Article written by
Tina MagrabiSenior Content Writer
Content reviewed by
Dr. Lewis JasseyMedical Director - Pediatric Medicine
Table of contents
Epidiolex, a CBD-based medication, has been approved by the FDA for the treatment of two severe forms of epilepsy: Dravet and Lennox-Gastaut Syndrome. CBD’s potential anti-seizure properties have made it an emerging therapeutic treatment for people with epilepsy.
Learn how CBD could work as an effective treatment for epilepsy, along with how to use the cannabinoid to manage and reduce seizures.
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How CBD Works for Epilepsy
There are several science-backed reasons why CBD seems to work for epilepsy:
- High concentrations of CBD stabilizes sodium channels, helping regulate the neurons in the brain.
- CBD seems to work on sodium, potassium and calcium ion channels in particular.
- Regulating sodium and calcium channels reduces the release of excitatory glutamate. This mechanism is important, as even slight irregularities in the actions of calcium and sodium channels can trigger epileptic seizures. Anticonvulsants that act in such a manner could also be used to treat disorders such as bipolar disorder.
- CBD acts as an anti-inflammatory as it suppresses damaging inflammatory responses.
- CBD desensitizes the temperature-regulating receptor, TRPV1 (vanilloid receptor). Those with conditions like neuropathy, rheumatoid arthritis and epilepsy have particularly sensitive TRPV1 receptors. TRPV1 receptors are usually targeted by benzodiazepine-based sedatives, which are addictive and can be a problem of its own. Cannabinoids like CBD are an ideal alternative.
It is interesting to note that THC also displays significant anticonvulsant properties, as do many other cannabinoids, psychoactive or non-psychoactive. Two of particular note are the CBD-related cannabidivarin (CBDV) and the acidic form of THC, tetrahydrocannabinolic acid (THCA).
The purity of the product and the dosage matters, too. Most hemp-derived CBD products available on the legal market may be ineffective, and may even make seizures worse. It is also worth noting that the biphasic effects of THC may give it both anticonvulsant and proconvulsant effects, depending on dosage and the amount of THC and CBD there is in the product. Epidiolex contains a high amount of CBD, with no THC or any other terpenes or flavonoids.
Many products available on the medical marijuana market suitable for epilepsy may contain high CBD:THC ratios of 20:1 and above. Combined low doses of THC and THCA may be beneficial, but too much may be best avoided.
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One clinical study revealed that Epidiolex use resulted in a nearly 44% reduction in seizures, compared with not quite 22% for people taking the placebo. These numbers serve as an example of the potential effectiveness of Epidiolex and other CBD-based treatment options for epilepsy in a small population sample. More research is needed to understand how CBD products work for people with epilepsy across a wider population.
Despite a limited amount of research, epilepsy and seizures more generally is a common qualifying condition for medical marijuana programs throughout the US. This prevalence suggests that there is a general consensus that cannabis is beneficial for people with epilepsy, even if the science has yet to provide conclusive evidence and data.
There are many reasons why CBD and other cannabinoids may help for epilepsy. Most importantly, the cannabinoid tends to be extremely well-tolerated by the body. Many of the anti-epileptic drugs (AEDs) currently prescribed for hard-to-treat types of epilepsy are benzodiazepine-based, and in some circumstances gabapentinoids, opioids and barbiturates are also used.
The side effects of benzodiazepines include addiction, drowsiness, confusion, dizziness, “brain fog” and impaired coordination. Such side effects either do not occur with CBD or are extremely mild in comparison.
What’s worse is that many forms of epilepsy like Dravet Syndrome are actually treatment-resistant, meaning that prescription sedatives may be ineffective for some. This is due to mutations in cytochrome enzymes, which means some people with Dravet may not process sedatives in the same way. Yet, sedatives are sometimes still prescribed, irrespective of an individual patient’s needs.
Risks and Side Effects
Just like any other medicine, CBD may have some side effects. These include:
- Changes in appetite
- Changes in mood
- Dry mouth
- Some people report high doses of CBD causing a “wiry” or “energetic” effect
Extreme side effects from CBD are rarely reported, but seek medical help immediately if you experience any reaction that is more than mild.
Due to how some liver enzymes may process anti-epileptic medications, CBD may negatively interact. If both AEDs and CBD are used at the same time, the AEDs are not metabolized properly and a dangerous amount of benzodiazepines build up in the blood, increasing the chance of overdose.
Many people who decide to use CBD may need to reduce their intake of AEDs. However, CBD does not necessarily replace all AEDs and some may still need to be used, based upon physician’s advice. Remember that we cannot just stop using benzodiazepines “cold turkey,” as doing so can be dangerous.
It is for this reason that, for those who are intending to utilize medical cannabis and CBD for seizures, they do so under the supervision of a doctor and develop a program for tapering sedative use slowly and over time, getting an idea of what the “ideal dosage” of CBD and other cannabinoids is for each individual patient.
Other drug-drug interactions with CBD include:
- Non-steroidal anti-inflammatory drugs (NSAIDs).
- Angiotensin II receptor blockers (ARBs)
- ACE inhibitors
- Beta blockers
- Calcium channel blockers
- HIV antivirals
- Proton-pump inhibitors
The above is not a comprehensive list, and not all drugs under the above classes will necessarily have negative effects when combined with CBD. This is because different drugs are metabolized in different pathways. Different cannabinoids are also likely to have different levels of interaction with other drugs.
How to Use CBD for Epilepsy
Not all types of epilepsy are the same. Moreover, each person has a unique body chemistry, so what may work for one person may not work for another, or one person may require a different dosage to another. Therefore, the following are general guidelines and not to be interpreted as medical advice.
For CBD ingestion methods, tinctures (CBD oil) are most often used, with coconut oil or olive oil being used as the main carrier oil. Epidiolex is a liquid solution that is generally administered orally through a syringe and may be taken with or without food.
Cannabinoids, including CBD, are biphasic. This means that cannabinoids can have different effects at different dosages. Plus, different people can have radically different reactions to the same cannabinoid taken at the same dosage because every body is different.
There are other issues with cannabinoids’ biphasic effects. For some people suffering from different types of epilepsy (i.e., not the severe forms of Lennox-Gastaut or Dravet), CBD in too high a dose may not be effective for some kinds of seizures, or in rare instances possibly even make seizures worse.
Too much THC may increase anxiety in some, and also make seizures feel worse. Another concern is synthetic CBD (and synthetic cannabinoids in general), which can have vastly different pharmacological effects from naturally-derived CBD, and can possibly also increase the likelihood of seizures.
For at least some people suffering from hard-to-treat forms of epilepsy such as Dravet and Lennox-Gastaut syndrome, CBD:THC ratios such as 18:1 and 20:1 work rather well. Small amounts of THC and THCA may also work in combination with CBD to exert anti-seizure effects and could possibly help make CBD work more effectively.
Higher doses of CBD and cannabinoids like cannabinol (CBN) may also have sedative effects, which can be beneficial in those with epilepsy. This is because CBN acts as an ideal replacement for benzodiazepines, where its sedative and anti-inflammatory properties are due to its action on vanilloid receptors. Targeting this receptor with cannabinoids instead may help treat seizures and a wide range of conditions (e.g. rheumatoid arthritis) in a far safer manner.
Epidiolex is usually administered twice daily, but until we have more clinical data, we cannot give precise dosing guidelines for other CBD-based products. However, as some general advice, “slow and low” is a good start. For many types of conditions, two to three doses of CBD-rich, cannabinoid-based tincture per day are used. If using cannabinoid products of any sort, it is important to look at total cannabinoid content and what ratio these are in. Other factors to consider are:
- Amount of other medications being used
To make clear, this does not constitute medical advice, but to serve as an example to illustrate how cannabinoids can be taken. As everyone has a unique endocannabinoid system (ECS), it can take time and effort to determine what the appropriate dosage is for every individual person. A physician can help you determine the right doses of CBD and other cannabinoids to treat epilepsy.
The Bottom Line on CBD and Epilepsy
There is currently one FDA-approved medication to treat epilepsy with CBD: Epidiolex. However, Epidiolex can be costly, and there are many CBD-rich products available on the medical cannabis market. Consult with your doctor before using any other type of CBD treatment to manage the symptoms of epilepsy.
The physicians at Leafwell are here to consult with you about what cannabis can do for epilepsy and many other conditions. Reach out and speak to a physician online today.
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Frequently Asked Questions
What CBD is best for epilepsy?
Epidiolex is a CBD-derived prescription medication that gained FDA approval in 2018. The drug has been shown to be beneficial in reducing seizures in certain individuals with severe forms of epilepsy.
In general, CBD-rich tinctures made from reputable sources are ideal. Hemp-derived CBD may not be useful.
Why does CBD help with seizures?
CBD helps with seizures in some people because it can help regulate neurons in the brain, thus reducing convulsions. The cannabinoid also has anti-inflammatory effects that could help decrease the frequency and severity of seizures.
Can you take CBD with epilepsy?
Your doctor may prescribe Epidiolex if you have a severe form of epilepsy such as Dravet syndrome or Lennox-Gastaut syndrome. Some may seek a medical marijuana certificate or recommendation in order to access other products that may be helpful. Speak with your doctor in further detail if you have epilepsy and would like to use other CBD products.