EPILEPSY AWARENESS
Written by Andrew Myers, RPh
Edited by Markita Wilburn, PharmD
Epilepsy is a neurological disorder that can affect any one of us regardless of race, age, or gender. Epilepsy occurs when people experience seizures repeatedly. This happens when there’s irregular electrical activity (either too much or too little) between brain cells. About 3.4 million people are living with epilepsy in the United States, with over 400,000 of those being children. Seizures are a symptom of epilepsy, but not all seizures are the same, and many people with epilepsy may have more than one type of seizure. Even more importantly, as much as a third of adults and up to 25% of children with epilepsy are not controlled adequately with pharmaceuticals. In the US alone, there are more than 22,000 deaths associated with seizure emergencies annually.
Medications used to prevent seizures include
Lamotrigine (Lamictal), Gabapentin (Neurontin), Levetiracetam (Keppra, Spritam), Phenytoin (Dilantin), Zonisamide (Zonegran), Carbamazepine (Tegretol), Oxcarbazepine (Trileptal), Valproic acid derivatives, Topiramate (Topamax) and Phenobarbital. Some of these medications are useful only for certain types of epilepsy, and some must be used in combination with others if a patient experiences multiple types of seizures. Many of these drugs have to be monitored frequently by testing blood levels, and this can make dosing difficult. Severe drug interactions are also possible with some of these drugs if used together.
The exact way some of these medications function is poorly understood, and older medications like Phenobarbital and Phenytoin exhibit non-specific neuronal suppression, which can adversely affect a patient's memory and cognitive abilities. While severe side effects are not common with most of these medications, life-threatening allergic reactions, aplastic anemia, and long-term damage to the patient’s liver and pancreas have all been observed.
ALTERNATIVE TREATMENTS for EPILEPSY
Patients who don’t respond very well to pharmaceutical medications (about 33%) and/or are sensitive to adverse reactions may sometimes avoid taking their medication and often look for alternative ways to treat their disease. Alternative approaches with variable degrees of success in treating epilepsy are vitamins, herbs, stress-relieving methods, acupuncture, vagus nerve stimulation, chiropractic care, and cannabis products.
Of particular interest, some forms of cannabis, primarily cannabidiol (CBD), have gained approval from the National Institutes of Health (NIH) as an adjunct treatment for epilepsy. Most importantly, this includes pediatric patients who, in some clinical studies, have exhibited up to a 50% reduction in their pharmaceutical medication and often became sustainably seizure-free. These incredible results have encouraged more studies with CBD; however, due to government restrictions on cannabis, it may be a while before additional research is completed.
SO WHY DOES CBD HAVE SUCH GREAT BENEFITS FOR EPILEPSY?
Next to tetrahydrocannabinol (THC), CBD is the second most prevalent active ingredient in marijuana. While CBD is an essential component of medical marijuana, it is also derived directly from the hemp plant. It is one of the hundreds of components in marijuana that do not cause mental stimulation. In the body, CBD and other cannabinoids work through a series of cellular messengers called the Endocannabinoid System (ECS).
The ECS is a vast network of chemical signals and cellular receptors densely packed in our brains and bodies. The "cannabinoid" receptors in the brain — CB1 receptors — outnumber many of the other receptor types. They act like traffic cops to control the levels and activity of many bodily responses. The ECS is a widespread neuromodulatory system that plays essential roles in central nervous system development, synaptic plasticity, and the response to internal and environmental stressors. It is critical for most of our daily functioning.
CBD is not the only cannabinoid that is beneficial — Cannabigerolic acid (CBGA), Cannadivarinic acid (CBDVA), Cannabidivarin (CBDV), and Cannabigerovarinic acid (CBGVA) have all shown an ability to reduce seizures in a mouse model of Intractable Epilepsy.
Clinically, Tetrahydrocannabinol (THC) can also be effective but not as good by itself for preventing seizure occurrence. THC is rather useful when consumed in combination with CBD. Together, they produce an “entourage effect” described as the synergy experienced when all cannabinoids and terpenes work together for a more potent and well-balanced response.
The more accessible marijuana cannabinoids CBD, THC, and THCA have been shown to reduce seizure activity through several proposed mechanisms of action.
CBD increases levels of our endocannabinoids by interfering with their enzymatic degradation.
CBD reduces neuronal excitability by modulating ion flow, like calcium and potassium.
THC activates CB1 receptors to suppress glutamate activity. This is relevant because increased glutamate causes neuronal excitation.
CBD is a potent anti-inflammatory agent that works against the accumulation of harmful oxidative products produced in response to neuron excitation and dysfunction. CBD reduces inflammation of the brain (neuroinflammation). Brain inflammation is thought to make seizures worse.
MMJ + EPILEPSY
Most patients looking to manage epilepsy with medical marijuana should focus on CBD-dominant strains. A 10:1 CBD:THC ratio is a good starting point for pediatric patients, while others benefit from a 1:1 CBD:THC ratio. Though psychoactive, high THC cultivars with the presence of linalool are becoming popular when looking for something more relaxing for both mind and body before bed. Linalool is a mildly psychoactive terpene with strong anticonvulsant action, ideal for unwinding and relaxation. THCV, non-psychoactive, has the potential to reduce seizure incidence, similar to that of CBD.
Commonly recommended strains for patients with seizure disorders are Harlequin, ACDC, and Harle-Tsu. Patients may also find benefits in the following products when looking to manage symptoms of epilepsy:
CBD Lemon Magik 7g ground flower by Terrapin
Electric Blanket 3.5g flower by Terrapin
1:3 Active Tincture by Organic Remedies
1:1 CBD Martian Monkey #14 vape cartridge by gLeaf
1:1 Restore Drops by Dr. Solomon’s
1:1 Harlequin RSO by Remedi
Indica Blend RSO by Maitri Genetics (THC only with linalool)
GOING FORWARD…
On December 2, 2022, President Biden signed the Medical Marijuana and Cannabidiol Research Expansion Act into law. The new law will make it significantly easier to conduct medical research on marijuana in the United States. The Epilepsy Foundation strongly supported the bill and looks forward to its implementation. Importantly for people with epilepsy, the new law also clarifies that physicians may discuss the benefits and risks of marijuana as a medical treatment with their patients without violating the Controlled Substances Act. Many physicians have been reluctant to discuss cannabis and CBD use with their patients for fear of legal repercussions. We hope this change will improve communications between people with epilepsy and their healthcare providers, resulting in improved treatment and outcomes.
Tips on what to do if someones having a seizure
REFERENCES
Therapeutic and clinical foundations of cannabidiol therapy for difficult-to-treat seizures in children and adults with refractory epilepsies, Exp Neurol. 2023 Jan:epub 2022 Oct 4.
An introduction to the endogenous cannabinoid system, Biol Psychiatry. 2016 Apr 1; 79(7): 516–525. Published online 2015 Oct 30.
https://laurasmercantile.com/the-endocannabinoid-system-how-cbd-works/
The Impact of Cannabidiol on Human Brain Function: A Systematic Review, Front Pharmacol. 2020; 11: 618184. Published online 2021 Jan 21.
https://www.epilepsy.com/advocacy/priorities/medical-cannabis-cbd
https://www.health.harvard.edu/blog/the-endocannabinoid-system-essential-and-mysterious-202108112569