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Promising Treatment for Traumatic Brain Injury

Traumatic brain injury (TBI) is one of the leading causes of death and disability worldwide in individuals under the age of 45. TBI affects approximately 1.7 million Americans each year with over 5.3 million Americans currently struggling with TBI disabilities. There are multiple causes from car accidents, falls, contact sport, to gunshot and stab wounds. TBI has been identified as the most common cause of epilepsy in adults. The effects can last a few days or the rest of a person’s life. Those effects include impairments related to thinking or memory, movement, sensation, vision and hearing along with emotional functioning (such as personality changes, depression, anxiety, etc.).

In the last several years two people close to me have been affected by traumatic brain injury. I never really thought about TBI until I saw the effects of the injury in two extremely active, successful, outgoing, and fun-loving people. My nephew, David*, was a Minor League Umpire and my close friend of 40 years, Tisa*, a wife, hard-working mother of 5, grandmother, and successful businesswoman.

In David’s case the multiple head injuries he received over a 5-year period caused a dramatic change in personality along with social anxiety and depression. He can no longer hold down a job and his ability to engage in relationships has suffered. The symptoms have become worse over time and traditional medication has not improved his condition.

Tisa walked out of work one evening to the parking lot and stepped on palm tree nuts. She fell to the ground headfirst. She had a small brain bleed which she seemingly recovered from. The effects have been long lasting. My friend who once loved to shop for everyone, have large gatherings with multiple friends and family and was always vibrant and the life of the party was not the same. Now, crowds and too many choices are confusing to her. She can no longer look at a computer screen and can no longer work as her headaches are severe most of the time. She also suffers from anxiety, depression, and insomnia. Again, traditional medication only made her worse.

Two-thirds of TBI patients are put on Anti-anxiety medications. Others are put on Anti-depressants, Anticonvulsants, Muscle relaxants and/or Stimulants. All of those listed come with a hefty side effect profile. Many times, the side effects are worse than the hoped-for cure. An NICHD study investigated the effectiveness of citicoline, a drug meant to help protect neurological functioning. The study found, however, that patients with TBI who took citicoline did not have any greater improvement in function than those who took a placebo.

In 1998, the Proceeding of the National Academy of Sciences published a groundbreaking report on the neuroprotective properties of cannabidiol (CBD) and tetrahydrocannabinol (THC). Co-authored by a team of researchers (AJ Hampson, M. Grimaldi, D Wink and Nobel laureate J. Axelrod) at the National Institutes of Mental Health, this preclinical study on rats would form the foundation and basis of a U.S. government-held patent on “Cannabinoids as antioxidants and neuroprotectants.”

The patent indicates that CBD and THC were found “to have particular application as neuroprotectants…in limiting neurological damage following ischemic insults, such a stroke or trauma.” These Phytocannabinoids were also considered useful for treating other neurodegenerative conditions, “such as Alzheimer’s disease, Parkinson’s disease, and HIV dementia.”

TBI and stroke are both acute and potentially lethal injuries and share many of the same pathological features and aberrant molecular mechanisms involving a primary ischemic insult that interrupts blood flow to the brain followed by a secondary injury cascade. This secondary cascade can last for days, weeks, or months, and can result in more permanent damage to the brain along with motor impairment, poor concentration, general cognitive decline, irritability, and sleep problems.

A 2011 article in the British Journal of Pharmacology, co-authored by Israeli scientist Raphael Mechoulam, describes the ECS (Endocannabinoid System) as “a self-protective mechanism.” In this study on mice it was found that endocannabinoid levels were highly elevated both during and immediately after a TBI, which suggests that the endocannabinoid system plays an important neuroprotective role. These endogenous compounds activate cannabinoid receptors, known as CB1 and CB2, which protect against TBI-induced neurological and motor deficits. Research shows that CBD seems to have a protective effect on brain cells following a traumatic brain injury. Although the mechanism and many aspects of this affect are unclear, studies do show that CBD reduces inflammation and increases blood flow to the brain, which decreases further damage or the secondary cascade effect after injury.

A study published by Trends in Molecular Medicine states, “Mounting in vitro and in vivo data suggests that the endocannabinoids 2-AG, as well as some plant and synthetic cannabinoids, have neuroprotective effect following brain injury. Cannabinoid receptor agonists inhibit glutamatergic synaptic transmission and reduce the production of tumor necrosis factor-a and reactive oxygen intermediates, which are factors in causing neuronal damage. The formation of the endocannabinoids anandamide and 2-AG is strongly enhanced after brain injury, and there is evidence that these compounds reduce the secondary damage incurred. Some plant and synthetic cannabinoids, which do not bind to the cannabinoid receptors, have also been shown to be neuroprotective, possibly through their direct effect on the excitatory glutamate system and/or as antioxidants.”

Although most to date are animal studies, there is a plethora of data that suggests and concludes that cannabinoids are particularly important and an effective alternative when treating mild to moderate TBI. Now that there are fewer legal restrictions on cannabis research more and more human studies are taking place and the results are promising. One of the most important aspects of treating TBI with cannabinoids (Full Spectrum CBD, i.e. the entourage effect) is the lack of side effects. The side effect profile in the traditional medication approach is sometimes far worse than the actual injury profile.

Both David and Tisa are starting a regimen of 25mg of Full Spectrum CBD via oral capsules. They will be titrated up to 50mg if needed. As TBI sufferers they are hopeful to have some relief of their symptoms and a semblance of ‘quality of life’ return. I will report in 30, 60 and 90 days the outcome.

A final word from Dr. Raphael Mechoulam, PhD, the man who in 1992-95 identified and isolated endogenous cannabinoids, anandamide and 2-AG and the concept of the endocannabinoid system.

I have spent most of my life decoding the mysteries to be found within this incredible plant. The collective work on the plant has currently led to identifying a major physiological system, the endocannabinoid system, which appears to be involved in numerous human illnesses. I would like to see my colleagues forge ahead with their investigations, advancing even further the acceptance and integration of cannabinoids, in particular cannabidiol, its derivatives and the specific CB2 agonists, in traditional medicine.

*Names and details included with consent from related parties

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