Documented cannabis use for the treatment of seizures dates back centuries and can be found in Sumerian texts. In the U.S., epilepsy is at an all time high. During the past decade, we have seen a lot of developments in epilepsy therapy from new devices and new medications and the advancement of dietary therapies, yet despite all of those advances, we still have approximately 30 percent of people, both children and adults with epilepsy, whose seizures cannot be fully controlled despite available therapies.
Epilepsy has an extraordinary impact on patient’s quality of life. Not only does it affect cognitive and behavioral functions, but if uncontrolled, it can lead to permanent disability. Patients lose the ability to work and earn a living which makes finding an effective treatment even more critical. There are two major constituents in medical cannabis, CBD (Cannabidiol) and THC. Cannabidiol is the major, non-psychoactive ingredient or compound. CBD as a treatment option for seizures represents a challenge and a unique opportunity.
In my medical practice, patients come seek my advice after they have they exhausted all pharmaceutical options (anti-seizure medications), and even very aggressive treatments — brain surgery, special restrictive diets (ketogenic/paleo-type diets). Patients who come to me have usually tried more than a dozen medications that have failed them.
On June 25, 2018, Epidiolex became the first cannabis-derived pharmaceutical approved by the FDA in the U.S. Made from CBD extract, the drug is not psychoactive and has been approved for two rare forms of epilepsy: Lennox-Gastaut syndrome and Dravet syndrome. Dr. Orrin Devinsky, the principle investigator of the study behind Epidiolex, states “the CBD binds with a novel receptor in the brain and thereby dampens down too much electrical activity. CBD seems to be a relatively unique mechanism of action that’s not shared by any of the existing seizure medications.” CBD is thought to act on specific brain receptors and likely modulates calcium activity in neurons.
Children and adults who come to my clinic have treatment resistant epilepsy. I work as a team with their neurologists to help integrate medical cannabis safely. More than 50 percent of my patients have a reduction in seizures after a trial of CBD extracts. Many patients report decreased frequency, severity and duration of the seizures. And interestingly, they report back that where the patient had a seizure before and it would take all day to get over that groggy and “hung over” feeling, the patient feels they can recover faster and feel like themselves again. CBD can interact with prescription medications, especially current anti-epilepsy medications as well as increase liver enzymes. It is best to consult your specialist and a physician who is experienced in integrative cannabis medicine before you try CBD for seizures. To assess safety and efficacy patients should be continually monitored and re-assessed to develop a personalized care plan tailored to their needs. Adequate pharmacokinetic data are needed to inform dosing recommendations and identify interactions with antiepileptic drugs (AEDs) and other medications that can cause toxicity or impair efficacy.
Pure CBD appears to hold great promise, especially for improving a seizure patient’s quality of life. Its lack of THC — and therefore of the risks associated with the use of cannabis in the young age — its excellent safety profile in humans, as well as its efficacy in clinical studies suggest that it could be a safe and effective drug for epilepsy. Medical cannabis is not a silver bullet. Patients and the medical community need objective and unbiased data on safety and efficacy to endorse cannabis to treat epilepsy. Patients are looking for reliable information , but have few trusted healthcare-provided resources.
Manufacturers of CBD products should heed Sandler’s advice when marketing their product and engaging in interstate commerce.