Many people with epilepsy, a chronic condition in which they suffer from recurring seizures, use anticonvulsant drugs to reduce the frequency and severity of their seizures.
But when those seizures are not well controlled by these medicines, some patients find cannabidiol, or CBD, to be a helpful additional treatment.
So what do experts say about the use of CBD oil for seizures? Read on for a full breakdown of CBD’s role in epilepsy treatments.
About CBD Oil for Seizures
CBD treats epilepsy.
In recent years, doctors, patients, and researchers have found evidence to support decades old indications that CBD, taken in combination with antiepileptic drugs, can reduce both the severity and frequency of epileptic seizures.
Just the Facts
CBD has a strong likelihood of improving outcomes for treatment-resistant forms of epilepsy.
Epilepsy is a disorder in which people suffer from chronic seizures, or abnormal electrical discharges in the brain. It’s the fourth most common brain disorder in the U.S.
Seizures may present as full-body convulsions, but they can also appear as sudden losses of consciousness or muscle control.
Most epilepsy patients use anticonvulsant drugs for treatment. But those with forms of epilepsy that are resistant to drugs often seek alternative treatments.
How CBD Oil Could Help With Epilepsy
CBD is a non-intoxicating compound derived from the cannabis sativa plant. Research has indicated that it may have various medicinal benefits for health conditions ranging from psoriasis to insomnia.
But perhaps the strongest data exists in support of using CBD to treat severe forms of epilepsy. Clinical trials have focused on patients who suffer from hard-to-treat seizure disorders like Lennox-Gastaut syndrome and Dravet syndrome. In these studies, participants typically took CBD in addition to their other epilepsy drugs. The results have been promising.
It’s not yet clear exactly how CBD interacts with seizure activity. However, there are several theories about how CBD works against seizures through different neurological methods.
Reducing calcium transmission
One theory has to do with special characteristics of the brains of epilepsy patients. These brains are preconditioned to have abnormal increases in electrical activity. Because CBD has been shown to reduce calcium transmission between certain channels, this may play a part in lowering electrical overexcitement.
Other theories focus on CBD’s ability to inhibit the uptake of adenosine, a substance that affects electrical transmission between synapses in the brain, and CBD’s ability to reduce the release of glutamine in the GPR55 receptor. Glutamine is the most prevalent neurotransmitter, and GPR55 is related to the more prominent cannabinoid receptor CB1R. Studies show that this receptor plays a role in regulating electrical activity in the brain.
Because CB1R is activated more firmly by tetrahydrocannabinol, or THC, than by CBD, CBD is not understood to play a direct role in that cannabinoid receptor’s potential to reduce seizures.
However, the combination of CBD and THC, as found in full spectrum CBD (as opposed to pure CBD isolate), may improve CB1R activation in epilepsy treatments.
On its own, THC can have adverse effects on patients, from nausea to unwanted psychoactive effects. But adding CBD into a THC-based regimen can mitigate these side effects and lead to a more comfortable treatment option.
Epidiolex for Seizures
In June 2018, GW Pharmaceuticals obtained the first approval from the US Food and Drug Administration for a cannabis-derived epilepsy drug. Epidiolex is an oral solution containing CBD isolate. The FDA approved it for medical use in the United States for the treatment of two forms of refractory epilepsy.
A 2017 trial conducted on Epidiolex showed promising evidence for its treatment of Dravet syndrome, a form of severe epilepsy that can begin affecting patients as young as a few months old. In the study, patients saw a decrease in the average number of monthly seizures by about half (from 12 to 6).
While Epidiolex will hopefully help patients, some who have already tried CBD isolate treatments and seen little results are seeking out full spectrum CBD treatments that include higher quantities of THC than hemp-based products do.
One study found that patients who moved to Colorado for “marijuana-based,” full-spectrum CBD reported higher reductions in seizures than patients who received the same treatments but were already living in Colorado beforehand. This suggests that a cannabis product with a higher concentration of THC may be beneficial for the treatment of seizures in some patients.
2019: CBD and Cognition in Adults with Epilepsy
In this new study, researchers looked at the long-term effects of CBD on cognition in adults with seizure disorders.
Adults with treatment-resistant epilepsy often experience cognitive dysfunction. While CBD is a promising treatment, there has not been much research on its long-terms effects on cognition.
In this open label study, 27 adults took cognitive performance tests before taking CBD. Then, after a year of CBD treatment, they took the tests a second time. Through this process, the researchers evaluated several types of brain function. Specifically, they tested the patients’ working memory, episodic memory, executive function, processing speed, and language.
At the one year mark, the data showed no change in any of the areas of cognitive function. This indicates that CBD did not have a negative effect on the patients’ cognitive abilities.
2018: CBD for Lennox-Gastaut
In one 2018 trial on Lennox-Gastaut, patients who received CBD reported 20% greater reduction in seizure frequency compared to patients in a placebo group.
Some patients in both trials experienced side effects from the CBD. Many of these were mild effects like sleepiness and tiredness. But some patients experienced more serious adverse events such as vomiting, diarrhea, and abnormal liver functions. None of the reactions were life-threatening.
This study was double-blind and placebo-controlled, which is an important and tricky aspect of CBD research. Because all forms of cannabis were once federally classified as a Schedule I drug, in the same schedule as cocaine and heroin, it has not been easy for CBD studies to obtain approval.
Before the 2018 Farm Bill removed hemp and hemp-derived CBD from the Controlled Substances Act, this posed a huge obstacle for more thorough research to be conducted on its medical benefits.
2017: Full Spectrum CBD vs. CBD Isolate for seizures
In 2017, researchers found that full spectrum CBD could be a more potent treatment option than CBD isolate.
Their paper looked at patients receiving a certain dose of full spectrum CBD. They then compared them to patients receiving a dose of CBD isolate that was three times higher. In the end, both groups reported a similar reduction in seizures. The researchers concluded that full spectrum CBD was three times as potent as CBD isolate.
Fabricio Pamplona is one of the researchers who conducted the meta-analysis. He told me over email that this did NOT suggest taking higher doses of full spectrum CBD would reduce epileptic seizures even more. Rather, full-spectrum CBD “is over three times as cost effective for the patient, because you need a lower dose.”
Pamplona also said these results support evidence of the “entourage effect” in epilepsy treatments. “Although the exact composition of synergic compounds could not be inferred from this paper,” he added, “It does suggest that there is some positive interaction between CBD and the complex matrix of phytocompounds in the cannabis plant.”
Concerns about CBD Oil for Seizures
CBD has been demonstrated to be a relatively safe addition to epilepsy treatment plans with minor side effects. Some patients have experienced elevated liver enzymes, particularly when using CBD products in combination with other seizure medications.
Finding the optimal dose is also a concern. It often takes patients time to figure out their correct CBD dosage. And this can be tricky because doctors aren’t always so knowledgeable about CBD treatments.
Heather Jackson, CEO of the cannabinoid therapy education and advocacy non-profit Realm of Caring, estimates there’s “probably one handful of doctors in this nation that really understand and will guide the family with dosing.”
And epilepsy patients seeking cannabis oil with higher levels of THC may have to obtain medical marijuana licenses. That’s because higher-THC cannabis oils may be derived from cannabis strains that are categorized as “marijuana.”
“For example, in Colorado, if you’re under 18 you have to have two doctors’ recommendations and…a medical cannabis license,” Jackson says. “And all those doctors are doing is saying that yes you have a condition…that you can receive a medical cannabis license for. In some places it’s extremely restricted, like Utah, where they do have some legislation but it’s only for epilepsy.”