Can Medical Marijuana Control Seizures?
Yes, in some patients medical marijuana can control seizures.
Also called medical cannabis, it is derived from the whole cannabis plant or consists of chemicals in the plant and is used for medicinal purposes. Cannabinoids are substances in cannabis that act on cells in the body, including the brain. Two main ones are tetrahydrocannabinol (THC) and cannabidiol (CBD).
THC is the major chemical compound found in many strains of marijuana. When it binds to receptors in the brain, it creates the high that people feel, which is considered a psychoactive effect. CBD is not psychoactive and cannot create a high.
Epidiolex, a mostly purified plant-based cannabidiol oil, was approved by the US Food and Drug Administration (FDA) in 2018 to treat seizures in people with Dravet syndrome and Lennox-Gastaut syndrome, two rare forms of childhood-onset epilepsy. In 2020, Epidiolex was approved to treat seizures caused by tuberous sclerosis complex, a rare genetic disease that causes benign tumors to grow in the brain—which can lead to seizures—and other areas. The drug is a liquid that’s administered orally with a special syringe.
Approval of Epidiolex for Lennox-Gastaut and Dravet syndromes was based on four randomized, double-blind, placebo-controlled clinical trials of 516 patients. Taken with other antiseizure medications, Epidiolex significantly reduced the number of seizures compared with the placebo. In a clinical trial for people with seizures caused by tuberous sclerosis complex, Epidiolex reduced seizures by 48 percent, versus 24 percent for the placebo. Since its approval, the drug has helped many people with these types of seizures, but it is not effective for everyone and may need to be discontinued due to side effects such as liver problems and suicidal thoughts.
Researchers are not clear how CBD works to treat seizures, but they have a few theories: It may slow the sending of messages to the brain, change calcium levels in the brain that affect signals between cells, or reduce inflammation in the brain.
Marijuana products sold in dispensaries and online are not approved or regulated by the FDA and can vary significantly in quality. No government agency regularly tests such products for safety or effectiveness, or verifies that what is listed on the label is actually in the product. In some cases, commercial, nonprescription cannabis products are thought to increase seizures.
Researchers continue to investigate the different chemical compounds in marijuana and how they may help treat neurologic diseases, including other types of epilepsy. A meta-analysis published in Epilepsia in 2020 found that CBD improved the effect of clobazam (Onfi), a benzodiazepine used as an add-on treatment for seizures in both children and adults who have Lennox-Gastaut syndrome. A study published in Epilepsy & Behavior in 2018 showed that Epidiolex reduced seizures associated with four other types of epilepsy—CDKL5 deficiency disorder, Aicardi syndrome, Doose syndrome, and dup15q syndrome—from an average of 59 a month to 22 a month. The improvement lasted the entire 48 weeks of the study.
Side effects observed during the clinical trials of Epidiolex include fatigue, nausea, and diarrhea. Some patients experienced elevated liver enzymes, most likely because CBD is broken down in the liver. Because of that, patients need their liver enzymes monitored while taking Epidiolex or any other medical cannabis product.
In patients whose seizures are uncontrolled—which is the case for roughly 30 percent of people with epilepsy—an FDA-approved CBD product may be an appropriate treatment. That decision should be reached after a thorough evaluation at a specialized epilepsy center of the effectiveness of all other possible treatments (including FDA-approved new and add-on medicines, dietary therapy, devices, and surgery). If doctors prescribe Epidiolex, they must monitor patients’ enzyme levels and watch for any interactions with other medications.
Dr. Patel is director of the Complex Epilepsy Clinic and associate medical director for quality improvement at Nationwide Children’s Hospital in Columbus, OH. He is also associate professor of clinical pediatrics and neurology at the Ohio State University College of Medicine.
Marijuana and Seizures: What You Should Know
Cannabis has been the talk of the town everywhere around the world ever since the 2018 farm bill was passed, ensuring its legalization in several states in the US. Ongoing research has been successful in proving marijuana’s potential medicinal benefits. They say the plant has miraculous properties of curing almost every medical or mental health condition that exists. It’s effectively treated insomnia, anxiety, aging skin, inflammation, epileptic seizures, chronic pain, muscle spasms, migraine, period cramps, and even some cancer-related symptoms. However, the data gathered until now is still somewhat insufficient for making big claims in an industry as sensitive as the healthcare sector.
A few more years of trials and testing will likely bring forth better conclusions. Nevertheless, the available evidence is already making people go insane over cannabis. Now, how exactly does marijuana work for medical conditions that involve seizures?
What Science Says
Cannabis plants are packed with more than a hundred cannabinoids in each strain. The most prominent ones are CBD (cannabidiol) and THC (tetrahydrocannabinol). While THC is the one that comes with psychoactive effects, CBD precisely renders relief for medical conditions. Therefore, if you’re consuming CBD with a minute proportion of THC (or no THC at all), it is unlikely that you will experience a “ high. ”
Since our body is also equipped with an endocannabinoid system (ECS), the chemical compounds in cannabis interact directly with it. The ECS controls various functions inside our body, for example, the central nervous system, immune system, several cardiovascular functions, etc. Marijuana has been used to treat seizures for centuries. The commodity may have found its true fame now, but its glory days date back to ancient times. Many types of medication were introduced in the US during 2018 after the farm bill was passed. Epidiolex is a plant-based oil that came into being around the same time and was recommended particularly for epilepsy patients.
Epidiolex was found to be beneficial for treating seizures in patients with varying conditions and syndromes such as benign tumors, tuberous sclerosis, dravet syndrome, etc. Clinical trials were conducted on a sample of 516 people. Half of them were given Epidiolex, while the other half were given placebos. The end results were surprisingly affirmative. 48% of individuals that were given Epidiolex were found with reduced seizures, while only 24% with the placebo responded with the same. It is yet unclear how exactly cannabis works to treat seizures. However, researchers have brought a few theories to the table. Marijuana might reduce inflammation in the brain cells, or it may tamper with calcium levels. Nonetheless, further research is needed to come up with a better conclusion.
Which Marijuana Strains Are Best For Treating Seizures?
Cannabis strains come in two main variations: Sativa and Indica. Sativa strains are supposed to make you feel energized and invigorated. They also help in improving focus and boost creative thinking abilities. Indica strains, on the other hand, are the complete opposite. They promote relaxation and run you through a tunnel of tranquility. They also help you remain calm and sleep better at night. So which one of the two is supposed to help epileptic patients? Well, both of them. Here are some of the strains that are bound to help.
- Charlotte’s Web
Charlotte’s Web belongs to the Sativa side of the family and gained widespread public and media attention after it helped a young girl with a rare condition that involves seizures. Thus, it was named after the little girl, Charlotte. Consumers also love this strain for other reasons. Even though it’s a Sativa, it makes you feel relaxed while you’re focused and energized too. While you’re at it, the strain will also make you feel more innovative.
- Ringo’s Gift
Ringo’s gift is a rare hybrid strain and is popular for possessing a balanced ratio of CBD and THC. Its dominance is on the Indica side as it renders a soothing feeling of serenity over your body. It’s known for treating stressed, anxious, and insomniac individuals precisely. Newly found evidence also regards it to be helpful for seizures.
- Sweet And Sour Widow
Sweet and Sour Widow is an Indica dominant strain and is popular for its sweet but pungent onion-like aroma. Since the THC levels are pretty low in this one, it’s best for people who are new to cannabis or those who are avoiding getting a foggy head. This strain makes you feel happier and uplifted. It’s also excellent for relaxation as it’s Indica-dominant.
The Bottom Line
Medical marijuana has taken over the world like an inevitable flood, and it continues to progress. Available data has proved it to be effective for seizures and countless other medical conditions. However, if you’re looking forward to consuming strains or other OTC goods to treat your health difficulties, it’s best to consult with a doctor first.
Using medical marijuana to stop seizures in kids
Desperate for relief, parents are taking unusual steps to help children plagued with seizures. The relief, however, comes in a most unlikely form: marijuana.
As many as 30 percent of people with epilepsy—or about one million Americans—still have seizures while on Food and Drug Administration (FDA)-approved treatments. It’s left many who suffer from uncontrollable seizures—or their parents, as many of them are children—turning to medical marijuana and its derivatives in an attempt to take back control of a disease with no cure.
A seizure is an abnormal electrical storm in the brain that causes sudden alteration in consciousness, sensation and behavior that can manifest from an eye flicker to full-body convulsions. People with medication-resistant (also called intractable) epilepsy suffer from consequences of recurrent seizures, which could damage the brain and adversely impact their quality of life. This is commonly observed in children with certain types of devastating pediatric epilepsy, such as Lennox-Gastaut, Doose and Dravet syndromes.
Stories about desperate parents seeking anything to relieve their children’s seizures abound, but how much scientific evidence is there for cannabis’ effectiveness?
D. Samba Reddy, PhD, RPh, professor in the Department of Neuroscience and Experimental Therapeutics at the Texas A&M Health Science Center College of Medicine, studies novel therapies for epilepsy. He recently published an article, with co-author Victoria Golub, in the Journal of Pharmacology and Experimental Therapeutics about the current state of research into medical marijuana for treating epilepsy.
“There was a lot of media attention about how medical marijuana is good for epilepsy,” said Reddy, who is a fellow of both the American Association of Pharmaceutical Scientists (AAPS) and the American Association for the Advancement of Science (AAAS). “We became interested in finding out whether there was scientific evidence in the literature to support the claims of these people who have seen great benefits.”
There are at least 85 active components of the plant colloquially known as marijuana, but two major ones of have been the focus of study: delta 9-tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the psychoactive component of the plant, while CBD doesn’t cause any sort of a “high” and isn’t thought to be addictive. Preliminary studies—largely in animal models—have shown CBD might have some anti-seizure potential.
Derivatives of marijuana high in CBD (but with negligible amount of THC) might offer some benefit for intractable epilepsy. CBD-enriched products, like Epidiolex and Realm Oil, exist, but their efficacy hasn’t been proven and they exist in a sort of legal grey area. Homemade compounds exist, but since they don’t go through rigorous best practice manufacturing procedures and haven’t been approved by the FDA, it can be difficult for consumers to know exactly what they’re getting.
Although THC is known to share the actions of anandamide (from the Indian Sanskrit word “anand” for bliss or happiness), a naturally occurring compound in the brain, the exact mode of anti-seizure action of CBD is unclear. “It is critical to know how CBD controls seizures, so pharmaceutical companies can design novel synthetic compounds for epilepsy that could surpass the hurdles of mixed CBD extracts,” said Reddy, who directs an epilepsy research lab at Texas A&M. These compounds might provide the benefits without some of the risks—or the legal issues—associated with the marijuana plant.
A standard manufacturing process and clinical trials might help answer some of these questions, but conducting one isn’t easy, and there are currently only 19 clinical trials going on to test the use of cannabinoids for epilepsy. For one thing, cannabis is still listed as a Schedule I substance by the federal government, meaning gaining permission to use it in research on human participants is extremely difficult.
Still, change is occurring at the state level. Recreational marijuana use is legal for adults in four states (Alaska, Colorado, Oregon and Washington) and in 23 states and Washington, DC, medical marijuana is allowed. Texas, in a law passed during the last legislative session in 2015, legalized low-THC cannabis oils for people with intractable epilepsy while still prohibiting medical marijuana more broadly.
A new study at the University of Colorado Anschutz Medical Campus is enrolling Dravet epilepsy patients who have tried Charlotte’s Web, a specific strain of medical marijuana that is low in THC and high in CBD. The researchers will compare the genetics of those who have seen seizure activity decreased dramatically (at least 50 percent) in response to the drug versus those who did not. Although this research could yield useful information about how CBD and genetic factors interact in a Dravet population, it is not the gold standard of scientific drug trials: the randomized, placebo-controlled, double-blinded clinical trial in which patients were randomly assigned to either CBD or a placebo.
As for experts like Reddy, who is a Texas board-certified pharmacist, most are taking a cautious wait-and-see approach.
The American Epilepsy Society (AES) has released a statement on the use of medical marijuana in the treatment of epilepsy stating that due to the lack of data, no conclusion can be drawn at present.
The Epilepsy Foundation doesn’t specifically discourage cannabis use, but urges anyone exploring treatment for epilepsy to work with their treating physician to make the best decisions for their own care and to follow applicable laws.
“Despite all of the controversy about medical marijuana as a potential therapy for epilepsy,” Reddy said, “most people agree that what we need is greater rigorous scientific study into cannabinoids to prove or disprove their safety and efficacy.”