CBD for Arteriovenous Malformation - September 2020

What is Arteriovenous Malformation? 

Arteriovenous malformation (AVM) is characterized by the unusual entanglement of blood vessels in the body. When AVM happens, these blood vessels bypass the normal tissues and divert the blood from the arteries directly to the veins ⁽¹⁾.

Doctors only discover AVM in most people when these patients are undergoing treatment for an unrelated health concern. Some are only diagnosed with AVM after death ⁽²⁾.

A 69-year-old man who had gastrointestinal bleeding was diagnosed with AVM in the small intestine. The doctors only discovered AVM when they performed small bowel endoscopy on the patient ⁽³⁾. 

AVMs can form anywhere in the body. It could also happen in the stomach and affect its other areas, such as the duodenum. 

AVM occurs before birth or shortly after. Its causes are unknown.  

According to the American Stroke Association ⁽⁴⁾, AVMs can also occur in the brain. It happens in less than 1% of the general population, mainly afflicting the cerebral vessels of males. 

Symptoms of AVM

The symptoms of AVM vary and depend on where they are located. The most common physical symptoms include ⁽⁵⁾:

• Buzzing or rushing sound in the ears
• Headache 
• Backache
• Seizures
• Loss of sensation in the affected part of the body
• Muscle weakness
• Changes in vision
• Facial paralysis
• Drooping eyelids
• Difficulty speaking
• Changes in the sense of smell
• Problems with motion
• Dizziness
• Loss of consciousness
• Bleeding
• Pain
• Cold or blue fingers or toes

People who have AVMs should be concerned about hemorrhage (uncontrolled bleeding). Less than 4% of AVMs hemorrhage, but excessive bleeding can be severe and even fatal ⁽⁶⁾. 

Other complications that could arise from AVM occurrence include:

• Stroke
• Numbness in the affected body part
• Speech or movement problems
• Developmental delays (children)
• Hydrocephalus (water buildup in the brain)
• Lower quality of life

Treatment of AVM

Medications to treat AVM have yet to be discovered; its symptoms can only be managed.

The most common ways to manage AVM is through embolization and sclerotherapy ⁽⁷⁾.

 Embolization involves putting materials like medical glue, metal coils, and plugs into the center of the AVM. These block the AVM and prevent blood from flowing into it, thereby helping in shrinking the AVM.

Sclerotherapy meanwhile happens when a sclerosant (liquid medicine) is injected into the AVM to destroy the vessels and cause less blood flow to the AVM or none at all. 

Researchers from the University of Edinburgh ⁽⁸⁾, however, caution against treating AVMs in the brain. Medical Research Council Senior Clinical Fellow Professor Rustam Al-Shahi Salman says, “We have found that, for most people whose AVM has not caused a bleed, the risks of treatment exceed the risks of leaving it alone over 12 years.”

The study found that patients who did not undergo treatment for AVM were less likely to have a stroke and to suffer a sustained disability, unlike those who opted for surgery. The researchers recommend that doctors treat the symptoms only and not the AVM itself ⁽⁹⁾. 

CBD for Managing AVM Symptoms

Some of the AVM symptoms include headaches, backaches, and pain. A study in 2006 ⁽¹⁰⁾ reveals that cannabidiol (CBD), the non-psychoactive component of cannabis plants, helps alleviate pain. These conditions include neuropathic, inflammatory, and oncologic pain. 

CBD also helps in treating seizures, another symptom of AVM. The only CBD product that has been approved by the U.S. Food and Drug Administration (FDA) is Epidiolex, a CBD prescription drug that is used in treating two rare and severe forms of epilepsy ⁽¹¹⁾. 

Even if the FDA does not approve CBD, it does not mean that it is unsafe. A study in 2018 ⁽¹²⁾ found that CBD is well-tolerated in humans. It is not addictive, and it has an excellent safety profile. 

The study also discussed the therapeutic benefits of CBD on various medical conditions like seizure disorders, psychotic symptoms, anxiety, depression, inflammation, cancer, cardiovascular diseases, neurodegeneration, symptoms of multiple sclerosis, and chronic pain ⁽¹³⁾. 

Another study conducted in 2012 ⁽¹⁴⁾ outlines CBD’s potential role in treatments involving the heart and the peripheral and cerebral vasculature. CBD has anti-inflammatory and antioxidant properties that have positive effects on the body.

CBD can help protect the body against vascular damage, inflammation, and even type-2 diabetes. In the study, CBD also increased blood flow in animal models of stroke. ⁽¹⁵⁾ 

Though some studies were done on animals, it does not mean that CBD’s effectiveness does not apply to humans. A study ⁽¹⁶⁾ states that humans and all animals except for insects have an endocannabinoid system (ECS) that works the same way, regardless of species. 

The ECS is the system that regulates cannabinoid function.

CBD has no standard dosage. It is recommended to begin with small doses, and if there are no adverse effects, patients can gradually increase their intake.

Patients are encouraged to inform their doctors before taking CBD.

Conclusion

AVM is a condition that is usually benign but can lead to various complications that could be life-threatening. It has no treatment yet, so experts can only manage its symptoms.

CBD has many therapeutic benefits that can help alleviate the symptoms of AVM.

Patients who have AVM should consult with their doctor first before taking CBD.

1. “Arteriovenous Malformations.” Arteriovenous Malformations | Johns Hopkins Medicine, www.hopkinsmedicine.org/health/conditions-and-diseases/arteriovenous-malformations.
2. Ibid.
3. Fujii, Takaaki, et al. “Arteriovenous Malformation Detected by Small Bowel Endoscopy.” Case Reports in Gastroenterology, S. Karger AG, 17 Oct. 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC4241646/.
4. “What Is an Arteriovenous Malformation?” Www.stroke.org, www.stroke.org/en/about-stroke/types-of-stroke/hemorrhagic-strokes-bleeds/what-is-an-arteriovenous-malformation.
5. John Hopkins Medicine. op. cit. 
6. Ibid. 
7. Ibid.
8. “Brain Blood Vessel Disorder Best Left Alone.” The University of Edinburgh, 24 June 2015, www.ed.ac.uk/medicine-vet-medicine/news-events/news-archive/news-2014/avm-290414.
9. Ibid. 
10. Manzanares, J, et al. “Role of the Cannabinoid System in Pain Control and Therapeutic Implications for the Management of Acute and Chronic Pain Episodes.” Current Neuropharmacology, Bentham Science Publishers Ltd., 4 July 2006, www.ncbi.nlm.nih.gov/pmc/articles/PMC2430692/.
11. Commissioner, Office of the. “What to Know About Products Containing Cannabis and CBD.” U.S. Food and Drug Administration, FDA, www.fda.gov/consumers/consumer-updates/what-you-need-know-and-what-were-working-find-out-about-products-containing-cannabis-or-cannabis.
12. Corroon, Jamie, and Joy A Phillips. “A Cross-Sectional Study of Cannabidiol Users.” Cannabis and cannabinoid research vol. 3,1 152-161. 1 Jul. 2018, doi:10.1089/can.2018.0006
13. Ibid. 
14. Stanley, Christopher P et al. “Is the cardiovascular system a therapeutic target for cannabidiol?.” British journal of clinical pharmacology vol. 75,2 (2013): 313-22. doi:10.1111/j.1365-2125.2012.04351.x
15. Ibid.
16. Silver, Robert J. “The Endocannabinoid System of Animals.” Animals : an open access journal from MDPI vol. 9,9 686. 16 Sep. 2019, doi:10.3390/ani9090686