Wednesday, April 25, 2018

Post Concussion Syndrome, Traumatic Brain Injury and Medical Cannabis



Currently, there is no effective drug for the treatment of traumatic brain injury and concussions. In the U.S., there are nearly 52,000 deaths and roughly 80,000 cases of severe disability related to traumatic brain injury every year. There are more than 5.3 million people in the U.S. living with disabilities related to traumatic brain injury — numbers far greater than those for multiple sclerosis, Parkinson's disease and Alzheimer's disease.

What is the most common sport causing head injury?
Football accounted for 47,000 of those head injuries, and baseball played a role in 38,394. Cycling was also the leading cause of sports-related head injuries in children under 14, causing 40,272 injuries, roughly double the number related to football (21,878).

At the November 2017 medical cannabis Advisory Board Hearing, Doctors recommended to add Post-Concussion Syndrome & TBI into the New Mexico Medical Cannabis Program with 5-0 Vote. The final decision rest with Secretary Lynn Gallagher at the Department of Health and is expected at the next hearing on May 11th 2018. View the Petition Here: http://lecuanmmcpmcabpetitions.blogspot.com/2017/09/petition-post-concussion-syndrome.html



Overview of Post-Concussion Syndrome and TBI
Post-concussion syndrome (PCS) is a variety of symptoms, including headaches and dizziness, that continue for weeks and sometimes months following a concussion. A concussion is a mild traumatic brain injury that typically occurs after a direct blow to the head. Not all concussions lead to post-concussion syndrome, which doesn’t seem to be correlated to the severity of the initial blow. What causes post-concussion symptoms to develop following certain concussions is yet to be identified. According to Mayo Clinic, some experts believe the symptoms come from structural damage to the brain or the disruption of neurotransmitter systems. Others believe that psychological factors may contribute. In addition to headaches and dizziness, post-concussion syndrome commonly causes fatigue, irritability, anxiety, insomnia, loss of concentration and memory, and noise and light sensitivity. Typically, symptoms associated with PCS develop within the first seven to 10 days after a concussion and eventually alleviate within a three-month period. In some cases, however, the symptoms can persist for a year or longer. Treatment for post-concussion syndrome depends on individual symptoms. Headaches are commonly treated with medications. Time, however, is often the best therapy for treating memory and thinking problems.

A traumatic brain injury (TBI) is a disruption of the normal function of the brain caused by a bump or blow to the head. A mild brain injury, or concussion, can cause temporary brain cell dysfunction, while a more serious injury can cause the brain tissue to bruise, tear or bleed and result in long-term complications or death.

In a TBI, the blow to the head causes damage to the brain cells. The damage can be isolated to the point of impact or can be more widespread if the impact causes the brain to moves back and forth within the skull. In addition, bleeding in the brain, or swelling, can cause greater damage to brain cells.

According to Mayo Clinic, additional complications can arise from TBI’s, including altered consciousness (coma, vegetative state, locked-in syndrome, brain death, etc…), seizures, fluid buildup, blood vessel damage, nerve damage, and intellectual, communication, sensory and behavioral problems.

The physical and psychological symptoms of a TBI can vary significantly and can arise immediately after the traumatic blow or even weeks later. Physical symptoms include a loss of consciousness or being dazed, headache, nausea or vomiting, fatigue, sleeping difficulties, sleeping more than usual and dizziness. It’s not uncommon for sensory problems, like blurred vision or ear ringing to occur. Also, memory and concentration problems, mood changes and a feeling of depression are cognitive symptoms of a TBI.

For mild brain injuries, rest and over-the-counter pain relievers for headaches are often adequate for recovery. More severe brain injuries require emergency care procedures to ensure oxygen, blood levels and blood pressure remain at adequate levels. Medications may be used to help limit secondary damage caused by fluid buildup. In some cases, surgery is required to repair skull fractures or to relief pressure by draining fluid.



Findings: Effects 
of Medical Cannabis on Post-Concussion Syndrome and TBI 
Preclinical findings have shown that cannabis offers therapeutic benefits following brain injuries. Studies have shown that the cannabinoids found in cannabis, most specifically cannabidiol (CBD), activate the body’s cannabinoid receptors (CB1 and CB2), though evidence also suggests that the neuroprotective effects from CBD come from the cannabinoid’s activation of the 5-hydroxytriptamine1A (5-HT1A) receptor (Mishima, et al., 2005). When these receptors are activated, they provide protection against neural damage following acute and chronic brain damage (Lopez-Rodriguez, et al., 2013). For example, in one study, the administration of cannabinoids following a traumatic brain injury decreased brain swelling and inflammation and was shown to improve recovery (Shohami, et al., 2011). Another showed that CBD alone provided neuroprotection and limited brain cell death in newborn mice following a hypoxic-ischemic event (Castillo, et al., 2010). Others have showed that cannabinoids, through the activation of the endocannabinoid system, prevent glutamate excitotoxicity, intracellular calcium accumulation, activation of cell death pathways, microglia activation, neurovascular reactivity and circulating leukocytes following a brain injury. Researchers concluded that modulating the endocannabinoid system is an effective way to provide neuroprotection and prevent and reduce brain injury (Fernandez-Lopez, Lizasoain, Moro & Orgado, 2013). Addition research has shown that cannabis’ cannabinoids provide brain and neuroprotection caused by disorders. One found that CBD reduces the oxidative stress and Alzheimer’s hallmark protein (β-amyloid), thus limiting nerve damage caused by the disorder and improving cell viability (Harvey, et al., 2012). An animal study showed that CBD and tetrahydrocannabinol (THC) treatments were effective at delaying and limiting neural damage caused by Huntington’s disease (Sagredo, et al., 2011). Another found that CBD, in addition to providing neuroprotective effects and reducing long-term brain injury, also helped restore neurobehavioral function following a hypoxia-ischemia event (Pazos, et al., 2012). Studies have also shown that cannabis can help post-concussion syndrome patients manage the symptoms associated with the disorder. CBD can lower stress, help combat depression, improve sleep and reduce pain (Abush & Akirav, 2013) (Campos, et al., 2012) (Chagas, et al., 2013) (Russo, Guy & Robson, 2007) (Baron, 2015).

Following the blow that leads to TBI’s, the body releases harmful mediators that lead to excitotoxicity, oxidative stress and inflammation and causes secondary, delayed neuronal death (Biegon, 2004). Cannabis, however, has been shown to offer protection to the neural system, thus reducing the amount of brain damage (Mechoulam, Spatz & Shohami, 2002) (Mechoulam & Shohami, 2007) (Mechoulam, Panikashvili & Shohami, 2002) (Biegon, 2004).

It’s cannabis’ two major cannabinoids, tetrahydrocannabinol (THC) and cannabidiol (CBD) that are responsible for these beneficial effects following TBI’s. Cannabinoids have been shown to act on the CB1 and CB2 receptors of the endocannabinoid system, which in turn prevents the release of proinflammatory cytokines that are released after brain drama and cause damage (Panikashvili, et al., 2006). Activating of the CB1 and CB2 receptors also has been shown to stimulate the release of minocycline, which reduces brain swelling and neurological impairment, and diffuses further injuries to the brain’s axons (Lopez-Rodriguez, et al., 2015) (Biegon, 2004).

In one study, cannabinoid administered to mice with brain injuries caused a significant reduction of brain swelling, as well as better clinical recovery, reduced infarct volume, and reduced brain cell death compared to the control group (Panikashvili, et al., 2001). In another, CBD was found to reduce acute and apoptotic brain damage (Castillo, et al., 2010). Piglets with brain injuries given CBD experienced less excitotoxicity, oxidative stress and inflammation (Pazos, et al., 2013). Mice that had suffered an impact brain injury showed marked recovery in object recognition and in performing a specific task after CB1 receptors were activated (Arain, Khan, Craig & Nakanishi, 2015). Cannabinoids have even shown to be effective at offering neuroprotection in newborn babies that have experienced a brain injury (Fernandez-Lopez, Lizasoain, Moro & Martinez-Orgado, 2013).

One study found that patients that had detectable levels of THC in their bodies were less likely to die as a result of a traumatic brain injury than those who didn’t (Nguyen, et al., 2014). Just recently, researchers from the University of Arizona found that trauma patients who tested positive for cannabis upon hospital admission were less likely to die during hospitalization (Singer, et al., 2017).


States that have Approved Medical Cannabis for Post-Concussion Syndrome
 And TBI
 
Currently, the state of Illinois has approved medical cannabis for the treatment of post-concussion syndrome. Currently, Illinois, New Hampshire, Washington have approved medical cannabis specifically for the treatment of traumatic brain injuries.



Recent Studies on Medical Cannabis' Effect on Post-Concussion Syndrome And Traumatic Brain Injury



Beneficial Cannabinoids and Terpenes Useful for Treating Post Concussion Syndrome And TBI

The cannabis plant offers a plethora of therapeutic benefits and contains cannabinoids and terpenoid compounds that are useful for managing symptoms with Post Concussion Syndrome And TBI. Although much of the scientific research surrounding cannabis has been focused on both Tetrahydrocannabinol (THC) and Cannabidiol (CBD) for their ability to be potent Analgesics and Anti-Nausea (Anti-Emetic) medicines, the following list denotes which cannabinoids and terpenoids also work synergistically with each other for possible therapeutic benefit:


References
Understanding medical cannabis.Elemental Wellness Center, 2014 Jul.


New Mexico’s medical cannabis history started in 1978. After public hearings the legislature enacted H.B. 329, the nation’s first law recognizing the medical value of cannabis...the first law.


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