How Does Cannabis Treat Epilepsy?
Published on September 14, 2015, By Gooey Rabinski
Conditions Epilepsy Marijuana Knowledge Base Medical
More than 2.3 million Americans live with epilepsy, a neurological condition that involves recurring seizures. About one million of these patients suffer uncontrollable seizures, a life-altering condition that prevents or makes difficult daily tasks like driving, caring for children, preparing food, or sustaining a job and career. In severe cases, patient quality-of-life can be so low that they become clinically depressed or wracked with anxiety in anticipation of their next seizure.
Epileptic seizures are caused by abnormal electrical discharges, or misfiring, among brain cells. This misfiring results in convulsions of the body, sometimes severely altered senses, and often the loss of consciousness. Some patients suffer literally hundreds of seizures per day. Epilepsy itself may be caused by viruses, head trauma, or even a hormonal imbalance. Often, however, the cause of the condition is idiopathic, meaning it is simply unknown.
The Epilepsy Foundation, a group of parent advocates, believes that cannabis should be a valid treatment option for physicians and patients dealing with epilepsy. The group also has called for an end to the Drug Enforcement Administration restrictions that limit research, including clinical trials.
"The Epilepsy Foundation supports the rights of patients and families living with seizures and epilepsy to access physician-directed care, including medical marijuana. The Epilepsy Foundation believes that an end to seizures should not be determined by one's zip code."
Long History of Cannabis Treatment
Ancient societies in Africa, China, Greece, India, and Rome used cannabis to treat epilepsy and other seizure disorders. Although they were most likely ignorant of the cause and mechanism of epilepsy, such cultures were aware of the healing and neuroprotective properties of cannabis. During the 19th century and up until 1937 when cannabis became illegal in the United States (a period that has been described as the Golden Age of medicinal cannabis), doctors frequently prescribed a cannabis tincture for a variety of conditions, including epilepsy and seizures.
In 1890, British physician J.R. Reynolds published his 30 years of experience with cannabis, recommending it for multiple conditions, including epilepsy. In his position as the court physician to Queen Victoria, he infamously prescribed a cannabis tea for her menstrual cramps.
The anticonvulsant properties of marijuana may be the oldest of its known medical benefits. During the 19th century, Dr. William O'Shaughnessy, an Irish physician, spent time in India and wrote extensively in Western medical journals about the medical efficacy of cannabis for a variety of conditions. In 1839, O'Shaughnessy discovered that a hemp tincture was an effective anticonvulsant and muscle relaxant.
O'Shaughnessy conducted case studies of his patients, including one of a 40-day-old baby with convulsions. He reported that the child responded well to cannabis therapy, transitioning from near death to "the enjoyment of robust health" in only a few days. According to Harvard psychiatrist Dr. Lester Grinspoon, as presented in his book Marihuana Reconsidered:
"Between 1839 and 1900, more than one hundred articles appeared in scientific journals describing the medicinal properties of the plant."
Understanding Seizures
Seizures are the most severe symptom of epilepsy. A seizure involves involuntary muscle spasms (convulsions) which may last seconds or minutes. It should be noted that not all patients who suffer seizures do so because they have epilepsy. Seizures can also be caused by withdrawal from certain drugs (like Xanax and some narcotics), cancer, meningitis, brain tumors, stroke, and a variety of head injuries.
Although epileptic seizures can occur without an understandable cause, they are often triggered by stress, high fever (in those under six years of age), sleep deprivation, strobing lights (including rapidly flashing elements in video games, depending on the sensitivity of the patient), hypoglycemia (low blood sugar), and even boredom.
Seizures are typically preceded by something called an "aura," a state of altered behavior that involves sensitivity to light and sound and strange smells (called olfactory hallucinations). Auras may also include a sudden feeling of fear, an inability to speak, visual hallucinations, nausea, and numbness or tingling sensations. Auras sometimes occur only seconds before a seizure, but may preclude an episode by up to 60 minutes. Typically, those who experience auras suffer the same symptoms each time (making it easier for them to predict the onset of a seizure).
Six primary categories of seizures are suffered by patients with epilepsy:
Absence: Characterized by lapses in consciousness.
Myoclonic: Involves sporadic (isolated) jerking movements.
Clonic: Symptoms include repetitive jerking movements.
Tonic: Symptoms include muscle stiffness and rigidity.
Atonic: Least severe type of seizure; involves loss of muscle tone.
Grand Mal: Also known as generalized tonic-clonic, characterized by muscle rigidity, full-body convulsions, and unconsciousness. The most severe and debilitating category of seizure that can be experienced by an epilepsy patient.
Unfortunately, many states that have implemented medical cannabis programs have specified "epilepsy" in their regulations, preventing non-epileptic seizure disorders from qualifying for the legal use of cannabis. Until such programs are updated to reflect the reality of patient suffering, millions of otherwise qualified patients will be deprived safe access and legal use of one of the most powerful and effective medicines available for a wide variety of seizure disorders — all because of a minor semantic discrepancy.
Side Effects of Conventional Treatments
Normally, epilepsy patients are prescribed one or more anticonvulsants. Pharmaceutical drugs in this class include carbamazepine (Tegretol), phenytion (Dilantin), primidone (Mysoline), valproic acid (Depakote), clonazepam (Klonopin), ethosuximide (Zarontin), and phenobarbital. The problem with such drugs is that they are often relatively ineffective and carry a plethora of negative side effects. In fact, it is these two factors that have driven many desperate patients to seek out medical cannabis as a solution where conventional pharmaceutical therapies have failed or provided too much suffering.
Unfortunately, about 30 percent of epilepsy patients are resistant to conventional anticonvulsant drug treatments, making the use of alternative treatments such as cannabis significantly more relevant. The lack of research into the efficacy of cannabis for epilepsy brings into question the ethics of the medical establishment, which has largely ignored cannabis and the sometimes amazing results it brings to a large percentage of epilepsy patients.
Side effects of conventional pharmaceutical drugs used to treat epilepsy include headaches, loss of hair, nausea, impotence, depression, liver failure, sedation, slurring of speech, double vision, weight gain, sleep disturbances, irritability, and mood disturbances. Consumption of multiple drugs simply compounds these negative symptoms. Often, patients report that they are not sure which is worst: Their disease or the side effects of the pharmaceutical drugs prescribed to treat it.
Several U.S. states, including Alabama, Utah, Wisconsin, Texas, New York, Louisiana, and Tennessee have passed CBD-only medical cannabis laws intended to help patients deal with diseases such as cancer and epilepsy. However, such laws are controversial because of something called the entourage effect, a theory of how the cannabinoids in marijuana work synergistically to produce an overall greater effect. When one considers that 111 cannabinoids and more than 200 terpenes have been discovered in cannabis, it becomes clear that cannabis as medicine is a complex science about which the medical establishment — and society overall — are very ignorant.
CBD-only laws have received a wealth of criticism. Paul Armentano, the Deputy Director of NORML, has called such laws "largely unworkable" because of not only the restrictions placed on doctors and patients, but also the fact that many children and adults have found significantly higher efficacy from cannabis extracts containing a mix of CBD, THC, and other cannabinoids.
According to the Marijuana Policy Project (MPP), "…only two percent of the registered patients in both Rhode Island and Colorado report seizures as their qualifying conditions," revealing that CBD-only laws sometimes provide safe access to relatively few patients. Unfortunately, the group reported that "The vast majority of [all medical cannabis] patients have symptoms that benefit from strains of marijuana that include more than trace amounts of THC."
The media has focused much attention on children who use CBD oil to combat intractable epilepsy, muscular dystrophy, and other severe neurological disorders. Some of these patients gain significant relief from a single-cannabinoid extract. Children who have gone from hundreds of seizures per week to only a couple per month using only CBD oil have gained ample media coverage.
One patient, nine-year-old Charlotte Figi of Colorado — after exhausting all other conventional treatments — experienced a 99 percent decrease in seizure activity using a CBD-only cannabis oil. Figi has been the unofficial poster child of advocates of CBD oil and efforts to legalize it. She is also the inspiration behind a CBD-only oil product called Charlotte's Web from CW Botanicals in Colorado.
Desperate parents of other children with similar conditions have also experimented with CBD oils and extracts. Many, unfortunately, have reported that the lack of THC in CBD oils often doesn't work for their children. Jason David has been treating his seven-year-old son, Jayden, who has Dravet syndrome — a severe form of epilepsy that doesn't respond to conventional treatments — with medical cannabis since 2011 (Charlotte Figi's mother learned about CBD oil from David).
"I wish Charlotte's Web worked for all epileptic kids, but it doesn't. The worst seizures Jayden ever had on medical cannabis was while we were using Charlotte's Web," said David. Some doctors and researchers estimate that only about 30 percent of children with epilepsy experience a significant decrease in seizure activity when taking a CBD-only oil or tincture that lacks THC.
Brian Wilson, a former New Jersey resident who moved to Colorado in 2014 because of its progressive medical marijuana law, is another parent of a child suffering from Dravet syndrome. In an interview with Ladybud in 2014, he said:
"CBD is a very important part of the mix, but only part. We saw minor seizure control and developmental progress with CBD alone, but we didn't see real seizure control until we added measurable levels of THC to the mix."
Wilson continued:
"Others see great results with THCA added in. Some see very good results with no CBD, like in New Jersey, where there is little to no CBD available. The point is, this is highly individualized medicine. There is no magic bullet."
Rebecca Hamilton-Brown is the founder of Pediatric Cannabis Therapy, a support group for parents of epileptic children with more than 2,500 members. She has been treating her son with cannabis for two years and gaining feedback from the group's many members.
"It is ignorance that leads people to believe that CBD only is the way to go."
said Hamilton-Brown.
"They either have never dosed their children or they are totally naïve when it comes to how the political machine works."
Are thousands of sick children and adults who would benefit from a multi-cannabinoid extract or concentrate of cannabis being disregarded by state governments that have or are seeking to legalize CBD-only oil?
The miracle story of Charlotte Figi is certainly inspiring; all patients deserve medicine that relieves them of their suffering. However, are paranoid politicians afraid to legalize cannabis extracts containing THC simply because of an 80-year-old stigma? Is the legacy of Reefer Madness — and the perception that euphoria is a sin in some religions — responsible for the passage of state laws that, while helpful for a small number of patients, leave most suffering with no medicine?
Anecdotal evidence of the power of cannabis to treat seizure disorders and epilepsy have been available for literally thousands of years. Studies conducted since the mid-1970s have found that THC and CBD, the primary cannabinoids in cannabis, deliver anticonvulsant and other valuable effects to epilepsy patients.
A 1975 study published in the Journal of the American Medical Association found that cannabis, when combined with conventional medicine, controlled the seizures in a 24-year-old patient. While conventional drugs (Phenobarbital and phenytoin) provided "incomplete control" of the patient's seizures, he experienced a complete cessation of seizures following a regimen of two to five cannabis joints per day.
A 2003 study conducted at the Virginia Commonwealth University and published in the Journal of Pharmacology and Experimental Therapeutics noted that the cannabinoids from marijuana provide benefits typically not found in conventional pharmaceutical treatments. Dr. Robert DeLorenzo, the lead researcher for the study, had been studying the therapeutic effects of cannabis on epilepsy and other illnesses for more than a decade at the time of the study. His team was the first to prove that cannabinoids can decrease seizures via the activation of the brain's CB1 receptors, which are found primarily in the memory-related areas of the brain and within the nervous system.
"This study indicates that cannabinoids may offer unique advantages in treating seizures compared with currently prescribed anticonvulsants. It shows not only the anticonvulsant activity of exogenously applied cannabinoids, but also suggests that the brain's cannabinoid system works to limit seizure duration by activating the CB1 receptor,"
said DeLorenzo. He added:
"Ingredients in marijuana and the cannabinoid receptor protein produced naturally in the body to regulate the central nervous system and other bodily functions play a critical role in controlling spontaneous seizures in epilepsy."
A 2014 study from Poland published in the Journal of Neural Transmission found that a synthetic form of THC called WIN 55,212-2, when used as a supplement to standard anti-seizure medication, resulted in a decrease in seizures. The study concluded that not only did the synthetic THC carry no negative side effects of its own, but that it also decreased the negative side effects of conventional pharmaceutical treatments.
"Because a substantial dose reduction of antiepileptic drugs in the mixture can be anticipated, it can be expected that concurrent adverse effects would be significantly reduced."
Need For Research
Dr. Orrin Devinsky, director of the Comprehensive Epilepsy Center at NYU Langone Medical Center, has called for additional research into the efficacy of cannabinoids like CBD and THC for the treatment of epilepsy. However, until cannabis is removed from Schedule I of the Controlled Substances Act — which legally defines it as more dangerous and addictive than cocaine and methamphetamines and completely lacking medical benefits — no human trials will occur.
Patients suffering from epilepsy and other seizure disorders may gain significant benefit from the use of cannabis to prevent and decrease the incidence of seizures. Those concerned with or opposed to the psychoactive effects of THC should experiment with CBD-only oils and tinctures, while understanding that they may not gain maximum efficacy from such a limited extract of the herb.
Photo credit: Locallyhealth.co.uk
Categories: Conditions, Epilepsy, Marijuana Knowledge Base, Medical
Gooey Rabinski
Gooey Rabinski is the author of Understanding Medical Marijuana.