Objective:Cannabis is classified as a class B drug in the UK with penalties for possession of up to 5 years in prison, an unlimited fine or both. Nevertheless it is widely available and is the most commonly used drug in the UK with approximately 2.6 million (7.6%) of adults reporting that they sometimes or regularly use it. It is not uncommon for people who present in our epilepsy clinic to report regular use of cannabis; some use it recreationally whilst others report ‘self-medicating’ based on the belief that it has a beneficial impact on their seizures. The aim of this study was to establish the prevalence of cannabis use in people with epilepsy referred for a neuropsychological assessment and to examine the impact of cannabis use on cognitive function in this group.Participants and Methods:All patients who attend for a neuropsychological assessment are routinely asked about illegal drug use in their clinical interview. This information is also captured in the medical and neuropsychiatric assessments they undergo when assessed by the multidisciplinary team. The electronic medical records of 800 consecutive patients who had undergone a neuropsychological assessment between 2019 and 2022 were searched for references to cannabis use. The neuropsychological profiles of patients reporting cannabis use were compared to those seen in the larger series across multiple cognitive domains.Results:Seventy (8.75%) of the patients in the series reported past or present cannabis use. Cannabis users were more likely to be male (p<0.01) and were younger (p<0.01) than those who did not report use. Reading IQ was significantly lower in the cannabis group (p<0.001). Patients who were regularly using cannabis at the time of the neuropsychological assessment did not differ from the rest of the cohort on tests of processing speed, working memory, naming or verbal fluency. There were no differences between the groups in their performance on an embedded measure of performance validity. However the patients who were regularly using cannabis at the time of their neuropsychological assessments scored significantly lower on tests of verbal learning (p<0.05) and reported significantly greater subjective memory problems in everyday life (p=0.02) than the non-cannabis group. The group using cannabis also scored significantly more highly on the depression (p<0.01) and anxiety scales (p=0.02) on the Hospital Anxiety and Depression Scale.Conclusions:The prevalence and patterns of cannabis use in the epilepsy population mirror those seen in the wider population. The impact on regular cannabis use on neuropsychological function appears to be most evident on measures of new learning and subjective measures of memory disturbance. Cannabis use is significantly associated with lower levels of cognitive reserve and elevated levels of anxiety and low mood. Whilst caution must be employed with respect to any direct attribution in these complex clinical presentations, these findings may be helpful in the interpretation of neuropsychological test scores and the planning of interventions, particularly with respect to subjective memory complaints in this group.

中文翻译：

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5 娱乐性大麻使用对癫痫神经心理功能的影响

目的：大麻在英国被列为 B 类毒品，持有大麻可被处以最高 5 年监禁、无上限罚款或两者兼施。尽管如此，它仍然广泛使用，并且是英国最常用的药物，大约有 260 万（7.6%）的成年人报告他们有时或经常使用它。在我们的癫痫诊所就诊的人报告经常使用大麻的情况并不少见；有些人只是为了娱乐而使用它，而另一些人则报告说“自我治疗”，因为他们相信它对他们的癫痫发作有有益的影响。本研究的目的是确定接受神经心理学评估的癫痫患者使用大麻的流行情况，并检查大麻使用对该群体认知功能的影响。 参与者和方法：所有参加神经心理学评估的患者均是在临床访谈中经常询问非法药物使用情况。在多学科团队进行评估时，这些信息也会被记录在他们接受的医学和神经精神评估中。研究人员对 2019 年至 2022 年间连续接受过神经心理学评估的 800 名患者的电子病历进行了搜索，以查找大麻使用的参考资料。将报告使用大麻的患者的神经心理学特征与跨多个认知领域的较大系列中所见的神经心理学特征进行比较。结果：该系列中的 70 名患者 (8.75%) 报告过去或现在使用大麻。与未报告使用大麻的人相比，大麻使用者更有可能是男性（p<0.01）并且更年轻（p<0.01）。大麻组的阅读智商显着较低（p<0.001）。在神经心理学评估时经常使用大麻的患者在处理速度、工作记忆、命名或言语流畅性测试中与其他队列中的患者没有差异。在绩效效度的嵌入测量中，各组之间的绩效没有差异。然而，与非大麻组相比，在神经心理学评估时经常使用大麻的患者在言语学习测试中的得分显着较低（p<0.05），并且日常生活中的主观记忆问题显着更大（p=0.02）。在医院焦虑和抑郁量表中，使用大麻的人群在抑郁量表 (p<0.01) 和焦虑量表 (p=0.02) 上的得分也显着更高。结论：癫痫人群中使用大麻的流行率和模式与更广泛的人口。定期使用大麻对神经心理功能的影响似乎在新学习的测量和记忆障碍的主观测量上最为明显。大麻的使用与认知储备水平较低以及焦虑和情绪低落水平升高显着相关。虽然必须谨慎对待这些复杂临床表现中的任何直接归因，