The FDA has approved a CBD drug for the treatment of epilepsy. Read about how CBD works for epilepsy and seizures.
Over thirty percent of epilepsy patients do not get better with anti-seizure prescriptions. The need for a more effective epilepsy treatment has led researchers to one of the world’s most controversial plants, cannabis.
For clarity, cannabis plants – both marijuana and hemp – contain over a hundred compounds called cannabinoids. Although CBD and THC have gotten the most attention within the medical (and even legal) niche, research perceives all the other compounds have unique potentials.
CBD and THC are widely available and most common because they both occur in large amounts. Their most-abundant nature encourages extraction and research.
Furthermore, CBD is widely commended for its therapeutic potentials. While CBD and THC may have similar chemical characteristics, THC causes the ‘high’ marijuana users experience while CBD counterbalances the psychoactive effect of THC.
A 2016 research led by Dr. Orrin Devinsky found a significant reduction in epileptic seizures. An initial 5mg/kg daily dose, worked up to 50 mg per kg daily, promised a remarkable improvement over 12 weeks of regular CBD administration.
In 2017, another study evaluated the use of top-quality CBD in people with Dravet syndrome. The result shows that about 43 percent of the participants had at least a 50 percent reduction in the frequency of convulsive seizures within 14 weeks of CBD administration.
Another double-blind study investigated CBD’s potency as an integrated treatment for the drug-resistant Lennox-Gastaut syndrome. The survey administered 20 mg/kg CBD daily and reported a significant drop in seizures. (As a note, the usual dose of CBD as a “supplement” is 20 mg/day – as opposed to 20 mg/kg as a medication).
Several other similar CBD for seizure studies suggest CBD may be a highly potent adjunctive therapy for drug-resistant epilepsy in children.
Note, however, that current evidence is limited to only these two forms of epilepsy.
Watch this 3:32 minute video from 2018 about the FDA approval of Epidiolex, the CBD drug
Data show that whole-plant cannabis may help reduce epileptic seizures. But doctors do not recommend using whole cannabis (especially high-THC varieties) due to their psychoactive effects. The THC component of whole-plant cannabis products increases the risk of depression, drug abuse, dependence and may even trigger suicidal attempts. Furthermore, THC is dangerous for pediatric patients.
Thankfully, research says CBD (without THC) offers safe treatment of epilepsy. Although users report a handful of negligible effects, such reactions are often short spanned and usually recorded in first-time users. Common side effects may include:
In addition, continuous use of high doses of CBD may result in hepatotoxicity, which doctors should monitor for their patients.
Studies show CBD consumed with food has a greater absorption rate than when consumed in a fasting condition.
Besides, CBD’s interaction with other drugs is another concern.
The body contains a family of enzymes called CYP450, which help break down CBD and other cannabinoids. CYP3A4 is specifically responsible for this task as it processes about 60 percent of pharmaceutical prescriptions. During the metabolism process, however, CBD can interfere with the CYP3A4.
Where CBD inhibits CYP3A4, the enzyme may become inefficient in breaking down medications consumed.
It can also be the other way round, though. Some prescription drugs inhibit CYP3A4. CBD used alongside these drugs can make it difficult for your body to process, making metabolism unhealthily slow. This could accumulate medications in the body, even at regular doses.
Excessive drug concentration in the body may cause exaggerated effects and undesirable side effects.
In June 2018, a prescription CBD product, Epidiolex, received FDA approval as a treatment for two rare and severe forms of epilepsy, Dravet and Lennox-Gastaut syndromes.
However, studies on CBD for adult epilepsy are limited. The common causes of adult focal epilepsy, including traumatic brain injury, post-stroke, and focal cortical dysplasia, are poorly captured in the studies.
Researchers are also concerned about the long-term psychiatric, behavioral, and cognitive adverse effects of using CBD for epilepsy.
As mentioned, about one-third of epileptic patients may develop tolerance. This may result in a need to increase the dosage by 30 percent or more than 30 percent response reduction. Tolerance was noticed after about seven months of regular administration.
That said, CBD’s efficacy and long term risks are still under research.
Even with the wide availability of FDA-approved pharm-grade CBD-infused Epidiolex, too often, the cost is a big scare for many potential users.
CBD for epilepsy is one of the most researched benefits of the increasingly popular cannabis extract, CBD. Note, however, that cannabis-rich products that also contain THC may worsen seizure and the dreaded psychoactive effect.
CBD, being non-psychoactive and safe, has proven an adjuvant treatment for drug-resistant epilepsy. Unlike THC-rich whole-plant cannabis products, CBD’s side effects (if any) are mild and with a low discontinuation level.
Future researches should focus on areas, including:
Silva GD, Del Guerra FB, de Oliveira Lelis M, Pinto LF. Cannabidiol in the Treatment of Epilepsy: A Focused Review of Evidence and Gaps. Front Neurol. 2020 Oct 19;11:531939. doi: 10.3389/fneur.2020.531939. PMID: 33192966; PMCID: PMC7604476.