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Houston JT, Nenert R, Allendorfer JB, et al. White matter integrity after cannabidiol administration for treatment resistant epilepsy. Epilepsy Res. 2021;172:106603doi: 10.1016/j.eplepsyres.2021.106603.
Houston, J. T., Nenert, R., Allendorfer, J. B., Bebin, E. M., Gaston, T. E., Goodman, A. M., & Szaflarski, J. P. (2021). White matter integrity after cannabidiol administration for treatment resistant epilepsy. Epilepsy research, 172106603. https://doi.org/10.1016/j.eplepsyres.2021.106603
Houston, J T, et al. "White matter integrity after cannabidiol administration for treatment resistant epilepsy." Epilepsy research vol. 172 (2021): 106603. doi: https://doi.org/10.1016/j.eplepsyres.2021.106603
Houston JT, Nenert R, Allendorfer JB, Bebin EM, Gaston TE, Goodman AM, Szaflarski JP. White matter integrity after cannabidiol administration for treatment resistant epilepsy. Epilepsy Res. 2021 May;172:106603. doi: 10.1016/j.eplepsyres.2021.106603. Epub 2021 Mar 08. PMID: 33725662.
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Epilepsy Res. 2021 May;172:106603. doi: 10.1016/j.eplepsyres.2021.106603. Epub 2021 Mar 08.

White matter integrity after cannabidiol administration for treatment resistant epilepsy.

Epilepsy research

J T Houston, R Nenert, J B Allendorfer, E M Bebin, T E Gaston, A M Goodman, J P Szaflarski

Affiliations

  1. Department of Neurology and UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: [email protected].
  2. Department of Neurology and UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA.
  3. Department of Neurology and UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA; Departments of Neurosurgery and Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA.

PMID: 33725662 DOI: 10.1016/j.eplepsyres.2021.106603

Abstract

OBJECTIVE: The effects of individual cannabinoids on white matter integrity are unclear. Human studies have shown white matter maturation alterations in regular recreational cannabis users with the magnitude of these effects dependent on the age of exposure. However, studies have yet to determine which phytocannabinoids are most responsible for these changes. In the current study, we analyzed the effects of pharmaceutical grade cannabidiol oral solution (CBD; Epidiolex® in the U.S.; Epidyolex® in the EU; 100 mg/mL oral solution) on white matter integrity using diffusion MRI in patients with treatment resistant epilepsy (TRE).

METHODS: 15 patients with TRE underwent 3 T diffusion MRI prior to receiving CBD and then again approximately 12 weeks later while on a stable dose of CBD for at least two weeks. DTI analyzes were conducted using DSI Studio and tract-based spatial statistics (TBSS).

RESULTS: DTI analysis using DSI Studio showed significant increases in fractional anisotropy (FA) in the right medial lemniscus (p = 0.03), right superior cerebellar peduncle (p = 0.03) and the pontine crossing tract (p = 0.04); decreased mean diffusivity (MD) in the left uncinate fasciculus (p = 0.02) and the middle cerebellar peduncle (p = 0.04); decreased axial diffusivity (AD) in the left superior cerebellar peduncle (p = 0.05), right anterior limb of the internal capsule (p = 0.03), and right posterior limb of the internal capsule (p = 0.02); and decreased radial diffusivity (RD) in the middle cerebellar peduncle (p = 0.03) and left uncinate fasiculus (p = 0.01). The follow-up ANCOVA also yielded significant results when controlling for covariates of CBD dosage, age, sex, change in seizure frequency, and scanner type: FA increased in the pontine crossing tract (p = 0.03); RD decreased in the middle cerebellar peduncle (p = 0.04) and left uncinate fasciculus (p = 0.04). Subsequent TBSS analysis controlling for the same variables yielded no significant white matter differences between groups.

CONCLUSION: These findings indicate relatively minor short-term effects of highly-purified plant-derived CBD on white matter structural integrity in patients with TRE.

Copyright © 2021 Elsevier B.V. All rights reserved.

Keywords: Cannabidiol; Diffusion MRI; Tract based spatial statistics; Treatment resistant epilepsy; White matter pathways

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