What Science Says About Epilepsy and Cannabis

As medical and adult-use marijuana legalization continues to spread across the United States, some of the most vocal advocates have been epileptics and their families. Cannabis compounds, CBD in particular, have been identified as an alternative therapy for reducing or eliminating epileptic seizures. While some in the medical community remain unconvinced, some patients speak about cannabis as an epilepsy wonder drug. So, what does science actually say about cannabis and epilepsy?

Understanding Seizures

Does cannabis lower your seizure threshold? To understand whether such a mechanism is possible, we must first understand what a seizure is, and how it occurs. Speaking in broad terms, a seizure can be caused by any disruption of the normal communications in your brain’s nervous system. When such an interruption is extreme enough, it will lead to uncontrolled electrical activity in your brain, resulting in a seizure. A seizure is mostly characterized by violent, uncontrollable muscle contractions. There is often also a loss of consciousness with certain types of seizures.

Potential Seizure Triggers

• Eating habits    
• Alcohol or drug withdrawal or use
• Illness    
• Flashing bright lights or patterns    
• Stress or emotional duress
• Menstrual cycle
• Sleep deprivation

It is important to understand that seizures, in and of themselves, are a symptom and not a disease.

Epilepsy is a medical condition that’s closely linked to seizures. When someone experiences two or more seizures in a 24-hour period without any other underlying causes identified, there is a strong likelihood they may be diagnosed as epileptic.

Treating Epilepsy

For these reasons, it is critical for epileptics to find a treatment that reliably helps them reduce the incidence of seizures. There are many medications on the market for the treatment and control of seizures. However, nearly a full one-third of all long-term epilepsy patients do not respond well to anti-epileptic pharmaceuticals.

Other patients are simply wary of using strong pharmaceutical products as their front-line option for the regular management of seizures. For example, habit-forming benzodiazepines like Klonopin/Clonazepam are often used as an acute treatment for seizures. While such medications can certainly be effective, they are not for everyone, and can be habit forming or addictive.

Alternative, non-pharmaceutical treatments for epilepsy can include:

• Lifestyle changes (stress reduction exercises, music therapy, etc.)
• Healthier diet (Ketogenic diet)
• Vagal Nerve Stimulation – a treatment wherein an electrical device is used to stimulate a particular part of the brain
• Surgery (in some cases)
• Maintenance with cannabis or CBD supplements – cannabis is prized both for its therapeutic effects and the fact that it can be consumed in various convenient ways such as vaping, pre-measured supplements, and mixing it in food

It's incredibly important to note that none of the above should be done in place of seizure medication, unless you have consulted with your primary doctor or physician.

Seizures and the Endocannabinoid System

While people talk about the human brain as analogous to a computer, we often don’t give this comparison credit for how close it truly comes to reality. Our brains have a huge number of tiny electrical pathways, much like a complex circuit board, and they can be rewired throughout our lives, impacting our associations, memories, and mental skill sets. Like computers, our brains also have “inputs” that allow them to receive signals from other parts of the brain or body. When it comes to describing these nervous system inputs in the brain, we use the term “neurotransmitters.”

A particular group of neurotransmitters makes up something called our endocannabinoid system. The endocannabinoid system hosts a series of receptors in the brain and throughout the body that allow us to enjoy the benefits of cannabis. It may also be key in managing seizures for some people.

In fact, the endocannabinoid system has been implicated in many of the basic functions that impact day-to-day human life, including:

• Sleepiness
• Hunger
• Pain suppression
• Mood regulation
• Immune system health

By binding with our endocannabinoid system’s receptors, compounds in cannabis known as cannabinoids can potentially affect any of the above.

For the medicinal treatment of seizures, we’ll mostly be looking at a popular therapeutic cannabinoid called Cannabidiol, or CBD. CBD is widely available and legal across the United States, including places where cannabis containing THC is still criminalized. Some medical users prefer CBD to full-spectrum cannabis with THC because it offers many of the same therapeutic benefits without the heady psychoactive high often associated with THC.

Is Cannabis Used to Treat Seizures?

Many people aren’t aware that cannabis extracts were used to treat seizures as early as the 1800s. Just as it is today, cannabis was once a popular treatment for various ailments. Unfortunately, the United States government’s subsequent successful push for cannabis prohibition ended this treatment and most research into cannabis-derived medications.

Over the last couple of decades, however, cannabis research has come back in a huge way. In particular, a significant amount of research has been done into CBD’s potential as an anti-seizure agent for treatment-resistant epileptics and children suffering from incurable forms of epilepsy.

In 2016, the United States Food and Drug Administration even approved the first CBD-derived commercial medication, Epidiolex. This medication was validated by exhaustive trials as being effective in reducing the occurrence of seizures in patients with three specific, uncommon subtypes of epilepsy.

How Does CBD Treat Seizures?

It is believed that CBD treats the symptoms of epilepsy (i.e., reduces seizures) by reducing the sensitivity of particular ion channels. These protein structures connect one side of a cell membrane to the other. The ion channels targeted by CBD seem to have some implication in the uncontrollable convulsions that define a seizure.

When someone experiences a seizure, these ion channels are sending repeated, rapid-fire signals that cause the involuntary jerking of muscles and cut off the patient’s ability to consciously control their own movements. Desensitizing those ion channels with CBD effectively slows them down and seems to be effective at interrupting the relentless cellular signals that would otherwise trigger a seizure. Studies in both children and adults have validated CBD as an effective means of reducing seizures.

Cannabinoids and Dravet Syndrome

Recent research into the use of cannabis compounds as anti-seizure drugs has been focused on a rare and serious form of epilepsy called Dravet Syndrome. Patients suffering from Dravet Syndrome can experience a significantly reduced quality of life due to frequent, major seizures and delayed cognitive development. Conventional therapies for epilepsy are often inadequate for patients battling Dravet Syndrome, leading researchers to look at CBD and other cannabis compounds as an alternative.

One of the first high-profile cases involving cannabis and the treatment of Dravet Syndrome was that of Charlotte Figi, a Colorado child suffering from Dravet Syndrome. In 2013, when Charlotte was only eight years old, her family revealed that medical marijuana had significantly reduced her seizures when no other medication or therapy had been able to.

Subsequent Studies

By 2016, scientists were hard at work trying to determine whether cannabis could be the basis for a reliable and effective epilepsy treatment. A groundbreaking 12-week study at New York University’s Langone Medical Center involved more than 150 epileptic patients and a high-potency CBD extract. The CBD was given as an additional supplement along with any epilepsy medications the patients were currently taking.

The results were promising. Seizures among the test population were reduced by a median rate of 36.5 percent, with 2 percent of patients seeing their seizures eliminated entirely for the duration of the 3-month study. Many patients experienced unwanted side effects such as fatigue, but only a small percent left the study due to the seriousness of those effects.

A prominent Australian family, the Lamberts, had a young daughter named Katelyn who suffered from Dravet Syndrome, which was not well treated by any other method. They began to search far and wide for effective alternative therapies. The Lamberts saw dramatic improvements in Katelyn’s condition after treating her with CBD oil.

The Lambert Initiative

The family was so moved and impressed by the results that they wanted to help other suffering children access what they saw as a wonder drug. In 2015, they made a sizable donation to the University of Sydney and helped to establish the Lambert Initiative for Cannabinoid Therapeutics, which is now the leading research institute in the field of cannabis-derived epilepsy treatments.

Some of the Lambert Initiative’s most promising research so far has been in identifying and isolating three specialized acidic cannabinoids that have shown promising anticonvulsant effects when used to treat Dravet Syndrome in mice. While most people know about THC and CBD, cannabis contains a vast assortment of other unique chemical compounds and terpenes which may have therapeutic applications of their own.

Of these three uncommon acidic cannabinoids identified by the Lambert Initiative, cannabigerolic acid (CBGA) is of particular interest. A lead researcher on the project referred to CBGA as the “mother of all cannabinoids.” This is not meant as a commentary on the strength of CBGA, but in a more literal sense: CBGA molecules are the precursors whereby more famous cannabinoids like THC and CBD develop. As it turns out, the researchers found that CBGA was actually more effective than CBD when it came to reducing seizures in mice with Dravet Syndrome.

Cannabinoids like CBGA, which are abundant earlier in a plant’s cycle and not found in large concentrations in harvested and cured cannabis products, have not enjoyed the same extent of scientific research as THC and CBD. Because of this, their full therapeutic potential for treating epilepsy and other medical conditions is only now beginning to be unlocked.

It is worth noting that CBGA in higher concentrations actually took on the opposite effect and seemed to trigger convulsions rather than discourage them. Further research may be necessary before the power of CBGA can be harnessed to reliably treat epilepsy in humans.

Is Treating Seizures with Cannabis Safe?

CBD is well tolerated among most people and generally considered safe. There are, however, a few concerns to be aware of before you commit to a cannabis-based epilepsy treatment regimen.

Before we dive into the concerns, it's worth reiterating that you should never stop anti-seizure medication without first consulting your doctor or physician.

One of the more serious issues is potential interactions with other drugs. One of the many effects CBD has on the body is as an inhibitor of your liver’s natural enzymes. Because of this temporary disruption in normal liver function, CBD use can alter the concentration of certain other drugs you may be taking. This can make them overly concentrated in your system or effectively block them, and either can be dangerous.

Because of this mechanism, some of CBD’s strangest and most extreme anecdotal side effects are probably not side effects of CBD at all but exacerbated side effects from other medications the user was taking alongside CBD.

It’s also important to be aware that, just like with other seizure drugs, not everyone struggling with epileptic seizures is going to respond well to CBD or other cannabis compounds. Research is ongoing to determine exactly which types of epilepsy cannabis is most effective in treating, and exactly which cannabis compounds should be isolated to do the job most effectively.
   

References :

1. O'Connell, B. K., Gloss, D., & Devinsky, O. (2017). Cannabinoids in treatment-resistant epilepsy: a review. Epilepsy & Behavior, 70, 341-348. https://doi.org/10.1016/j.yebeh.2016.11.012
2. Nazarov, A. I. (2022). Consequences of Seizures and Epilepsy in Children. Web of Scientist: International Scientific Research Journal, 3(02), 483-489. https://doi.org/10.17605/OSF.IO/R5WSK
3. Devinsky, O., Marsh, E., Friedman, D., Thiele, E., Laux, L., Sullivan, J., ... & Cilio, M. R. (2016). Cannabidiol in patients with treatment-resistant epilepsy: an open-label interventional trial. The Lancet Neurology, 15(3), 270-278. https://doi.org/10.1016/S1474-4422(15)00379-8
4. Anderson, L. L., Low, I. K., Banister, S. D., McGregor, I. S., & Arnold, J. C. (2019). Pharmacokinetics of phytocannabinoid acids and anticonvulsant effect of cannabidiolic acid in a mouse model of Dravet syndrome. Journal of natural products, 82(11), 3047-3055. https://doi.org/10.1021/acs.jnatprod.9b00600
5. “The Lambert Family.” The University of Sydney, Lambert Initiative for Cannabinoid Therapeutics. https://www.sydney.edu.au/lambert/about/the-lambert-family.html