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Book an AppointmentEpilepsy is associated with abnormal electrical activity in the brain, which causes convulsions, loss of consciousness, sensory disturbances and, in some cases, sensitivity to lights, patterns and sounds. Medical cannabis extracts, and the phytocannabinoid cannabidiol (CBD), are now available for prescription in the U.S. for managing seizures associated with treatment-resistant epilepsy, particularly Lennox-Gastaut syndrome and Dravet syndrome.
Epilepsy is generally divided into four basic types, depending on the type of seizures the patient is having. These include:
There are also different kinds of seizure. Different types of seizure occur with different types of epilepsy. The types of seizures include:
“Status epilepticus” is the status given to any seizure or series of seizures that lasts a long time, where the person does not regain consciousness. Status epilepticus is a medical emergency and can cause severe brain damage or death.
Approximately 50 million people worldwide have epilepsy, and the Centers for Disease Control estimates about three million adults and 470,000 children in the U.S. with epilepsy.
If you read through all the conditions on this site, you will notice that two things bind almost all of them: stress and the very much related inflammation. Epilepsy is no different, where neuroinflammation leads to a persistent state of neuronal hyperexcitability. As a result, there are lesions found in the nervous system, and there is impaired regulation of the immune system in the injured neuronal tissue.
There are several ways epilepsy is managed. These include:
The idea that marijuana could help reduce the frequency of seizures has been around since the 1970s. Alongside glaucoma, cancer and multiple sclerosis (MS), epilepsy was one of the first conditions where cannabinoid-based treatments were thought to have therapeutic (in this case, antiseizure) effects.
There is now a considerable body of evidence showing that cannabidiol (CBD) can help reduce the frequency of seizures in people suffering from Dravet syndrome or Lennox-Gastaut syndrome, which are particularly severe and treatment-resistant forms of childhood epilepsy. We now have the Schedule V CBD-based Epidiolex available for prescription in the U.S., which has been shown to be effective in reducing seizures in those with Lennox-Gastaut syndrome or Dravet syndrome.
One of the other reasons why CBD may help is because many people with epilepsy find the drugs (benzodiazepines in particular) ineffective and/or find the side effects intolerable. Cytochrome P450 (CYP450), CYP2C9, CYP3A, CYP2C19 and CYP2D6 are all enzymes responsible for the metabolism of many anti-epileptic drugs (AEDs), such as Clobazam. Many of those with epilepsy have mutations in the genes that code for these enzymes, meaning that the anti-epileptic drugs (AEDs) they are being given are not effective and can even be harmful.
Side effects of antiseizure medications include addiction, drowsiness, fatigue, tremors, headache, vomiting, being in a “fog” and death in cases of overdose. CBD could help reduce or replace the need for such drugs, with the added benefit of having far fewer adverse side effects. CBD use could also help reduce needing further, more invasive treatments.
Phytocannabinoids (plant cannabinoids) other than CBD that display anti-seizure properties include:
CBD displays significant antiseizure activity.
THC:CBD:
These terpenes have relaxing and pain-relieving properties that can help provide relief from some of the side-effects of seizures.
Flavonoids have anti-inflammatory properties.
Artisanal CBD products are generally best avoided, as their THC content may induce seizures. Small amounts of THC may be helpful for some for its sedative and analgesic properties, and may also reduce the amount of CBD needed for therapeutic effects such as managing chronic pain and helping overcome addiction to sedatives.
Products rich in CBD with some CBC, CBDV, THCA and CBDA could be most helpful. Some terpenes like beta-caryophyllene, linalool and myrcene have displayed anti-inflammatory and sedative effects that could help manage seizures, but there is little definitive evidence.
Flavonoids like quercetin, kaempferol and catechin may also have neuroprotective and anti-seizure properties that could help manage epilepsy, but there are only studies on rodents so far.
Dosing guidelines for Epidiolex can be found here. To quote:
“EPIDIOLEX is to be administered orally. Seizures may benefit from a dosage increase up to a maximum recommended maintenance dosage of 10 mg/kg twice daily (20 mg/kg/day), in weekly increments of 2.5 mg/kg twice daily (5 mg/kg/day), as tolerated.”
High doses of CBD are needed for its sedative effects. As medical cannabis products contain other cannabinoids as well as CBD, the dosing regiment may differ. However, the guidelines for Epidiolex may still be useful for some patients figuring out their ideal dosage.
Billy Caldwell and the Fight for Medical Cannabis in the UK | The Independent
CBD Oil Hailed A Miracle Drug For Children With Severe Epilepsy
“Evidence concerning the potential anti-seizure efficacy of cannabinoids reached a turning point in the last 12 months, with the completion of three high-quality placebo-controlled adjunctive-therapy trials of a purified CBD product in patients with Dravet and Lennox-Gastaut syndrome. In these studies, CBD was superior to placebo in reducing the frequency of convulsive (tonic-clonic, tonic, clonic, and atonic) seizures in patients with Dravet syndrome and the frequency of drop seizures in patients with Lennox-Gastaut syndrome. For the first time, there is now class 1 evidence that adjunctive use of CBD improves seizure control in patients with specific epilepsy syndromes.” Source: Perucca, Emilio,
J Epilepsy Res. 2017 Dec 31;7(2):61-76. doi: 10.14581/jer.17012. eCollection 2017 Dec.
“Nineteen participants completed the 20-week intervention. Mean dose achieved was 13.3 mg/kg/day of CBD (range 7-16 mg/kg/day) and 0.27 mg/kg/day of THC (range 0.14-0.32 mg/kg/day). Adverse events common during titration included somnolence, anorexia, and diarrhea. Abnormalities of liver transaminases and platelets were observed with concomitant valproic acid therapy. There was a statistically significant improvement in quality of life, reduction in EEG spike activity, and median motor seizure reduction of 70.6%, with 50% responder rate of 63%.”
McCoy B, Wang L, Zak M, Al-Mehmadi S, Kabir N, Alhadid K, McDonald K, Zhang G, Sharma R, Whitney R, Sinopoli K, Snead OC 3rd. ‘A prospective open-label trial of a CBD/THC cannabis oil in dravet syndrome.’ Ann Clin Transl Neurol. 2018 Aug 1;5(9):1077-1088. doi: 10.1002/acn3.621. PMID: 30250864; PMCID: PMC6144444.
“This study indicates that highly purified CBD modulates and potentially normalizes rs-FC in the epileptic brain. This effect may underlie its efficacy. This study provides Class III evidence for CBD’s normalizing effect on rs-FC in TRE.”
Nenert R, Allendorfer JB, Bebin EM, Gaston TE, Grayson LE, Houston JT, Szaflarski JP. ‘Cannabidiol normalizes resting-state functional connectivity in treatment-resistant epilepsy.’ Epilepsy Behav. 2020 Nov;112:107297. doi: 10.1016/j.yebeh.2020.107297. Epub 2020 Jul 31. PMID: 32745959.
There is a large body of evidence showing that several phytocannabinoids found in cannabis have antiseizure properties when carefully dosed. Medical cannabis preparations could be of great use for those with treatment-resistant forms of epilepsy such as Lennox-Gastaut syndrome and Dravet syndrome.
Medical cannabis could also help with other kinds of epilepsy, treatment-resistant or not, as many find the side effects of current AEDs intolerable. CBD represents an excellent, well-tolerated alternative to current prescription medications. However, artisanal, hemp-based CBD products are not necessarily recommended for epilepsy, as they may increase the risk and frequency of seizures. Pharmaceutical-grade CBD and medical cannabis products may be better suited.
More research is also needed on other phytocannabinoids, terpenes and flavonoids for their potential antiseizure effects.
Using Cannabis for a Child with Epilepsy
How CBD Can Help Treat Epilepsy
CBD and the Brain: The Impact of Cannabidiol on Brain Health
Seizures and Seizure Disorders
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