Cannabis and Seizure Disorders
“Epilepsy refers to a spectrum of chronic neurological
disorders in which clusters of neurons in the brain sometimes signal abnormally
and cause seizures (NINDS, 2016a).
Epilepsy disorder affects an estimated 2.75 million
Americans, across all age ranges and ethnicities (NINDS, 2016a).
Although there are many antiepileptic medications currently
on the market, about one-third of persons with epilepsy will continue to have
seizures even when treated (Mohanraj and Brodie, 2006).
Both THC and CBD can prevent seizures in animal models (Devinsky
et al., 2014).”
Epilepsies are the
third most common class of neurological disorders.
Cannabinoids THC and CBD bind themselves to endocannabinoid receptors,
which are located throughout the brain, and body. When cannabis, high in CBD,
is consumed – these cannabinoids go to work in halting the seizure activity
within the brain.
Some parents turned to cannabis, only after trying multiple
anti-epilepsy drugs (AED) that have failed for their children’s epilepsy,
because they were frustrated by little to no results from the AEDs. High CBD
cannabis was given to some of these children who were suffering from hundreds
of seizures per week. CBD oil halted these seizures.
Parents moved to legal states, like Colorado, where they
could get access to this high CBD oil. Companies started cultivating these high
CBD strains and developed products to help adults and children with
neurological disorders, such as seizures.
History of Cannabis
and Seizure Disorder
The earliest descriptions of cannabis use to treat
epilepsies are from medieval Arabic medical texts. As early as the 10th century, the Persian medical
writer al-Majusi recommended that the juice of hemp leaves be poured into the
nose to prevent seizures. https://www.tandfonline.com/doi/abs/10.1300/J175v01n01_05
In the 15th century, the polymath al-Badri
claimed that the epilepsy of a son of the caliph’s chamberlain was successfully
treated with cannabis resin, although modern scholars question the veracity of
this account.
in The Herb: Hashish Versus Medieval Muslim Society
in The Herb: Hashish Versus Medieval Muslim Society
Cannabis and Seizure
Disorder used Today
Anti-epilepsy drugs (AEDs) are the primary treatment option
for seizure disorders. Some patients experienced little to no help at all from
these AEDs. 30 percent of epilepsies do not respond to currently available drug
treatments, over 20 million people worldwide have drug-resistant epilepsies. https://www.ncbi.nlm.nih.gov/pubmed/17874969
These facts underscore the pressing need for new, effective
AEDs. There is potential use in cannabis medicine. Researchers have long known
that both THC and CBD can cause and prevent seizures.
https://www.ncbi.nlm.nih.gov/pubmed/24854329
https://www.ncbi.nlm.nih.gov/pubmed/24854329
Cannabis has been used to treat several severe childhood
epilepsies, including Dravet Syndrome, which strikes very young children with
catastrophic results and can be life-threatening.
https://www.thieme-connect.com/products/ejournals/pdf/10.1055/s-0037-1598109.pdf
https://www.thieme-connect.com/products/ejournals/pdf/10.1055/s-0037-1598109.pdf
Reviews and Studies
on Cannabis and Epilepsy
“We identified two systematic reviews of randomized trials
assessing the efficacy of cannabis or cannabinoids, used either as monotherapy
or in addition to other therapies, in reducing seizure frequency in persons
with epilepsy. Gloss and Vickrey (2014)
published a systematic review of randomized controlled trials. They identified
four reports (including one conference abstract and one letter to the editor)
of cannabinoid trials, all of which they considered to be of low quality.
Combined, the trials included a total of 48 patients. The systematic review's
primary prespecified outcome was freedom from seizures for either 12 months or
three times the longest previous seizure-free interval. None of the four trials
assessed this endpoint. Accordingly, Gloss and Vickrey asserted that no
reliable conclusions could be drawn regarding the efficacy of cannabinoids for
epilepsy.
Koppel et al. (2014)
published a fair-quality systematic review. They identified no high-quality
randomized trials and concluded that the existing data were insufficient to
support or refute the efficacy of cannabinoids for reducing seizure frequency.
Recent systematic reviews were unable to identify any
randomized controlled trials evaluating the efficacy of cannabinoids for the
treatment of epilepsy. Currently available clinical data therefore consist
solely of uncontrolled case series, which do not provide high-quality evidence
of efficacy. Randomized trials of the efficacy of cannabidiol for different
forms of epilepsy have been completed and await publication.”
-The Health Effects of Cannabis and Cannabinoids:
assessments on therapeutic efficacy of CBD in epilepsy
https://www.ncbi.nlm.nih.gov/books/NBK425767/
https://www.ncbi.nlm.nih.gov/books/NBK425767/
The anti-epilepsy effects of cannabinoids have been studied
since the mid-1970s.
Fried and McIntyre 1973
Fried and McIntyre 1973
Research focus has been primarily on CBD as an AED, with other cannabinoids, CBDV and THCV, in early
human trails.
Cannabidiol (CBD) reliably delivers a range of
anticonvulsant effects with few known adverse results and no intoxication.
Cannabidivarin (CBDV) is a non-psychoactive cannabinoid that
will not cause the euphoric feeling of being “high.” It is found more
prevalently in indica strains, specifically landrace indica strains, and
strains that are lower in THC. Like CBD, CBDV significantly reduces the
frequency and severity of seizures. It also reduces or even eliminates nausea
associated with several conditions, and helps to reduce inflammation throughout
the body. CBDV is also beneficial in the treatment of pain and mood disorders.
Tetrahydrocannabivarin (THCV) is a marijuana compound that
potentially provides people with an array of benefits and unique effects. THCV
was discovered in 1973 and is an extremely well-studied cannabinoid. THCV is only
psychoactive in high doses. In low doses, THCV acts as an antagonist of the CB1
receptor, which means you won’t experience a ‘high’. When you increase the dose
THCV switches behavior and acts as a CB agonist, like THC, which means
you WILL get a ‘high’ feeling. There is evidence that THCV reduces seizures and
since it is non-intoxicating in smaller doses, could be a useful way to treat
children with epilepsy.
https://www.marijuanabreak.com/thcv-tetrahydrocannabivarin
https://www.marijuanabreak.com/thcv-tetrahydrocannabivarin
The results of a GW trial in Dravet syndrome released in
December 2016, for their Epidiolex product containing CBD dissolved in sesame
oil showed at a dose of 20 mg of CBD per kilogram of patient weight, 43 percent
of CBD patients had a greater than 50 percent reduction in convulsive seizures
compared to 27 percent of patients taking placebos.
An additional four CBD patients achieved convulsive seizure
freedom during maintenance. 93 percent of patients were on multiple AEDs during
the CBD trial. The effect of these AEDs on efficacy will be explored more in
the future.
THCV in cell and animal models of epilepsies produces
contradictory results. https://www.ncbi.nlm.nih.gov/pubmed/20196794
Following promising animal studies, clinical trials of CBDV
for treatment of seizure disorders could begin soon.https://www.ncbi.nlm.nih.gov/pubmed/22970845
CBG is another cannabinoid that may exhibit anti-seizure
properties. Synthetic cannabinoids that target the CB1 receptor have so
far demonstrated significant anti-seizure activity in animal models of chronic
epilepsy.
https://www.fasebj.org/doi/abs/10.1096/fasebj.27.1_supplement.660.2
https://www.fasebj.org/doi/abs/10.1096/fasebj.27.1_supplement.660.2
Reports in 2016-2017 have shown that the concentration of
linalool in particular cannabis cultivars exhibited anticonvulsant activity in
human patients.
https://www.ncbi.nlm.nih.gov/pubmed/28254350
https://www.ncbi.nlm.nih.gov/pubmed/28254350
How Cannabis Helps
Seizure Disorder
The mechanism by which cannabinoids inhibit seizure activity
is still not understood, but certainly extends beyond interaction with the
cannabinoid receptors CB1 and CB2 to other receptor systems within the body.
A cannabinoid might modulate neural circuitry to gain
control over seizure activity, here are the different receptors and ion
channels in the nervous system that have been linked to the THC’s limited
anti-seizure activity: CB1, CB2, TRPA1, TPRV2, TRPM8, GPR55, 5-HT3A, PPARy, u-
and delta-opioid receptors, the beta-adrenoreceptors, and calcium, potassium,
and sodium ion channels.
CBD doesn’t activate CB receptors, but it does activate the
TRPV1 receptor, calcium and sodium ion channels, the 5-HT1A and 5-HT2A
receptors, the GPR55 and the adenosine receptors A1 and A2, and more.
Linalool, a terpene found in some cannabis strains, has
anticonvulsant effects.
https://www.ncbi.nlm.nih.gov/pubmed/20452289
https://www.ncbi.nlm.nih.gov/pubmed/20655301
https://www.ncbi.nlm.nih.gov/pubmed/20452289
https://www.ncbi.nlm.nih.gov/pubmed/20655301
It will likely take some time to sort out incredibly complex
potential receptor interactions to determine the cannabinoid mechanisms of
action for the dozens of different seizure disorders.
Dosing with Cannabis
Dosage guidance depends upon the type of disorder and the
cannabinoid being used. Consultation with a physician is highly recommended to
help determine appropriate guidelines. Daily doses are important to help keep seizure activity at bay.
Typically, a CBD protocol begins with a dose of 10 mg twice
a day, then this dose is doubled every 3 days until seizure control or the
daily dose equals 20 mg per kilogram of the patient’s body weight.
Conventional oral use is typical, since doses tend to be
large, up to 1200 mg per day, for patients who have been treating with cannabis
for some time.
Some Adults use herbal cannabis in combination with
conventional AEDs. Some adults achieve seizure control with herbal cannabis
alone, that they smoke or vaporize.
Chemotypes of medicinal cannabis to look for are CBD
varieties, such as ACDC, Harlequin, Dance World, Sour Tsunami, and Ringo’s
Gift, have become popular among adult patients with seizure disorders.
CBDV and THCV varieties are very rare, however, some local
dispensaries may carry special medications such as oil, or edibles highlighting
these specific cannabinoids.
You can use Leafly.com
to find a dispensary near you that offers specific products with a high CBD
cannabinoid content, or Linalool terpene content. It is easy to find medical
marijuana with high CBD oil, just make sure to purchase from a reputable
source. Talk to a trusted physician who knows and understands your medical
condition and cannabis and the endocannabinoid system. Finding the best dose,
or medication, that works for you may take some time and patience.
If you are looking for a Medical Marijuana Doctor near you,
who can help you find the right cannabis medicine for your specific seizure
disorder, you may visit MarijuanaDoctors.com
Information about Cannabis and Seizure Disorder was taken
from the amazing book:
Cannabis Pharmacy – The Practical Guide to Medical
Marijuana by Michael Backes, Andrew Weil, M.D. and Jack D. McCue, M.D.,
medical editor
More Articles for
research on Cannabis and Seizure Disorder
The Epilepsy Foundation: Medical Marijuana and Epilepsy
Epilepsy Society: Cannabis Oil for Epilepsy
Cannabinoids in the Treatment of Epilepsy
WebMD: Low Dose of CBD Liquid Eases Epilepsy Seizures
Project CBD: Epilepsy and Seizure Disorders