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Epilepsy is a group of neurological disorders, characterized by seizures, which affect 1 in 26 people in the United States. Studies have shown cannabidiol (CBD), a major cannabinoid found in cannabis, is effective at significantly decreasing the frequency of seizures and has the potential of offering complete seizure freedom.
Overview of Epilepsy
Epilepsy is a central nervous system disorder that can range in severity from being relatively benign to disabling and even life threatening. In epilepsy, nerve cell activity in the brain becomes disrupted, causing seizures, convulsions, strange sensations and a loss of consciousness. The occurrence of a seizure doesn’t necessarily mean a person has epilepsy. Experiencing two or more seizures, however, is call for the diagnosis of epilepsy.
According to the National Institute of Neurological Disorders and Stroke, the possible causes of epilepsy include an abnormality in brain wiring, an imbalance of neurotransmitters (nerve-signaling chemicals), changes in important brain cells called channels, or any combination of these factors. Genetics, head trauma, brain conditions, infectious diseases, prenatal injury, and developmental disorders can initiate these causes.
There is no cure for epilepsy, so treatment focus remains on limiting seizures through medication, diet adjustments, devices, and in some cases, surgery. It’s important to be treated for epilepsy, as seizures can cause you to fall and are dangerous when you’re driving or swimming. Severe childhood epilepsies that are characterized by frequent seizures can cause delays in neurodevelopment and an impaired quality of life. In rare cases, experiencing abnormally prolonged seizures can lead to unexplained death.
Findings: Effects of Cannabis on Epilepsy
A number of scientific reviews analyzing previously-published research on cannabis’ effect on epilepsy conclude that a major cannabinoid found in cannabis, cannabidiol (CBD), is a well-tolerated and promising therapeutic treatment that has demonstrated the ability to reduce or even eliminate seizures3,4,5,6,7,10,16,18,19,25,26. One study found that CBD was able to prevent seizures associated with cocaine use28. Tetrahydrocannabinol (THC) has also demonstrated efficacy at reducing seizures in children with epilepsy21. Another cannabinoid found in cannabis, cannabidivarin (CBDV) has shown to have non-psychoactive anticonvulsant effects1,13. In a preclinical trial, the administration of cannabis provided significant anticonvulsant effects in mice and rats13.
CBD’s ability to decrease or eliminate seizures is due to its effects on the endocannabinoid system30. CBD interacts with the system’s cannabinoid receptor 1 (CB1); The CB1 receptor then dampens neurotransmission and produces an overall reduction in neuronal excitability2,12,20,25,29,30.
Research also finds that cannabis is effective in the treatment of severe pediatric epilepsy disorders like Dravet syndrome, Doose syndrome and Lennox-Gastaut syndrome. In one questionnaire study, 84% of parents reported a reduction in their child’s seizure frequency with cannabis treatment. Out of those parents, 11% of them responded that their child has reached complete seizure freedom, while 42% reported a greater than 80% reduction in seizure frequency. The parents also reported additional beneficial effects, such as increased alertness, better mood and improved sleep24. Another survey found that CBD-enriched cannabis brought about a reduction in seizure frequency in 85% of children with epilepsy, while 14% experienced complete seizure freedom. The children also reported an improvement in sleep (53%), alertness (71%), and mood (63%) while being treated with CBD17. One case report analyzing a young epileptic girl found that medical marijuana brought the child’s seizure frequency from nearly 50 convulsive seizures per day to 2-3 nocturnal convulsions per month. In addition, the child was able to wean from the additional anti-epileptic drugs she had been taking22. Another study examining the effect of CBD-enriched medical cannabis on children with epilepsy found that 89 percent of children reported a reduction in seizure frequency with CBD treatment. The children also reportedly saw improvements in behavior and alertness, language, communication,motor skills and sleep27.
Traditional medicines used to treat epilepsy often come with a number of adverse side effects. However, the cannabinoids found in cannabis have shown to produce anticonvulsant effects in preclinical and preliminary human studies while producing fewer adverse effects that other anti-epileptic drugs8. A questionnaire study found that parents tried an average of 12 different anti-epileptic drugs, due to ineffectiveness or unacceptable side effects, before finding gentle effectiveness with cannabis24.
States That Have Approved Medical Marijuana for Epilepsy
Currently, 26 states have approved medical marijuana specifically to treat epilepsy. These states include: Alabama (debilitating epileptic conditions), Connecticut, Delaware (intractable epilepsy), Florida, Georgia (seizure disorder), Iowa (intractable epilepsy), Louisiana, Maine, Mississippi (intractable epilepsy), Missouri (intractable epilepsy), New Hampshire, New Jersey (seizure disorders), New Mexico, New York, North Carolina (intractable epilepsy), North Dakota, Ohio, Oklahoma (pediatric epilepsy), Pennsylvania, South Carolina (Dravet syndrome, Lennox-Gastaut syndrome, Refractory epilepsy), Texas (intractable epilepsy), Utah (intractable epilepsy), Virginia (intractable epilepsy), West Virginia (epilepsy, intractable seizures), Wisconsin (seizure disorders), and Wyoming (intractable epilepsy).
In addition, several states have approved medical marijuana to treat seizures. These states include: Alaska, Arizona, Arkansas, California, Colorado, Delaware, Hawaii, Louisiana, Maryland, Michigan, Minnesota, Montana, Nevada, New Hampshire, North Dakota, Ohio, Oregon, Pennsylvania (intractable seizures), Rhode Island, Tennessee (intractable seizures), Vermont and Washington.
The state of Massachusetts will consider allowing medical marijuana to be used for the treatment of epilepsy if it’s determined in writing by a qualifying patient’s physician.
In Washington D.C., any condition can be approved for medical marijuana as long as a DC-licensed physician recommends the treatment.
Recent Studies on Cannabis’ Effect on Epilepsy
- Amada, N., Yamasaki, Y., Williams, C.M., and Whalley, B.J. (2013, November 21). Cannabidivarin (CBDV) suppresses pentylenentetrazole (PTZ)-induced increases in epilepsy-related gene expression. Peer J, 1:e214; doi 10.7717/peerj.214. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3840466/.
- Blair, R.E., Deshpande, L.S., Sombati, S., Falenski, K.W., Martin, B.R., and DeLorenzo, R.J. (2006, June). Activation of the cannabinoid type-1 receptor mediates the anticonvulsant properties of cannabinoids in the hippocampal neuronal culture models of acquired epilepsy and status epilepticus. The Journal of Pharmacology and Experimental Therapeutics, 317(3), 1072-1078. Retrieved from http://jpet.aspetjournals.org/content/317/3/1072.long.
- Blair, R.E., Deshpande, L.S., and DeLorenzo, R.J. (2015, September). Cannabinoids: is there a potential treatment role in epilepsy? Expert Opinion on Pharmacology, 16(13), 1911-4. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4845642/.
- Cilio, M.R., Thiele, E.A., and Devinsky, O. (2014, June). The case for assessing cannabidiol in epilepsy. Epilepsia, 55(6), 787-90. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/epi.12635/full.
- Cunha, J.M., Carlini, E.A., Pereira, A.E., Ramos, O.L., Pimentel, C., Gagliardi, R., Sanvito, W.L., Lander, N., and Mechoulam, R. (1980). Chronic administration of cannabidiol to healthy volunteers and epileptic patients. Pharmacology, 21(3), 175-85. Retrieved from https://goo.gl/JKQU41.
- Detyniecki, K., and Hirsch, L. (2015, October). Marijuana use in epilepsy: The myth and the reality. Current Neurology and Neuroscience Reports, 15(10), 65. Retrieved from http://link.springer.com/article/10.1007%2Fs11910-015-0586-5.
- Devinsky, O., Cilio, M.R., Cross, H., Fernandez-Ruiz, J., French, J., Hill, C., Katz, R., Di Marzo, V., Jutras-Aswad, D., Notcutt, W.G., Martinez-Orgado, J., Robson, P.J., Rohrback, B.G., Thiele, E., Whalley, B., and Friedman, D. (2014, June). Cannabidiol: pharmacology and potential therapeutic role in epilepsy and other neuropsychiatric disorders. Epilepsia, 55(6), 791-802. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4707667/.
- dos Santos, R.G., Hallak, J.E., Leite, J.P., Zuardi, A.W., and Crippa, J.A. (2015, April). Phytocannabinoids and epilepsy. Journal of Clinical Pharmacology and Therapeutics, 40(2), 135-43. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/jcpt.12235/full.
- Epilepsy (2014, November 22). Mayo Clinic. Retrieved from http://www.mayoclinic.org/diseases-conditions/epilepsy/home/ovc-20117206.
- Filloux, F. M. (2015). Cannabinoids for pediatric epilepsy? Up in smoke or real science? Translational Pediatrics, 4(4), 271–282. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4729003/.
- Friedman, D., and Devinsky, O. (2015, September 10). Cannabinoids in the Treatment of Epilepsy. The New England Journal of Medicine, 373(11), 1048-58. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMra1407304.
- Hill, T.D., Cascio, M.G., Romano, B., Duncan, M., Pertwee, R.G., Williams, C.M., Whalley, B.J., and Hill, A.J. (2013, October). Cannabidivarin-rich cannabis extracts are anticonvulsant in mouse and rat via a CB1 receptor-independent mechanism. British Journal of Pharmacology, 170(3), 679-92. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3792005/.
- Hill, A., Mercier, M., Hill, T., Glyn, S., Jones, N., Yamasaki, Y., Futamura, T., Duncan, M., Stott, C.G., Stephens, G.J., Williams, C.M., and Whalley, B. (2012). Cannabidivarin is anticonvulsant in mouse and rat. British Journal of Pharmacology, 167(8), 1629–1642. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3525866/.
- Hill, A.J., Williams, C.M., Whalley, B.J., and Stephens, G.J. (2012, January). Phytocannabinoids as novel therapeutic agents in CNS disorders. Pharmacology & Therapeutics, 133(1), 79-97. Retrieved from http://www.sciencedirect.com/science/article/pii/S016372581100180X.
- Hoffman, M.E., and Frazier, C.J. (2013, June). Marijuana, endocannabinoids, and epilepsy: potential and challenges for improved therapeutic intervention. Experimental Neurology, 244, 43-50. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3332149/.
- Hosseinzadeh, M., Nikseresht, S., Khodagholi, F., Naderi, N., and Maghsoudi, N. (2016, April). Cannabidiol Post-Treatment Alleviates Rat Epileptic-Related Behaviors and Activates Hippocampal Cell Autophagy Pathway Along with Antioxidant Defense in Chronic Phase of Pilocarpine-Induced Seizure. Journal of Molecular Neuroscience, 58(4), 432-40. Retrieved from http://link.springer.com/article/10.1007%2Fs12031-015-0703-6.
- Hussain, S.A., Zhou, R., Jacobson, C., Weng, J., Cheng, E., Lay, J., Hung, P., Lerner, J.T., and Sankar, R. (2015, June). Perceived efficacy of cannabidiol-enriched cannabis extracts for treatment of pediatric epilepsy: A potential role for infantile spasms and Lennox-Gastaut syndrome. Epilepsy & Behavior, 47, 138-41. Retrieved from http://www.epilepsybehavior.com/article/S1525-5050(15)00157-2/fulltext.
- Jones, N. A., Hill, A. J., Smith, I., Bevan, S. A., Williams, C. M., Whalley, B. J., and Stephens, G. J. (2010). Cannabidiol Displays Antiepileptiform and Antiseizure Properties In Vitro and In Vivo. The Journal of Pharmacology and Experimental Therapeutics, 332(2), 569–577. Retrieved from http://doi.org/10.1124/jpet.109.159145.
- Jones, N.A., Glyn, S.E., Akiyama, S., Hill, T.D., Hill, A.J., Weston, S.E., Burnett, M.D., Yamasaki, Y, Stephens, G.J., Whalley, B.J., and Williams, C.M. (2012, June). Cannabidiol exerts anti-convulsant effects in animal models of temporal lobe and partial seizures. Seizure, 21(5), 344-52. Retrieved from http://www.seizure-journal.com/article/S1059-1311(12)00057-X/fulltext.
- Karlócai, M. R., Tóth, K., Watanabe, M., Ledent, C., Juhász, G., Freund, T. F., & Maglóczky, Z. (2011). Redistribution of CB1 Cannabinoid Receptors in the Acute and Chronic Phases of Pilocarpine-Induced Epilepsy. PLoS ONE, 6(11), e27196. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3208595/.
- Lorenz, R. (2004, February-April). On the application of cannabis in paediatrics and epileptology. Neuroendocrinology Letters, 25(1-2), 40-4. Retrieved from http://www.nel.edu/pdf_/25_12/NEL251204A02_Lorenz_.pdf.
- Maa, E., and Figi, P. (2014, June). The case for medical marijuana in epilepsy. Epilepsia, 55(6), 783-6. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/epi.12610/full.
- NINDS Epilepsy Information Page. (2015, July 17). National Institute of Neurological Disorders and Stroke. Retrieved from http://www.ninds.nih.gov/disorders/epilepsy/epilepsy.htm.
- Porter, B.E., and Jacobson, C. (2013, December). Report of a parent survey of cannabidiol-enriched cannabis use in pediatric treatment-resistant epilepsy. Epilepsy & Behavior, 29(3), 574-7. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4157067/.
- Rosenberg, E.C., Tsien, R.W., Whalley, B.J., and Devinsky, O. (2015, August 18). Cannabinoids and Epilepsy. Neurotherapeutics, Epub ahead of print. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604191/.
- Szaflarski, J.P., and Bebin, E.M. (2014, December). Cannabis, cannabidiol, and epilepsy–from receptors to clinical response. Epilepsy & Behavior, 41, 277-82. Retrieved from http://www.epilepsybehavior.com/article/S1525-5050(14)00413-2/fulltext.
- Tzadok, M., Uliel-Siboni, S., Linder, I., Kramer, U., Epstein, O., Menascu, S., Nissenkorn, A., Yosef, O.B., Hyman, E., Granot, D., Dor, M., Lerman-Sagie, T., and Ben-Zeev, B. (2016, February). CBD-enriched medical cannabis for intractable pediatric epilepsy: The current Israeli experience. Seizure, 35, 41-4. Retrieved from http://www.seizure-journal.com/article/S1059-1311(16)00005-4/fulltext.
- Vilela, L.R., Gomides, L.F., David, B.A., Antunes, M.M., Diniz, A.B., Moreira, F.D., and Menezes, G.B. (2015). Cannabidiol rescues acute hepatic toxicity and seizure induced by cocaine. Mediators of Inflammation, Article ID 523418, 12 pages. Retrieved from https://www.hindawi.com/journals/mi/2015/523418/.
- Wallace, M.J., Wiley, J.L., Martin, B.R., and DeLorenzo, R.J. (2001, September 28). Assessment of the role of CB1 receptors in cannabinoid anticonvulsant effects. European Journal of Pharmacology, 428(1), 51-7. Retrieved from http://www.sciencedirect.com/science/article/pii/S0014299901012432.
- Wallace, M.J., Martin, B.R., and DeLorenzo, R.J. (2002). Evidence for a physiological role of endocannabinoids in the modulation of seizure threshold and severity. European Journal of Pharmacology, 452(3), 295-301. Retrieved from http://www.sciencedirect.com/science/article/pii/S0014299902023312.
- Wallace, M.J., Blair, R.E., Falenski, K.W., Martin, B.R., and DeLorenzo, R.J. (2003, October). The endogenous cannabinoid system regulates seizure frequency and duration in a model of temporal lobe epilepsy. The Journal of Pharmacology and Experimental Therapeutics, 307(1), 129-37. Retrieved from http://jpet.aspetjournals.org/content/307/1/129.long.
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