Epilepsy is a relatively common chronic neurological disorder that causes recurrent seizures over time. It is estimated that around 65 million people around the world live with the disease, with 3 million in the U.S. alone. Medical cannabis has proven to help reduce the instances of seizure and particularly helpful for patients that do not respond to anticonvulsants.
Seizures result from a sudden and abnormal electrical activity in the brain and the central nervous system. Anyone can develop epilepsy; however, it is more common in old adults and young children and also a bit more common in males. This condition has no cure and is currently managed using medications and other therapies (including medical cannabis).
The seizures caused by epilepsy vary in manifestation from small, unrecognizable shakes to violent convulsions characterized by total loss of motor control. The small seizures do not pose a major health threat; however, extended convulsions can lead to permanent brain injury.
Patients suffering from epilepsy show different symptoms. This is normally categorized depending on the severity of the seizures, which depend on the cause of epilepsy and the side of the brain affected.
Potential symptoms before a seizure occurs:
- Anxiety (or feeling afraid)
- Distorted, change or loss of vision
Symptoms during a seizure:
- Loss of consciousness
- Loss of orientation or confusion
- Clenching teeth or biting tongue
- Loss of bladder control and bowel movement
- Drooling or foaming from the mouth
Some patients have reported strange sensations such as smelling an odor that is not actually there, mood swings and tingling before a seizure episode.
How medical cannabis can help in treating epilepsy
There has been evidence from a wide range of small clinical studies, laboratory tests and anecdotal reports over the years, suggesting that cannabidiol, the non-psychoactive compound in cannabis, can help treat epileptic seizures. Due to federal regulation, however, these studies have been limited in both scope and depth, leaving a lot of room to cover, but the initial results are already very promising.
The potential benefits of using marijuana to treat seizures caused by epilepsy were brought to the limelight when an 8-year-old girl from Colorado was featured on CNN. Reportedly, medical marijuana helped Charlotte Figi reduce her epileptic seizures dramatically. Now, even more studies are shedding more light on how cannabis can help, especially for patients not responding to the normal anticonvulsants.
A team of researchers at the New York University Langone Medical Center lead by Orrin Devinsky carried out a large study to test cannabis’ effectiveness in managing treatment-resistant epilepsy. The study tested 162 patients with an extract of 99% cannabidiol oil (CBD oil) and monitored them for 3 months. The treatment was given on top of the patients’ medications.
The study showed that cannabis was able to reduce the instances of seizures by the same rate as prescription drugs and 2% of the subjects did not show any signs of seizures. However, a large number of the group (79%), reported adverse side effects such as sleepiness and fatigue. The effects were not high enough to cause the treatment to be brought to a halt.
To date, Devinsky’s study is the strongest pointer to marijuana’s effects in controlling seizures since all the rest were done on a subject group of less than 20 individuals. Hirsch and Detyniecki published a subsequent commentary on the same journal citing the limitations of the study which included placebo effects and drug interactions. However, the same researchers are currently carrying out blind and placebo-controlled clinical trials to test CBD on Lennox-Gastaut syndrome, a different form of epilepsy that does not respond to treatment.
Depending on the mode of ingestion, cannabis has some side effects. For instance, when smoked, the risk factors related to smoking will apply. Side effects of the specific cannabis preparations used in most clinical trials and anecdotal reports have not been well recorded. This is mostly because varying strains and doses were used. However, increased appetite and short-term memory problems have been extensively cited.
It is also important to note that even though cannabis is a plant, its compounds, just like any other drugs, are broken down in the liver and hence, interactions with other drugs is highly possible.
Epileptic seizures are caused when clusters of cells in the cerebral cortex are activated abruptly, triggering an excess of electrical energy. The effects of the seizures such as loss of consciousness, minor spasms, falling, uncontrollable shaking etc. all depend on the area where the hyperactivity is happening. In most epilepsy cases, the cause is usually idiopathic or unknown.
The condition occurs when brain tissue undergoes permanent changes that lead it to become highly excitable hence sending abnormal signals repeatedly. A single seizure that does not recur is not considered epilepsy.
Some of the common causes include:
- Dementia (Alzheimer’s disease)
- Traumatic brain injury
- Congenital brain defects
- Transient ischemic attack or stroke
- Brain injury during or near birth
- Brain tumor
- Infections such as; meningitis, brain abscess, encephalitis, AIDS etc.
- Metabolic disorders that exist since birth e.g. phenylketonuria
- Abnormal blood vessels in the brain
- Some medication such as antidepressants, cocaine, amphetamines, tramadol etc.
- Illnesses that destroy brain tissue
Currently, epilepsy has no cure, treatment may involve medication or even surgery. Surgery is often used when the condition is as a result of a tumor, bleeding in the brain or presence abnormal blood vessels.
Anticonvulsants are the drugs used to reduce the severity and frequency of future seizures. They are mostly taken by mouth and also depend on the type of seizures manifested by the patient. The dosage is usually adjusted regularly and frequent blood tests are also common to check for side effects. Most of the anticonvulsants have been shown to cause birth defects and therefore, women wishing to get pregnant have to talk to their physicians about adjustments.
Some types of epilepsy do not respond to medication this is called “medically refractory epilepsy.” Patients can also be treated by placing a Vagus Nerve Stimulator (VNS), an electrical device that helps reduce the number of seizures.
Based on the evidence already available, if a patient has tried various standard medication with no improvement to the seizures, the medical cannabis, more specifically CBD, is a low-risk alternative. As the scientific community looks at more data, there is much to hope for, however, patients should be cautious until the full effects of cannabis are investigated.