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The Role of Medical Cannabis in Managing Epilepsy and Seizure

Epilepsy is a chronic neurological disorder marked by recurrent, unprovoked seizures. Seizures, which are essentially sudden surges of electrical activity in the brain, can vary from a momentary disruption of the senses to short periods of unconsciousness or staring spells to severe and prolonged convulsions.

The disorder can be caused by various factors, including genetic predisposition, brain injuries, tumors, infections, and even certain developmental disorders.

The impacts of epilepsy on affected individuals go beyond the physical manifestations of a seizure. People with epilepsy often face psychological challenges, including anxiety, depression, and cognitive difficulties.

Socially, the unpredictability of seizures can lead to stigma, discrimination in workplaces, limitations on driving, and other daily life restrictions.

Are you or a loved one struggling with epilepsy? Have traditional treatments left you searching for more effective solutions? It’s time to explore a path that countless individuals have ventured down, finding solace and improved health through cannabis-based therapies.

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Getting approved for your medical marijuana card has never been easier. But more importantly, our compassionate doctors will help you find relief, improve your health, and elevate the quality of your life.

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Traditional Treatments for Epilepsy

Traditional treatments for epilepsy have primarily revolved around antiepileptic drugs (AEDs). These medications aim to reduce the number of seizures, and for some people, they can eliminate seizures altogether.

Examples of commonly prescribed AEDs include valproic acid, carbamazepine, lamotrigine, and levetiracetam.

Apart from medications, certain surgical procedures like resective surgery (removal of the part of the brain where seizures originate) or the implantation of a vagus nerve stimulator (a device that sends electric impulses to the brain) can be explored for those who don’t respond to medications.

Additionally, dietary therapies, such as the ketogenic diet, have shown promise in managing epilepsy, especially in children.

Cannabis: Emerging as a Potential Treatment Option

In recent years, there’s been growing interest in the therapeutic potential of cannabis for a range of medical conditions, including epilepsy.

Cannabis, often referred to as marijuana, is a plant that has been used both recreationally and medicinally for centuries. Its potential in epilepsy management stems from its compounds, known as cannabinoids.

Of the many cannabinoids found in the cannabis plant, cannabidiol (CBD) has received the most attention for its antiepileptic properties.

Several anecdotal reports and a few clinical trials suggest that CBD, either on its own or in combination with other medications, can reduce the frequency and severity of seizures, especially in forms of epilepsy that are resistant to traditional treatments.

In fact, due to the mounting evidence, the U.S. Food and Drug Administration (FDA) approved Epidiolex, a CBD-based drug, for the treatment of two severe forms of epilepsy in 2018. This marked a significant step forward, recognizing the potential therapeutic benefits of cannabis-derived compounds.

While cannabis and its derivatives show promise, it’s essential to approach this potential treatment option with caution. Thorough research and understanding are necessary to determine the most beneficial and safest ways to incorporate cannabis into epilepsy management.

Whole Plant for Epilepsy

Whole plant medicine means using the entire cannabis plant with all its natural compounds instead of just taking parts like CBD or THC alone. This approach is thought to make the plant’s helpful components work better together, leading many people to support this more natural use of cannabis.

Recent studies suggest that using the whole cannabis plant might work better than just using parts of it in things like vapes, edibles, or oils. Why? Because the cannabis plant has lots of different helpful parts that can work better together. When you use the whole plant, you don’t miss out on any benefits.

Products like vapes or oils often use just one part of the cannabis plant. For example, they might use CBD, a substance found in cannabis that can help with health problems. But the cannabis plant has much more to offer. When used entirely, the plant’s different parts support each other, making the treatment more effective, especially for serious health issues like epilepsy.

Whole plant medicine’s advantages come from what’s known as the “entourage effect.” This idea, brought to light by experts like Dr. Raphael Mechoulam and Dr. Ethan Russo, means that the full range of natural substances in cannabis can work better together in our bodies.

The whole plant has a bigger effect than just the individual parts.

While many people favor using the whole cannabis plant for this reason, others find that specific extracts or concentrates also meet their needs.

So, for epilepsy treatment, the whole cannabis plant could be a real game-changer. It uses every part of the plant, making sure nothing helpful is left out. While vapes, oils, and edibles are convenient, they might not provide the full range of benefits.

Turning to the whole plant means you’re getting all the good stuff it has to offer, which can be better for managing epilepsy.

Interaction with the Human Endocannabinoid System

The effects of cannabinoids can be attributed to their interaction with the human endocannabinoid system (ECS). The ECS is a complex cell signaling system that plays a pivotal role in regulating a range of functions and processes in the body, including:

  •  Appetite
  •  Mood
  •  Sleep
  •  Memory
  •  Reproduction and fertility

The ECS comprises three primary components:

1. Endocannabinoids: These are naturally occurring cannabinoids within the body, similar to those found in the cannabis plant. The two main endocannabinoids are anandamide (AEA) and 2arachidonoylglyerol (2AG).

2. Receptors: Endocannabinoids bind to these receptors to signal the ECS to take action. The two main types of receptors are:

  • CB1 Receptors: Primarily found in the central nervous system.
  • CB2 Receptors: More commonly found in the peripheral nervous system, especially immune cells.

3. Enzymes: These break down endocannabinoids once they’ve carried out their function.

When you consume cannabis or any cannabinoid-infused product, the introduced cannabinoids interact with this system:

THC primarily binds to CB1 receptors, which are found in the brain. This binding results in psychoactive effects or the feeling of being “high.”

CBD doesn’t bind directly to CB1 or CB2 receptors in the way that THC does. Instead, it works by inhibiting the enzymes that break down the body’s own endocannabinoids, leading to an increase in their levels.

The diverse effects of different cannabinoids, their concentrations, and their interactions lead to a wide array of potential therapeutic benefits and experiences with the cannabis plant.

As research continues, our understanding of these interactions and their implications will only deepen, paving the way for more targeted and effective therapeutic applications.

Clinical Evidence and Studies on Cannabis and Epilepsy

Epilepsy affects millions worldwide, and while traditional treatments are effective for many, a significant portion of patients remain resistant to conventional therapies. This has led to a surge in research exploring alternative treatments, including cannabis.

Here’s an overview of the clinical evidence and findings on cannabis for epilepsy management:

Major Studies on Cannabis and Epilepsy

Epidiolex Trials

Arguably the most pivotal trials in this realm are those that tested the efficacy of Epidiolex, a purified CBD formulation. In three randomized, double-blind, placebo-controlled trials, Epidiolex significantly reduced the monthly frequency of seizures in patients with Lennox-Gastaut syndrome and Dravet syndrome.

Based on these results, the FDA approved Epidiolex in 2018 for the treatment of these two severe forms of epilepsy.

The University of Alabama at Birmingham Studies

This study assessed the safety and efficacy of CBD oil in children and adults with treatment-resistant epilepsies. The findings showed that CBD oil, given in addition to routine epilepsy medications, reduced the frequency of seizures significantly.

Survey-Based Studies

While not as rigorous as controlled trials, several survey-based studies, like those from Stanford University and the Epilepsy Therapy Project, indicated that a substantial percentage of patients (especially children with severe forms of epilepsy) reported a decrease in seizure frequency after using CBD-enriched cannabis preparations.

Patient Testimonials and Success Stories

While scientific studies provide the bedrock for medical advancements, patient stories often bring to light the human side of these findings:

Charlotte Figi

Perhaps the most well-known case is that of Charlotte Figi, a girl with Dravet syndrome. After starting a CBD-rich extract, her seizures drastically decreased from about 300 a week to just a couple per month.

Her story garnered significant media attention and greatly influenced public perceptions about the medicinal value of cannabis.

Other Stories

Many patients and caregivers have come forward over the years to share their experiences. Stories abound of children and adults experiencing fewer seizures, increased alertness, a better mood, and improved sleep after starting cannabis or CBD treatments.

Statistical Data on Cannabis Efficacy in Epilepsy Management

Epidiolex Trials Data

In clinical trials, patients treated with Epidiolex experienced a 42% to 44% median reduction in drop seizures (common in Lennox-Gastaut syndrome) compared to a 17% reduction with placebo.

In Dravet syndrome, there was a 39% reduction in seizure frequency with Epidiolex, compared to a 13% decrease in the placebo group. Another study shows that cannabis users reported a 58% reduction in anxiety and stress.

Both scientific studies and patient testimonials underline the potential of cannabis as an adjunctive treatment for epilepsy. However, it’s essential to approach treatment with guidance from medical professionals and remain informed about the latest research and recommendations.

Forms, Dosages, and the Role of CBD in Epilepsy Treatment

The therapeutic potential of cannabis in epilepsy management has spurred innovations in its delivery and formulation. Understanding the various forms and their appropriate dosages is crucial for effective and safe treatment.

Various Forms of Medical Cannabis for Epilepsy Treatment

Oils

Cannabis, or CBD oil, is one of the most common forms used for epilepsy treatment. These oils can be taken sublingually (under the tongue) for faster absorption or can be ingested directly. They are particularly favored by children or those who may have difficulty with other forms.

Tinctures

Similar to oils, tinctures are liquid extracts of the cannabis plant but are often more diluted. They can be administered sublingually using a dropper.

Capsules and Edibles

These are ingestible forms where precise dosages can be administered. They may take longer to produce effects compared to sublingual methods due to the digestive process but they offer a more controlled and discrete method of consumption.

Vaporized or Inhaled

While less common for epilepsy treatment, some patients might use vaporizers to inhale cannabis. This method allows for rapid absorption into the bloodstream via the lungs.

Topicals

While not typically used for epilepsy, topical cannabis formulations like creams or balms are available for other conditions and are applied directly to the skin.

Recommended Dosages and Patient-specific Treatment Plans

The optimal dosage of cannabis for epilepsy varies widely based on several factors, including the specific cannabinoid being used (e.g., CBD vs. THC), the form of administration, the patient’s body weight, metabolism, and the specific type of epilepsy being treated.

  1. Starting Low: A general approach often recommended is “start low and go slow.” This means beginning with a small dosage and gradually increasing until the desired effects are achieved or until side effects become problematic.
  2. Patient Monitoring: Regular monitoring by a healthcare professional is essential. This allows for adjustments in dosage based on seizure control and potential side effects.
  3. Consistency: Once an effective dosage is determined, maintaining consistent levels in the body is crucial for continued seizure control.
  4. Individualized Plans: Given the variability in response and the different types of epileptic syndromes, treatment plans should be highly individualized. What works for one patient might not work for another, underscoring the importance of personalized medicine in this realm.

The Role of CBD-dominant Strains in Seizure Management

CBD-dominant strains of cannabis have taken center stage in epilepsy management, particularly for treatment-resistant forms of the disease.

  1. Minimized Psychoactive Effects: CBD-dominant strains provide therapeutic benefits without the psychoactive effects commonly associated with THC. This makes them particularly appealing to children or those who want to avoid the “high.”
  2. Clinical Efficacy: As mentioned earlier, rigorous clinical trials with Epidiolex (a purified CBD product) have demonstrated significant reductions in seizure frequencies in specific epileptic conditions.
  3. Broader Spectrum of Cannabinoids: While CBD plays a central role, other cannabinoids and terpenes present in CBD-dominant strains might contribute to their therapeutic effects through the “entourage effect,” where these compounds work synergistically.

While the use of cannabis and its derivatives holds significant promise for epilepsy management, the approach should be systematic, guided by medical professionals, and tailored to individual patient needs.

As research continues and our understanding deepens, we can expect more refined recommendations and treatment protocols in the future.

Legal and Ethical Considerations in Cannabis Use for Epilepsy

The evolving landscape of medical cannabis presents several legal and ethical challenges, particularly for vulnerable populations such as children with epilepsy.

As the medical community, legislators, and the public navigate through these challenges, several key aspects come to the forefront.

Legal Status of Medical Cannabis

The legal status of medical cannabis varies significantly around the world, influencing patient access, research opportunities, and clinical application.

As of April 24, 2023, medical cannabis products have been legalized in 38 states, three territories, and the District of Columbia.

Guidelines for Practitioners Recommending Cannabis

For healthcare practitioners, the recommendation of medical cannabis for epilepsy is guided by a combination of regulatory compliance and professional responsibility.

    1. Compliance with Laws: Practitioners must be fully aware of and compliant with the legal parameters governing medical cannabis in their jurisdiction, including qualifying conditions, prescription requirements, and reporting obligations.
    2. Continuing Education: As cannabis research is evolving, healthcare providers should stay informed about the latest scientific evidence and shifts in medical practice standards concerning cannabis-based treatments.
    3. Patient-Centric Approach: Providers should consider the individual patient’s medical history, the severity of their condition, previous treatment outcomes, and the patient or family’s preferences and expectations.
    4. Informed Consent and Risk Disclosure: It’s crucial to engage patients or their guardians in thorough discussions about the risks, benefits, and uncertainties associated with cannabis use, ensuring informed decision-making.
    5. Close Monitoring and Follow-Up: Due to the variable nature of cannabis products and individual patient responses, initiating treatment should be followed by close monitoring for efficacy, side effects, and potential drug interactions, with adjustments as necessary.

Navigating the legal and ethical landscape of medical cannabis requires a careful and informed approach that considers the legal context, the welfare of patients, and the responsibilities of healthcare providers.

As legal attitudes continue to evolve and clinical research expands, these considerations may shift, necessitating ongoing engagement with current developments in the field.

Cannabis in Managing Epilepsy and Seizures

Navigating the complex journey of epilepsy management can be a challenging task for many patients and medical professionals alike.

Traditional treatments, though effective for some, fail to provide relief for others, making alternative approaches like cannabis increasingly noteworthy.

However, this area’s evolving nature necessitates a comprehensive understanding of both the promises and uncertainties involved.

Advocating for Further Research and Open Dialogues

Despite the strides made in understanding cannabis’s role in epilepsy treatment, much remains unknown. It is crucial to advocate for further robust, large-scale clinical studies to meticulously assess long-term efficacy, optimal dosages, and potential risks.

Enhanced research could facilitate more precise guidelines for practitioners, potentially integrating cannabis more seamlessly into the arsenal of tools against epilepsy.

Furthermore, an open and informed dialogue between patients and medical professionals is paramount. Healthcare providers are encouraged to stay abreast of the latest research, legal changes, and therapeutic methods to offer sound advice to their patients.

Patients and caregivers must feel empowered to initiate conversations regarding alternative treatments, including cannabis, and to actively participate in decision-making processes regarding their healthcare.

Finally, as society progresses in its understanding and regulations surrounding medical cannabis, multidisciplinary collaboration is essential. Continued advocacy for policy reform—reflecting scientific evidence and patient experiences—can help harness cannabis’s therapeutic potential responsibly and effectively.

The collective journey towards seizing control of epilepsy is not without its hurdles, but with continued research, informed dialogue, and empathetic care, a path forward can be forged.


References

FDA Regulation of Cannabis and Cannabis-Derived Products, Including Cannabidiol (CBD)

https://www.fda.gov/news-events/public-health-focus/fda-regulation-cannabis-and-cannabis-derived-products-including-cannabidiol-cbd 

UAB News – CBD oil may reduce frequency and severity of epileptic seizures

https://www.uab.edu/news/research/item/7808-cbd-oil-may-reduce-frequency-and-severity-of-epileptic-seizures-according-to-uab-findings 

Charlotte’s Web: A CBD Origin Story

https://archive.hightimes.com/article/share/5e7b4004-7d53-46ed-82ac-554da7cd5270 

EPIDIOLEX: A Treatment Innovation

https://www.epidiolex.com/epidiolex-results 

Dravet Syndrome Efficacy

https://www.epidiolexhcp.com/efficacy-and-safety/dravet-syndrome 

State Medical Cannabis Laws – NCSL

https://www.ncsl.org/health/state-medical-cannabis-laws 

How Cannabidiol Counters Epileptic Seizures

https://nyulangone.org/news/study-reveals-how-cannabidiol-counters-epileptic-seizures 

A naturalistic examination of the perceived effects of cannabis on negative affect

https://www.sciencedirect.com/science/article/pii/S0165032718303100?via%3Dihub

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