CBD for Epilepsy

What is Epilepsy

Epilepsy is a neurological disorder in which the normal patterns of brain activity becomes disturbed, causing strange sensations, emotions, and behavior. It can also cause seizures, convulsions, muscle spasms, and loss of consciousness. Cases of epilepsy can range from benign to life-threatening, and anyone can develop it—epilepsy affects people of all ages, sexes, races, and ethnicities.

Typically, at least two unprovoked seizures are required before an epilepsy diagnosis. Because epilepsy is caused by abnormal brain and neuron activity, seizures can affect any process that the brain coordinates. Seizure symptoms can vary greatly depending on the type of seizure that is had.

Symptoms of epilepsy

The two broadest categories of seizures are focal seizures or partial seizures that are caused by abnormal activity in just one area of the brain, or generalized seizures that involves all areas of the brain. Each of these have their own etiology and symptomology.

Focal Seizures

Focal seizures without loss of consciousness - These seizures can alter someone’s emotions or senses—causing differences in the way things look, smell, taste, feel, or sound—as well as spontaneous sensory symptoms such as tingling, dizziness, or flashing lights. This type of seizure can also cause muscle spasms or involuntary jerking of a body part or limb.

Focal seizures with impaired awareness - These seizures can cause either a change or total loss of consciousness or awareness. Someone experiencing this type of focal seizure may be unable to respond to their environment, stare into space for a period of time, or perform repetitive movements, such as hand rubbing, chewing, swallowing, or walking in circles.

Generalized Seizures

Absence seizures - These cause the person seizing to stare into space and make subtle body movements example eye blinking, lip smacking, etc. They can also cause brief loss of awareness and occur most commonly in children.

Tonic seizures - Causes the stiffening of muscles—most often in the back, arms, and legs—and may result in the person seizing to fall to the ground.

Atonic seizures - Causes a complete loss of muscle control—often resulting in the person seizing to suddenly collapse or fall to the ground.

Clonic seizures - Causes repeated or rhythmic muscle jerking—usually in the neck, face, and arms.

Myoclonic seizures - Causes sudden jerks or twitches of the arms and legs.

Tonic-clonic seizures - The most extreme type of epileptic seizure. Can cause an abrupt loss of consciousness, muscle stiffening, body shaking, tongue biting, or a loss of bladder control.

Epilepsy Medications & Treatment

While there is no cure for epilepsy, there are treatment options with treatment mainly focussing symptom management and seizure control. Once a diagnosis is made, it is recommended to start treatment as soon as possible.

Pharmaceutical Interventions
The most common therapeutic intervention for epilepsy is anti-epileptic drugs (AEDs), also called anti-seizure or anti-convulsive drugs. Different medicines tend to work better with certain kinds of seizures when compared to others and if one treatment fails, another may be work better.

AEDs work by changing the levels of certain chemicals, helping to reduce the frequency and severity of seizure activity. However, they cannot stop seizures from happening all together and they cannot cure epilepsy.

There are several types of AEDs including sodium valproate, carbamazepine, lamotrigine, levetiracetam, oxcarbazepine, ethosuximide and topiramate. Although AEDs are effective in helping control seizures in about 70% of people, they are not without side-effects. These include drowsiness, irritability, nausea, stomach upset or discomfort, headaches, tremors, swollen gums and rashes.

Non-Pharmaceutical Interventions
In cases where AEDs are not effective and when it is medically a viable option, epilepsy surgery may be recommended. This involves surgery that removes the area of the brain causing seizures and often results in seizure activity stopping completely.

Dietary changes can also help, especially in children. This involves going a ketogenic diet high in facts and low in carbohydrates and protein. It is thought that this diet may make seizures less likely by changing the levels of chemicals in the brain in a similar way as AEDs do.

There are also other therapies available that work by changing the electrical signals in the brain. Vagus nerve stimulations (VNS) is when a small electrical device similar to a pacemaker is placed under the skin of the chest and attached to a wire that goes under the skin and connects to the vagus nerve in the neck. Similar to VNS is deep brain stimulation (DBS) which is similar but the connected wires run directly into the brain.

CBD for Epilepsy

Research & Scientific Evidence

Cannabidiol (CBD) for epilepsy has been extensively researched for the past several years, with Dravet syndrome (DS) and Lennox-Gastaut syndrome (LGS) which are two forms of epilepsy, being the 1st and only FDA-approved use of CBD.

In a review from 2016 published in Epilepsy and Behavior, researchers summarized the findings of a collaboration between a group of clinical investigators and GW Pharmaceuticals developed to explore the use of CBD in patients with childhood-onset treatment resistant epilepsy (TRE).

They reviewed findings from several surveys, case studies, case series, and placebo-controlled trials, including an open-label interventional trial of CBD in patients with TRE, a state-sponsored CBD treatment program and Epidiolex placebo-controlled clinical trials.

They concluded that sound scientific evidence exists that suggest that CBD is a viable, safe and well-tolerated treatment option for epileptic conditions in addition to effectively reducing convulsive seizures and drop seizures. In addition, open-label studies with CBD supports its efficacy in a broader range of seizure syndromes including TRE, DS, LGS, Tuberous Sclerosis Complex (TSC), Febrile Infection-Related Epilepsy Syndrome (FIRES) and focal epilepsy.

In an open-label clinical study from 2017 and published in Epilepsia, researchers surveyed paediatric patients that were being treated with CBD to evaluate seizure frequency as well as their quality of life before and after 12 weeks of receiving treatment.

In addition to baseline AEDs, paediatric patients received 2 – 5 mg of CBD per kg per day (mg/kg/day), divided in two dosages. This was gradually increased until intolerance or a maximum dose of 50 mg/kg/day over 12 weeks. Quality of Life in Childhood Epilepsy (QOLCE) scores and monthly motor seizure frequencies were assessed during the initial 4-week baseline and again after the 12-week treatment period.

They observed improvements in caregiver‐reported QOL in children and young adults with severe, childhood onset epilepsy, including energy/fatigue, memory, other cognitive functions, control/helplessness, social interactions, and behavior, as well as improvements in general QOL sub-scores. They also found a ≥50% reduction in mean monthly motor seizures from baseline, therefore showing that not only is CBD effective in reducing symptomology but also overall quality of life.

Building on previous studies that evaluated CBD in TRE patients, this 2019 clinical trial published in the journal CNS drugs evaluated the pharmacokinetics and safety of CBD in pediatric patients with treatment-resistant epilepsy.

Pediatric patients (aged 1 to ≤ 17 years) with treatment-resistant epilepsy were divided into three experimental groups, receiving a daily dose of 5, 10, or 20 mg/kg/day of orally administered CBD respectively as an add-on to their current AED regimen. Dosages were increased to twice daily doses totaling 10 mg/kg/day (group 1), 20 mg/kg/day (group 2), or 40 mg/kg/day (group 3).

Although individual results varied, they found that in addition to CBD being effective in controlling the frequency of seizures resulting from children and adults suffering from epilepsy, it is also has a positive safety profile. Their data showed that overall, CBD can be considered as safe at all doses they examined with only mild dose-related side-effects such as diarrhea, flatulence, somnolence, and psychomotor hyperactivity, usually only in patients also taking clobazam. This could be due to concomitant administration of clobazam resulting in an increase in CBD exposure.

Time to onset of cannabidiol (CBD) treatment effect in Lennox-Gastaut syndrome: Analysis from two randomized controlled trials

Based on data from randomized trials conducted a few years ago, it is certain that CBD helps to reduce the number of seizures and adverse events resulting from epilepsy. In the published 2021 post hoc analysis of two randomized controlled trials, an attempt was made to estimate the time of the first effects of cannabidiol treatment. The studies involved people diagnosed with Lennox-Gastaut syndrome. Their age was on average 15.3 years.

A total of 396 patients participated in the studies. 210 subjects who completed the study were assigned to receive a dose of CBD and 158 subjects to receive placebo. Patients received a preparation of hemp origin containing highly purified CBD at a dose of 10/20 mg/kg/day or placebo. The first differences in droplet rate reduction between placebo and CBD occurred during the titration period and became significant by day 6 (p=0.008). The analysis shows that the effectiveness of CBD in treating ailments that result from suffering from epilepsy can occur within the first week of starting treatment.

The analysis of the studies described above does not exclude that the treatment effect may occur a little later in some patients, while the pooled results confirm the effectiveness of CBD in mixing the number of LGS-associated seizures with an acceptable safety range.

Effect of Cannabidiol on Interictal Epileptiform Activity and Sleep Architecture in Children with Intractable Epilepsy: A Prospective Open-Label Study

The use of CBD in the treatment of epilepsy has increased significantly over the last five years. In order to complement the scientific achievements, it was decided to conduct a study in which the impact of CBD therapy on inter-epileptic epileptic activity and sleep quality in children with drug-resistant epilepsy was assessed. The results were published in 2021 in CNS Drugs.

The study was open to people aged 3 months to 18 years suffering from drug-resistant epilepsy according to the criteria in the League Against Epilepsy. The study excluded people who were treated with cannabis-based products, were pregnant or had unstable liver and kidney disease. CBD was administered orally as an adjunct to current background epilepsy therapy at a dose of 5 mg/kg/day. The dose was increased by 2-5 mg/kg/day to 18-20 mg/kg/day for 14 days. If the number of seizures was too low, the dose could be increased to 50 mg/kg/day.

All subjects underwent monitoring of resting EEG prior to initiation of CBD and after 3 months of treatment. In addition to EEG monitoring, the Child Behavior Checklist (CBCL) was used to assess behavioural problems. The reduction in the number of seizures was 54.7 ± 26.1% after 3 months, and one patient experienced no seizures throughout treatment. Patients did not report seizure frequency, 24 subjects had a ≥ 50% reduction in seizure frequency. Patients have been shown to improve sleep quality.

The results indicate that CBD works effectively in the treatment of seizures and significantly affects the reduction of IED and improvement of sleep structure in children with drug-resistant epilepsy. It does not cause serious side effects. More studies are needed to investigate the clinical relevance of this treatment in different types of epilepsy.

Safety and Tolerability of Transdermal Cannabidiol Gel in Children With Developmental and Epileptic Encephalopathies: A Nonrandomized Controlled Trial

Developmental and epileptic encephalopathies (DDE) are the most severe group of drug-resistant epilepsies. DEE patients are usually intellectually disabled and often struggle with behavioral problems. Unfortunately, oral ASMs are a challenge for children with behavioural problems, so it is worth looking for an effective alternative that could facilitate adherence to recommended treatment programs. A study published in 2021 evaluated the safety and tolerability of using CBD transdermal gel in children with DEE. The frequency of seizures, sleep and quality of life were controlled.

The participants of the study were children aged 3-18 years, who had been diagnosed with DEE for at least one year. Eligible subjects had 5 or more seizures within the initial 28-day period. The study excluded people who had been treated with cannabis in the last 3 months, or who had used a strong inhibitor or inducer of CYP3A4 in the last 3 months. Patients used 4.2% CBD transdermal gel delivering 125 mg CBD per sachet. Those weighing less than 25 kg received 250 mg/day and those weighing more than 25 kg received 500 mg/day. After 2.5 months, the dose could be increased to 750 mg/day and 1000 mg/day, respectively. Among 48 patients, 33 with Focal Awareness Impairment (FIAS) and Tumor Sclerosis Syndrome (TCS), a 58% reduction in seizure rate was observed within 5 months. Family members noted improvements in social and interpersonal engagement, irritability, alertness, energy, sleep, and cognition and concentration.

The results of the study indicate that the CBD transdermal gel was safe, well tolerated and there were no serious side effects. The use of the gel reduced the incidence of FIAS and TCS and the burden of epileptic disease.

Anecdotal Evidence

The media is full of stories about children who have effectively treated their epilepsy with high-quality CBD oil. Arguably the most well-known of these is probably Charlotte Figi, but there are many others as well, including Billy Caldwell and Alfie Dingle from the UK. In addition, many adults are also reporting that CBD can help reduce and control seizure activity as can be evidenced from the many testimonials, social media comments and product reviews.

Testimonials of patients taking CBD for epolepsy

CBD as a complementary treatment
There is a lot of evidence for CBD as being an effective treatment option for epilepsy, especially in patients suffering from DS, LGS and TRE. However, much of the research of CBD for epilepsy also involves using it as an add-on to the patients’ current AED regime, hinting that CBD could be more effective as a complimentary treatment to AED drugs.

However, CBD can also help in other ways such as reducing the side effects of AEDs. For instance, CBD has been shown to help stabilize mood, helping reduce the irritability that is often associated with many AEDs. Similarly, stomach discomfort and nausea is often reported as a side effect of anti-seizure medications, and can also be relieved by CBD.

Bottom Line

A reasonable amount of research from animal studies and clinical trials indicate CBD has the potential to be a safe, effective treatment option for both children and adults suffering from epilepsy. However, the number of patients using prescription CBD is relatively small, while the studies are generally limited in duration and scope, preventing definitive conclusions from being drawn. Always consult a medical practitioner before using CBD for epilepsy as it can interact negatively with other medications. In addition, your physician can monitor dosage, symptom severity and other clinical parameters to ensure that your CBD treatment is both safe and effective.