November is National Epilepsy Awareness month. This year the Epilepsy Foundation is focusing on raising awareness of SUDEP, or sudden unexpected death in epilepsy. It’s estimated that 1 in 150 people who suffer from uncontrolled seizures pass away from SUDEP. There are steps that can be taken to help reduce the risk of harm, and the Epilepsy Foundation provides recommendations on just how to do so.
There are over 2 Million Americans who have been diagnosed with epilepsy. We want to do our part in not only raising awareness of SUDEP and epilepsy, but provide insight to the potential benefits of medical cannabis in treating epilepsy and seizures. There are currently 19 states who support utilizing medical marijuana to help manage epilepsy. In fact, targeted CBD extractions derivative from hemp are legal in all 50 states.
WHAT IS EPILEPSY?
Epilepsy is a chronic neurological disorder characterized by unprovoked, and unpredictable seizures. Epilepsy is caused when nerve cell activity in the brain becomes disrupted, often causing seizures, periods of unusual behavior, and sometimes unconsciousness. Some individuals will experience unprovoked seizures in their lifetime without being afflicted with epilepsy. As always we recommend talking to your primary physician about any health concerns you may have.
Epileptic seizures range from brief episodes, to severe long periods of violent shaking. Seizures are usually preceded by what are known as “auras,” which cause sensitivity to light and sound, and strange smells. Auras may also cause a feeling of fear, the inability to speak, visual hallucinations, nausea, numbness, and tingling sensations.
There are six categories of seizures which people afflicted with epilepsy deal with:
Absence: Characterized by lapses in consciousness.
Myoclonic: Involves sporadic (isolated) jerking movements.
Clonic: Symptoms include repetitive jerking movements.
Tonic: Symptoms include muscle stiffness and rigidity.
Atonic: Least severe type of seizure; involves loss of muscle tone.
Grand Mal: Also known as generalized tonic-clonic, characterized by muscle rigidity, full-body convulsions, and unconsciousness. The most severe and debilitating category of seizure that can be experienced by an epilepsy patient.
Seizures caused by epilepsy are treatable with prescription medication in about 70% of the population, however the remaining 30% have difficulty in finding treatment options. This is where medical marijuana shows promise; in providing relief for those difficult to treat epilepsy patients.
Prior to the prohibition of marijuana, doctors in the 19th century utilized medical cannabis in treating a variety of conditions including epilepsy and seizures. In 1850, medical cannabis was added to the United States Pharmacopeia, noting its use for convulsive disorders. In the following, we will outline promising research on the efficacy of medical marijuana in treating epilepsy.
Research on medical marijuana and epilepsy/seizures started in the mid 1970’s. While this research is promising, there is still not enough definitive evidence to provide a clear cut answer. We strongly recommend seeking medical advice from your primary physician prior to seeking alternative treatments.
One of the first studies on medical cannabis and epilepsy was conducted in 1975 and published in the Journal of the American Medical Association. The study found that when combined with conventional medicine, medical cannabis helped control the seizures in a 24 year old patient. While conventional drugs (Phenobarbital and phenytoin) provided “incomplete control” of the patient’s seizures. He experienced a complete cessation of seizures following a regimen of two to five cannabis joints per day.
Later in, 2003 Dr. Robert DeLorenzo led a study at the Virginia Commonwealth University which was published in the Journal of Pharmacology and Experimental Therapeutics. Lorenzo’s team were the first to provide evidence that cannabinoids can decrease seizures through the activation of the brain’s CB1 receptors (those found primarily in the memory-related areas of the brain and within the nervous system).
“This study indicates that cannabinoids may offer unique advantages in treating seizures compared with currently prescribed anticonvulsants. It shows not only the anticonvulsant activity of exogenously applied cannabinoids, but also suggests that the brain’s cannabinoid system works to limit seizure duration by activating the CB1 receptor,”
“Ingredients in marijuana and the cannabinoid receptor protein produced naturally in the body to regulate the central nervous system and other bodily functions play a critical role in controlling spontaneous seizures in epilepsy.”
In 2013, Catherine Jacobson, M.D. and Brenda E. Porter of the Department of Neurology at Stanford University, conducted a study on the use of cannabidiol-enriched cannabis in children with treatment-resistant epilepsy. The CBD survey consisted of 24 questions that measured clinical factors, the effect of CBD on the child’s seizure frequency and side effects. The CBD survey was presented to a Facebook group composed of parents using CBD to treat seizures in children with treatment-resistant epilepsy. Nineteen responses met the inclusion criteria, which were a diagnosis of epilepsy and CBD use.
Thirteen children had Dravet syndrome, four had Doose syndrome, and one each had Lennox-Gastaut syndrome and Idiopathic Epilepsy. The average number of antiepileptic drugs (AEDs) per child tried before using cannabidiol-enriched cannabis was 12. Sixteen (84%) of the 19 parents reported a reduction in their child's seizure frequency while taking cannabidiol-enriched cannabis. Of these, eight (42%) reported a greater than 80% reduction in seizure frequency, six (32%) reported a 25-60% seizure reduction, and two (11%) reported complete seizure freedom. Other beneficial effects included increased alertness, better mood, and improved sleep. Side effects included drowsiness and fatigue.
One of the largest studies on medical marijuana and treatment-resistant epilepsy was conducted this past December and found more promising results. The research was led by neurologist Dr. Orrin Devinsky, director of the Comprehensive Epilepsy Center at New York University Langone Medical Center. The researchers treated 162 patients with 99% cannabidiol (CBD) extract. The study spanned a period of twelve weeks and was conducted in 11 separate epilepsy centers.
The results showed a median 36.5% reduction in monthly motor seizures, with the median monthly frequency of motor seizures falling from 30 motor seizures a month at the study’s start to 15.8 over the 12 weeks. Equally important, CBD was shown to have a sufficient safety profile and was well-tolerated by many patients, despite some isolated adverse events.
“We are very encouraged by our trial results showing that CBD was safe and well-tolerated for most patients, and that seizures dropped significantly,” says Devinsky. “But before we raise hopes for families who regularly deal with the devastation of treatment-resistant epilepsy, more research, including further studies through our ongoing randomized controlled trial, are needed to definitively recommend CBD as a treatment to patients with uncontrolled seizures.”
Despite Devinsky’s research, he still cautions that “I think, based on the evidence that we have, if a child has tried multiple standard drugs and the epilepsy is still severe and impairing quality of life, then the risks of trying CBD are low to modest at best,” Devinksy says. “[But] I do feel it is critical for us as a scientific community to get [more] data.”
While there is still much research to be conducted on CBD/medical marijuana as an alternative treatment option for epilepsy and seizure patients, one recent story sticks out as awe inspiring. Charlotte is one of many young children who suffers from Dravet Syndrome and was dealing with uncontrollable and lengthy seizures, roughly 300 times per week. Charlotte’s parents began administering CBD and found some truly astonishing results.