Could Cannabis Help Treat Drug-Resistant Epilepsy?
Just over 1% of the U.S. population has active epilepsy. This disorder of the central nervous system can severely impact quality of life for those who have been diagnosed, the most severe among them being seizures. Epilepsy can be difficult to treat with existing medications. Furthermore, even when those pharmaceutical options do work, they may come with side effects patients find intolerable.
Cannabis has emerged as a possible alternative treatment for certain types of epilepsy, and has been a lifeline for those who cannot tolerate medication or do not respond to conventional treatment. What do we know so far?
What is Epilepsy?
Epilepsy is a neurological disorder that affects more than 50 million people worldwide, including around 3.4 million people in the U.S. It is caused by abnormal brain activity which can trigger seizures, confusion, uncontrollable twitching, anxiety, and loss of consciousness.
Seizures are one of the most recognizable symptoms of epilepsy, though they can take on different forms and can look different from patient to patient. Some people living with epilepsy will stare blankly during a seizure, while others will convulse more visibly in a way that many have seen depicted on TV or may have witnessed in person. Some patients will only occasionally experience seizures, while in the most severe cases, a patient can experience many per day. In some cases, epilepsy is a lifelong condition that can only be managed with treatment. In others, particularly children living with epilepsy, the condition may only be temporary.
There are several types of generalized seizures a person living with epilepsy may experience. This matters, as it can help determine how effective particular treatment options may be. These seizures include:
• Absence seizures: Most common in children, these seizures cause the person to stare into space blankly. These may occur in a series and cause lack of awareness or confusion.
• Tonic seizures: Tonic seizures cause tightening of the back, arms, and legs. When someone has a tonic seizure, they may collapse.
• Atonic seizures: Atonic seizures cause total loss of muscle control and generally cause someone to suddenly drop to the ground.
• Clonic seizures. Clonic seizures are typically characterized by a rapid jerking of the head, neck, face, or arms.
• Myoclonic seizures: Myoclonic seizures are characterized by rapid, inconsistent twitching or flailing of the arms and legs.
• Tonic-clonic seizures: Sometimes referred to as grand mal seizures, tonic-clonic seizures cause body stiffening, convulsing, and abrupt loss of consciousness.
It is important to note that in addition to the generalized seizures listed above, there are also focal, or partial seizures. These seizures occur in one hemisphere of the brain, but can expand into one of the generalized seizures listed above.
Unfortunately, there are some cases in which epileptic seizures are resistant to conventional treatment. Generally, a patient's seizures are considered treatment resistant if they persist even after the patient takes the appropriate dose of two anti-seizure medications. The result is a serious reduction in quality of life, as well as cognitive problems. As a result, researchers are eagerly investigating potential new treatments for epileptic seizures that could offer an alternative to people living with drug-resistant epilepsy.
Cannabis as an anti-convulsant
Cannabis has long been used as an anti-convulsant, throughout both ancient and modern times. Specifically, delta-9 Tetrahydrocannabinol (THC) and Cannabidiol (CBD) are thought to offer anti-convulsant properties that could control epileptic seizures. While the research is limited and results are mixed, many patients may consider trying cannabis for managing seizure disorders, especially if they are suffering with side effects from traditional medications or are seeing no positive results from those courses of treatment.
One of the most well-known examples is of Charlotte Figi, a child with Dravet syndrome. Her seizures were controlled by taking CBD oil derived from a high CBD, low THC hemp cultivar that would later be named after her – Charlotte's Web. When she began taking CBD oil, Charlotte was able to eat, play, and socialize with other children in a way she hadn't before. Charlotte died in 2020 from pneumonia-related complications.
There are countless stories like Charlotte's, where child and adult epilepsy patients found relief with cannabis. One survey of 1,000 people living with epilepsy found that 14% were consuming cannabis to control their symptoms. Of that group, nearly 9 in 10 reported they found it effective for treating symptoms and helping to manage seizures.
Though anecdotal evidence is strong, it's not all we have to rely on. A scientific review of human trials studying cannabis and epilepsy performed between 1978 and 2017 sums up nicely a long history of promising scientific research into cannabis's potential for treating symptoms of epilepsy:
• Renown cannabis researcher Raphael Mechoulam took part in a 1978 trial in which four out of nine patients with drug-resistant epilepsy were given 200mg of CBD daily for three months, while the remaining group were given placebos. Two of the patients in the CBD group had no seizures, while another saw significant improvement; only one patient in the CBD group saw no improvement.
• A double-blind trial involving 15 patients was conducted in 1980, in which seven patients were given 200mg to 300mg of CBD daily for 18 weeks, while the other group received placebos. EEG and ECG scans were administered on participants twice per month. Four patients receiving CBD were seizure free, while three saw significant improvement and only one did not improve.
• In 2017, 162 patients with Dravet syndrome and Lennox-Gastaut syndrome were given 2 to 5 mg/kg of CBD per day, which was gradually increased to 50 mg/kg per day for 12 weeks. Seizures were reduced among the treatment group by 36.5%, with particular improvement noted among patients with atonic and focal seizures.
The researchers conducting the scientific review concluded that "cannabis preparations for the treatment of drug-resistant epilepsy … are observed to be more efficacious with less side effect profile" than other medicative treatments.
The emergence of Cannabis-derived pharmaceuticals
As it turns out, the research into cannabinoids for the treatment of seizures was so compelling, a pharmaceutical company developed a CBD-derived medication for the treatment of Dravet syndrome and Lennox-Gastaut syndrome, the specific conditions studied in the 2017 trial mentioned above. That medication, called Epidiolex, became the first cannabis-derived pharmaceutical product to receive approval from the U.S. Food and Drug Administration (FDA) in 2018.
To attain that approval, Epidiolex had to prove its effectiveness. It was put to the test in three randomized, double-blind, placebo-controlled clinical trials. These trials involved 516 patients with one of the two conditions. Epidiolex, alongside other medications, was found to reduce the frequency of seizures significantly when compared with placebo.
The limitations of Cannabis as an anti-convulsant
Unfortunately, research has yielded some mixed results. In some studies, cannabis was observed to have no effect or even exacerbate seizures associated with epilepsy. It is impossible at this time, given the body of evidence established by researchers, to predict precisely what effect cannabis will have on a case by case basis, as it appears to elicit highly individualized responses.
Moreover, much of the research regarding cannabis and seizures relies on observations of Dravet or Lennox-Gestalt seizures. These are rare, specific types of seizures mostly experienced by children. It is not necessarily accurate to assume that the studies involving these types of seizures will translate to other, more common types of seizures experienced by many adults.
Finally, cannabis is known to interact with several medications, including some that people living with epilepsy may take regularly. It's important to consult a doctor before adding cannabis to your care routine. It is important to regularly follow up even after consuming cannabis for some time to determine whether it is having any adverse effect on treatment. Anyone living with epilepsy or seizures should only consume cannabis under medical supervision.
Which Cannabis products may help?
For the many people living with seizures that may not benefit from Epidiolex, natural cannabis products may also provide relief. Much of the research focuses on CBD, which is considered the more effective anti-convulsant compared with THC; however, some research examines a combination of THC and CBD. The results suggest that high-CBD products are the best bet for people living with epilepsy or frequent seizures.
However, common side effects of other epilepsy medications include insomnia, and THC is often cited as a sleep promoting phytocannabinoid. Choosing a product with a balanced THC:CBD ratio may offer relief to some consumers.
For people who do not want to experience the heady effects of THC, CBD oil or tinctures are likely the best bet. These are concentrated products that do not feel heady.
There are options when it comes to Cannabis and Epilepsy
The research demonstrates that phytocannabinoids can help significantly improve epileptic seizures in some patients. Whatever your goals, there are a wide variety of cannabis products that can offer what you need. Everyone is different and, especially when it comes to seizures, cannabis may not be correct for everyone, so it's important to discuss with your doctor adding cannabis to your routine before doing so. As part of a holistic treatment plan, cannabis could play a positive role in helping manage symptoms of epilepsy.