An epilepsy diagnosis can throw an unexpected blow not only for those experiencing chronic seizures, but their families as well, especially when mainstream treatment heavily relies on daily prescription medications often loaded with side effects.
Cannabis used as a medicinal form of treatment for anticonvulsant properties connects back to early civilizations in ancient China, Africa, Rome, and Greece, with documented uses going back as early as 1100 AD by Arabic writer al-Mayusi. In contrast, it is still difficult to find research into the cannabis plant’s medicinal properties, as economic and political interests in today’s culture (in the west, at least) have been more centred around suppression and control. It has been long recognized that natural remedies and ancient, anecdotal, wisdom is often overlooked by the scientific medical world we are surrounded by today.
Researchers are aiming to discover and create treatment procedures for epilepsy patients with the use of cannabis, as this is one remedy not to be overlooked as it’s benefits could be life-changing to many epilepsy sufferers. According to the Royal College of Physicians in Ireland, Irish neurologists are producing guidelines to provide clarity on the topic.
Dr. Colin Doherty, the spokesperson for the epilepsy clinical advisory group, showed that the cannabadiol (CBD) product known as Epidiolex was quickly unfolding as a top contender as a treatment option for severe epilepsy in the United States.
What Is a Cannabadiol?
A Cannabadiol (CBD), which the U.S. drug Epidiolex is derived from, is one component of an estimated 113 active cannabinoids known to be in cannabis. CBD is known to account for around 40% of the cannabis plant’s extract, making it a significant phytocannabinoid. CBD is considered to cover a wide range regarding potential medical applications.
As a purified, 99% oil-based CBD extract, Epidiolex is known to be made in order to give consistent dosing through producer, GW Pharmaceuticals. Some centres for Epilepsy have been granted permission from the U.S. Food and Drug Administration (FDA) to use this product on a limited number of patients at each centre, based on what is referred to as “compassionate use”.
An open-label study (no placebo control) was conducted on 214 epilepsy patients who received the 99% CBD pharmaceutical Epidiolex for 12 weeks or more. The results showed that those who received the drug were between the ages of 2 and 26, with the median age being 11. Those who were already on the anti-seizure medication called clobazam showed higher incidents of response compared to patients not using this medication prior. All of the patients in the study had epilepsy and were not responding to currently available treatments, however, during the study their seizures were shown to decrease by 54%, on average.
Aside from CBD, it has been shown that no other derivatives of cannabis have been adequately studied to such a degree that they would be shown to be safe and effective to use in a clinical setting. The lack of evidence surrounding long-term benefit as well as long-term side effects have been the primary barriers to cannabis derivatives being prescribed for treatment of epilepsy. Doherty has gone on to say that, aside from the drug Epidiolex, there have been no other cannabis products backed by a licensing or scientific jurisdiction.
While Doherty has said that specific products containing cannabis appear encouraging as a course of treatment, there are others which both hold potential harm and are not held under proper testing. THC in specific is one of the cannabis derived products which remains inadequately assessed, and holds potentially harmful psychoactive effects, specified Doherty.
This group of neurologists, as expected, remained conscious about how impactful an epilepsy diagnosis is for children and adults alike, as well as the potential for helplessness felt by their impacted families.
The group was confident in their commitment to ensure that any and all treatments for adult and child epilepsy are demonstrated to be both safe and of value to patients. This notion proves to be of most importance when used with children because of their rapid brain development.
Can Cannabis help Seizures?
Evidence has routinely shown that cannabidiol holds potential in being helpful in controlling seizures, due to it’s non-psychoactive compounds. Evidence has come from anecdotal reports, studies done in a lab, as well as small clinical studies conducted several years ago. Implementing these studies have proved difficult due to time and financial restrictions. Additionally, researchers are bound by federal regulations, which means extremely limited access to cannabis, and cannabidiol in particular.
Potential side effects?
Marijuana is broken down in a user’s liver like many medicines, even though it is in plant form. The misbelief that it is completely safe because it is in plant or oil form (such as CBD) is unsound. Additionally, there are medical interactions that have potential to occur that require testing. The effects felt from marijuana often vary dependant on how the product was consumed, through eating or smoking.
Speaking to cannabidiol (CBD) directly, in relation to the open-label study outlined above, side effects felt in 10% or more of the patients consisted of:
- Fatigue (17%)
- Diarrhea (17%)
- Decreased appetite (16%)
- Sleepiness (21%)
The majority of the side effects felt were mild to moderate and went away. Of the 214 participants, 52 experienced serious side effects. 22 were thought to have had a reaction to the drug, with the most common being incidence of long or repeated seizures (otherwise called status epilepticus).
Data regarding drug to drug interactions with use of CBD in epilepsy patients has shown that:
- As the drug clobazam breaks down, there seems to be an interaction with CBD in certain patients, which causes increased fatigue in those who are using both clobazam and CBD.
- There were some patients who showed an increase in liver enzymes (up to three times or more the normal level) were also using valproic acid. VPA is an anti-seizure medication commonly used. It was concluded that as VPA breaks down in the system, one of it’s constituents possibly interact with CBD, as the VPA levels in the body were not seen to increase with paired use of CBD. This interaction can put some people at an increased risk for issues with their liver.