Abstract
Several new antiepileptic medicines became available for clinical use in the last
two decades. However, the prognosis of epilepsy remains unchanged, with approximately
one-third of patients continuing to have drug-resistant seizures. Because many of
these patients are not candidates for curative epilepsy surgery, there is a need for
new seizure medicines with better efficacy and safety profile. Recently, social media
and public pressure sparked a renewed interest in cannabinoids, which had been used
for epilepsy since ancient times. However, physicians have significant difficulty
prescribing cannabinoids freely because of the paucity of sound scientific studies.
Among the two most common cannabinoids, cannabidiol has better antiepileptic potential
than tetrahydrocannabinol. The exact antiepileptic mechanism of cannabidiol is currently
not known, but it modulates a number of endogenous systems and may have a novel anticonvulsant
effect. However, it has broad drug-drug interactions with several agents, including
inducer and inhibitor of CYP3A4 or CYP2C19. Cannabidiol can cause liver enzyme elevation,
especially when co-administered with valproate. The US Food and Drug Administration
(FDA) has approved pharmaceutical-grade cannabidiol oil for two childhood-onset catastrophic
epilepsies: Dravet syndrome and Lennox-Gastaut syndrome. The Drug Enforcement Agency
also reclassified this product as a schedule V agent. However, other cannabidiol products
remain as a schedule I substance and are primarily used without regulation. Additionally,
the FDA-approved pharmaceutical-grade cannabidiol oil is expensive, and insurance
companies might approve this only for the designated indications. In despair, many
individuals may resort to unregulated medical cannabis products in an attempt to control
seizures. Rather than spontaneous treatment without medical supervision, adequate
medical oversight is indicated to monitor and manage the proper dose, side effects,
validity of the product, and drug-drug interactions.
Keywords
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Article info
Publication history
Published online: March 22, 2019
Accepted:
March 14,
2019
Received:
October 31,
2018
Footnotes
Conflicts of interest: None reported.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
