Challenges and advances in the use of cannabidiol in the treatment of patients with refractory epilepsy: An integrative review
DOI:
https://doi.org/10.33448/rsd-v12i9.43209Keywords:
Refractory epilepsy; CBD; Cannabidiol.Abstract
Introduction: Epilepsy is a neurological syndrome characterized by two or more spontaneous epileptic seizures, caused by excessive neuronal discharges due to different etiologies. Currently, there are numerous drugs available to control it. However, a portion of the population is drug resistant, that is, seizures occur even with appropriate use of antiepileptic drugs. Clinical trials since 1980 have demonstrated the anticonvulsant and neuroprotective properties of cannabidiol - the non-psychoactive component of Cannabis Sativa -. However, there is not a satisfactory amount of research that reliably establishes the adverse effects of CBD. Objectives: To add knowledge, through analysis of studies regarding the therapeutic management of cannabidiol in refractory epilepsy. Methodology: This is an integrative literature review. The research was carried out in July 2023, based on the PICO strategy. Using the descriptors “cannabidiol and refractory epilepsy”, “challenges of cannabidiol refractory epilepsy”, “cannabidiol and epilepsy”. As inclusion criteria, there are articles from the last ten years in any language. Results: 1,293 results were found in the PubMed, Virtual Health Library and Google Scholar databases. After the analysis and exclusion stages, 12 studies met the full text evaluation and eligibility criteria. Conclusion: Given these results, there is a need for studies that corroborate the efficacy and safety of cannabidiol in refractory epilepsy, in order to eliminate the limitations of the treatment and resolve the challenges in relation to its approval and use.
References
Anvisa. (2018). Registrado primeiro medicamento à base de Cannabis sativa, 2018. https://www.gov.br/anvisa/pt-br/assuntos/noticias-anvisa/2018/registrado-primeiro-medicamento-a-base-de-cannabis-sativa.
Arzimanoglou, A., Brandl, U., Cross, J. H., Gil-Nagel, A., Lagae, L., Landmark, C. J., Specchio, N., Nabbout, R., Thiele, E. A. & Gubbay, O. (2020). The Cannabinoids International Experts Panel; Collaborators. Epilepsy and cannabidiol: a guide to treatment. Epileptic Disord. 22(1): 1-14. 10.1684/epd.2020.1141.
Barroso, V. V., Júnior, C. J. Z. & Neto, P. C. M. (2023). Cannabis medicinal: guia de prescrição. Ed. Manole.
Bolsoni, L. M., Crippa, J. A. S., Hallak, J. E. C., Guimarães, F. S., & Zuardi, A. W. (2022). O efeito ansiolítico do canabidiol depende da natureza do trauma quando os pacientes com transtorno de estresse pós-traumático recordam o evento desencadeador. Revista brasileira de psiquiatria (São Paulo, Brasil: 1999) 44 (3), 298–307. https://doi.org/10.1590/1516-4446-2021-2317
Crippa, J. A. S. et al. (2023). Canabidiol na medicina: da pesquisa à prática clínica. Manole.
Davis, B. H., Beasley, T. M., Amaral, M., Szaflarski, J. P., Gaston, T., Perry Grayson, L., Standaert, D. G., Bebin, E. M., Limdi, N. A., & UAB CBD Study Group (inclui todos os investigadores envolvido no programa UAB EAP CBD) (2021). Preditores farmacogenéticos de resposta e tolerabilidade do canabidiol na epilepsia resistente ao tratamento. Farmacologia clínica e terapêutica, 110 (5), 1368–1380. https://doi.org/10.1002/cpt.2408
Devinsky, O., Cross, J. H., Laux, L., Marsh, E., Miller, I., Nabbout, R., Scheffer, IE, Thiele, EA, Wright, S., & Canabidiol no Grupo de Estudo da Síndrome de Dravet (2017). Ensaio de canabidiol para convulsões resistentes a medicamentos na síndrome de Dravet. The New England Journal of Medicine, 376 (21), 2011–2020. https://doi.org/10.1056/NEJMoa1611618
Devinsky, O., Marsh, E., Friedman, D., Thiele, E., Laux, L., Sullivan, J., Miller, I., Flamini, R., Wilfong, A., Filloux, F., Wong, M., Tilton, N., Bruno, P., Bluvstein, J., Hedlund, J., Kamens, R., Maclean, J., Nangia, S., Singhal, N. S., Wilson, C. A., Cilio, M. R. (2016). Cannabidiol in patients with treatment-resistant epilepsy: an open-label interventional trial. The Lancet. Neurology, 15(3), 270–278. https://doi.org/10.1016/S1474-4422(15)00379-8
Devinsky, O., Patel, A. D., Cross, J. H., Villanueva, V., Wirrell, EC, Privitera, M., Greenwood, SM, Roberts, C., Checketts, D., Vanlandingham, K. E., Zuberi, SM, & Grupo de Estudos GWPCARE3 (2018). Efeito do canabidiol nas convulsões por quedas na síndrome de Lennox-Gastaut. O jornal de medicina da Nova Inglaterra, 378 (20), 1888–1897. https://doi.org/10.1056/NEJMoa1714631
Devinsky, O., Patel, A. D., Thiele, E. A., Wong, M. H., Appleton, R., Harden, C. L., Greenwood, S., Morrison, G., Sommerville, K., & GWPCARE1 Parte A Grupo de Estudo (2018). Ensaio de segurança randomizado e com variação de dose de canabidiol na síndrome de Dravet. Neurologia, 90 (14), e1204–e1211. https://doi.org/10.1212/WNL.0000000000005254
Fisher, R. S., Cross, J. H., French, J. A., Higurashi, N., Hirsch, E., Jansen, F. E., ... & Zuberi, S. M. (2017). Operational classification of seizure types by the International League Against Epilepsy: Position Paper of the ILAE Commission for Classification and Terminology. Epilepsia, 58(4), 522-530.
Garzon, E. (2002). Epilepsia Refratária: Conceito e Contribuição das Novas Drogas Antiepilépticas e de outras Modalidades Terapêuticas. Revista Neurociências, 10(2), 66–82. https://doi.org/10.34024/rnc.2002.v10.8897
Gunning, B., Mazurkiewicz-Bełdzińska, M., Chin, R. F. M., Bhathal, H., Nortvedt, C., Dunayevich, E., & Checketts, D. (2021). Cannabidiol in conjunction with clobazam: analysis of four randomized controlled trials. Acta neurologica Scandinavica, 143(2), 154–163. https://doi.org/10.1111/ane.13351
Mendes. K. D. S. Silveira, R. C. de C. P. & Galvão. C. M. (2008). Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto & Contexto - Enfermagem. /7(4), 758 764. https://doi.org/10.1590/S0104-07072008000400018
Mendes, K. D. S., Silveira, R. C. D. C. P., & Galvão, C. M. (2019). Uso de gerenciador de referências bibliográficas na seleção dos estudos primários em revisão integrativa. Texto & Contexto-Enfermagem, 28, e20170204.
Patel, S., Grinspoon, R., Fleming, B., Skirvin, L. A., Wade, C., Wolper, E., Bruno, P. L., & Thiele, E. A. (2021). The long-term efficacy of cannabidiol in the treatment of refractory epilepsy. Epilepsia, 62(7), 1594–1603. https://doi.org/10.1111/epi.16936
Privitera, M., Bhathal, H., Wong, M., Cross, J. H., Wirrell, E., Marsh, E. D., Mazurkiewicz-Beldzinska, M., Villanueva, V., Checketts, D., Knappertz, V., & Vanlandingham, K. (2021). Tempo para início do efeito do tratamento com canabidiol (CBD) na síndrome de Lennox-Gastaut: análise de dois ensaios clínicos randomizados. Epilepsia, 62 (5), 1130–1140. https://doi.org/10.1111/epi.16878
Reithmeier, D., Tang-Wai, R., Seifert, B., Lyon, AW, Alcorn, J., Acton, B., Corley, S., Prosser-Loose, E., Mousseau, D. D., Lim, H. J., Tellez-Zenteno, J., Huh, L., Leung, E., Carmant, L., & Huntsman, R.J. (2018). O protocolo para o estudo Canabidiol em crianças com encefalopatia epiléptica refratária (CARE-E): um estudo de fase 1 de escalonamento de dosagem. Pediatria BMC, 18 (1), 221. https://doi.org/10.1186/s12887-018-1191-y
Roever, L., Resende, E. S., Gomes-Neto, M., Durães, A. R., Reis, P. E. O., Pollo-Flores, P., & Silva, R. M. L. da. (2021). Compreendendo o GRADE: PICO e qualidade dos estudos. Revista Da Sociedade Brasileira de Clínica Médica, 19(1), 54–61. http://www.sbcm.org.br/ojs3/index.php/rsbcm/article/view/795/453
Schoedel, K. A., Szeto, I., Setnik, B., Sellers, E. M., Levy-Cooperman, N., Mills, C., Etges, T., & Sommerville, K. (2018). Abuse potential assessment of cannabidiol (CBD) in recreational polydrug users: A randomized, double-blind, controlled trial. Epilepsy & behavior: E&B, 88, 162–171. https://doi.org/10.1016/j.yebeh.2018.07.027
Szaflarski, J. P., Devinsky, O., Lopez, M., Park, Y. D., Zentil, P. P., Patel, A. D., Thiele, E. A., Wechsler, R. T., Checketts, D., & Sahebkar, F. (2023). Long-term efficacy and safety of cannabidiol in patients with treatment-resistant epilepsies: Four-year results from the expanded access program. Epilepsia, 64(3), 619–629. https://doi.org/10.1111/epi.17496
Thiele, EA, Bebin, E. M., Filloux, F., Kwan, P., Loftus, R., Sahebkar, F., Sparagana, S., & Wheless, J. (2022). Tratamento de longo prazo com canabidiol para convulsões em pacientes com complexo de esclerose tuberosa: um ensaio de extensão aberto. Epilepsia, 63 (2), 426–439. https://doi.org/10.1111/epi.17150
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Flávia Daniele de Oliveira Ervilha; Halley Ferraro Oliveira
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
