how fast does cbd oil work for epilepsy

Cannibidiol (CBD) oil treatment for epilepsy

Le Bonheur Children’s Hospital neurologist and co-director of the Neuroscience Institute, James Wheless, MD, recently hosted a Facebook Live Q&A discussing cannabidiol (CBD) oil and its use with epilepsy patients. He was joined by the Eagle family whose son, Jackson, has seen relief from seizures as part of a CBD trial at Le Bonheur. Here are the top five questions about CBD oil raised during the interactive discussion:

What is the difference between CBD and medical marijuana?

(Dr. Wheless) Historically, the cannabis plant was bred for tetrahydrocannabinol (THC), the marijuana component, for illicit use. The second most common compound in the cannabis plant is cannabidiol (CBD), which is what has recently been approved to treat epilepsy. CBD contains less than 1 percent of tetrahydrocannabinol (THC) the chemical responsible for most of marijuana’s psychological effects and does not contain enough to cause psychoactivity.

How do I get CBD? Can I just buy it from a dispensary?

(Dr. Wheless) CBD oil has now been approved by the FDA as a prescription drug under the name Epidiolex. This drug was developed through trials and studies over the last five years in order to get approval to bring to market this year. It is available as a prescription from your neurologist from a specialty pharmacy.

Epidiolex meets stringent federal standards – it’s manufactured with the same kind of rigor and attention to detail of any other medicine. CBD oil purchased from a dispensary does not guarantee the same consistency as prescription Epidiolex. Epidiolex meets federal standards so that you can be certain every dose is exactly the same and that there are no other chemicals or impurities in the CBD oil. With third-party dispensaries, quality may vary from month to month depending on the batch. We have patients who have told us that CBD oil they purchased from a dispensary might work one month but not the next. No third-party dispensaries could match the degree of purity and consistency as Epidiolex.

What are the side effects of CBD?

(Mrs. Eagle) Jackson has not experienced many side effects while taking CBD oil. He became irritable and cried easily when we raised his dose of CBD but that went away when we dialed it back.

(Dr. Wheless) The side effects of CBD are less severe and easier to tolerate compared to most epilepsy medications. Some patients have gastrointestinal side effects where they may feel a little queasy because the CBD is taken in liquid form with sesame oil. Some patients can also get sleepy or tired while taking Epidiolex.

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Can CBD treat any type of epilepsy?

(Dr. Wheless) Currently, Epidiolex is primarily used to treat specific epilepsies – Lennox-Gastaut Syndrome and Dravet Syndrome. These are both associated with convulsive seizures. This was the approval for the initial medicine, but other areas of epilepsy are being studied since we believe that CBD oil can work for others, too. However, there are children that do not have those conditions who are currently able to get Epidiolex, so if your child is having ongoing seizures it may be something to think about.

How long does it take to see results from CBD oil?

(Mrs. Eagle) CBD oil did not take long at all to start helping Jackson – maybe days or a week. We immediately had no seizures. We’ve seen many other improvements in cognition with Jackson. In occupational therapy, he would get zeroes on his progress report, but in the last quarter he had five or six things that he had mastered.

(Dr. Wheless) We usually get people up to dose over two to four weeks. As we do that, usually the patients who are going to respond to CBD already see the number of seizures going down. We may still need to tweak dosage, but they already see that it’s helping. Conversely, for patients who it does not work for will know that up front because if they haven’t seen changes in six week we know this probably won’t be the medicine for them.

Cannabidiol reduces seizures in kids with severe form of epilepsy, trial shows

Research focused on Dravet syndrome, a rare form of treatment-resistant epilepsy that begins in infancy

A cannabis compound has been proven for the first time to reduce the frequency of seizures in people with a rare, severe form of epilepsy, according to the results of a randomized trial.

For years, parents have pointed to anecdotal benefits of cannabidiol (CBD), a compound in the marijuana plant that does not produce a high, saying it reduces seizures in treatment-resistant epilepsy.

Now doctors have performed a large-scale randomized trial to show cause and effect, with the findings published in Wednesday's issue of the New England Journal of Medicine.

To conduct the study, the researchers focused on Dravet syndrome, a rare form of epilepsy that begins in infancy and has a high mortality rate. The syndrome is linked to a particular mutation and often resists combinations of up to 10 conventional seizure medications. They enrolled 120 patients who ranged in age from 2.5 to 18 years.

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Sixty-one patients were randomly assigned to cannabidiol, and the 59 others to placebo. Neither the researchers nor the families knew who received the medication to prevent bias. All continued to take their existing medications for 12 weeks.

"The message is that cannabidiol does work in reducing convulsing seizures in children with Dravet syndrome," lead author Dr. Orrin Devinksy, who is director of NYU's Langone Comprehensive Epilepsy Center, said in a hospital video.

Marijuana compound and epilepsy

For those in the cannabinoid group, the median number of convulsive seizures per month dropped from 12.4 per month before treatment to 5.9 seizures, the researchers reported.

The placebo group, in comparison, only saw their convulsive seizures fall from 14.9 per month to 14.1.

The study was funded by GW Pharmaceuticals, which also designed and helped run it; one of the company doctors involved also has a related patent pending.

The most common adverse event was drowsiness, reported in 22 patients in the cannabidiol group and six patients in the placebo group. Many of these patients were taking another anti-epileptic medication. Some gastrointestinal effects, such as vomiting and diarrhea, were also reported.

A total of 12 patients quit the study: nine on the drug and three in the placebo group.

'Last hope' for parents

Dr. Mark Ware, who directs the Canadian Consortium for the Investigation of Cannabinoids, says the findings add credibility to the widely held anecdotal view that CBD helps patients with epilepsy.

But he cautioned that the CBD used in the trial is a pharmaceutical grade product, administered under carefully controlled experimental conditions with careful medical supervision.

"It is important to note that not all patients will respond," Ware said in an email.

The McKnight family, of Constance Bay, Ont., has used a combination of high CBD, low THC oil to control seizures in their nine-year-old son, Liam, for four years now. He has Dravet syndrome.

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Before he started using the oil, Liam was having upward of 80 seizures per day. They left him catatonic, lying on the couch, unable to walk or go to school — despite taking up to 10 anti-seizure medications.

"We were trying everything, and despite everything we were trying, we were losing our battle," his mother, Mandy McKnight, recalls. "The cannabis … was probably our last hope."

Within 24 hours of starting the oil, McKnight says Liam's seizures stopped for 10 days. Though the seizures came back, she estimates the frequency was about 90 per cent less than before.

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Liam can now go for weeks without a seizure, although they tend to return when he is sick with an infection.

McKnight says she welcomes the new findings, as it proves what parents like her have been advocating to their medical teams. "Sometimes science doesn't always lead the way — sometimes it has to catch up."

Accepting side-effects

At Toronto's Sick Kids Hospital, neurologist Blathnaid McCoy is conducting a similar study. She and her team have just enrolled their 20th and final participant in a Tilray-sponsored trial of a combination CBD and THC treatment for children with Dravet syndrome.

McCoy noted there is a significant placebo effect when it comes to epilepsy. That's why it's so important that this team was able to show improvements in seizures above placebo.

"If it improves your seizure control, then families will accept a certain amount of side-effects," McCoy said.

McCoy noted that a THC-CBD combination product is what's available in Canada, so it's what patients here are using.

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But, she adds, THC may have some added benefit since it binds directly to cannabinoid receptors. Since little is known about using THC medicinally in children, figuring out the safe dose and limiting side-effects will be key, McCoy said.

Another pediatric epilepsy specialist sees a potential role for cannabis-based treatments in a select group of children with resistant epilepsy, including those with Dravet syndrome.

Parents' misconceptions

"To parents I would caution that while cannabidiol is a plant-based product, it appears to have the potential to interact negatively with other antiseizure treatments and cause side-effects," said Dr. Richard Huntsman, a pediatric neurologist at the University of Saskatchewan. He is co-leading a pilot study of highly concentrated CBD oil in children with epilepsy.

Medical supervision is key in part because CBD could affect liver function, said Dr. Danielle Andrade, a neurologist and director of the epilepsy program at Toronto Western Hospital.

Andrade is concerned about misconceptions of using CBD in other types of epilepsy when there is no evidence it works.

"All the patients that were treated, they have very significant learning disability, developmental disability. We don't really know what effects it could cause someone who is higher functioning," Andrade said.

The CBD product used in the study, called Epidiolex, is not approved by regulators or available for sale.