Cannabis and Epilepsy Treatment
Cannabis for epilepsy: is there enough evidence of efficacy?
Epilepsy is characterized by recurring seizures of variable intensity and effect. These seizures are usually caused by disturbances in specific regions of the brain’s circuitry that create storms of extra electrical activity. Epilepsy is surprisingly common, exceptionally disruptive, and potentially deadly.
Many South Africans with treatment-resistant epilepsy are searching for something to help, and some are turning to cannabis to try to reduce seizure frequency. With clinical trials of cannabidiol-based drugs under way, evidence for this treatment option may soon be forthcoming. However, concerns remain about side effects, such as sedation, interactions with other drugs, and potential disturbances of brain development.
Stories of cannabis’s abilities to alleviate seizures have been around for about 150 years but interest in medical marijuana has increased sharply in the last decade with the help of legalization campaigns. In particular, both patients and scientists have started to focus on the potential benefits of CBD, one of the main compounds in cannabis. Unlike tetrahydrocannabinol (THC), which is responsible for its euphoric effects, CBD does not cause a “high” or pose the same type of risks that researchers have identified for THC, such as addiction and cognitive impairment. Rather, studies have shown that it can act as an anticonvulsant and may even have antipsychotic effects.
The interest in cannabis-based products for the treatment of refractory epilepsy has skyrocketed in recent years. Marijuana and other cannabis products with high content in Δ(9) – tetrahydrocannabinol (THC), utilized primarily for recreational purposes, are generally unsuitable for this indication, primarily because THC is associated with many undesired effects. Compared with THC, cannabidiol (CBD) shows a better defined anticonvulsant profile in animal models and is largely devoid of adverse psychoactive effects and abuse liability. Over the years, this has led to an increasing use of CBD-enriched extracts in seizure disorders, particularly in children. Although improvement in seizure control and other benefits on sleep and behaviour have been often reported, interpretation of the data is made difficult by the uncontrolled nature of these observations.
People with epilepsy are prone to seizures, which can range from brief lapses in attention to disabling episodes of involuntary movements and unconsciousness. Seizures stem from overactive neurons in the brain that run out of control. This state can arise for different reasons, leading to different seizure types and different forms of epilepsy.
Current medicines keep seizures in check for a majority of people with epilepsy — up to 65 million worldwide. But around 30% of people do not get control over their seizures. Rare epilepsies that arise in childhood, such as Dravet syndrome or Lennox-Gastaut syndrome, are particularly intractable, with children still experiencing 50–75 seizures a day, despite taking multiple medicines. Even new medicines developed in the past decade still do not thwart seizures in children with these conditions, and they could face greater disability if uncontrolled seizures derail their brain development.
Although cannabis was used as treatment for epilepsy in Victorian times and even earlier, the practice declined as other medicines were discovered and the plant was deemed illegal. Interest revived in the 1990s with the discovery of an endogenous cannabinoid system in the brain, which consists of two receptors, cannabinoid receptor 1 (CB1) and CB2, and two endogenous ligands, 2-arachidonoylglycerol (2-AG) and anandamide. The most abundant components of cannabis are cannabinoids, a family of compounds that share chemical structures unique to the plant. Of these, three cannabinoids bind to CB receptors, including THC and CBD.
Charlotte Figi, an eight-year-old girl from Colorado with Dravet syndrome, a rare and debilitating form of epilepsy, came into the public eye in 2013 when news broke that medical marijuana was able to do what other drugs could not: dramatically reduce her seizures. Now, new scientific research provides evidence that cannabis may be an effective treatment for a third of epilepsy patients who, like Charlotte, have a treatment-resistant form of the disease.
These inspiring stories help illuminate the efficacy of medical cannabis while defining its range of treatment from the elderly to the young. While the capabilities of CBD and medical cannabis use seems to be self-evident, the DEA has only recently allowed academic institutions to explore the effects, side effects, and usefulness of cannabis as a medicinal plant. This seemingly innocuous change of face is an enormous leap forward for researchers, pharmaceutical companies, breeders, and the cannabis community at large as more scientific capital is put toward understanding this populous plant.
Evidence from laboratory studies, anecdotal reports, and small clinical studies from a number of years ago suggest that cannabidiol, a non-psychoactive compound of cannabis, could potentially be helpful in controlling seizures. Conducting studies can be difficult as researchers have limited access to Cannabis due to South Africa’s regulations and even more limited access to cannabidiol; there are also increased financial and time constraints.
But with CBD recently rescheduled to a Schedule 4 substance and talk of its scheduling being scrapped altogether isn’t about time that we cater for those people in South Africa who want to buy CBD oil for epilepsy treatment?
Always consult with your doctor before starting any new medication or stopping your current medication.