Marijuana use among patients with epilepsy at a tertiary care center

Kerr, Alysse; Walston, Victoria; Wong, Victoria S. S.; Kellogg, Marissa; Ernst, Lia

doi:10.1016/j.yebeh.2019.05.037

Cited by 19 publications

(42 citation statements)

References 18 publications

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“…Pharmaceutical CBD is currently a restricted prescription medication, and insurance coverage is often limited to only those patients with the specific approved indications. As a result, a large number of patients with epilepsy elect to use alternative CBD products sold widely as dietary supplements by commercial vendors [6]. Other patients elect to use cannabinoid products that are less refined and include other phytocannabinoids and terpenoids found in cannabis, many of which contain THC in addition to or in lieu of varying concentrations of CBD [7].…”

Section: Introductionmentioning

confidence: 99%

Cross-sectional and longitudinal evaluation of cannabidiol (CBD) product use and health among people with epilepsy

Strickland

Jackson²,

Schlienz

et al. 2021

Epilepsy & Behavior

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Recent approval of Epidiolex Ò (pharmaceutical cannabidiol/CBD) for the treatment of Lennox Gastaut syndrome (LGS) and Dravet syndrome highlights a therapeutic efficacy of CBD in the treatment of epilepsy. However, a large number of patients with epilepsy elect to use alternative artisanal CBD products due to cost or access constraints. Despite widespread availability and variety of these artisanal CBD products, studies evaluating their safety or efficacy are rare, making conclusions about clinical utility uncertain. The purpose of the present study was to evaluate cross-sectional and longitudinal associations of artisanal CBD product use with quality of life, mental health, healthcare utilization, and epilepsyspecific outcomes within a large, observational cohort of people with epilepsy. Participants who reported using artisanal CBD products at baseline (Artisanal CBD Users; n = 280) and participants who used no cannabis-based products (Controls; n = 138) completed web-based assessments evaluating psychiatric symptoms, healthcare utilization, and epilepsy-specific factors. Follow-up surveys were collected in a subset of participants (n = 190) following baseline assessment for longitudinal comparison. Crosssectionally, higher quality of life, lower psychiatric symptom severity, and improved sleep were observed among Artisanal CBD Users at baseline compared with Controls. Initiation of artisanal CBD product use was also related to improved health outcomes longitudinally. No group differences were observed for seizure control, but both groups included a high number of individuals with no past month seizures. Artisanal CBD Users reported significantly better epilepsy medication tolerability, use of fewer prescription medications overall, and reduced healthcare utilization compared with Controls. These findings are consistent with research indicating that practitioners recommending CBD in clinical care for epilepsy report integrating the use of CBD both as a means to improve patient quality of life as well as for seizure control.

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Section: Introductionmentioning

confidence: 99%

Cross-sectional and longitudinal evaluation of cannabidiol (CBD) product use and health among people with epilepsy

Strickland

Jackson²,

Schlienz

et al. 2021

Epilepsy & Behavior

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“…Even when highly educated patients intend to use CBD oil similarly to the dosing used in clinical trials for epilepsy, they tend to use a sub therapeutic dose or not understand how much they are actually taking. This limitation in our study is in coherent with the fact that many cannabis dispensaries do mark products with respect to THC and CBD content [50]; however, multiple studies have demonstrated that the labeling can be inaccurate [54,55]. The number of doses per day varied among the participants in the study which is expected as cannabis was not being used as a medication; otherwise, one would expect it to be taken regularly in the same manner as other epilepsy medications.…”

Section: Discussionmentioning

confidence: 86%

“…Patient who reported the use of cannabis to the physician were screened using cannabis urine testing as per standard clinical care. They were assessed using the drug severity index (DSI) and a timeline follow-back (TLFB) method as an additional method of verifying user status together with a modified nine-item survey on cannabis use to ascertain how patients with epilepsy at a tertiary care clinic in Mansoura/Egypt are using cannabis outside the medical system, and to elaborate on their perception about cannabis use during the course of the disease [50].…”

Section: Cannabis Use Surveymentioning

confidence: 99%

Cannabis Influences the Putative Cytokines-Related Pathway of Epilepsy among Egyptian Epileptic Patients

et al. 2019

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The study aims to investigate: (1) the prevalence of cannabis among epileptic patients seen at Mansoura University Hospital, (2) serum levels and gene expression of cytokines in epilepsy patients and the controls. and (3) the possibility that cannabis use affects the cytokine levels in epilepsy patients, triggering its future use in treatment. We recruited 440 epilepsy patients and 200 controls matched for age, gender, and ethnicity. Of the epileptic patients, 37.5% demonstrated lifetime cannabis use with a mean duration of 15 ± 73 years. Serum levels of interleukin IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, and tumor necrosis factor-α (TNF-α), were analyzed and gene expression analysis was conducted only for those cytokines that were different between groups in the serum analysis. The “Epilepsy-only” patients had significantly higher serum and mRNA levels of IL-1α, β, IL-2,6,8, and TNF-α compared to the controls and the “Cannabis+Epilepsy” group (p = 0.0001). IL-10 showed significantly lower levels in the “Epilepsy-only” patients compared to the controls and “Cannabis+Epilepsy” (p = 0.0001). Cannabis use is prevalent among epilepsy patients. Epilepsy is characterized by a pro-inflammatory state supported by high serum and gene expression levels. Cannabis users demonstrated significantly lower levels of inflammatory cytokines compared to epilepsy non-cannabis users which might contribute to its use in the treatment of resistant epilepsy.

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“…Three eligible studies, including 1 cross-sectional study, investigated other outcomes. One study assessed potential pharmacokinetic interactions [157], one investigated perception about cannabis use and benefits [158], and the third assessed doses of cannabidiol [116].…”

Section: Epilepsymentioning

confidence: 99%

A Mapping Literature Review of Medical Cannabis Clinical Outcomes and Quality of Evidence in Approved Conditions in the USA from 2016 to 2019

Jugl

Okpeku

Costales

et al. 2021

Med Cannabis Cannabinoids

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In 2017, a National Academies of Sciences, Engineering, and Medicine (NASEM) report comprehensively evaluated the body of evidence regarding cannabis health effects through the year 2016. The objectives of this study are to identify and map the most recently (2016–2019) published literature across approved conditions for medical cannabis and to evaluate the quality of identified recent systematic reviews, published following the NASEM report. Following the literature search from 5 databases and consultation with experts, 11 conditions were identified for evidence compilation and evaluation: amyotrophic lateral sclerosis, autism, cancer, chronic noncancer pain, Crohn’s disease, epilepsy, glaucoma, human immunodeficiency virus/AIDS, multiple sclerosis (MS), Parkinson’s disease, and posttraumatic stress disorder. A total of 198 studies were included after screening for condition-specific relevance and after imposing the following exclusion criteria: preclinical focus, non-English language, abstracts only, editorials/commentary, case studies/series, and non-U.S. study setting. Data extracted from studies included: study design type, outcome definition, intervention definition, sample size, study setting, and reported effect size. Few completed randomized controlled trials (RCTs) were identified. Studies classified as systematic reviews were graded using the Assessing the Methodological Quality of Systematic Reviews-2 tool to evaluate the quality of evidence. Few high-quality systematic reviews were available for most conditions, with the exceptions of MS (9 of 9 graded moderate/high quality; evidence for 2/9 indicating cannabis improved outcomes; evidence for 7/9 indicating cannabis inconclusive), epilepsy (3 of 4 graded moderate/high quality; 3 indicating cannabis improved outcomes; 1 indicating cannabis inconclusive), and chronic noncancer pain (12 of 13 graded moderate/high quality; evidence for 7/13 indicating cannabis improved outcomes; evidence from 6/7 indicating cannabis inconclusive). Among RCTs, we identified few studies of substantial rigor and quality to contribute to the evidence base. However, there are some conditions for which significant evidence suggests that select dosage forms and routes of administration likely have favorable risk-benefit ratios (i.e., epilepsy and chronic noncancer pain). The body of evidence for medical cannabis requires more rigorous evaluation before consideration as a treatment option for many conditions, and evidence necessary to inform policy and treatment guidelines is currently insufficient for many conditions.

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Marijuana use among patients with epilepsy at a tertiary care center

Cited by 19 publications

References 18 publications

Cross-sectional and longitudinal evaluation of cannabidiol (CBD) product use and health among people with epilepsy

Cross-sectional and longitudinal evaluation of cannabidiol (CBD) product use and health among people with epilepsy

Cannabis Influences the Putative Cytokines-Related Pathway of Epilepsy among Egyptian Epileptic Patients

A Mapping Literature Review of Medical Cannabis Clinical Outcomes and Quality of Evidence in Approved Conditions in the USA from 2016 to 2019

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