Cannabidiols säkerhet och effektivitet vid behandling av epileptiska anfall : En litteraturstudie

Sammanfattning: Background: Epilepsy is a neurological illness that affects tens of millions of people globally and can lead to large restrictions in the affected individuals lives. Up to one third of epilepsy patients present epileptic seizures despite treatment with conventional antiepileptic drugs. Relatively recent research into new epileptic treatments has led to the development of cannabidiol-based anticonvulsant drugs. Cannabidiol (CBD) is extracted from the plant Cannabis sativa. CBD is a non-psychoactive cannabinoid, compared to other cannabinoids like tetrahydrocannabidiol (THC). CBD is considered to possess neuroprotective and anticonvulsant properties that can help patients with treatment-resistant forms of epilepsy such as Lennox-Gastaut syndrome (LGS) and Dravet syndrome (DS). The precise mechanism of action is not known, though it is speculated to stem from CBDs agonist or antagonist activity at various ion channels and neurotransmitter transporters. Objective: The purpose of this literature study was to evaluate the effects and safety of cannabidiol in patients with epilepsy.  Method: This thesis is a literature study that was performed by retrieving and reviewing scientific studies from the PubMed database. Search terms such as ‘’Cannabidiol’’, ‘’epilepsy’’, ‘’CBD’’ and ‘’seizure’’ were used. Inclusion criteria for the studies were that the studies should be five years or younger and have at least 50 participants. Results: Five scientific articles were included in the literature study. Any sort of seizure reduction was noted in 36-63,6% of the participants, ≥50% seizure reduction was noted in 36-55% of participants. 1-3% had a 100% seizure reduction. The seizure reductions were greater amongst the CBD groups than in the placebo groups. The vast majority of the adverse effects were deemed to be mild or moderate with diarrhea, somnolence and decreased appetite being the most common. There were elevations of aminotransferase liver enzymes in 1,4-15% of the participants, primarily amongst participants that combined CBD with valproic acid. Mortalities were noted in the studies, though none were considered to be related to treatment. Conclusions: To alleviate human suffering and develop better treatment options of difficult to treat conditions, research into previously tabooed substances is justified. CBD appeared to have good seizure reducing properties when used against various types of epilepsy, with over all tolerable adverse effects. However the studies also indicate that CBD might not be safe to combine with all other antiepileptic drugs, such as valproic acid because of elevations of liver enzymes that might indicate hepatotoxicity. Additional studies are also required to evaluate the correlation with CBD plasma concentration and seizure reduction.