Gaston Tyler E, Martin Roy C, Szaflarski Jerzy P
Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA; Veteran's Administration Medical Center, Birmingham, AL, USA.
Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Neurology, Division of Neuropsychology, University of Alabama at Birmingham, Birmingham, AL, USA.
Epilepsy Behav. 2021 Sep 23;124:108316. doi: 10.1016/j.yebeh.2021.108316.
Anecdotal reports of the benefits of cannabis and its components in the treatment of epilepsy have been reported for millennia. However, only recently randomized controlled trial data in support of cannabidiol (CBD) became available resulting in its FDA approval for the treatment of seizures and epilepsy. One of the most common and debilitating comorbidities of epilepsy is cognitive impairment. This impairment has a multifactorial etiology including network dysfunction due to seizures, negative cognitive side effects from anti-seizure medications (ASMs), and mood disturbances. Knowing the effects of a particular ASM (either positive or negative) is vital for providers to counsel patients on expected side effects, and may result in choosing a particular regimen over the other if the patient already suffers from significant cognitive deficits. Unlike most other ASMs and other well-studied cannabinoids such as Δ9-tetrahydrocannabinol, CBD has been shown to have additional mechanisms of action (MOA) that result in neuroprotective, anti-inflammatory, anti-oxidant, and neurogenesis effects. These additional MOAs suggest that the use of CBD could lead to other actions including positive effects on cognition that may be independent of seizure control. This targeted review discusses the currently available data on CBD's effects on cognition in epilepsy. First, we review the proposed mechanisms by which CBD could exert effects on cognition. Then, we present the pre-clinical/animal data investigating cognitive effects of CBD in seizure/epilepsy models. Finally, we discuss the available human data, including the studies in people with epilepsy that included cognitive evaluations pre- and on-CBD, and studies investigating if CBD has any effects on brain structure or function in areas pertinent to memory and cognitive functions.
数千年来，一直有关于大麻及其成分在治疗癫痫方面益处的轶事报道。然而，直到最近才有支持大麻二酚（CBD）的随机对照试验数据，这使得其获得了美国食品药品监督管理局（FDA）对癫痫发作和癫痫治疗的批准。癫痫最常见且使人衰弱的合并症之一是认知障碍。这种障碍有多种病因，包括癫痫发作导致的网络功能障碍、抗癫痫药物（ASM）的负面认知副作用以及情绪障碍。了解特定ASM的效果（无论是正面还是负面）对于医疗服务提供者向患者提供有关预期副作用的建议至关重要，如果患者已经存在明显的认知缺陷，这可能会导致选择一种特定的治疗方案而非另一种。与大多数其他ASM以及其他经过充分研究的大麻素（如Δ9 - 四氢大麻酚）不同，CBD已被证明具有额外的作用机制（MOA），可产生神经保护、抗炎、抗氧化和神经发生作用。这些额外的MOA表明，使用CBD可能会带来其他作用，包括对认知的积极影响，而这可能与癫痫控制无关。本专题综述讨论了目前关于CBD对癫痫认知影响的可用数据。首先，我们回顾CBD可能对认知产生影响的潜在机制。然后，我们展示临床前/动物数据，这些数据研究了CBD在癫痫发作/癫痫模型中的认知作用。最后，我们讨论现有的人类数据，包括对癫痫患者在使用CBD前后进行认知评估的研究，以及研究CBD是否对与记忆和认知功能相关区域的脑结构或功能有任何影响的研究。
