreting our findings. Nevertheless, we presented a broad overview of certain aspects of CBD use by European experts of childhood epilepsy and highlighted several limitations for its use in clinical practice.
CBD appears to be increasingly used by the participants of our survey, but the individual experience remains limited. There are diverse opinions about the use of CBD to treat epilepsy in children and adolescents and widely differing views on several aspects in managing the CBD treatment. KK conceptualized and designed the questionnaire, collected contact data, performed the survey, analyzed data and drafted the initial manuscript.
VA-A contributed to data collection, and revised the manuscript. AS-B contributed to the design of the questionnaire and revised the manuscript. JJ contributed to the design of the manuscript, contributed to the collection of contact data and revised the manuscript. All authors gave final approval of the version to be published. All authors agree to be accountable for the content of the work. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
The Supplementary Material for this article can be found online at: National Center for Biotechnology Information , U. Journal List Front Neurol v. Published online Sep 7. Author information Article notes Copyright and License information Disclaimer.
This article was submitted to Epilepsy, a section of the journal Frontiers in Neurology. Received May 3; Accepted Aug The use, distribution or reproduction in other forums is permitted, provided the original author s and the copyright owner s are credited and that the original publication in this journal is cited, in accordance with accepted academic practice.
No use, distribution or reproduction is permitted which does not comply with these terms. Introduction Cannabidiol CBD , an active cannabinoid without psychotropic effects and abuse liability, has recently gained interest as a treatment option for intractable epilepsy 1.
FDA panel backs marijuana-based drug for childhood seizures
Facts about Seizures and Epilepsy .. Diets and Adults: an Update for · Top 10 Dietary Treatment Articles of · Will My Child Get a Heart Attack?!? Targeted Research Initiative for Research Regarding Cannabidiol and Epilepsy. Reported daily CBD doses range from 10 to 50 mg/kg body weight. CBD, children, EEG, electroencephalogram, epilepsy, seizure From participants using CBD for childhood epilepsy, information about the following .. the safety and efficacy of THC or hemp oils for treatment of childhood epilepsy are. Keywords: Cannabis, Cannabidiol, Epilepsy, Seizures, Review (hashish oil), all of which have been used through the centuries mostly for . with Dravet syndrome, 27 children aged 4 to 10 years received CBD doses of 5.