Benefits of Medical Marijuana for Epilepsy

Medical marijuana (cannabis) has been studied to treat several neuropsychiatric disorders and health conditions, such as Alzheimer’s disease, multiple sclerosis, HIV/AIDS, Crohn’s disease, glaucoma, and epileptic seizures.

In June 2018, the U.S. Food and Drug Administration approved Epidiolex, the first plant-based CBD (cannabidiol) formulation for the treatment of two rare forms of childhood-onset epilepsy: Lennox-Gastaut syndrome (LGS) and Dravet syndrome. In 2020, Epidiolex was further approved to treat tuberous sclerosis complex (TSC), a rare genetic disorder causing benign brain tumors that can lead to seizures. This CBD oral solution can be used in adults and children as young as 1 year old.

Epidiolex is classified as medical cannabis (commonly referred to as medical marijuana). Epidiolex is a CBD-based oral solution manufactured from the Cannabis sativa plant; this oral liquid is available at a concentration of 100 mg/mL that is strawberry-flavored. Epidiolex is a clear, colorless, or sometimes yellowish solution dispensed in a child-resistant amber glass bottle.

The FDA approval of Epidiolex is the result of numerous studies in the U.S. over several years. This approval also proves that marijuana contains active ingredients that can lead to ground-breaking medical treatment of drug-resistant seizures and other health conditions.

Please continue reading to learn more about the use of medical marijuana for epilepsy treatment.

What is medical marijuana?

Medical marijuana or cannabis is obtained from the Cannabis sativa and Cannabis indica, and Cannabis ruderalis plants. The term cannabis generally refers to the whole plant, while marijuana is the dried leaves, stems, and female flowers of the cannabis plant. Medical cannabis, which is obtained from the whole cannabis plant, contains chemicals used for medical purposes.

Cannabinoids are the major substances in cannabis that affect cannabinoid receptors in the body—THC and CBD are the two major ingredients.

Tetrahydrocannabinol (THC) is the psychoactive component that causes what is commonly called “getting high.”
Cannabidiol (CBD) does not have psychoactive effects. However, it has shown some beneficial effects on certain body systems. CBD is the chemical compound that has been shown effectiveness in reducing seizure frequency in some people with epilepsy.

Does cannabis help seizures?

Studies have shown that cannabidiol (CBD) can help reduce seizures in specific groups of people with epilepsy who have not responded to conventional antiepileptic drugs. This has led the U.S. Food and Drug Administration (FDA) to approve a medication called Epidiolex, which contains purified (over 98%) CBD extract from the cannabis plant.

Double-blind placebo-controlled clinical trials have been done. In such clinical trials, researchers give a placebo (a sham substance or “sugar pill”) to one group and CBD at different doses to other groups. The researchers do not know who is getting a placebo versus CBD. Here are some of the key findings of various clinical trials.

Clinical Trial #1

CBD was given twice a day for 14 weeks to people with Lennox-Gastaut syndrome who had two or more drop seizures each week.
All study participants were taking other anti-seizure medications.
The treatment resulted in a reduction in drop seizure frequency from baseline by nearly 42% in the group receiving 20 mg CBD and 37% in the group receiving 10 mg CBD. This was compared to around a 17% reduction in the placebo group.
Only a small number of people needed to stop taking Epidiolex due to side effects. This was usually the case in people taking higher doses of CBD.
The change in liver function is the most frequent cause of discontinuing Epidiolex.

Clinical Trial #2

This clinical trial looked at the effects of placebo or CBD oral solution (20 milligrams per kilogram of body weight per day) given in addition to standard seizure medications for Dravet syndrome and drug-resistant seizures.
During the CBD treatment period, 43% of patients taking cannabidiol showed at least a 50% reduction in convulsive seizure frequency. This was compared to 27% of patients in the placebo group. However, there was no significant reduction in non-convulsive seizures.
5% of people became seizure-free with CBD compared to 0% with placebo.
Adverse events in the CBD group included vomiting, diarrhea, fatigue, sleepiness, fever, and abnormal liver function tests.

Clinical Trial #3

People ranging in age from 2 to 26 years old received Epidiolex.
All patients had drug-resistant seizures that had not responded to currently available epilepsy treatments.
Epidiolex (99% CBD) was given for at least 12 weeks.
Patients reported that seizures decreased by 54% on average.
Study participants who were also taking the anti-seizure medication clobazam (Onfi) responded better than those who were not on this medicine.

What are the side effects of Epidiolex?

The most frequent adverse effects of Epidiolex treatment are effects on liver function. Common side effects of Epidiolex include sleepiness, sedation, and lethargy, especially at higher doses. Other commonly reported side effects of Epidiolex include decreased appetite, diarrhea, malaise, fatigue, lack of energy, insomnia, sleep disorders, rash, and infections.

Note that the risk of increased liver enzymes is higher when Epidiolex is taken with another anti-seizure medication called valproic acid (Depakote, Valproate). CBD also has drug interactions with other anti-seizure medications like topiramate (Topamax) and zonisamide (Zonegran), as well as other medications not used to treat epilepsy.

Should I take medical cannabis for epilepsy if other medications have not worked to treat seizures?

Your medical providers can help you decide if Epidiolex (medical marijuana) is right for you. Keep in mind that Epidiolex is only FDA-approved to treat certain epilepsy syndromes that have not responded to traditional treatments. It will not reduce seizure activity in every type of epilepsy.

With that said, if conventional treatments have not worked to control seizures, medical marijuana may be a viable option for you. However, you should only take medical marijuana for your epilepsy after a thorough evaluation by a doctor specializing in treating epilepsy and other neuropsychiatric disorders.

Your doctor may recommend Epidiolex after you have tried all other treatment options, including FDA-approved medicines, dietary therapy, and other therapeutic measures.

Will medical marijuana give me enough seizure control to stop other medications?

Some people can achieve sufficient seizure control with medical marijuana to the point that they can stop their other anti-seizure medications. However, this is not the case for everyone. Always make decisions regarding continuing or discontinuing seizure medications under the guidance and supervision of your treating physician.

What if my physician won’t prescribe medical marijuana for epilepsy?

CBD has been studied for the treatment of epilepsy and other neurological conditions. However, it may not benefit everyone with epilepsy. Your physician will consider various factors, such as your overall health status, other medications, baseline seizure control, and medical history, before deciding to give you medical marijuana for epilepsy. You should work with your treating healthcare provider to develop a treatment plan.

What’s the difference between commercial grade CBD, dispensary grade CBD, and Epidiolex?

Commercial grade CBD is available in health food stores; however, It is not subject to regulations regarding safety and efficacy. Examples of commercial-grade products include CBD oil, gummies, and topicals. Dispensary-grade CBD is available in medical marijuana dispensary stores and is subject to certain regulations concerning safety and efficacy. Epidiolex is an FDA-approved drug for epilepsy that contains purified CBD. It is carefully formulated with stringent quality control to provide a uniform strength and concentration of CBD. Also, it has undergone clinical trials to ensure safety and efficacy.

Using commercial-grade CBD to treat epilepsy can be very dangerous. These products are available over-the-counter in health food stores. However, they may not contain the exact amount of CBD mentioned on the label. They may also contain contaminants like mold and bacteria. Changes in the consistency of CBD in these products may lead to changes in seizure frequency and severity.

If you want to consider medical marijuana therapy for epilepsy, you should discuss this treatment option with your doctor. It is important always to take medical marijuana exactly as directed under the supervision of your doctor.

References:

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8bf27097-4870-43fb-94f0-f3d0871d1eec