Epilepsy and Cannabis, yes to CBD (Cannabidiol)?

There’s much attention in the scientific community and the public opinion with regards to the progress and the therapeutic perspectives investigated through research on the effects of cannabis for medical use and of phytocannabinoids.

A field of large interest is the use of CBD in the treatment of forms of epilepsy which are drug resistant, which is resistance to drugs or reduction of effectiveness of the drug in the treatment of the disorder.

In particular, the 41^ National Congres of the Italian League against Epilepsy (Lega Italiana, contro l’Epilessia, LICE), held last June 6 in Rome, during which some rare and drug resistant forms of epileptic encephalitis, like Dravet Syndrome and the Lennox-Gastaut Syndrome, were discussed.

“It’s the first time – prof. Oriano Mecarelli, epileptologist of the University La Sapienza in Roma and President of the LICE, declared – that the delicate topic of epilepsy treatment with cannabis derivatives is officially discussed in the event of one of our scientific meetings”.

Medical Cannabis, not just THC

Giovanni Ambrosetto, neurologist of the University of Bologna, has focused the attention on CBD, which today is studied as an anti-epileptic, while until ten years ago when medical cannabis was discussed, research was exclusively aimed on THC.

“There is great enthusiasm with regards to the therapeutic properties of this molecule (CBD)”, Ambrosetto declares, who has also sent out a message to physicians:

“We have to learn to know the properties of these substances, like we have always done with other anti-epileptic drugs, banish prejudice connected to them, without however believing in miraculous results”.

Yes to Cannabis, but with caution

The LICE wants transparency on many aspects regarding the treatment of epilepsy with cannabis derivatives, considering that still a lot of confusion exists, both amongst those working in the sector and amongst patients and relatives.   

“According to recent controlled studies published in respected international magazines – Mecarelli stated – treatment with CBD reduces the frequency of the epileptic seizures and improves the quality of life in the above mentioned drug-resistant epileptic encephalitis with onset in childhood and hence we have now scientific evidence that CBD is effective as an additional treatment to the standard treatment”.

Interview with Pasquale Striano

In the past weeks we’ve had the pleasure to have an interview and discuss the topic with Pasquale Striano, Associate Professor of Pediatrics, Department of Neurosciences, rehabilitation, ophthalmology, genetics and mother-infant sciences (DINOGMI), University of Genova, - G. Gaslini Institute.

In Italy over 500.000 individuals are affected by epilepsy with about 30.000 new cases each year, Cannabinoids can be effective in the treatment of this disorder? Have we got sufficient scientific studies? 

"The use of cannabinoids for medical purposes - Striano declares – has always provoked discussions. However there is growing evidence which would confirm its potential. When CBD is involved, the therapeutic effectiveness seems real”.

“Numerous scientific studies on CBD have been conducted and with more than well-founded reasons. It has, in fact, been demonstrated in several occasions, both anecdotally and clinically, that positive effects on a wide range of health states exist. One of the medical fields in which CBD is showing the best results are the cases related to epilepsy in its most severe form”.

Are there enough scientific studies in Italy to be able to assert that Cannabis can be used securely by patients?

In Italy there is still very little clinical data available. At the Gaslini Institute of Genova, before the Regional Decree n° 271/2016, and subsequently with the purchase of the treatment at private authorized Pharmacies, eleven patients have been monitored, who  had taken, in the past and under close medical surveillance, cannabinoids in different formulations.

Some patients, affected by drug-resistant epileptic disorders, had a considerable benefit from the cannabinoid treatment, being an improvement at EEG level with reduction of paroxysmal activity, improvement in behaviour and sleep-wake rhythms. 

These are, however, only isolated “case reports”, the issue is that at today’s date no randomized and controlled studies are available on cannabinoids and that, as a consequence, it is hard to express judgements, in spite of the fact that the results obtained up to now look very promising. 

Looking at the future, how do you consider the ‘state’ of research in Italy on the topic and which are, according to your point of view, the aspects requiring major investments?

Genetic research on epilepsy represents at the moment a highly suggestive and promising research frontier and important prospects can be glimpsed by means of the creation of new medical drugs, aimed at specific pathogenic mechanisms, or with a specific action on mutated proteins, up to a substitute gene therapy for the most severe forms (Precision Medicine).

In future, it will be fundamental to implement the integrated research platforms. Moreover, the realization of networks for clinical testing, will allow the expansion of the sample populations of patients with epilepsy, genetically defined, in a manner that the new discoveries can be translated in benefits at clinical level.

Sadly enough, epilepsy is still burdened with a heavy stigma and there are still many people who erroneously believe epilepsy to be a rare disease or a mental disorder with scarce treatment possibilities and hardly compatible with a ‘normal’ life. Still, that during a seizure one becomes violent, or that one cannot drive a car, practise sports and, when a woman is involved, that she has difficulty conceiving or that it is forbidden for her to breastfeed.

Thus, a contribution to the elimination of stereotypes and prejudices is a correct language, which is expressed in a way that people suffering from epilepsy are not excluded because of a condition and that there are growing resources for the community, also at job level.

Epilepsy doesn’t necessarily preclude, in fact, normal work activities. A renowned American epileptologist, Lennox, states: “The individual with epilepsy suffers, more than from his/her disorder, from all it brings about, especially at a social level”.

This statement, in spite of the fact that many years have passed since it was made, is still extraordinarily true!