The U.S. FDA approved the use of Epidiolex – a plant derived formulation of CBD as an oral solution for treating seizures associated with two syndromes of epilepsy- Lennox-Gastaut syndrome and Dravet syndrome. This is the first ever FDA approved plant-based drug to treat seizures in Dravet syndrome. Cannabidiol has been found to significantly reduce seizures in patients suffering from severe forms of epilepsy.
A study based on the effects of adjunct treatment with pharmaceutical grade cannabidiol (CBD) oral solution Epidiolex, on attention control processes linked with stimulus conflict resolution in patients with Treatment-Resistant Epilepsy (TRE) revealed that :

  • CBD enhanced seizure control and mood and slows response time in TRE
  • CBD reduced attention-related frontal activity and connectivity in TRE
  • CBD impacts brain activation and patterns of connectivity in TRE
  • Right insula/MFG activity and connectivity reductions improve flanker task accuracy.

This study reveals the way CBD impacts the neural substrates working in attention processing and how alteration of the activity and functional connectivity associated with attentional control processes in the right insula/MFG might be functioning to improve cognitive performance in treatment-resistant epilepsy. The results also hinted that CBD alters attention control processing in patients with treatment-resistant epilepsy by decreasing right superior frontal gyrus (SFG) and right insula/MFG activation associated with stimulus conflict resolution and by cushioning differences in condition-based function connectivity of the right SFG.
Cannabidiol can also bring improvements in seizure frequency and efficacy for patients with treatment-resistant epilepsy. Further, Open label CBD research by Dr. Devinsky has shown favorable results for treatment-resistant epilepsies. Orrin Devinsky, MD, Director of NYU Langone  Comprehensive Epilepsy Center is the primary investigator of the CBD for drug-resistant seizures in Dravet Syndrome trial. After many years of anecdotal assertions about the benefits of cannabidiol, it was found that CBD reduced the frequency of seizures by 39% for patients of Dravet syndrome which is a rare, severe type of epilepsy, in the initial large-scale randomized clinical trial for the compound. The findings were published online in the New England Journal of Medicine.
Investigations based on study at the University of Alabama at Birmingham on cannabidiol showed their published evidence of marked improvements in seizure frequency. The results presented in the journal Epilepsy and Behaviour, hinted that administration of CBD oil decreased adverse events and severity of seizures, in addition to a decrease in overall seizure frequency.
Extensive evidence has been collected that supports the role of endocannabinoids in synaptic transmission and the moderation of the rate of neuronal firing. The role of endocannabinoid signaling pathways in the pathophysiology of epilepsy and the likelihood of aiming at these pathways for purposes of therapy is indicated by various experimental and clinical findings. Experimentally, various studies reviewed have displayed that there is an alteration of endogenous cannabinoids system in various models of seizures and epilepsy. On the other hand, external modulations of the endogenous cannabinoid system can stop or alter seizure activity. Clinical findings indicating a role of the endocannabinoid system in epilepsy reveals a reduced anandamide concentration within the cerebrospinal fluid of persons with new-onset temporal lobe epilepsy, indication of downregulation of CB1 receptors and associated molecular components in glutamatergic neurons which produce glutamate that is one among the general excitatory neurotransmitters in the CNS taken from surgical samples of epileptic human hippocampus.
Cannabinoids possess multiple and complex pharmacological attributes. CBD is devoid of any psychoactive effects and contain anticonvulsant, anti-anxiety, immune-regulating, analgesic, antiemetic, anti-inflammatory, neuroprotectant and anti-tumorigenic characteristics. In particular, antagonism of G protein-coupled receptor 55 (GPR55) and impact on adenosine reuptake have been indicated to influence the anti-seizure action of CBD.

Conclusion

CBD has been found in various experimental findings to improve attention processing and functional connectivity associated with the attentional control processes in the right insula/middle frontal gyrus which can help in enhancing cognitive performance in treatment resistant epilepsy. This can go a long in modulating seizure control and the best part is that CBD is not linked with the development of tolerance after continuous administration in different seizure models nor are there any evidence of a withdrawal symptom after its discontinuation.

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