Epilepsy affects slightly over 1% of the U.S population. That translates to about 3 million adults and 400,000 children. On a global scale, there are about 50 million people who suffer from epilepsy. While some epilepsy patients will have as little as one to two seizures a year, others have to battle with daily seizures.
Some epilepsy patients suffer from treatment-resistant seizures. Such patients are likely to experience daily seizures that do not respond to conventional anti-seizure medications. Other patients are simply not able to put up with the adverse effects of traditional pharmaceutical medications for epilepsy or epilepsy surgery.
Epilepsy is one of the qualifying conditions for medical cannabis treatment in several states that have a legal marijuana program. That means that patients suffering from epilepsy in these states can legally access medical cannabis to control seizures in epilepsy. That is not the only option that epilepsy sufferers have.
In 2018, the Food and Drug Administration (FDA) approved a pharmaceutical drug with synthetic CBD for the treatment of epilepsy in children, after thorough evaluation. Specifically, the drug was FDA approved for the treatment of two types of intractable childhood seizures: Lennox Gastaut syndrome and Dravet syndrome, and tuberous sclerosis complex. This drug was approved for use in children who are at least above the age of one.
Patients suffering from treatment-resistant seizures have played a big role in pushing medical cannabis for epilepsy to the limelight. One notable case is that of Charlotte Figi (now late) whose moving story was published by CNN in 2013. Charlotte, a daughter of Matt and Paige Figi developed a severe form of seizure disorder (Dravet Syndrome, also known as myoclonic epilepsy of infancy or SMEI) when she was barely 3 months old.
By the time Charlotte was 2.5 years old, she was experiencing 300 grand mal seizures each week. After trying different medications with no success, Paige tried a high CBD low THC product from a local dispensary in Denver to treat seizures. The treatment was able to reduce the frequency of her seizures down to about one to two a month. At some point, she moved from status epilepticus to being seizure-free.
This story was highly publicized and caught the attention of large media houses and legislators. Alfie Dingley is another child with a severe form of epileptic seizure disorder whose moving story was published in 2018. According to Alfie’s mother, cannabis saved her son’s life. Such stories and the relentless efforts of marijuana advocates have made it possible for thousands of patients to be able to access medicinal cannabis for epilepsy in 36 states and counting so far.
What is Medical Marijuana?
This refers to the use of the chemical compounds that are found in the cannabis plant (Cannabis Sativa plant) to treat medical conditions. It is also called medical cannabis.
The cannabis plant is made up of different classes of chemical compounds: phytocannabinoids, terpenes, flavonoids, and nutrients.
Phytocannabinoids make up the greater component of medicinal cannabis. So far, about 114 phytocannabinoids have been identified, but just a handful have been studied for their positive effects. Delta-9-tetrahydrocannabinol (THC), and Cannabidiol (CBD) have been of greatest interest to medical researchers. Other phytocannabinoids that have made waves for their therapeutic potential in the recent past include cannabinol (CBN), cannabichromene (CBC), cannabidiolic acid (CBDA), and cannabigerol (CBG).
Researchers have also looked at specific terpenes for their therapeutic potential. For example, linalool has shown anticonvulsant properties. Cannabis is able to offer the benefits of whole plant medicine when different bioactive molecules work in synergy. For example, combining CBD with THC and other cannabinoids and terpenes as the active ingredients may offer stronger healing effects as compared to consuming CBD on its own. This is referred to as the entourage effect.
How Does Medical Marijuana Reduce Epileptic Seizures?
Epileptic seizures are usually a result of uncontrolled electrical misfiring of neurons in the brain. This produces involuntary jerks, convulsions, and sometimes even unconsciousness.
Medical cannabis is made up of hundreds of bioactive compounds known as phytocannabinoids and terpenes. These compounds are responsible for the therapeutic effects of cannabis.
Tetrahydrocannabinol (THC) and cannabidiol (CBD) are the most prominent cannabinoids in cannabis. They also happen to be the most studied, especially in neuropsychiatric disorders. Other cannabinoids include THCA, CBDA, CBG, CBN, and CBC. A major difference between the two phytocannabinoids is that while THC is psychoactive and will cause euphoria, CBD is not.
How do Phytocannabinoids Heal?
The human body is made up of several vital systems, one of them is the endocannabinoid system (ECS). Not much was known about the ECS until the 1980s. It is no surprise that medical textbooks do not mention the ECS and consequently, most doctors will graduate from medical school without knowing a thing about the ECS or how medical cannabis works.
The ECS is responsible for maintaining homeostasis, or a state of physiological balance in the body. While disease offsets this balance, the ECS works to restore the balance through endocannabinoids and endocannabinoid receptors which make up the ECS. Some of the vital functions that are regulated by the ECS include the following:
- Hormonal function
- Nervous function
- Appetite and metabolism
- Poor quality sleep or sleep disorder
Phytocannabinoids mimic the action of the body’s endogenous cannabinoids. Consequently, phytocannabinoids are able to cause healing by influencing certain body systems that are modulated by the ECS.
Is There Evidence Backing Cannabis for Epilepsy?
There are several cases that provide anecdotal evidence for the use of marijuana to control seizures in epilepsy, such as the case of Charlotte Figi and Alfie Dangley. Apart from that, several studies have demonstrated the safety and efficacy of using marijuana to treat seizures.
A research that was conducted in 1981 reviewed clinical trials involving the use of medical cannabis to treat epilepsy for a decade. The results not only revealed efficacy but improved sleep outcomes, compared to placebo. More recently (2017), a Chinese researcher by the name of Chung Mo Koo published a scientific report with the title “Could Cannabidiol be a Treatment Option for Intractable Childhood and Adolescent Epilepsy?”
Koo observed from one of the trials that patients receiving 50 mg/ kg of cannabinoids experienced a 50% reduction in the frequency of their seizures. Another double-blind placebo-controlled trial showed a similar pattern: after six months of treatment cannabis patients were experiencing half the number of drop seizures they were experiencing before marijuana treatment.
CBD has shown the greatest potential in the management of uncontrolled seizures. Some research has shown that CBD exerts this effect by suppressing GPR55 and TRPV1 receptors and thereby reducing the excitability of neurons. CBD also offers neuroprotective benefits and hence shields brain cells from easy damage.
A 2019 careful review analyzed existing literature and studies on the use of CBD for epilepsy treatment. As was expected, the relative safety and efficacy of CBD were again established. The researchers however recommended further research in larger randomized trials.
FDA Approves Epidiolex
In 2018, the food and drug administration approved a CBD-based drug for the treatment of severe forms of drug-resistant epilepsy, specifically Dravet syndrome and Lennox Gastaut syndrome. Several clinical trials had been conducted to prove the safety and efficacy of CBD before Epidiolex was approved.
CBD for Lennox-Gastaut syndrome
Lennox-Gastaut syndrome is a severe form of drug-resistant epilepsy that affects many children in the U.S. It makes up about 2.5% of all epilepsy cases. A recent clinical trial showed the effectiveness of CBD in reducing seizures in this type of epilepsy. The frequency of drop seizures experienced by the study participants dropped by 48%-71% while the total number of seizures by 48% – 68% after they received CBD.
CBD for Dravet syndrome
Dravets syndrome is a very rare type of childhood epilepsy that has been linked to a genetic mutation (SCN1A mutation). A 2017 study concluded that cannabidiol can be used to reduce seizure frequency in Dravet’s syndrome. This was a double-blind placebo-controlled clinical trial with a CBD group and a control group.
Does THC Help with Epilepsy?
THC, the psychoactive component in cannabis may help with epilepsy, even though much of the spotlight has been focused on CBD. A recent report published by Stanford scientists showed that an equivalent of THC can cause a significant reduction in seizure-like activity in the brain. However, it also triggered post-seizure oxygen deprivation. The open-label clinical trials investigating the potential of marijuana in treating Dravet’s syndrome combined 2 mg/mL THC with 100 mg/mL CBD. This trial was aimed at establishing the dosing and tolerability of medical cannabis for seizure treatment. All 20 children with Dravet that were in the trial on this drug for 20 weeks reported significant improvements in quality of life while their seizures decreased in severity significantly. While CBD oil appears to possess stronger potency in reducing seizure frequency, combining both cannabinoids provides entourage benefits and is therefore useful. But be aware that THC will trigger psychoactive effects, it is advisable to give it in low amounts.
How To Use Marijuana For Epilepsy
Medical cannabis comes in a variety of formulations. When choosing the best way to consume medical cannabis, you will need to consider the medicinal cannabis laws in your state of residence. Some states place restrictions on the cannabis products that can be used by patients who qualify for this kind of treatment.
For example, if you live in Utah, you will be able to legally access the following cannabis products from a dispensary:
- Tablets and capsules
- Transdermal patches
- Gelatinous cubes
The following cannabis products are prohibited in Utah:
- Smokable forms
- Edibles such as cookies, brownies, and candies
You can choose a consumption method that suits your unique needs and preferences.
How To Dose Medical Marijuana
Dosing marijuana is an intricate act. You have to put in the hard work to discover the dose that is able to get your seizures under control. Your medical provider should be able to work with you through this journey. And as usual, it always helps to start with a low dose and adjust upwards until you find what works best for you.
When combining THC with CBD, studies have shown that you can start with an estimate of 2 to 16 mg/kg/day of CBD and 0.04 to 0.32 mg/kg/day of THC. This was used in open-label clinical trials for children with Dravet’s syndrome. The researchers found that this dose was both effective and well-tolerated.
For CBD, you can start with a dose of 5-6 mg/kg/day or 2.5mg/kg twice daily. A 2019 study found this dose to be both effective and safe in managing seizures. This is the same dose that is used for Epidiolex.
Can Medical Marijuana Cure Epilepsy?
While cannabis may not be a cure for epilepsy, it may significantly reduce epileptic seizures and improve the quality of life of the patients. Clinical trials and other studies have shown that medical cannabis treatment is both safe and effective in managing drug-resistant seizures. Cannabis is especially useful in treating intractable childhood seizures such as Dravet’s syndrome and Lennox Gastaut syndrome.
Is Medical Marijuana Legal?
Marijuana has so far been legalized in 36 states in the US for medicinal use. Other states are having positive deliberations about legalizing cannabis for medical use and we expect to see this figure going up in the coming years. However, marijuana still remains illegal under federal law.
The drug enforcement administration (DEA) classifies marijuana under schedule 1 of the controlled substances act. This class includes drugs that have no known medical value and at the same time have a high potential for abuse (same classification Heroin, LSD, MDNA). While medical cannabis is legal in the 36 states that have legalized it, it remains illegal under federal law.
The Agricultural Act (aka The Farm Bill) of 2018 legalized hemp at the federal level. This means that hemp-derived CBD (containing less than 0.3% THC) is legal under federal law. Hemp-derived CBD products are therefore legal across most states in the U.S.
Epidiolex, a pharmaceutical form of cannabis, has FDA approval for the treatment of Dravet syndrome and Lennox- Gastaut epilepsy syndromes. This makes it legal at the federal level as well.
Does Marijuana Interact With Other Anti Seizure Medications?
CBD interacts with several other medications including some anti-seizure medications such as sodium valproate. CBD may either amplify or reduce the effects of these drugs. Therefore it is important to consult with your pharmacist or medical professional before you begin treatment with cannabis, especially if you are taking other medications.
Does Cannabis Have Side Effects?
Yes, cannabis has some side effects. This will vary depending on what it contains, CBD or THC. These side effects are likely to be experienced when you take too much of the medication. Therefore, it is important to consume an amount that your body can tolerate, especially when you are starting out.
CBD may cause the following adverse effects:
- Decreased appetite
- Low blood pressure
- GI disturbance
- Increased liver enzymes
THC may cause the following adverse effects?
- Dry eyes and mouth
- Increased anxiety
- Increased or decreased appetite
- Increased heart rate
- Slower reaction time
- Short term memory loss
- Elevated liver enzymes
Because of these side effects, it is important to consult a healthcare expert about the use of cannabis for managing epileptic seizures. For additional information, you can use these resources: