How To Use CBD for Epilepsy

How To Use CBD for Epilepsy
jen keehn

Written by Jen Keehn

Updated February 23, 2021

Dr. Zora DeGrandpre

Medically Reviewed by Dr. Zora DeGrandpre

Ever since the release of Sanjay Gupta's WEED documentary on CNN, people all over the world have been paying attention to CBD's potential to help people with epilepsy – especially children with intractable epilepsy (epilepsy which has poorly responded to treatment).1, 2

We won't say that CBD cures epilepsy – and we don’t think you shouldn't listen to anyone who tells you that. What we (and researchers) will say is that it is a promising and effective treatment for some—especially children—with some forms of epilepsy.

What we can also say is that CBD can potentially improve the lives of people suffering from epilepsy. CBD can reduce seizures and the negative side effects of commonly used anti-epilepsy medications (AEDs).

However, it's important to keep in mind that CBD is not a cure-all for epilepsy. There are some children who do not respond well to CBD treatment and it does not work for everybody.

Side effects, although usually not a problem with CBD, are possible.

Due to the severity of epilepsy, CBD should only be used under medical supervision, especially if CBD is being used on a child with epilepsy.

What is Epilepsy?

Epilepsy is a disorder characterized by recurring seizures. 

A seizure is a sudden surge of electrical activity in the brain. When a seizure occurs, there is an overexcitation of neuronal activity in the brain. There are over forty different types of epilepsy and many different types of seizures. Epilepsy is typically treated with antiepileptic drugs (AEDs).

AEDs are designed to stop or inhibit the excitation of neuronal activity which causes seizures. 

While AEDs do work for some patients, many people do not respond to them and for the ones that do, the side effects can be severe and problematic.

How Does CBD Work to Stop Seizures?

CBD and other cannabinoids like THC and THCA have been shown to successfully work as anti-epileptic agents.  

The majority of research has been focused on CBD because CBD has the ability to stop seizures without being psychoactive. This is especially important for children as well as adults who are not comfortable with the psychoactive effects of THC.

CBD works to stop seizures by helping to improve or enhance the functioning of the endocannabinoid system.

The main purpose of the endocannabinoid system is to help maintain balance (homeostasis) in the body.  The endocannabinoid system (ECS) helps maintains balance by regulating the activity of neurotransmitters, most importantly by sending messages to neurons to either increase or decrease their activity.

Since seizures are a state of overexcitation of neurotransmitter activity, it's thought that the endocannabinoid system plays a crucial role in decreasing the overexcitation of the neurons.

A poorly functioning ECS may also be responsible for chronic seizures.

In studies where scientists purposefully interfered with the normal function of the ECS, it was found that seizure duration and frequency increased.3, 4 

Examinations of surgically removed epileptic human brain tissue and cerebrospinal fluid showed decreased levels of endocannabinoids, enzymes required to make endocannabinoids like 2-AG, and down-regulated cannabinoid receptors.5

The anti-epileptic effects of CBD are still not entirely understood. As the legal situation of cannabis continues to improve, more research will yield new answers and results.

There are Four Main Ways in which CBD May Function as an Antiepileptic Agent

neurons
  • CBD increases levels of our natural endocannabinoid-receptor binding substances (endocannabinoids) by interfering with their degradation. The increased level of endocannabinoids helps the ECS better perform its function of maintaining balance in the body.6 
  • CBD may reduce the excitability of neurons by modulating the flow of ions like calcium and potassium. Endocannabinoids are neuromodulators and CBD can mimic their activity to some extent.7
  • CBD suppresses glutamate activity. This is relevant because glutamate causes neuronal excitation.8
  • CBD is a potent anti-inflammatory agent. CBD reduces inflammation of the brain (neuroinflammation). Brain inflammation is thought to make seizures worse.9

What Are the Benefits of Using CBD For Epilepsy?

Patients who use CBD for epilepsy show:10

Can Using CBD for Epilepsy Have Adverse Side Effects?

One of the best properties of CBD is that it rarely has severe side effects, even at higher doses.

However, this does not mean that the side effects of CBD are non-existent. Patients using CBD for epilepsy should only do so under the supervision of a doctor's care.

Patients using CBD for epilepsy have reported the following side effects:

In a recent randomized, double-blind, placebo-controlled trial on 120 children and young adults with Dravet syndrome, the following side effects were experienced by some subjects:11

Can CBD Interact With My Current Epilepsy Medication?

CBD is metabolized by the same family of enzymes (cytochrome P450) which metabolize AEDs and many other medications.12 

Drug interactions with CBD can occur and result in abnormal blood levels of AEDs.

This is why we recommend for those with epilepsy to only add CBD to their medication regimen under the supervision of a doctor.

Your doctor may recommend you adjust the dosage or time of day you take your AEDs.

You should work with a doctor who has experience working with cannabis medicine.

How Should I Use CBD For Epilepsy?

Patients are using CBD for epilepsy in the form of vaping, sublingual tinctures, oral capsules, and oral concentrates. 

CBD to THC ratios which have shown to be effective are CBD dominant ratios ranging from 2:1 to 20:1 (CBD:THC).13

As is typical with cannabis medicine, patients should start with a low dose and incrementally increase the dose every few weeks depending on the results—the “rule of thumb” is to Start Low and Go Slow.

Epilepsy is a serious, life-threatening condition. CBD should be used only under the supervision of a medical doctor, preferably one experienced in cannabis.

There are three doctors we at CBD School know of who are experienced with working with cannabis and epilepsy patients:

We understand you may not live anywhere near a doctor who specializes in using cannabis.

But that doesn't mean you cannot do consultations over Skype with one.

Reach out to Doctors Patel, Goldstein, and Gedde to find out how you can schedule a Skype consultation with them. Dr. Patel provides some insight with her Q&A section of our article: Is Using CBD Oil for Epilepsy Effective.

What are Terpenes and Can Terpenes Help with Reducing Seizures?

Terpenes are the natural aromatic substances found in nearly all plants and create the scent for that plant. Many terpenes have been shown to have beneficial effects.14  

Terpenes that may have anticonvulsant effects include β-caryophyllene, linalool, pinene, and limonene.15

Other cannabinoids like THCA (the acidic form of THC) and THC may also be effective for reducing seizures.16 THCA is non-psychoactive while THC is psychoactive.

What are the Results of Studies Which Used CBD For Epilepsy?

  • In 1980, 16 patients with seizure disorders unresponsive to treatment were given either CBD or a placebo. Three CBD patients became seizure free, four CBD patients reported improvement.17
  • In 1985, 12 adults with seizure disorders unresponsive to treatment were given either CBD or a placebo. No benefits were reported.18
  • In 2015, preliminary studies indicated a role for cannabinoids in the treatment of epilepsy.19
  • GW Pharmaceuticals, the makers of a pure CBD extract called Epidiolex did trials in the U.S. on children with severe epilepsy. Of 123 patients, 46% reported a decrease in seizure frequency.20 
  • The most recent efficacy and safety systematic review of the use of CBD in epilepsy concluded that “Adjunctive CBD in patients with LGS [Lennox–Gastaut syndrome] or DS [Dravet Syndrome] experiencing seizures uncontrolled by concomitant anti-epileptic treatment regimens is associated with a greater reduction in seizure frequency and a higher rate of AEs than placebo.”1

references

1Lattanzi S, Brigo F, Trinka E, Zaccara G, Cagnetti C, Del Giovane C, Silvestrini M. Efficacy and safety of cannabidiol in epilepsy: a systematic review and meta-analysis. Drugs. 2018 Nov;78(17):1791-804.  

2O'Connell BK, Gloss D, Devinsky O. Cannabinoids in treatment-resistant epilepsy: a review. Epilepsy & Behavior. 2017 May 1;70:341-8.

3Zareie P, Sadegh M, Palizvan MR, Moradi-Chameh H. Anticonvulsive effects of endocannabinoids; an investigation to determine the role of regulatory components of endocannabinoid metabolism in the Pentylenetetrazol induced tonic-clonic seizures. Metabolic brain disease. 2018 Jun;33(3):939-48.

4Smolyakova AM, Zagzoog A, Brandt AL, Black T, Mohamed K, Laprairie RB. The endocannabinoid system and synthetic cannabinoids in preclinical models of seizure and epilepsy. Journal of Clinical Neurophysiology. 2020 Jan 1;37(1):15-27.

5Friedman D, Devinsky O. Cannabinoids in the treatment of epilepsy. New England Journal of Medicine. 2015 Sep 10;373(11):1048-58.

6Corroon J, Felice JF. The Endocannabinoid System and its Modulation by Cannabidiol (CBD). Alternative Therapies in Health & Medicine. 2019 Mar 2;25.

7Watkins AR. Cannabinoid interactions with ion channels and receptors. Channels. 2019 Jan 1;13(1):162-7.

8Gobira PH, Vilela LR, Gonçalves BD, Santos RP, de Oliveira AC, Vieira LB, Aguiar DC, Crippa JA, Moreira FA. Cannabidiol, a Cannabis sativa constituent, inhibits cocaine-induced seizures in mice: possible role of the mTOR pathway and reduction in glutamate release. Neurotoxicology. 2015 Sep 1;50:116-21.

9Atalay S, Jarocka-Karpowicz I, Skrzydlewska E. Antioxidative and anti-inflammatory properties of cannabidiol. Antioxidants. 2020 Jan;9(1):21.

10Morano A, Fanella M, Albini M, Cifelli P, Palma E, Giallonardo AT, Di Bonaventura C. Cannabinoids in the treatment of epilepsy: Current status and future prospects. Neuropsychiatric disease and treatment. 2020;16:381.

11Dos Santos RG, Guimarães FS, Crippa JA, Hallak JE, Rossi GN, Rocha JM, Zuardi AW. Serious adverse effects of cannabidiol (CBD): a review of randomized controlled trials. Expert opinion on drug metabolism & toxicology. 2020 Jun 2;16(6):517-26.

12Brown JD, Winterstein AG. Potential adverse drug events and drug–drug interactions with medical and consumer cannabidiol (CBD) use. Journal of clinical medicine. 2019 Jul;8(7):989.

13Perucca E. Cannabinoids in the Treatment of Epilepsy: Hard Evidence at Last? J Epilepsy Res. 2017 Dec 31;7(2):61-76. doi: 10.14581/jer.17012. PMID: 29344464; PMCID: PMC5767492.

14Cox-Georgian D, Ramadoss N, Dona C, Basu C. Therapeutic and medicinal uses of terpenes. InMedicinal Plants 2019 (pp. 333-359). Springer, Cham.

15Ferber SG, Namdar D, Hen-Shoval D, Eger G, Koltai H, Shoval G, Shbiro L, Weller A. The “entourage effect”: terpenes coupled with cannabinoids for the treatment of mood disorders and anxiety disorders. Current neuropharmacology. 2020 Feb 1;18(2):87-96.

16McCoy B, Wang L, Zak M, Al‐Mehmadi S, Kabir N, Alhadid K, McDonald K, Zhang G, Sharma R, Whitney R, Sinopoli K. A prospective open‐label trial of a CBD/THC cannabis oil in dravet syndrome. Annals of clinical and translational neurology. 2018 Sep;5(9):1077-88.

17Cunha, Jomar M., et al. “CHRONIC ADMINISTRATION OF CANNABIDIOL TO HEALTHY VOLUNTEERS AND EPILEPTIC PATIENTS” Pharmacology 21: 175-185 (1980)

18Ames, F.R., and S. Cridland. “Anticonvulsant effect of cannabidiol.” South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 69.1 (1986): 14-14.

19Blair RE, Deshpande LS, DeLorenzo RJ. Cannabinoids: is there a potential treatment role in epilepsy? Expert Opin Pharmacother. 2015;16(13):1911-4. doi: 10.1517/14656566.2015.1074181. Epub 2015 Aug 3. PMID: 26234319; PMCID: PMC4845642.

20Pauli CS, Conroy M, Heuvel BD, Park SH. Cannabidiol drugs clinical trial outcomes and adverse effects. Frontiers in pharmacology. 2020;11.

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