Source of cannabinoids: what is available, what is used, and where does it come from? Epileptic Disorders

N. Specchio, N. Pietrafusa, H.J. Cross

Research output: Contribution to journalArticlepeer-review

Abstract

Cannabis sativa L. is an ancient medicinal plant wherefrom over 120 cannabinoids are extracted. In the past two decades, there has been increasing interest in the therapeutic potential of cannabis-based treatments for neurological disorders such as epilepsy, and there is now evidence for the medical use of cannabis and its effectiveness for a wide range of diseases. Cannabinoid treatments for pain and spasticity in patients with multiple sclerosis (Nabiximols) have been approved in several countries. Cannabidiol (CBD), in contrast to tetra-hydro-cannabidiol (THC), is not a controlled substance in the European Union, and over the years there has been increasing use of CBD-enriched extracts and pure CBD for seizure disorders, particularly in children. No analytical controls are mandatory for CBD-based products and a pronounced variability in CBD concentrations in commercialized CBD oil preparations has been identified. Randomized controlled trials of plant-derived CBD for treatment of Lennox-Gastaut syndrome (LGS) and Dravet syndrome (DS) have provided evidence of anti-seizure effects, and in June 2018, CBD was approved by the Food and Drug Administration as an add-on antiepileptic drug for patients two years of age and older with LGS or DS. Medical cannabis, with various ratios of CBD and THC and in different galenic preparations, is licensed in many European countries for several indications, and in July 2019, the European Medicines Agency also granted marketing authorisation for CBD in association with clobazam, for the treatment of seizures associated with LGS or DS. The purpose of this article is to review the availability of cannabis-based products and cannabinoid-based medicines, together with current regulations regarding indications in Europe (as of July 2019). The lack of approval by the central agencies, as well as social and political influences, have led to significant variation in usage between countries. © 2020 Epileptic Disorders
Original languageEnglish
Pages (from-to)S1-S9
JournalEpileptic Disord.
Volume22
Issue numberS1
DOIs
Publication statusPublished - 2020

Keywords

  • antiepileptic drugs
  • cannabidiol
  • cannabinoids
  • cannabis-based products
  • Dravet syndrome
  • legislation
  • Lennox-Gastaut syndrome
  • anticonvulsive agent
  • cannabichromene
  • cannabigerol
  • cannabinoid
  • cannabinol
  • cannabis
  • dronabinol
  • medical cannabis
  • nabiximols
  • plant extract
  • anticonvulsant activity
  • antiemetic activity
  • antiinflammatory activity
  • Cannabis sativa
  • child
  • dietary supplement
  • drug efficacy
  • drug safety
  • epilepsy
  • human
  • intellectual impairment
  • intoxication
  • intractable epilepsy
  • law
  • Lennox Gastaut syndrome
  • medicolegal aspect
  • mental disease
  • meta analysis (topic)
  • multiple sclerosis
  • neurologic disease
  • neuropathic pain
  • posttraumatic stress disorder
  • priority journal
  • randomized controlled trial (topic)
  • Review
  • scientific literature
  • seizure
  • severe myoclonic epilepsy in infancy
  • spasticity
  • tonic clonic seizure
  • tranquilizing activity
  • drug combination
  • myoclonus epilepsy
  • preschool child
  • Anticonvulsants
  • Cannabidiol
  • Cannabinoids
  • Child
  • Child, Preschool
  • Dronabinol
  • Drug Combinations
  • Epilepsies, Myoclonic
  • Epilepsy
  • Humans
  • Lennox Gastaut Syndrome
  • Plant Extracts
  • Seizures

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