Cannabis derived treatments for persistent health conditions ranging from anxiety to insomnia, chronic pain to nausea have been hailed as a medical miracle of the modern age. It seems that every day further therapeutic properties of the marijuana plant’s hundreds of cannabinoids are discovered and development begins on the next marijuana wonder therapy.
One group of patients needs that medical cannabis miracle more than the rest of us.
Lennox-Gastaut syndrome and Dravet syndrome are two chronic seizure conditions that typically affect children and teenagers. These seizures are more commonly known as epilepsy. One of the sadder aspects of infant and childhood epilepsy is that up to 30 percent of afflicted children do not improve with mainstream treatment. Lennox-Gastaut syndrome and Dravet syndrome are two of epilepsy’s most treatment resistant forms, and can affect infants as young as one and two years of age.
Many parents and caretakers of children with Lennox-Gastaut syndrome and Dravet syndrome look for hope and relief everywhere. In recent years, that hope for relief has been seen in human interest profiles of Lennox-Gastaut syndrome and Dravet afflicted children whose lives seem to have been dramatically improved by CBD and other medical cannabis products.
A parent or caretaker of a child plagued by an intractable seizure condition has only one question for the medical marijuana industry: Can cannabis help my child?
The short answer may very likely be yes. The scientific evidence forms a clear consensus. The endocannabinoid system is one key to countering the processes that produce epileptic seizures. In children, the cannabinoid best suited to doing that work is cannabidiol (CBD).
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Can CBD be used to treat epilepsy?
Not only can CBD-based medical cannabis treatment be used to treat children and adolescents who suffer from intractable epilepsy, it is being used.
In January 2020, the U.S. National Library of Medicine published an article titled “Medical Cannabis for Intractable Epilepsy in Childhood: A Review.” The entry provides an overview of studies conducted during the previous six years into the efficacy of using medical cannabis products to relieve the symptoms of intractable childhood seizure disorders.
The National Library of Medicine author, Bruria Ben-Zeev, MD, a specialist in pediatric neurology, notes a long history of study, predating the discovery and isolation of CBD, that documents cannabis being applied as an epilepsy therapy.
Ben-Zeev links Chinese historical records from 2700 BC and Sumerian and Akkadian tablets inscribed in 1800 BC to nineteenth century papers published by leading physicians of the day, all extolling the virtues of cannabis as an anticonvulsant.
The Marijuana Tax Act of 1937 and the subsequent 1941 banishment of cannabis and its derivatives from the American pharmacological tool kit derailed the modern medical community’s understanding of how cannabis as a whole and CBD effectively can be weaponized against intractable epilepsy.
Decades later, the medical establishment picked up its examination of therapeutic properties of cannabis components. Limited clinical trials in the 1970s drilled down on treating drug-resistant epilepsy patients with purified CBD (cannabidiol). The results of these 1970s trials were revisited by a 2012 research review. While stopping short of acknowledging CBD’s efficacy in managing symptoms of intractable seizure disorders, the review of the 1970s findings concluded that daily CBD dosage was safe enough to warrant further exploration.
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CBD in the community
In the past decade, word of mouth praising CBD products from family advocacy groups has been amplified on social media and through other Internet coverage. As anecdotal and video testimony has stacked up, belief in medical marijuana products as effective treatment for Dravet syndrome and Lennox-Gastaut syndrome has expanded among the public.
Parents and caretakers are purchasing cannabidiol in the forms of sprays, pills, oils, or tinctures, CBD-infused edibles, topical creams and balms, and swearing to the improvements these products have delivered to the quality of life for their children suffering from seizure disorders.
This widespread enthusiasm for medical cannabis treatments among the general populace has kick started commercial and clinical research into use of CBD in particular to treat pediatric epilepsy.
In effect, the willingness of parents and caretakers of children with Lennox-Gastaut syndrome and Dravet to seek solutions in over the counter therapeutic CBD products has pushed medical authorities to consider, research and develop cannabis based protocols for treating intractable childhood seizure disorders.
The zeal of Dravet and Lennox-Gastaut parents demanding their doctors investigate medical marijuana treatments for childhood epilepsy prompted a September 2019 editorial response in the medical journal Contemporary Pediatrics. Under the heading “Examining Cannabidiol Use in Children,” the opinion piece by Andrew J. Schuman, MD, withholds endorsement of so-called artisanal CBD medical products applied to childhood epilepsy cases.
Dr. Schuman reserves his qualified recommendation for a cannabis derived anticonvulsant medication called Epidiolex, the first and only Food and Drug Administration approved prescription CBD medication used to treat seizures associated with Lennox-Gastaut and Dravet syndromes.
“The Epidiolex trials,” Dr. Schuman admits, “provide evidence that CBD in appropriate dosages can be effective for refractory seizures in children with either Lennox-Gastaut syndrome or Dravet syndrome.”
How does cannabis and CBD work for epilepsy?
Commercial “artisanal” CBD and Epidiolex perform basically the same seizure disruptive functions. Their effectiveness is tied to the distinct differences between CBD and Delta-9-tetrahydrocannabinol or THC.
THC typically affects several of the body’s receptors and impacts our sense of pain, anxiety levels and memory, as well as affecting perception, learning and motor control. CBD, however, has a sedative effect on many neurotransmitters. It does not interact in the same way with our body as THC and when taken together, CBD blocks many of the effects THC has on the user.
CBD’s ability to inhibit the effects of THC seems to be tied in with CBD’s ability to inhibit seizures.
Why does CBD work for epilepsy?
Multiple factors go into current theories for why CBD is effective in reducing the severity of intractable childhood seizure conditions.
The experts aren’t sure precisely why CBD reduces convulsions in so many children suffering from chronic seizure conditions. However, Dr. Ben-Zeev is certain that:
1) A Facebook group of 150 parents reported an 84 percent reduction in seizure frequency after using CBD extracts to treat their children; 11 percent became seizure-free.
2) In another online survey, 117 parents of children with epilepsy using CBD extract reported 85 percent responders, with 14 percent of the children achieving seizure freedom.
3) A survey from Mexico tracked 53 patients aged 9 months to 18 years, reporting 83 percent of patients experienced improved seizure control, and 16 percent became seizure-free while using cannabis extract compounds.
4) Based on parental reports and a medical chart review, one third of 75 children and adolescents with Lennox–Gastaut syndrome and Dravet syndrome who received dosages of oral cannabis extracts experienced more than a 50 percent reduction of seizures.
5) A multicenter retrospective study from three epilepsy clinics in Israel treating 74 children for intractable epilepsy found that 52 percent of patients experienced more than 50 percent reduction in seizure frequency.
6) A chart review on the effect of artisanal cannabis on 272 pediatric epilepsy patients from Washington and California noted a more than 50 percent reduction in seizure frequency in 45 percent of patients, with 10 percent becoming seizure-free.
Is THC useful for epilepsy? What about THCA?
Dr. Ben-Zeev finds that studies of THC’s effect on seizures has had mixed results, including THC triggering proconvulsant responses—“making it less attractive for clinical epilepsy treatment.”
According to a report from CBD Project, a non-intoxicating cannabinoid found in raw and live cannabis called THCA shows great promise in treating epilepsy. One presumed benefit of THCA is that lower doses would be required than with other cannabis derived epilepsy treatments. However, research into THCA appears to be mostly at the preclinical stage. Though there is insufficient hard data to recommend it as a current treatment, anecdotal expectations mark THCA as a treatment to watch for in the future.
What are downsides to using cannabinoids for childhood epilepsy?
Dr. Schuman warns in Contemporary Pediatrics, “adverse effects seen in at least 10 percent of Epidiolex-treated patients included elevated liver enzymes, somnolence, decreased appetite, diarrhea, fatigue, sleep problems, and malaise. An increase in suicidal ideation was also seen.”
Trials have shown that CBD-based medical products can disrupt the function of drugs common to epilepsy treatment such as propofol, bupropion, morphine, clobazam, lorazepam, and phenytoin.
Finally, Dr. Schuman cites a study finding that many over the counter CBD products were labeled incorrectly as to contents and concentration. Schuman follows his citation of this study by insisting that the state of Utah reported 52 cases of poisoning resulting from CBD oil ingestion, with symptoms including “hallucinations, nausea, vomiting, seizures, and loss of consciousness.”
The takeaway: CBD and other cannabis derived therapeutic products offer hope for children suffering from chronic seizure conditions, and your child’s health deserves the advice and guidance of medical professionals in the application of all medical cannabis therapies.