Epilepsy is a chronic disease characterized by recurrent unprovoked seizures. Up to 30% of children with epilepsy will be refractory to standard anticonvulsant therapy, and those with epileptic encephalopathy can be particularly challenging to treat. The endocannabinoid system can modulate the physiologic processes underlying epileptogenesis. The anticonvulsant properties of several cannabinoids, namely Δ-tetrahydrocannabinol and cannabidiol (CBD), have been demonstrated in both in vitro and in vivo studies. Cannabis-based therapies have been used for millennia to treat a variety of diseases including epilepsy. Several studies have shown that CBD, both in isolation as a pharmaceutical-grade preparation or as part of a CBD-enriched cannabis herbal extract, is beneficial in decreasing seizure frequency in children with treatment-resistant epilepsy. Overall, cannabis herbal extracts appear to provide greater efficacy in decreasing seizure frequency, but the studies assessing cannabis herbal extract are either retrospective or small-scale observational studies. The two large randomized controlled studies assessing the efficacy of pharmaceutical-grade CBD in children with Dravet and Lennox-Gastaut syndromes showed similar efficacy to other anticonvulsants. Lack of data regarding appropriate dosing and pediatric pharmacokinetics continues to make authorization of cannabis-based therapies to children with treatment-resistant epilepsy challenging.
When conventional treatments do not work to control seizures, as is the case for roughly 30% of people with epilepsy, it is not unreasonable to consider CBD oil. However, this should only be considered after a thorough evaluation at a specialized epilepsy center to look at whether all possible treatments (including FDA-approved new and add-on medicines, dietary therapy, devices, and surgery) have been reasonably tried.
Summarized below are the results from a study published in the New England Journal of Medicine in May 2018.
In this episode of Hallway Conversations, epilepsy.com Editor-In-Chief Dr. Joseph Sirven interviews Dr. Jose Cavazos MD, PhD, professor of neurology at the University of Texas Health Science Center in San Antonio. They discuss Dr. Cavazos’ experience serving as a panelist on the recent U.S. Food and Drug Administration (FDA) Peripheral and Central Nervous System Drug Advisory Committee review of Epidiolex ® for the treatment of Dravet and Lennox-Gastaut syndromes.
Should a person with epilepsy pursue medical cannabis if all other medications do not work?
The 2018 Farm Bill, signed into law by President Trump in December 2018, exempts hemp and hemp-derived products, including CBD, from the Controlled Substances Act. Previously, hemp-derivatives were classified as Schedule I cannabis products, meaning they had no acceptable medical use and had a high potential for abuse. The Farm Bill lifts federal restrictions surrounding CBD and legalizes the cultivation, manufacturing, and sale of these products across the United States. However, this does not mean that all hemp-derived products, including CBD, are medically appropriate.
Results from 214 people who received Epidiolex (99% CBD) in an open-label study (without a placebo control) and who completed 12 weeks or more on the drug were published in 2015 in Lancet Neurology.
The use of cannabis to treat epilepsy and other neurological conditions has been studied for a number of years. It has been hotly debated too.
Early evidence from laboratory studies, anecdotal reports, and small clinical studies over a number of years suggest that cannabidiol (CBD) could potentially help control seizures. Research on CBD has been hard to do and taken time due to federal regulations and limited access to cannabidiol. There are also many financial and time constraints. In recent years, a number of studies have shown the benefit of specific plant-based CBD product in treating specific groups of people with epilepsy who have not responded to traditional therapies.
Cannabis oil that contains very low amounts of THC or none at all is preferred for use as medicine. This oil can be made from both marijuana and hemp plants. Hemp strains often contain CBD without THC.
Cannabis is the proper name for marijuana, a cousin of the hemp plant and one that has long been classified as an illegal substance. However, with many states now opting to legalize cannabis for medical use, research is being conducted on how it can be used to treat seizures in children with epilepsy.
There are many treatments for seizures in children, but not all children respond to one or more of them. Cannabis oil is a new and sometimes controversial treatment that is currently gaining ground as a natural and non-invasive way to keep seizures under control.
How Does Cannabis Oil Benefit?
THC is the component of cannabis that produces the characteristic euphoric state often referred to as a “high.” Cannabidiol does not produce psychoactive effects, but has been shown to promote positive effects in different parts of the body. Cannabidiol is the component in cannabis that is hypothesized to ease seizures in children.
Far from being the stereotypical drug that makes a person want to eat snacks and watch television all day, cannabis contains chemicals that are able to work with the body to ease seizures. The two major components of cannabis are tetrahydrocannabinol (THC) and cannabidiol (CBD).
Although marijuana has been shown to be habit-forming, it is not addictive. Its habit-forming properties are usually associated with the effects of THC on a person. Cannabis oil that contains little or no THC is typically not habit-forming.