October 07, 2022
2 minute read
Salpekar J. Review of cannabinoids across the epilepsy treatment spectrum. Presented at: BRAINWeek; September 28-30, 2022; Vegas.
Salpekar reports doing research under contract for Jazz Pharmaceuticals.
LAS VEGAS — Cannabinoids have been shown to effectively control seizures across the epilepsy spectrum; however, product quality control remains a challenge, according to a presenter at BRAINWeek 2022.
“We’re not really helped by the medical establishment, or the government, or anybody else,” Jay Salpekar, MD, associate professor of psychiatry and neurology at Johns Hopkins University School of Medicine and director of neuropsychiatry in the epilepsy program at the Kennedy Krieger Institute, said during the presentation. “That’s the thing that rang true with parents, with their kids and epilepsies, things just stopped working. They had to try something different.
Another barrier, Salpekar said, is that there is an overrepresentation of psychiatric comorbidities in epilepsy, with 10% to 33% of patients reporting symptoms of anxiety and depression. Research has also shown that epilepsy is linked to a fivefold increase in suicidal ideation.
Salpekar noted that because some anticonvulsants improve behavior as well as seizures, it’s been suggested that cannabinoids might do the same. This requires an understanding of the endocannabinoid system in the brain and how cannabinoids affect it, he said.
Within the clinical spectrum, there are few treatments available – CBD, THC, and synthetic THC among them – with research available on CBD dating back only to 1980. Additionally, pharmaceutical grade CBD is only approved for the symptoms of crisis and not the root cause of illness, Salpekar said.
Physicians should also be mindful of interactions with other drugs and metabolic processes, as well as considerations for the appropriate ratio of CBD to THC in the prescribed product.
Salpekar noted that the CBD to THC ratio in pharmaceutical grade CBD is 50:1, which is optimal for seizure control. However, opinions vary on the appropriate ratio for treating seizures, mood disorders, and anxiety.
Also of note, Salpekar said, is the way CBD is administered, with the ingested product having an onset of 30 minutes to 2 hours and a duration of 2 to 5 hours, while the sublingual and inhaled forms have a greater impact. immediate and potentially shorter duration.
Clinical treatment with CBD, he continued, also depends on how terpenes – unsaturated hydrocarbons found in the essential oils of plants, especially conifers and citrus fruits – affect different receptors. For example, lavender may be more effective against anxiety, and limonene may help with depressive symptoms.
However, according to Salpekar, product quality control remains the biggest challenge.
“We know that high-ratio CBD is effective for seizure control,” he said. “We have very good data on this. It may not work for all types of seizures, and it may not work all the time. But we still don’t know what the dosage is. It takes a bit more thought to really nail it.