We’ve all heard the rumors and seen the videos going viral on social media saying that marijuana cures seizures. It’s been quite the popular topic lately! But are these statements really true? Is weed, the stuff of Woodstock, truly a good treatment for seizures? Or is this just hype pushing for the much-anticipated legalization of cannabis everywhere? There’s all kinds of speculation and debate. It’s one thing to debate the subject with your friends and coworkers, but what if you or your loved one actually do suffer from seizures, and you need real help? What then? Could cannabis really be your answer? Well, that’s why I’m here: to investigate with you.
Seizures are a result of abnormal electrical activity in the brain and central nervous system. They can range from small shakes to very violent convulsions and total loss of control. Small, short-lived seizures don’t cause brain damage, but the big, bad ones can damage the brain permanently. The symptoms are very individual and specific, but in each person they are repetitive.
Every year, an average of 15,500 people in Canada are diagnosed with Epilepsy, a disorder that causes seizures. As of 2016, epilepsy was present in over 3 million people in America. It is estimated that about 50,000,000 people worldwide live with this disease. Those who are most at risk include children, the elderly, and those who have dementia or a genetic predisposition for epilepsy. For many people, seizures are not just a distant fear; they’re a part of everyday life. Here is a list of causes and symptoms:
Seizures can be focal or generalized. In simple focal seizures, or partial seizures, abnormal activity happens only in one part of the brain. These account for less than 15% of seizures of epilepsy patients. There may be changes in mood or vision, temporary paralysis, jerking, or sensory symptoms.There’s no impairment to cognitive abilities or memory, and the person is still conscious.
Dyscognitive, or complex, partial seizures end in change or loss of consciousness. The person might be confused, lose memory or awareness, or behave repetitively – like rubbing their hands together or walking in circles. To the average person, it may just look like the person is a little dazed and confused. These are often misdiagnosed as a migraine or something else, because the symptoms aren’t the same as other seizures. However, they are a type of seizure, making up one third of seizures in people with epilepsy.
More than 30% of epilepsy patients suffer from generalized seizures, which are seizures that affect the entire brain. There are six types of them:
Because of the potential for a seizure to happen at any time, epilepsy disrupts everyday life. Normal activities such as bike riding, driving, or even bathing, become hazardous – someone with epilepsy is 15-19 times more likely to drown than someone without it. Pregnancies could have bad complications. Psychological problems, like depression and anxiety, can arise. An epilepsy patient is even at risk for falling and breaking a bone just walking around!
There are additional, rare complications with epilepsy that could potentially be life-threatening, such as status epilepticus, which causes recurrent seizures, or seizures that last longer than five minutes. Status epilepticus can cause permanent brain damage, or even death. Another is unexplained death related to epilepsy (SUDEP).
Marijuana – among many, many other names – is the word used to refer to the flowers, and sometimes the leaves, of the cannabis plant. Medical marijuana is marijuana used for medicinal purposes.
The ingredients in the cannabis plant are called cannabinoids. There is a whole list of cannabinoids (and other medical marijuana terms), but the two most well-known are tetrahydrocannabinol and cannabidiol, commonly shortened to THC and CBD. THC is the one that has the psychoactive effects – it’s what gets you high. CBD does not have these psychoactive effects, so it won’t get you high. It does, however, have a lot of medicinal value, and is the man cannabinoid that is focused on in seizure medication.
Cannabis has been used to treat illnesses, including seizures, throughout history. It’s said that there are 3800-year-old Sumerian tablets that speak of this, and 3000-year-old seeds in Siberian burial mounds, among other things! The Chinese used medical marijuana thousands of years ago. William O’Shaughnessy, a British doctor, published an article on the success of cannabis treatments for an infant’s convulsions in 1843. Even George Washington, the American president, grew cannabis on Mount Vernon.
In recent years, however, super-strict government regulations have made it very hard to study cannabis; it’s illegal in many places. This means that there is limited access, time, and funds to conduct what studies are held. Despite these challenges, there is evidence from studies in labs and small clinics, as well as anecdotal reports and press releases, that suggests that CBD may help control seizures.
Epidiolex, a 99% oil-based CBD extract by GW Pharmaceuticals, has been the subject of some open-label studies in the US due to its consistent amounts in each dose. Some of the more recent, gold-standard studies (placebo controlled and double-blind) were on difficult epilepsies such as Dravet Syndrome and Lennox-Gastaut Syndrome (LGS). GW Pharmaceuticals has made the information from these studies available at press releases and major scientific meetings.
There were 214 people in one of these open-label studies¹, who all had epilepsy and did not respond to other treatments. The age range was 2 to 26 years old, with an average age of 11 years old. These patients were on Epidiolex for at least twelve weeks. On average, the patients’ seizures decreased by 54%, though it was noted that those who were taking clobazam (Onfi), another seizure medication, had a better response than the patients who weren’t.
Two more studies for LGS and one for Dravet, all using Epidiolex, showed great results. In the LGS studies, drop seizures were reduced by over 40% in the patients using Epidiolex, while they were only reduced by 20% in the patients who got the placebo. Again in the Dravet study, compulsive seizures dropped by 40% as compared to a drop of only 17% in the placebo group.
An open-label study done in Israel² used a product of 20 parts CBD to 1 part THC on children up to age 18 with epilepsy that was hard to control. A significant amount of them reported a reduction in seizures, while 7% of them stated that seizures had worsened.
A randomized, double-blind, placebo controlled study on Dravet syndrome, posted to the New England Journal of Medicine, saw that 43% of their patients had their seizures decreased by at least half, as opposed to 27% in the placebo group – that’s 23 percentage points higher. The average decrease in seizures from CBD medication was 39%, while the placebo group average was only about 13%. In this same study, 5% of the patients taking CBD became completely seizure-free. The 120 patients were all children and young adults, which makes sense, seeing as how 20% of people with Dravet Syndrome die before age 20.
There was another study done by physicians Dustin Sulak, Russel Saneto, and Bonni Goldstein on 272 patients across three different US states (Maine, Washington, and California) using artisanal (not FDA approved) cannabis. Here are the results from the patients:
This means that 10% of the patients saw the seizures stop completely, and at least some seizure reduction was found in 86% of patients.
These three physicians believe that a combination of cannabinoids, not just CBD alone, is best to treat seizures. They found that tetrahydrocannabinolic acid (THCA) can sometimes work when THC and CBD do not, and that some terpenes such as linalool may also have anti-convulsive effects.
They also found that cannabinoids have biphasic effects, so high doses can have the opposite effect of low doses. For example, 0.002mg/kg in mice and 0.02mg/kg/day in humans both had anti-convulsive effects. They say that if higher doses of cannabinoids prove ineffective, that lower doses may actually work instead. They tested this on THC, CBD, and THCA, and found it to be true, with the addition of the terpene linalool showing an increase in effectiveness.
There were several challenges faced by the physicians in this study. First, access and quality control of the cannabis treatment was difficult to maintain. Since the artisanal cannabis preparations were priced from 5 to 50 cents per milligram, high dosages were financially unfeasible unless patients were to grow their own cannabis. That means potential interruptions in treatments, which can result in rebound seizures. There was also the potential for disruption by federal agencies, even though the physicians and patients were operating according to state law. On top of all that, inaccurate labeling of cannabis products in the industry is an issue, with some products claiming more or less cannabis content than they actually contain.
Overall, the three physicians found that whole-plant artisanal cannabis treatments were not only safe and effective at various dosages, but that they had a wider therapeutic window than Epidiolex. Their consensus is that this is a better way than the single-molecule medications that big pharma tends to favor.
The placebo effect is a major factor in all of these studies. This was evidenced by one particular study that found that 47% of patients who had moved to Colorado for cannabis treatment saw improvement, as opposed to 22% of patients who already lived there.
Marijuana has many effects, which can vary due to simple things such as the way it is ingested, or the type of strain used. It is broken down by the liver, like many other things. The side effects in people with seizures have not been well documented, since different strains and dosages were used.
There was safety data taken from the open-label study on Epidiolex. The side-effects of 10% or more of the patients, which were mild and went away, were as follows:
Serious side effects occurred in 52 people, and 22 of those side effects had a possibility of being related to Epidiolex. The most common serious side effect was status epilepticus. Do remember that these patients were only taking CBD, not THC, and not the whole cannabis plant. Other reactions may happen when THC or other compounds become involved.
The safety data from the LGS and Dravet studies showed similar side effects with tiredness, diarrhea, and upset stomach. However, in these studies, the placebo group also showed these side effects. There is speculation that those side-effects may have come from the fact that both products were oil-based, and have nothing to do with the involvement of cannabis.
There have also been reports of drug-to-drug reactions in seizure patients using CBD. Those taking valproic acid (VPA) saw a in increase of liver enzymes up to three times what’s normal, even though they didn’t increase their dosage of VPA while taking CBD. It’s thought that one part of VPA may interact with CBD as it’s broken down in the liver, increasing the risk of liver issues. Clobazam also seems to interact with CBD in some people as it’s broken down, and may actually be the cause of tiredness in these individuals.
It might be wise to compare the side effects of cannabis to those of other epilepsy medications, such as:
Nearly 30% of epilepsy patients do not respond to traditional epilepsy medications, and the ones who do still have to deal with these side effects. Common medications include valproic acid, phenytoin, clonazepam, phenobarbital and ethosuximide.
Self-medication for epilepsy using cannabis is strongly cautioned against, due to lack of consistency in the CBD amounts of retail products. A slight change in dosage, and seizures could worsen. However, there are some people who have no other option.
So where exactly does marijuana stand in the legal world? Well, in Canada, you’re safe – that is, as long as you’re using it for medicinal purposes. Canadian law categorizes cannabis as a Schedule II drug, meaning that it is possible for medical marijuana to be obtained legally, but recreational use is still illegal.
In the US, some states have begun to legalize cannabis, though it remains illegal under the national federal law, classified as a Schedule I drug – the same classification level as heroin, meaning that the government says it has “no currently accepted medical use and a high potential for abuse” – which, as we can see, may not be a totally accurate statement. It is up to each person in their state, if it is legal there, to choose between following their state law or the federal law. Even according to state laws, it is illegal to transport marijuana across state borders, and to have it shipped to you. So if someone lived in a legalized state, and wanted to go on a trip, they would be completely breaking the law if they brought their cannabis with them. Things are changing – US Surgeon General Vivek Murthy admitted that “for certain medical conditions and symptoms” it can be “helpful” – but the process is slow.
Many other countries have been rethinking their laws as well. Israel and the Netherlands have medical marijuana programs, Portugal has decriminalized it, and Uruguay has voted to legalize it.
The best place to start with the stories of real patients is Charlotte Figi. She is a little girl with Dravet Syndrome who once had 300 drop seizures a week. When she began taking medical marijuana, her seizures got better in a week. The strain she takes was named after her – it’s called Charlotte’s Web. Here’s a video of her and a little boy named Zaki, who was having 22 seizures an hour until he started on CBD meds. You’ll also want to read the story of Sam Vogelstein, written by his own father, about their journey into medical marijuana treatment, and Addelyn Patrick, who was also suffering from life-threatening seizures.
Billy Caldwell, an 11-year-old with severe epilepsy, was the first person in the UK to ever receive a medical marijuana prescription. Cannabis stopped the sudden onset seizure caused in Annalise Lujan by a rare, one-in-a-million epileptic disease known as Febrile Infection-Related Epilepsy Syndrome (FIRES).
So, what’s the deal? Is cannabis the epilepsy cure we’ve been looking for? Well, I would say that the word cure is a strong one. However, it has improved the lives of many patients, with much gratitude in particular from parents who feel that they’ve gotten their children back. Is it the answer for you? Maybe. It does have a small chance of making seizures disappear. But even if it only improves the lives of people, of children, who barely have one… I would say that it is definitely worth looking into, and definitely worth a try.
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