CBD use & epilepsy

Research on the use of medical marijuana (also called medical cannabis) in individuals with epilepsy has increased over the last decade. Along with this has come lively discussions and debates on the benefits and risks of introducing cannabis into healthcare. Families often have questions surrounding this hot topic, and specifically how it relates to individuals with epilepsy. Here are answers to some frequently asked questions.

Note: This post is intended to be informational and we do not support or encourage the use of CBD without the consultation of a medical provider. Always consult with your physician before making any changes to your treatment plan.

What is medical cannabis?

Medical cannabis is whole plant marijuana or chemicals in the plant used for medical purposes. Cannabinoids are substances in cannabis that act on cells in the body to cause some effect. Tetrahydrocannabinol (THC) and cannabidiol (CBD) are two types of cannabinoids found in cannabis. THC, not CBD, is what causes intoxication or the psychoactive effect of “getting high.” Isolated CBD does not produce any “high” effects.

What role does CBD play in epilepsy treatment?

One in 26 individuals will develop epilepsy in their lifetime, and about one third of those people will have seizures resistant to standard anti-seizure medications. Isolated CBD is being studied as an alternative treatment option for these individuals. A list of current clinical trials studying this option can be found at www.clinicaltrials.gov. While some studies have shown the effectiveness of CBD in reducing seizures in people with epilepsy, the evidence is limited. More comprehensive research is needed to better assess the benefits and risks.

What CBD treatments are currently approved for patients with epilepsy?

In 2018 the U.S. Food & Drug Administration (FDA) approved Epidiolex, a plant-based formulation of CBD. Epidiolex is for the treatment of seizures associated with Lennox-Gastaut syndrome (LGS) and Dravet syndrome (DS) in people two years of age or older. This marked the first plant-based drug derived from the cannabis plant to be brought to market in the United States.

DS can be diagnosed both clinically or through genetic testing.
LGS is diagnosed clinically. While genetic factors are thought to play a role in the development of LGS, a specific genetic cause has yet to be identified.

Are there any side effects?

Yes. The safety data from the clinical trials conducted for Epidiolex reported the most common side effects were tiredness, diarrhea, and upset stomach. They did note that people getting the placebo (comparable “treatment” but without medical properties) also reported diarrhea and upset stomach, suggesting the oil-based product could have contributed to these symptoms. Importantly, drug-drug interactions have been reported in multiple studies that could result in exacerbated symptoms and an increased risk for liver issues.

For any treatment regimen, individuals may have varying responses to types and doses of particular medications. Certain genetic testing services, called pharmacogenetic testing or PGx, evaluates genetic factors that may impact how someone breaks down certain drugs, as well as how multiple drugs interact to impact his or her treatment response.

Is medical cannabis legal?

Currently, the medical use of cannabis and/or CBD is legal in 46 states and the District of Columbia. However, the specific laws and regulations surrounding cannabis vary state-to-state.

Are CBD treatments available for other neurodevelopmental disorders (NDDs)?

Currently, no other approved treatments are available for patients with NDDs. However, research is being conducted to study the effect of CBD treatment in individuals who have genetic diagnoses such as Tuberous Sclerosis Complex and Angelman syndrome.

Key Takeways:

More comprehensive research is needed to assess both the benefits and risks of medical marijuana with more certainty.
Currently, Epidiolex is the only FDA approved CBD drug.
CBD oil should only be considered with guidance and a thorough evaluation at a specialized epilepsy center to look at whether all possible treatments have been tried.

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