Over the last decade, the number of documentaries, patient testimonies, and anecdotal stories concerning the treatment of seizures using cannabis has skyrocketed. Indeed, it has become one of the most well-known medical uses of the plant alongside mitigating the effects of chemotherapy for cancer patients.
The benefits of cannabis in the treatment of epilepsy and seizures has been most widely publicized with its use for children, so it is important that we are able to separate the facts from the hype and identify any potential side effects of the technique.
Why Do People Look to Cannabis as a Treatment?
Cannabis plants (those of the family Cannabaceae) contain over 545 compounds, the most important of which are known as cannabinoids such as ∆9-tetrahydrocannabinol (THC), cannabidiol (CBD), and cannabinol (CBN). Different strains of the plant contain different proportions of these and about 60 other cannabinoids, leading to different medicinal or recreational effects.
With regards to epilepsy and seizures, we are primarily interested in the cannabinoid CBD, which is non-psychoactive and primarily affects CB-2 receptors throughout the body. CBD is found in very low concentrations in most recreational cannabis, however, can be very high in hemp or CBD concentrated strains of Cannabis sativa.
The compound works as an antagonist, or inhibitor, at several receptors which causes a decrease in neural excitability. Neuronal excitability is the term used to describe how likely a neuron is to fire, or in the case of seizure activity, misfire. This is why CBD may have potential in treating seizures.
What Causes Seizures?
A seizure involves irregular electrical activity in the brain, which may lead to:
- Changes in behavior
- Altered awareness
- Unpredictable muscle movements
There are many causes or triggers of seizures which are considered acute, and include:
- Low blood sugar
- Reaction to medicines or drugs
- Lack of sleep, and others
These are usually of short duration, and although once a person has one, they are more prone to have others, it may be quite rare within their lifetime.
Epilepsy, however, is a condition in which seizures become chronic and frequent and require consistent treatment and medications. Not only are seizures physically dangerous, they have been corelated with reduced neurodevelopment, mood alteration, learning disabilities, and an overall decrease in quality of life.
When onset in childhood, it is quite common for these seizures to be resistant to anti-epileptic drugs (AEDs), Ketogenic diets, steroids, or surgery. It is these types of seizures that we will be discussing in this article, as these are the ones in which treatment using cannabis has shown most promising.
Studies Involving Cannabis and Seizures
One of the first comprehensive studies regarding the treatment first appeared on the National Institute of Health website in 2013. In this study, 19 parents who were part of a Facebook group were surveyed to collect information on their experiences.
All had previously tried multiple other treatments, with an average of 16 different AEDs per child prior to using cannabidiol (CBD)-enriched cannabis. The results were startling, with 84% (16 parents) reporting decreases in seizure frequency.
Of those, 2 had no seizures, 8 had an over 80% reduction, and 6 had up to 60% reduction. The parents also reported that, compared to the AEDs, their children had increased alertness, better mood, and improved sleep. A similar study involving 75 adolescents in Colorado showed a third of those receiving CBD had over 50% reduction in seizures.
Although these were only surveys, double-blind placebo-controlled studies have also been published on the topic.
In 1978, a study by Mechoulam et al randomized 9 patients to either a placebo or 200mg daily dose of CBD, and found that after 3 months half the treatment group was seizure free with no changes in the placebo group.
A larger study in 2013 involved 10 epilepsy centers using CBD to treat children and young adults, and found that out of 137 patients, the median reduction in seizures was 54%
Furthermore, studies in animals have provided evidence of a mechanism for the effect of cannabis on seizures, with relationship to the hippocampus. The hippocampus is known to cause seizures with the release of potassium ions causing what is known as hippocampal seizures. In several studies conducted between 1970 and 1996 it was shown that CBD effectively blocked the release of potassium ions from the hippocampus in rats, thus preventing this type of seizure.
Treatment of Seizures Using Cannabis
The treatment of epileptic seizures using cannabis is actually documented back to 1800 BCE amongst the Sumerians. It was well documented throughout the Victorian Era, however fell out of use following the Marijuana Tax Act of 1937. Despite being deemed by the US government as a Schedule I Drug with “no medicinal benefits,” several studies were carried out over the last 40 years regarding cannabis and epileptic seizures.
In the 1990’s, anecdotal stories started to emerge of parents using high CBD cannabis oils to treat their children’s epilepsy, and with the rise of social media and the internet these stories became so prevalent they could no longer be ignored. Throughout the last 40 years, many parent’s stories have been documented, and epidemiological studies have indicated that more focused research was needed to investigate these claims.
What are the Side Effects?
From the studies and surveys described above, the risks and side effects of using cannabis to treat seizures were far less than conventional AEDs. The most commonly reported side effects were drowsiness and fatigue. However, other beneficial effects were also reported by parents, including:
- Better mood
- Increased alertness
- Better sleep
- Decreased self-stimulation
This is compared with the side effects of conventional AEDs, which are highly reported and include:
- An overall decrease in quality of life
Some studies have indicated that using cannabis during adolescence can lead to adverse effects on brain development, however all of these studies were conducted with full spectrum cannabis high in THC content, and not just CBD. According to a 2014 Cochrane Study which was supported by the American Academy of Neurology, it was concluded that “no reliable conclusions can be drawn at present regarding the efficiency of cannabinoids in the treatment for epilepsy” due to a lack of data. These studies did little to sway public opinion however, and most concerns revolve instead around regulation.
Currently, most CBD concentrated cannabis oil is purchased through retail markets in legal states, and through the black market it states where it is still illegal. In both cases, there is little testing or oversight in the manufacture, labeling, or sale of the product.
It can be very common for parents to receive medication that is either not what is claimed, or that is contaminated with fungus or pesticides. It is also very important that users are getting cannabis products with little to no THC, which can actually activate seizures rather than suppress them. In either case, we still highly recommend consulting a doctor before beginning any new treatment, and always insist on third party testing for any products you purchase.