Sports Injuries and Medicine Reillo MR & Levin I Sports Injr Med 03: JSIMD-158. Review Article DOI: 10.29011/2576-9596.100058 Cannabidiol (CBD) in the Management of Sports-Related Traumatic Brain Injury: Research and Efficacy Michele R Reillo*, Ian Levin University, Cannabis Academy, Ontario, Canada *Corresponding author: Michele R Reillo, University, Cannabis Academy, Ontario, Canada. Email: [email protected] Citation: Reillo MR, Levin I (2019) Cannabidiol (CBD) in the Management of Sports-Related Traumatic Brain Injury: Research and Efficacy. Sports Injr Med 03: 158. DOI: 10.29011/2576-9596.100058 Received Date: 15 October 2019; Accepted Date: 25 October 2019; Published Date: 30 October 2019 Introduction receptors in the brain, regulates the vast array of physiological processes essential for human life [1,2]. The pandemic of sports-related traumatic brain injury and the associated development of chronic traumatic encephalopathy The Human Endocannabinoid System has prompted an interest within the medical community in the role The human endocannabinoid system is responsible for of the endocannabinoid system and the use of Cannabidiol (CBD) memory networks in the brain, both excitatory and inhibitory, to reduce acute and chronic cerebral inflammation among athletes. including the neurogenesis of hippocampal granule cells, which The purpose of this medical research review is to examine sports- regulate the timing of the endocannabinoids in accordance with related traumatic brain injury and the preventative and therapeutic the brain’s needs, pain perception, mood, synaptic plasticity, motor use of cannabidiol among athletes. Given the high morbidity and learning, appetite and taste regulation, and metabolic function, which mortality rate associated with post- concussion syndrome and regulates the storage of energy and transport of cellular nutrition. chronic traumatic encephalopathy, and the critical role of the Cannabinoid receptor binding sites are located in the forebrain areas endocannabinoid system in health maintenance and cerebral injury associated with higher cognitive function, forebrain, midbrain, and recovery, examination of the administration of Cannabidiol (CBD) hindbrain areas associated with movement control, and hindbrain is warranted. areas associated with motor and sensory functions attributed to the The Human Brain autonomic nervous system. The endocannabinoid system affects the lipocytes and fat cells, collectively known as adipocytes, The brain is the core governing structure of the human body. At a hepatocytes, in the gastrointestinal tract, musculoskeletal system, weight of over three pounds, the human brain, comprised of eighty- and endocrine system. The endogenous arachidonate-based lipids, six billion neurons and associated glial cells and blood vessels, is anandamide and 2-arachidonoylglycerol (2-AG) are physiological the largest and most complex of all mammalian brains. The human ligands for the cannabinoid receptors. cerebral cortex, a thick layer of neural tissue, is divided into four Cannabinoid receptors CB1 and CB2, two G-protein- lobes of the forebrain; the frontal, parietal, temporal, and occipital coupled receptors, facilitate the responses of the endocannabinoid lobes. Each lobe is comprised of cortical areas associated with system in the body, which are critical to maintaining homeostasis. particular executive functions, including self control, planning, CB1 receptors are located in the central and peripheral nervous reasoning, abstract thought, motor control, language, and vision. systems as well as the lungs, kidneys, and liver. CB2 receptors are The two hemispheres of the brain are defined by lateralization predominantly expressed in the immune system and hematopoietic processes, such as language, which is associated with left-sided cells. hemispheric dominance, and spatiotemporal reasoning, which is associated with right-sided dominance. The cerebellum, or The direct effect of Endocannabinoid Deficiency (CECD) hindbrain, located at the base of the brain above the brainstem, correlates with multisystem clinical outcomes in such conditions coordinates voluntary movements such as posture, balance, as hyperinsulinemia, diabetes, dementia, cardiovascular disease, coordination, speech, and learned motor behaviors. Further, the multiple sclerosis, and obesity. Three primary categories are herein brainstem, which includes the medulla oblongata, pons, and the defined to discuss Endocannabinoid Deficiency (CECD): genetic, midbrain, regulates motor and sensory aspects of the central nervous acquired, and idiopathic autoimmune. Genetic Endocannabinoid system, as well as cardiac and respiratory functions. Finally, the Deficiency (CECD) relates to hereditary acquisition of a disorder; endocannabinoid system, comprised of neuromodulator lipids and acquired refers to an external impetus or one of traumatic 1 Volume 03; Issue 02 Sports Injr Med, an open access journal ISSN: 2576-9596 Citation: Reillo MR, Levin I (2019) Cannabidiol (CBD) in the Management of Sports-Related Traumatic Brain Injury: Research and Efficacy. Sports Injr Med 03: 158. DOI: 10.29011/2576-9596.100058 origination, and idiopathic autoimmune refers to etiologies for Types of Traumatic Brain Injuries Endocannabinoid Deficiencies (CECD) which do not have direct associations. Diseases and disorders are assigned to one or more Diffuse Axonal Injury (DAI) of these categories because often secondary disorders arise with Diffuse Axonal Injury (DAI) is a traumatic brain injury physiological changes associated with the primary diagnosis. For which causes the formation of extensive lesions in white matter example, deficiency in human cannabinoids which contribute tracts occurs over a widespread area. Diffuse Axonal Injury to ataxia arising from traumatic brain injury is categorized as (DAI) varies in degree from mild to severe, and is one of the most acquired, originating from an external source. The presentation common and devastating types of traumatic brain injury, associated of ataxia related to CECD in multiple sclerosis, for example, with the primary damage occurring in concussive injury. Severe is categorized as idiopathic autoimmune, and ataxia related DAI is associated with coma and a 90% mortality rate. Indeed, to CECD in Huntington’s Chorea is categorized as hereditary. those patients who regain consciousness remain significantly Because the endocannabinoid system facilitates communication impaired and require lifetime care. Concussion is a milder type and coordination between various cell types, deficiencies directly of diffuse axonal injury. DAI differs from traumatic brain injury affect physiological homeostasis with similar manifestations but secondary to a direct impact to the head which is associated with unique originations. cerebral deformation. Instead, DAI is associated with repetitive, Cannabidiol (CBD), a non-psychotropic cannabinoid accelerated and decelerated shear forces and rotational forces naturally occurring in human and animal species, occurs as a which thrust the brain against the skull, similar to shaken baby phytocannabinoid, CBD oil, which is derived from the industrial syndrome. In athletics, examples of forces associated with DAI hemp plant. The restorative effects of Cannabidiol (CBD oil), include repetitive injury to the occipital region of the skull from which increases anandamide and other lipid neurotransmitters, rebounding in basketball, indirect force to the neck and torso, thereby restoring the endocannabinoid system, is of interest in which causes the head to rotate and move forward and laterally, the medical management of traumatic brain injury in athletes. associated with football and rugby, and head passing associated Cannabidiol (CBD), derived from the hemp plant, demonstrates with soccer, which causes frontal and occipital damage as the brain anti-inflammatory and immune-modulating properties. Cannabidiol forcefully impacts with the skull. (CBD) has a low affinity for CB1 and CB2 receptors in the human The major cause of damage in DAI is the disruption of axons, body, but acts as an indirect antagonist of their agonists. (Antagonists the neural processes that allow one neuron to communicate with are defined as substances that stop or inhibit the effects of another another. White matter is comprised of mylineated tracts of axons. substance on the cellular surface, producing the same effect as a Forces which result in acceleration cause shearing injuries and substance which would normally bind to the receptor. Agonists are cellular damage as tissue slides over other tissue. When the brain chemicals that bind to receptors and illicit a biological response.) is accelerated, parts of differing densities and distances from the Therefore, cannabidiol (CBD) may enhance the therapeutic effects axis of rotation slide over each other, stretching axons that traverse of other cannabinoids, possibly by increasing the density of the junctions between areas of different density. Junctions where white CB1 receptors. Cannabidiol (CBD) has been demonstrated to cross and grey matter connect are especially susceptible to the formation the blood-brain barrier and exert antioxidant, antimicrobial, and of lesions associated with DAI. neuroprotective properties, rendering it valuable in the prevention and treatment of oxidative stress associated with neurological and In the white matter, lesions associated with DAI range in traumatic cerebral disorders. diameter from one to fifteen millimeters and are characteristically