| خلاصه مقاله | Introduction: Treatment-refractory epilepsy remains an important clinical problem. The brain’s endocannabinoid system which is activated by marijuana or endogenous homologous provides on-demand protection against the convulsive activity. Recently, there is considerable interest by the public and physicians in using medical marijuana or its derivatives to treat seizures. There is clinical evidence of success in diminishing seizure frequencies with cannabis derivatives such as marijuana, however, it remains largely illegal and may induce adverse consequences.
Materials & Methods: This review article is the result of a review of research published in PubMed, Wiley, Science direct, ISI, Scopus, etc. between 2000 and 2021 about using cannabis and marijuana in the treatment of epilepsy, as well as the role of endocannabinoid system in the brain functions.
Results: The CB1 receptors of the endocannabinoid system are expressed predominantly at presynaptic sites in GABAergic neurons. These receptors are present in high densities at neuronal terminals of the basal ganglia, cerebellum, hippocampus, neocortex, hypothalamus, and limbic cortex The agonistic activity of CB1 decreases cAMP by inhibition of adenylyl-cyclase, induces potassium efflux by stimulating A type and G-protein coupled inward rectifying potassium channels; also, it decreases calcium influx by inhibiting voltage-dependent N and P/Q-type calcium channels. This diminishes neuronal hyperexcitability and may attenuate seizure frequency
Conclusion: Seizures affect the endocannabinoid system and the expression of CB1 protein in the animal hippocampus. This increases the expression of CB1 receptors in the CA1 through CA3 regions of the hippocampus and is postulated to be the mechanism of action for epilepsy control. For those whose seizures remain uncontrolled without alternative conventional interventions available, medical marijuana has received anecdotal support, but only on an empirical basis. Any clinical trial is appropriate only in selected refractory cases and only when strictly monitored by a physician. Being illegal in many jurisdictions remains a concern. |