Approximately 420,000 children in the U.S. have epilepsy or a related disorder, and about one in 26 people will suffer from a seizure or related epileptic disorder in their lifetime. This disease is prevalent worldwide and has been around for thousands of years, although relatively undiagnosed until recent times. It is probable that cannabis was used long ago for those suffering from epileptic fits, seizures, or “possessions”, as it was referred to in ancient Roman, Egyptian, and Chinese cultures. Many years later, in our modern era, the stigma of cannabis is lifted and once again humankind is recognizing the benefits of medical cannabis for treatment in this disease…
This stigma has now been overcome, at least in our own country, to a CNN special with Sanjay Gupta and Charlotte Figgy in 2013. It was determined that the use of cannabis was highly beneficial for Dravet’s Syndrome or childhood epilepsy in a young girl, Charlotte Figgy. A high CBD strain of cannabis proved effective in reducing seizures by ten-fold, to reduce weekly seizures from 300 to 30 or less. This turned the tide in the US towards medical cannabis, after which the majority of Americans favored medical use by a substantial margin.
The most likely cannabinoid to help epileptic patients has been shown to be CBD or Cannabidiol. This is attributed to seizure reduction, inducing calmness, and overall relaxation. The anticonvulsant effect of CBD is beneficial in epilepsy, and there is both anecdotal and clinical evidence to support this fact. Hence, new drugs using cannabis and extracts of the plant have been developed in order to treat patients with this disease directly or to use in conjunction with traditional therapy. The traditional therapeutic approach involves many available drugs that can be helpful but have several negative side effects, therefore new drug therapies which are less harmful are acceptable. Medical cannabis can provide an effective alternative to traditional epilepsy treatments and gives patients relief without the risks of negative effects from conventional drugs.
Here is a quick look at some current research concerning endocannabinoids and epilepsy. Remember that your body makes its own cannabinoids, called endocannabinoids, as opposed to similar compounds in cannabis – and these are called phytocannabinoids.
Is the endocannabinoid system involved in human epilepsy?
Yes. There are defects in the endocannabinoid system in persons with epilepsy. In one study, 12 patients with newly diagnosed temporal lobe epilepsy had lower levels (p < .01) of anandamide in CSF as compared to controls. In tissue removed from 30 patients undergoing epilepsy surgery, the levels of CB1 receptor messenger RNA were lower in some excitatory nerve endings as compared to the specimens obtained post mortem from persons without epilepsy. It was also noted that in the epilepsy patients, there was reduced expression of diacylglycerol lipase α, the enzyme that synthesizes 2-AG in postsynaptic neurons. (Recall that 2-AG is a fully efficacious agonist of both CB1 and CB2 receptors.)
Although a bit complicated, this mechanism of action has been clinically proven – i.e. cannabinoids can help limit seizures. This scientific evidence, along with anecdotal evidence from Charlotte Figgy, helped provide the force to create the drug EPIDIOLEX.
Epidiolex was created by GW Pharmaceuticals under the watch of Ethan Russo M.D., senior medical advisor, and cannabis researcher. This is an organic whole plant extract but only contains natural CBD, with only .3% THC or less. This company GWPH seems to grow lots of cannabis in indoor greenhouses under strict medical supervision, and they currently have two main products Epidiolex and Sativex. Sativex is used mainly for multiple sclerosis or MS, and epidiolex for Dravet’s Syndrome and Lennox-Gestalt syndrome, forms of childhood epilepsy. Epidiolex can also be useful in adult seizures as well. Approval or Epidiolex is pending for two other diseases Tuberous Sclerosis and Rett’s syndrome.
Recently, Epidiolex was approved by the FDA for use in the United States, in spite of the CBD present. Previously it has been used in many other countries, rather successfully, so finally the US determined it was acceptable clinically to approve it. However, the DEA classification as CBD as a schedule 1 drug complicated its approval. It was determined to allow the CBD in Epidiolex to be placed in schedule 5. All other forms of CBD are still in schedule 1. This will allow the use for Epidiolex for patients in the US, but note that CBD overall is still in Schedule 1. This is sort of confusing, and typical of some of the cannabis dilemmas that can arise concerning the legality and classification of some of the compounds in the plant.
Soon this drug will be available for doctors and cannabis providers to prescribe for their patients suffering from this disease, many of whom are young children. Currently, in medical or legal cannabis states similar compounds to Epidiolex are already available - sort of in the generic form of the patented Epidiolex, but equally effective. Basically, it is any high CBD tincture, but the licensing agreement as a pharmaceutical drug goes to GW Pharmaceuticals because of their unique extraction process.
High doses of CBD and Epidiolex can be given with minimal or no side effects. Epidiolex also potentiates other anti-epileptic drugs so their dosage can be lowered, or possibly eliminated. It is manufactured as a tincture to be placed under the tongue for sublingual absorption. Also effective is the cannabis that is smoked, inhaled, eaten, or vaporized – but only strains that are high in CBD (i.e. Charlotte’s web).
Typically, there always seems to be a need for more research with medical cannabis in clinical randomized controlled studies. However, in this case, that is not necessary. The studies have been done, the issue now becomes to educate doctors, patients, and other medical professionals in the proper use of this new drug in the everyday treatment of the disease. Hopefully, all the individuals with seizure disorders will have a new avenue of treatment open for them, and be able to live a more productive and healthy life.