Childhood epilepsy is a serious problem. Some children have multiple seizures a day, lasting more than five minutes. When seizures last this long, children are at risk for brain damage and other health issues. Many treatments include medication or surgery, as well as other options. However, these methods do not work all the time. Cannabidiol or CBD has been revolutionizing treatment for children’s seizures.
What are Seizures?
A seizure is defined as a sudden or uncontrolled disturbance in the electrical part of the brain. It can cause someone to have changes in behavior, feelings, movement, and consciousness. There are many types of seizures. Those who have two or more seizures or have seizures that are recurring are likely to have epilepsy. The different types of seizures have different severity. You can determine seizure type by where they begin and how they begin in the brain. Most seizures last between thirty seconds and two minutes; however, some may last over five minutes. If a seizure lasts five minutes or longer, it is considered an emergency.
Seizures are fairly common. Someone may experience seizures after different medical conditions. Sometimes they occur due to stroke, infection, illness, or head injury. However, most of the time, the origin of seizures is unknown.
Most of the time, seizures can be controlled through different treatments, including epilepsy treatment. Medication, such as antiepileptic drugs, is used to treat seizures. However, sometimes, medication isn’t enough to become seizure-free. Not to mention, certain medications can provide serious side effects.
Everyone is different. Seizure symptoms and signs are all going to vary by person. Some symptoms and signs are very mild, whereas some people have severe signs or symptoms. When someone is about to have a seizure or has had a seizure, they may experience:
- Emotional Symptoms, which could include an experience of déjà vu, anxiety, or fear.
- Loss of Consciousness
- Loss of Awareness
- Jerking of the Arms and/or Legs (Uncontrollable)
A doctor classifies seizures into two categories. They are either generalized or focal seizures. This is determined based on where the brain activity begins and how it begins. There is another category labeled unknown onset. This means that doctors do not know how the seizure began.
These seizures happen when one area of the brain experiences abnormal activity. This seizure type can happen with or without consciousness.
Focal Seizures Without Consciousness Loss
This type of seizure may alter how a person feels emotions. It may also affect how the person looks at things, tastes, smells or feels during the seizure. However, they do not lose consciousness. This type of seizure may cause jerking or sensory symptoms. This could be tingling or flashing lights.
Focal Seizures with Loss of Consciousness
A person with this type of seizure loses consciousness or have a loss of awareness. This may result in the person staring off into space or not responding as they normally would. They are not going to respond to you and may start performing repetitive movements. This could include chewing, walking in circles, hand rubbing, and swallowing.
Many people confuse focal seizures with a multitude of different neurological disorders. Some other neurological disorders that could be confused with focal seizures are migraines, mental illness, or even narcolepsy.
Generalized seizures involve different parts of the brain. There are multiple types of generalized seizures.
These are known as petit mal seizures. These are the most common seizures that occur in children. When someone has this type of seizure, they may stare into space or start doing small body movements. Someone may start to smack their lips or blink rapidly. Many times, absence seizures happen one after another and could cause someone to be unaware of what has happened.
When this seizure occurs, your muscles stiffen. Generally, the muscle groups that are targeted are the legs, arms, and back muscles. Many times, people fall to the ground or fall over when this seizure occurs.
Atonic seizures can also be called drop seizures. A person who experiences this seizure loses control of their muscles. Most of the time, this causes the person to fall suddenly or collapse.
This type of seizure has repeated movements of the muscles. Generally, the neck and face are affected by this type of seizure.
This is a sudden movement. This could be jerking or twitching of both arms and legs. However, it could be twitching or jerking of just one as well.
These were called grand mal seizures before they were renamed. This is the worst and most dramatic seizure type. This can cause someone to lose consciousness and become stiff. The body may start to jerk. Many people lose control of their bladder and could even bite their tongue.
When the brain is not affected by epilepsy, the neurons in the brain are sending and receiving electrical impulses. This, in return, tells your body what to do. Your body communicates with these signals and neurons to live out everyday life. When this electrical signal is interrupted or disrupted, it could cause a seizure.
The most common cause of a seizure is epilepsy. However, that doesn’t mean you have epilepsy if you have a seizure. However, other causes can bring on a seizure:
- High fevers
- Lack of sleep
- Medication, including certain antidepressants, smoking therapies, and pain relievers are the most common type of medications that can cause seizures.
- Brain tumor
- Trauma to the head
- Drugs (most commonly cocaine or amphetamines)
- Low blood sodium, known as hyponatremia. This can happen under diuretic therapy.
- Alcohol abuse (it can also occur during withdrawal from those addicted to alcohol)
Dravet syndrome is a rare and genetic dysfunction of the brain. It generally occurs within the first year of a child’s life. It often occurs in those who are otherwise in perfect health. This was previously known as PMEI or polymorphic epilepsy in infants. This disease begins at an early age and continues throughout the child’s life.
- When the seizures start, the child will have normal development. However, when the seizures continue, children usually develop learning disabilities.
- This is a very commonly misdiagnosed disease.
- 8/10 who have the syndrome will have gene mutations. These mutations cause problems with how the ions in the brain function. These seizures are refractory. They do not respond to medications.
Those who suffer this disease will start by having a high fever and a large tonic-clonic seizure. After this initial seizure, myoclonic seizures occur. However, later in life, a child can experience all types of seizures.
This is a form of epilepsy. Those who suffer from LGS experience multiple types of seizures. They particularly experience atonic or drop seizures and tonic seizures. A person may experience intellectual developmental issues; however, that is not always impaired. The cause of this syndrome is not known.
This disease accounts for only five percent of all epilepsy cases in children. These seizures are very hard to control, and those with this problem will need treatment for their whole life. Those who suffer from this disease may have behavioral issues as well. This makes life with LGS difficult to manage.
This is a disease that will continue throughout the life of the child. Generally, LGS will change appearance as a person ages. There is no cure for this disease. However, there are treatment options.
This type of epilepsy means that medications can not control it. It may also be referred to as “uncontrolled” or “refractory” epilepsy. There are a few other names you may hear if you have this type of epilepsy. You may hear uncontrolled, drug-resistant epilepsy, or intractable. A doctor will try many different treatments for this type of epilepsy. This could include the use of CBD with CBD products. A doctor may also use medical cannabis as well to help treat difficult seizure disorders.
What is CBD?
CBD is a shorter term for cannabidiol. You may also hear the term CBD oil. CBD is a cannabinoid. It is one of the many different cannabinoids that are produced solely from the cannabis plant. CBD doesn’t have any psychoactive measures. This means that unlike THC or tetrahydrocannabinol, it does not have any functions associated with a high. The THC in the plant produces psychoactive effects on the brain.
What is THC?
THC or tetrahydrocannabinol is the compound that is responsible for producing psychological effects. It is a cannabinoid that is found in the cannabis plant. When someone ingests THC, certain areas of the brain are affected. This could include thinking, pleasure, memory, coordination, and time perception.
Does Cannabis Have Side Effects?
Cannabis or marijuana has several side effects. It all depends on how the item is used. For example, if someone is smoking it, it could have an impact on the lungs and heart.
You must know that even though this is a plant, it is broken down by your liver. It is broken down like many other medications. Many people believe because cannabis is a plant, that it is completely safe. However, this is not true. Just because it is a plant or oil from the plant, it could still interact with medications.
Cannabis Drug Interactions
Some drug interactions have been revealed during the studies of epilepsy and CBD. More studies are being done, but here is what we know so far.
- Those who are prescribed Valproic Acid or VPA have liver enzymes that are three times higher than they should be. VPA is a very commonly prescribed medication to treat seizures. In this study, the medication levels were not increased when the person was also taking CBD. It is believed that a byproduct of VPA may negatively interact with cannabis oil when both are broken down in the liver. This could cause people to have issues with their liver.
- When Onfi or clobazam is broken down, the interactive or major part of this drug interacts with cannabis oil. However, this doesn’t occur in everyone. Most people whom this occurs in are very tired when they are taking both Onfi and CBD.
Treating Seizures in Children
There are many treatment options available to children, including medication or diet changes (such as a ketogenic diet). Keep in mind that many children with epilepsy or other seizure disorders have refractory epilepsy. This means that their condition cannot be controlled with medications. This has led doctors in multiple different epilepsy centers to turn to the medical use of cannabis or CBD, which has been backed by much research, including a 2016 open-label study on cannabidiol in patients with treatment-resistant epilepsy, led by Dr. Orrin Devinsky.
What is an Epilepsy Center?
When a child or adult has seizures, they are often treated by healthcare professionals at an epilepsy center. These centers have highly knowledgeable teams of doctors who work with the families to create proper care for a child. They want to ensure that the proper diagnosis is made and that treatment will work. A team generally includes neurosurgeons, epileptologists, nurse specialists, and EEG technologists. You may occasionally have someone who is training in the field present as well. Epilepsy centers are designed to provide care to children who have epilepsy or seizures. They also are designed to help those who have refractory epilepsy.
There are different levels of care. Knowing the different levels of epilepsy can help the patient or parent, as well as the healthcare provider, to best determine the proper steps to help your child overcome or get their seizures under control. There are four different levels of epilepsy care. Only levels three and four are seen at epilepsy centers.
- This care occurs at an emergency facility. It may also occur at your primary care doctor’s office as well. They may conduct an epilepsy evaluation.
- This is where you would talk to a neurologist. The consultation could occur at an epilepsy center. (You are not receiving treatment at this time.)
- (Also step 4.) You are taken care of at the treatment center for seizures and/or epilepsy.
Level 3 Epilepsy Center
This is the basic range of medication or knowledge needed for treatment. They provide medical, psychosocial, and neuropsychological services to patients. They are treating patients that have refractory epilepsy. A level three epilepsy center has basic evaluations and basic services. You may even see that some of these have noninvasive evaluations for surgery. This may also include the implantation of a VNS or vagus nerve stimulator. They do not perform complex surgeries or evaluations.
Level 4 Epilepsy Center
These centers are more complex and provide more complex care. They have intensive monitoring and more extensive treatment options. They also do evaluations for many types of complex epilepsy surgeries.
People Who Should Be Seen in an Epilepsy Center
If your child has seizures and they are not under control within three months by the care of your child’s pediatrician, you should contact a neurologist as ongoing seizures that are not under control can harm the quality of life. An epilepsy center may be the best option for the treatment of epilepsy for your child.
You will also want to see an epileptologist if you are seeing a general neurologist and your seizures are not controlled within a year. You can request to see an epileptologist at this point.
CBD in Epilepsy
The studies in the United States of Epidiolex have been ongoing for many years. The study of this plant-based medication gained the Food and Drug Administrations’ (FDA) approval in 2018.
What is Epidiolex?
Epidiolex is an oral medication that is used to treat seizures in those who have Dravet or Lennox-Gastaut syndrome. It is also used in children. This drug may be used for those who have refractory epilepsy as well. This is the first FDA approved drug that has a drug substance that comes from the marijuana or cannabis plant. It is also the first drug to be approved for use for patients who have Dravet Syndrome.
The plant is 98% oil-based CBD that has been extracted by the marijuana plant. This is a Schedule I substance because it has chemical components that are derived from the cannabis plant. GW Pharmaceuticals make this medication. It is controlled by this company to ensure all doses are the same, and the medication is consistent.
Possible Side Effects of Epidiolex:
- Decrease in Appetite
Studies of Epidiolex
This medication was studied in controlled clinical trials. In this trial, some people were taking a placebo and others were given cannabis oil or CBD at different doses. The researchers did not know who was in which group. These are the best studies to be conducted to provide the best results.
The clinical trials found:
- The most common side effects were sleepiness, fatigue, lack of energy, insomnia, and decreased appetite.
- All participants of the study were on other medications for seizures.
- Side effects were most common in those taking higher dosages.
- The most common problem that caused the medication to stop being taken was liver function changes.
- Overall, those with LGS or Dravet had positive effects from the use of Epidiolex.
More specifically, a 2016 series of multicenter and multinational clinical trials have been put into action by Mayo Clinic in Rochester, Minnesota. These double-blind, placebo-controlled trials were the first studies concerning CBD in the U.S. These studies shed light on the use of CBD, bringing forth more data than just the anecdotal evidence seen in the media.
Children in these studies were either placed on Epidiolex or a placebo drug for 12 weeks, with parents and healthcare providers blinded to which any child received during the study period. 15 children with LGS or Dravet Syndrome completed the study at Mayo Clinic, with promising results. Data from the Dravet syndrome study group found that seizures had been reduced by 39 percent in those treated with CBD while only 16 percent of children in the placebo group saw a reduction in seizure activity.
Laws Surrounding Medical Marijuana and Cannabidiol
In December of 2018, President Donald Trump exempted hemp and hemp-derived items from the Controlled Substances Act. This included CBD. Before this Farm Bill was signed, hemp and cannabis products were Schedule I cannabis products. This meant they could not be used in medical use. This was because they were thought to have high abuse potential. The Farm Bill had lifted any restrictions that were surrounding cannabidiol. It also meant that it could be cultivated, manufactured, and sold throughout the United States. However, just because this was lifted, doesn’t mean that the use of CBD is always medically appropriate.
Today, over half of the fifty states have different laws surrounding cannabis. Half the states allow cannabis to be used medically. This means that it can be recommended as a treatment option and dispensed for those who need it for medical reasons. While the Farm Bill was passed, it still does not affect the laws that surround an individual state’s medical cannabis laws and/or programs.
Those who use cannabis as a treatment must follow regulations and rules that are needed. This means they must get medical cards and renew them when needed. There are different requirements by states.
It was in 2018 that Epidiolex was allowed to be used in medical practices. This medication is used for those who have Dravet and Lennox-Gastaut syndrome (as stated above). They can prescribe this medication just as they would other medications for seizures. In September of 2018, the DEA made it a Schedule V drug which allows it to be on the market so consumers can purchase it. Those who prescribe this medication do not need special certificates or licenses. This is the only cannabis-derived medication as of right now. It has the approval of the FDA for use for treatment in adults and children.
CBD and Seizures in Children
CBD has been the only approved drug as of right now to treat severe forms of epilepsy that begin early on in childhood. The DEA or drug enforcement agency has approved Epidiolex as the best anti-seizure medication for children who suffer from Dravet and Lennox-Gastaut syndromes. This is a drug that comes from the cannabis plant.
This drug is designed to help those who are two years old or older who have seizure-related syndromes. These forms of epilepsy start during early childhood and can be very difficult to control. There are no cures or treatment options outside of using this drug. There are no traces of THC or tetrahydrocannabinol in this drug. This means that a child will not experience psychoactive effects or receive a high.
Many people turn to CBD for the treatment of problems; however, it is only proven to help epilepsy. Studies have established that CBD is one of the best treatments for epilepsy or seizures. However, it is uncertain how CBD affects the body beyond helping with seizures.
Using CBD When Medications Do Not Work
The most conventional treatment for seizures is medication. However, in certain cases, medications do not always work. They may help minimize the number of seizures that are happening in a day, but they do not always control the problem. About thirty percent of people who have epilepsy have symptoms that are not under control with the use of medications alone. If you or your child is part of this thirty percent, CBD oil may be of benefit.
You should only consider this method of treatment if you have talked to your doctor about it. You should be evaluated at a special epilepsy center. They may try you on special diets or other types of medications that have not been tried with you yet before you start trying CBD oil. The epilepsy center may try different devices, surgery, or add additional medications to your routine.
The Problem with Medication
The problem with medication for children is that when people have seizures over and over, their medications are raised. However, every medication has limits. This means that once the limit dose is reached, you would have to start your child on another medication. Adding medication after medication and increasing doses is not always the best option for a child’s life. This is especially true if your children are very young.
Medications also have very serious and listing amounts of side effects. Adding more drugs to the concoction only increases a child’s chance of experiencing side effects.
CBD Replacing Epilepsy Medications
There were many cases where those who have epilepsy were able to wean off of their medications. However, this isn’t the case for everyone. It is highly unlikely that a child who has severe or rare forms of epilepsy can go without medications. If you want to try to wean off of medications, make sure that you are working closely with your neurologist. You never want to try this on your own as it could be hazardous for your child. Plus, those who use CBD or Epidiolex are not guaranteed that it will work.
Seizures happen to children and adults alike. However, many children with epilepsy struggle with one of two rare forms of epilepsy that are uncontrollable with medication, that they can develop at a young age. That is where the use of CBD and medical cannabis comes into play. Medical cannabis or CBD can be used in children who have these diseases to help control seizures. Controlling seizures with medication alone can be very difficult. Studies have shown that the use of medication and CBD is the best treatment plan.
If your child has been recently diagnosed with seizures or epilepsy, the American Epilepsy Society (AES) is a resource that may be beneficial for learning more about your child’s condition, in addition to any resources your child’s doctor provides you with.