Uso de cannabinoides en el tratamiento de la epilepsia refractaria. Revisión bibliográfica

Abstract

Background: epilepsy is a frequent disease worldwide. In Ecuador, the incidence is 7 - 12 cases per 1000 inhabitants; 43% of them suffer a recurrence, and up to 20% of epilepsy cases develop refractory epilepsy. Therapeutic approach includes multiple therapeutic schemes; cannabinoids (CBD) are one of the emerging options. Objective: to describe the use of cannabinoids in the treatment of patients with refractory epilepsy. Methodology: a bibliographic review on the use of CBD to treat refractory epilepsy was carried out in scientific databases like PubMed, Cochrane Library and SpringerLink. Using keywords and mesh terms (in PubMed), an Excel database was created to remove duplicates and those that were not related to the topic or showed exclusion criteria. Results: 50 articles were used. CBD mechanism of action has its own objectives/targets like cannabinoid receptors; it modulates receptors like 5-HT and also decreases the hepatic metabolism of other antiepileptics by inhibition of cytochrome P450. It is indicated in patients over 1 year of age, in epileptic encephalopathies and another antiepileptic drug. CBD causes side effects (mild/moderate: hyporexia, somnolence, nausea, vomiting, and diarrhea) and some can be attributed to other concomitant antiepileptic drugs. Conclusions: the use of cannabinoids is indicated for the treatment of refractory epilepsy related to epileptic encephalopathy, as an adjuvant in other antiepileptic drugs. CBD has not shown significant benefits in other types of epilepsy. Each case should be analyzed individually to assess therapeutic benefits.