This amazing guest post was written by Dr. Simone Burke, a Naturopathic Doctor. You can check out her website here!
Epilepsy is the fourth most common neurological disorder affecting people of all ages. It is estimated that 65 million people worldwide have epilepsy. In the United States alone, 3.4 million people have epilepsy and 470,000 of those are children (2).
Epilepsy is defined as “a brain disorder associated with an increased susceptibility to seizures”(2).
Epilepsy is most commonly treated with anti-convulsant medication but in the last decade research has exploded in the use of cannabinoids (CBD) found in marijuana for the treatment of epilepsy.
In 1930 Cannabis was made illegal in many countries but now with the latest research some states are changing their regulations and allowing its use specifically for anti-seizure. This has been made possible as in December of 2015 The United States Drug Enforcement (DEA) eased some of the regulatory requirements for research facilities that are conducting FDA approved clinical trial on cannabidiol (CBD). Up to this point, getting statistical data was difficult as the amount of CBD required for trials was often above the amount that was approved under the DEA (4).
There is evidence dating as far back as 2,700 BC, in the time of Chinese Emperor Shen Nung that suggests that Cannabis was used for medicinal properties (11). In 1843 physician W.B. O’Shaughnessy documented the anti-seizure effect in a baby girl who had recurrent seizures so it has been in use throughout the ages. The problem has been a lack of statistical evidence to support this use but recent studies detailing quality, placebo-controlled trials are changing that (11).
There is a misconception that all cannabis gives you a ‘high.’ However, this is not the case. Marijuana contains more than 460 active chemicals and over 60 unique cannabinoids (13). There are 2 major components of interest in cannabis: cannabinoids (CBD) and tetrahydrocannabinol (THC). It is the THC that produces the euphoria or high that has given Cannabis its reputation whereas it is the cannabinoids that have the anti-seizure effect.
The cannabis plant has different properties and levels of different compounds depend on the species of plant, as well as the environment it is grown in – type of soil etc. Cannabis that is used for recreational purposes are high in THC whereas cannabis used for anti-seizure are high in CBD and low in THC. The properties for THC and CBD are different and have different effects on the body.
THC is great for spasms, nausea, pain, tremors, as an anti-inflammatory, and as an appetite while CBD reduces inflammation, protects the nervous system, regulates the immune system, is an anti-oxidant, anti-seizure, and antipsychotic (5).
There are numerous studies coming out on some of the benefits of CBD:
For Pain relief and Inflammation
In 2012 an article published in the Journal of Experimental Medicine found that cannabinoids had a significant effect at suppressing inflammation and reducing chronic pain. The cannabinoids offer a novel approach to pain management as the study noted that the subjects did not develop a tolerance to the it’s pain reducing effects (6).
Another study done in 2007 published in Current Medical Research and Opinion found that cannabinoids (using cannabidiol/THC buccal spray) were effective in treating neuropathic pain in MS (7).
A 2012 study in the British Journal of Pharmacology found that cannabidiol indirectly activated a part of the brain that reduced nausea and vomiting (10).
A study published in 1999 found that CBD reduced anxiety and was beneficial for people with social anxiety disorder. With the results of this study, research is underway to look at its effects for a variety of other anxiety disorders (8).
A study done in 2011 in Neuropsychopharmacology found that cannabidiol had reduced the anxiety effect of public speaking (9).
The 2017 publication in the Journal of Epilepsy Research was significant as it detailed 3 class 1, placebo-controlled studies using purified CBD in addition to anti-epileptic drugs in patients with Dravet syndrome and Lennox-Gastaut syndrome (11).
These studies showed that CBD was superior to placebo in reducing the frequency of seizures in patients with Dravet syndrome and reduced the number of drop seizures in Lennox-Gastaut syndrome.
This now provides class 1 evidence that is needed to support the use of CBD as an anti-seizure adjunctive therapy.
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In May 2017 the first randomized placebo-controlled double-blind trial was done to observe whether CBD had an effect on seizure activity in Dravet Syndrome. These results were published in the New England Journal of Medicine. 23 centres in the USA and Europe participated in the trials.
In total there were 120 patients that had been diagnosed with Dravet syndrome and all patients had at least 4 convulsive seizures within the 4 weeks prior to the trial. The trial lasted 14 weeks. During the first 2 weeks, the dose was titrated up to 20mg/kg/day taken in divided doses, followed by 12 weeks at the full dosage. The patient’s ages ranged from 2.3 to 18.4 years old and the mean age was 9.8 years.
Patients were randomly selected to either receive CBD or placebo which was added on to their existing medication.In most (65%) cases this was clobazam. The results were interesting. They compared the baseline monthly frequency of convulsive seizure which includes tonic-clonic, tonic, clonic and atonic seizures and in the CBD group the number of seizures decreased from 12.4 to 5.9 whereas the placebo group decreased from 14.9 to 14.1.
43% of the patients in the CBD group had a reduction in their seizure activity by 50% or more compared to only 27% in the placebo group. 3% of the patients become completely seizure free in the CBD group compared to none in the placebo group. Treatment with CBD did not significantly affect non-convulsive seizures.
Double-blind trials in Lennox-Gastaut syndrome
There were two well-controlled double-blind trials in patients with Lennox-Gastaut syndrome (11).
The first trial for Lennox-Gastaut syndrome consisted of 171 patients. The patients had a median baseline of 74 monthly seizures were randomly selected to receive oral CBD or placebo over a period of 14 weeks. For the first two weeks the CBD dosage was titrated up to 20mg/kg/day, after which there was a 12 week maintenance dose. The patients treated with CBD had a 44% median percentage reduction in monthly seizures as compared to the placebo group whose reduction rate was 22%.
44% of those patients had a 50% or more reduction in seizures compared to the placebo which was 24%. 14 patients in the CBD group withdrew prematurely as compared to 1 person in the placebo group. There were more adverse effects reported in the group that received CBD (86% in the CBD group as compared to 69% in the placebo). Adverse effects included diarrhea, decreased appetite, vomiting, fever, and sleepiness.
The second Lennox Gastaut trial was larger and groups were randomized to three groups: 2 groups had CBD dosages at 10 mg/kg/day or 20mg/kg/day or were in the placebo group. There were a total of 225 patients whose mean age was 16 years of age and the median number of drop seizures was 85. Patients were receiving a median of 3 concomitant anti-Epileptic Drugs. This trial was done over 14 weeks – the first 2 weeks where the dose was titrated up and the remaining 12 weeks were at the maintenance dose.
The group receiving the dosage of CBD at 20mg/kg/day had the highest reduction in seizure frequency at 42%, then the group taking 10mg/kg/day seizures decreased by 37% and seizures in the placebo group decreased by 17%. Compared with the placebo group, there was a significant decrease in both groups taking CBD compared to placebo.
Adverse effects such as sleepiness and loss of appetite were also significantly higher in the groups taking CBD (94% in the 20mg/kg/day and 84% in the 10mg/kg/day group).
How to Legally Acquire CBD
Marijuana is a Schedule I controlled substance because of the presence of the psychoactive ingredient tetrahydrocannabinol (THC) (4). CBD has less that 1% THC so there are no psychoactive properties to CBD. However, the FDA approves drugs for medical use in the United States, while the DEA regulates the handling of all controlled substances, including those being used by researchers to conduct studies. Medical research is being done and class 1 trials demonstrating statistical evidence are going a long way to support its use.
Each state has different regulations as to what is required to use it legally – such as patient registry requirements. To date, there are 17 states that have approved the use of low THC, high CBD products for medical reasons. Some state specifically for anti-seizure use. The 17 states that allow limited access to marijuana products low in THC and high in CBD include (12):
- North Carolina
- South Carolina
- Idaho (vetoed by governor in 2015)
Make sure that you check your state requirements and follow the regulations outlined. Also, ensure you consult with your MD.
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