Does CBD Oil Work to Help With Seizures?
- In a 2017 study in the New England Journal of Medicine, researchers led by Orrin Devinsky, M.D., concluded that among patients with Dravet syndrome, CBD use resulted in a more significant reduction in convulsive-seizure frequency than placebo(1).
- In a randomized, double-blind, placebo-controlled trial done in the USA, the Netherlands, and Poland in 2018, researchers found that add-on CBD proved efficacious for the treatment of individuals aged 2 to 55 years old with drop seizures associated with Lennox-Gastaut syndrome(2).
- The studies on CBD in individuals with Dravet and Lennox-Gastaut syndrome contributed to the U.S. Food and Drug Administration’s decision to approve Epidiolex (pharmaceutical-grade pure CBD) as an evidence-based treatment for treatment-resistant epilepsy due to these syndromes(3).
- For some forms of epilepsy, there is currently no cure or treatment of seizures. Increasing a patient’s quality of life is a significant motive of health professionals for initiating treatment, as shown in a 2018 study published in Epilepsy and Behavior(4).
- The Centers for Disease Control and Prevention (CDC) once included epilepsy as a condition that may increase the risk of serious COVID-19, likely because it is a chronic neurological condition. However, in general, there is currently no evidence of increased risk of infection in people with epilepsy, according to the International League Against Epilepsy (ILAE)(5).
Why People Are Turning to CBD for Seizures
Cannabidiol (CBD), an active cannabinoid without psychoactive effects and abuse liability, has recently gained interest as a potential treatment option for epilepsy.
Recent legal changes in the status of medical cannabis within several European countries have made CBD more accessible to health care professionals, according to a 2018 study published in the European Journal of Pain(6).
The authors of a 2014 study in Epilepsy and Behavior noted that many families with children dealing with treatment-resistant epilepsy began to explore the use of CBD-enriched cannabis and reported a successful reduction of seizure frequency(7).
Studies showed CBD’s antiepileptic efficacy in acute and chronic seizure models in rodents, although the precise mechanisms of action remain unclear(8).
Various studies using purified CBD in animal models of partial and generalized epilepsy also showed anticonvulsant effects(9). The studies were done on rats, gerbils, and mice.
Meanwhile, small randomized controlled trials and open-label studies of purified CBD in humans with treatment-resistant epilepsy had shown mixed results(10).
In a 2017 study in the New England Journal of Medicine, researchers led by Orrin Devinsky, M.D., concluded that among those with the Dravet syndrome, CBD use resulted in a more significant reduction in convulsive-seizure frequency than placebo(11). It is important to note that many of these studies used a combination product that contained CBD and THC, sometimes in a one-to-one ratio.
Dr. Orrin Devinsky is a neurologist specializing in epilepsy treatments and the director of the Comprehensive Epilepsy Center.
The results of the study mentioned were encouraging. On average, convulsive seizures decreased from nearly 13 seizures to about 6 seizures per month with CBD.
The average change was from nearly 15 to about 14 seizures per month with the placebo. A minority of patients, about 5%, became seizure-free.
However, CBD use was also linked to higher rates of adverse events, including diarrhea, vomiting, fatigue, fever, drowsiness, and abnormal results on liver-function tests.
In a randomized, double-blind, placebo-controlled trial done at 24 clinical sites in the USA, the Netherlands, and Poland in 2018, researchers investigated the efficacy of CBD for the treatment-resistant Lennox-Gastaut syndrome (LGS).
Results indicated that add-on CBD proved efficacious for the treatment of individuals (aged 2 to 55 years old) with drop seizures associated with Lennox-Gastaut syndrome(12).
Drop seizures (also called atonic seizures or drop attacks) are a type of seizure characterized by a sudden loss of muscle strength, causing the person to fall to the ground(13).
In the said study, the average reduction in drop-seizure frequency during the treatment period was nearly 42% in the high-dose CBD group, about 37% in the low-dose CBD group, and 17% in the placebo group.
The authors also found CBD to be generally well-tolerated. However, 74 of the 86 patients experienced adverse effects, like diarrhea, drowsiness, fever, decreased appetite, and vomiting.
The studies on CBD as add-on anticonvulsant in individuals with Dravet and Lennox-Gastaut syndrome contributed to the U.S. Food and Drug Administration (FDA)’s decision to approve Epidiolex (pharmaceutical-grade pure CBD) as an evidence-based remedy for treatment-resistant epilepsy due to the syndromes(14).
Still, doctors’ attitudes concerning the use of the medical cannabis plant, in general, and CBD for the treatment of epilepsy appear to be divided(15). Also, data about the clinical use of CBD in daily practice are not available.
How CBD Oil Works to Help With Seizures
To understand how CBD works to help with seizures, one must understand how the endocannabinoid system (ECS) works.
The therapeutic effects of cannabinoids, such as CBD, are realized by their interaction with the body’s ECS and its specialized cannabinoid receptors.
The ECS, integral to the body’s physiologies, is responsible for regulating a wide range of body functions, including pain sensation, immune response, anxiety, sleep, mood, appetite, metabolism, and memory.
CB1 and CB2 are the two main types of receptors found in specific parts of the human body. These receptors each have particular roles in the ECS.
CB1 receptors are mostly located in the brain and central nervous system. However, they are also found in the reproductive organs, gastrointestinal and urinary tracts, liver, lungs, and retina(16).
CB1 receptors play a role in motor regulation, memory processing, appetite, pain sensation, mood, and sleep(17).
The activation of CB1 receptors has also been linked to neuroprotective responses. This activity suggests the cannabinoids with a higher affinity for CB1 receptors could help in the treatment and prevention of neurodegenerative medical conditions, such as Parkinson’s disease, Alzheimer’s disease, and multiple sclerosis.
Meanwhile, CB2 receptors are primarily situated on cells in the immune system and its associated structures.
When CB2 receptors are triggered, they stimulate a response that fights inflammation, reducing pain, and minimizing damage to tissues.
CBD has a very weak affinity for the CB1 and CB2 receptors, and its anti-seizure activity at specific concentrations is brought about by other mechanisms(18).
In particular, the reabsorption of adenosine and the blocking of GPR55 receptors in the brain have been suggested to play an essential role in CBD anti-seizure activity(19).
Adenosine is a neurotransmitter that can stop convulsions and seizures(20). A 2017 study published in Neuropharmacology noted that the therapeutic increase of adenosine effectively prevents epileptic seizures(21).
GPR55 is a type of protein in the brain. A study found that GPR55 function was enhanced by epilepsy in a manner that made the disease worse.
However, CBD remained sufficiently potent in epileptic brains, suggesting an anticonvulsant characteristic of CBD(22).
The anticonvulsant properties of CBD may be related in part to CBD-mediated modulation of the ECS(23).
This action is done explicitly through the inhibition of anandamide degradation or decline, resulting in decreased excess brain activity(24).
Anandamide is an endocannabinoid that acts as a neurotransmitter and regulates emotions.
Research found that endocannabinoids are released by bursts of action potentials, including events resembling spikes, and probably by seizures as well(25).
The Pros and Cons of CBD Oil for Seizures
- CBD’s efficacy as a potential remedy to seizures or the management of epilepsy symptoms has been shown in the studies stated above.
- CBD is non-addictive, says Nora Volkow, director of the National Institute on Drug Abuse (NIDA) in a 2015 article(26). This characteristic makes CBD safe for daily consumption.
- CBD is generally well-tolerated with a good safety profile, the World Health Organization (WHO) stated in a critical review(27).
- In a 2017 review published in Cannabis and Cannabinoid Research Journal, CBD was considered tolerable at doses of up to 1,500 mg per day(28).
- CBD oil may be purchased without a prescription in locations where they are legally available.
- The FDA has approved Epidiolex, a drug for seizures that has CBD as its main ingredient(29).
- No study validates CBD alone can be used in treating epilepsy and all its symptoms. Studies are too limited to determine whether or not CBD is an effective treatment for conditions other than the ones approved by the FDA(30).
- As with the use of any natural chemical compound, there are risks involved in using CBD for seizures.
According to the Mayo Clinic, possible side effects of CBD use include drowsiness or sleepiness, dry mouth, diarrhea, fatigue, and reduced appetite(31).
- CBD has been shown to alter how the body metabolizes certain medications, as a 2017 research reveals(32).
- The lack of regulation makes it difficult to determine whether the CBD gummies, tinctures, patches, balms, and gelcaps contain what the product label claims.
A 2017 review published in the Journal of the American Medical Association revealed labeling inaccuracies among CBD products. Some products had less CBD than stated, while others had more(33).
How CBD Oil Compares to Alternative Treatments for Seizures
Epilepsy is a type of neurological condition that can get in the way of everyday life, particularly when seizures occur frequently.
Medicines and surgical techniques can control seizures in 70% of individuals diagnosed with epilepsy-seizure disorders.
Unfortunately, for some forms of epilepsy, there is currently no cure or treatment of seizures(34).
However, there are self-management strategies that epilepsy patients can apply to control their seizures better and take care of their health.
These self-management techniques include the following:
- Get 7 to 8 hours of sleep every night.
- Follow a well-balanced diet and keep a healthy weight.
- Find ways to lower stress and get help for emotional problems.
CBD’s therapeutic properties may help with these self-management strategies.
CBD for Improved Sleep
Sleep deprivation is well-recognized as a precipitant or trigger for seizures and most epilepsies. Meanwhile, studies have shown CBD to be useful at inducing restful sleep.
A study published in Pharmaceuticals (Basel) in 2012 compared CBD with a sleep aid called nitrazepam(35).
The authors found that high-dose CBD at 160 milligrams increased the subject’s duration of sleep.
Similarly, a 2017 study published in the Current Psychiatry Reports noted that at moderate to high doses, CBD might have therapeutic potential for the treatment of insomnia(36).
CBD for Brain Health and Body Weight Management
Full-spectrum CBD oil derived from hemp contains Omega-3 fatty acids, which could have an anti-inflammatory effect on the brain and help cognitive function in those with severe epilepsy.
A study published in the Journal of Epilepsy and Clinical Neurophysiology found that the administration of supplements consisting of omega 3 and omega 6 fatty acids to human subjects resulted in a reduction of the number of seizures in refractory epilepsy(37).
Also called by some other names, like uncontrolled, intractable, or drug-resistant epilepsy, refractory epilepsy affects about one-third of people with epilepsy(38).
A special diet, called a ketogenic diet, might also help control seizures linked to refractory epilepsy. This type of diet is high in fats and low in carbohydrates.
However, individuals following this diet should work closely with their doctor and take supplements of certain nutrients as needed.
CBD can be beneficial to people who are trying to manage their weight. A study published in Nature Journal has shown that CBD could increase the levels of leptin in the brain(39).
Leptin is the hormone that makes an individual feel full or satiated. The reduced cravings for unhealthy, calorie-dense foods may help individuals achieve their weight loss goals fast.
In another study, researchers found that CBD might interfere with the secretion of cortisol, reducing blood levels significantly(40).
Chronic stress and persistently high cortisol levels may be associated with increased appetite and weight gain(41).
CBD for Reduced Anxiety and Depression
Anxiety, depression, and psychosis may complicate epilepsy, both before certain seizures and also between seizures in individuals with epilepsy.
These symptoms may be part of the epilepsy syndrome arising as a consequence of surgery or the use or withdrawal of antiepileptic drugs (AEDs)(42).
Results of a study published in the Neuropharmacology Journal indicated that CBD might help block anxiety-induced sleep disturbances through its anti-anxiety effects on the brain(43).
A 2018 study published in the Frontiers in Immunology Journal showed CBD as a potential remedy to depression(44).
In the study, researchers found that CBD showed anti-anxiety, antiepileptic, and non-psychoactive properties that might help reduce depression linked to stress.
How to Choose the Right CBD for Seizures
Full-spectrum CBD hemp oil contains all nutrients from hemp, including trace amounts of THC (tetrahydrocannabinol), terpenes, flavonoids, fatty acids, and essential oils.
The combination of all these components creates a synergy known as “entourage effect.”(45).
This phenomenon occurs when the multiple compounds working together achieve more than the sum of what the same compounds could achieve acting individually.
Broad-spectrum CBD oils are like full-spectrum oils without THC. CBD isolates carry only pure, isolated cannabidiol.
If individuals with seizures do not want any amount of THC in their system, broad-spectrum CBD can be used. If they are allergic to specific components of the hemp plant, CBD isolates are the only option.
Regardless of the form of CBD products that individuals choose for their seizures, careful consideration must be employed in selecting the best CBD oil that is right for their lifestyle and preferences.
The following factors are essential to ensure the safety and reliability of the CBD products purchased:
1. Research on the exact legal stipulations applicable to CBD in the area where it would be purchased and used.
2. Purchase only high-quality, non-GMO, organic hemp-derived CBD products from legitimate and reliable CBD brands.
The majority of companies that manufacture the best CBD oil products grow their hemp from their own farms, or they purchase from licensed hemp producers.
3. When buying from an online store, research product reviews. When buying from a physical store or dispensary, check whether the store is authorized by the government to sell CBD.
4. Knowing the extraction method and carrier oil used in making the CBD oil is also essential.
Researchers of a study indicate that the Supercritical-CO2 extraction process is recognized as safe by the U.S. Food and Drug Administration (FDA) in pharmaceutical manufacturing(46).
The supercritical CO2 extraction method allows for the highest purity and potency because the process does not extract any unwanted ingredients and impurities.
The most natural carrier oils that may be used include MCT oil (medium-chain triglycerides from coconut oil), hemp seed oil, and extra-virgin olive oil.
5. One important thing to look for in CBD products is certification codes. Several certification authorities approve certain products only after some thorough screening tests and third-party lab testing.
6. Compare a CBD company’s claims about its products’ potency with that of the third-party lab reports.
7. Consulting with a medical professional experienced in CBD use is ideal before one purchases his or her first bottle of CBD.
CBD Dosage for Seizures
Dosing may depend on several factors, such as the age of the patient, the cause of epilepsy, etiology, seizure type, and other medications that are currently taken(47).
CBD doses up to 50 mg/kg were found to be safe. However, given the lack of data, an upper permissible dose cannot be defined(48).
Long-term data of CBD use are also limited (49). Thus, no defined timeframe qualifies as CBD treatment failure, as reflected by the doctors’ differing opinions about when to discontinue a CBD treatment.
How to Take CBD Oil for Seizures
CBD taken orally is swallowed or ingested in the form of capsules, food, or liquid, which are convenient and straightforward ways to take CBD oil (cannabidiol oil), especially for beginners.
CBD oil in these forms gets absorbed through the digestive tract. However, absorption is slow, and dosing is tricky due to the delayed onset (one to two hours) of effect, unknown stomach acids, and recent meals, among other factors.
CBD oil may also be taken sublingually (under the tongue) using a dropper and then allowing the oil to be absorbed into the bloodstream.
In a 2010 review, published in the International Journal of Pharmacy and Pharmaceutical Sciences, researchers found that peak blood levels of most substances given sublingually are achieved in 10 to 15 minutes, which is faster than when those same drugs are ingested orally(50).
Sublingual absorption is an efficient way of consuming CBD tinctures. According to studies, CBD oil has a sublingual bioavailability of 13% to 19%, with some studies putting it as high as 35%(51).
Bioavailability is the extent and rate to which a compound or an active drug ingredient is absorbed and becomes readily available for the body to use(52).
When taking tinctures sublingually, keep the CBD oil under the tongue for 60 to 90 seconds before swallowing it.
If users find the earthy, grassy taste of pure CBD oil unappealing, other CBD brands offer a variety of delicious flavors to explore.
CBD oil can also be mixed with other foods and beverages that are easy to consume. However, keep in mind that oil and water do not mix.
An additional fat, like milk, may be necessary for the oil to bind and completely dissolve while maintaining the smooth consistency of the drink.
Given that CBD is a highly lipophilic (soluble in lipids or oils) molecule, it may dissolve in the fat content of food, increasing its solubility and absorption, according to a 2018 study published in the journal Frontiers in Pharmacology(53).
CBD oil may also be used in massage therapies. According to the Epilepsy Society in the UK, complementary therapies, like herbal remedies and massages, can help promote well-being, reduce stress, and may be used with any antiepileptic drugs currently taken by an individual(54).
There is, however, limited absorption through the skin with topical CBD oil. For topical products, look for keywords on the product labels that indicate that the product uses nano technology, encapsulation, or micellization of CBD.
These words indicate that their formulation can transmit CBD through the dermal layers, rather than just staying on the skin.
Meanwhile, CBD oil vapes are one of the quickest ways to get CBD into the body since it enters the bloodstream through the lungs, without going through the digestive system.
When inhaling CBD using a vape pen, effects can be felt in minutes. However, the effects last for only 30 minutes to an hour or two. Also, with CBD vapes, it is difficult to determine precisely the amount of CBD is in each draw.
As a 2018 study published in Molecules indicated, the primary limitations of inhaling are the variability in individuals’ inhalation techniques and respiratory tract irritation during inhalation(55).
Although labels for CBD oil vape products usually indicate the amount per inhale, this amount may vary in individuals. Thus, getting the dose right requires a bit of experimentation at first.
Vaping is not for everyone. Experts are not sure whether or not vaping causes lung problems. However, they believe that the most likely culprit is a contaminant, not an infectious agent(56).
Possibilities may also include chemical irritation or allergic or immune reactions to various chemicals or other substances in the inhaled vapors.
Individuals contemplating vaping CBD for the first time must proceed with caution and first consult with a doctor experienced in cannabis use.
Seizure vs. Convulsion: What Is the Difference?
Epilepsy is a disorder of the brain. Intellectual disability is relatively common in individuals with epilepsy, with prevalence estimated to be around 25%, according to a 2017 study published in PLoS One(57).
Epilepsy is diagnosed when a person has had at least two seizures, also called epileptic seizures.
The signs of a seizure typically depend on the type of seizure. In some cases, it is difficult to determine if someone is having a seizure.
A person having a seizure may look confused or seem like they are staring at something that is not there. Other seizures can cause the person to fall, shake, and become unaware of what is going on around them(58).
The terms seizure and convulsion are often used interchangeably, although they are not the same.
Seizures are electrical disturbances in the brain, while convulsions are uncontrollable muscle contractions.
During convulsions, a person has uncontrollable shaking that is rapid and rhythmic, with the muscles contracting and relaxing repeatedly(59).
The Case for Medical Marijuana in Epilepsy
Charlotte Figi was an inspiration to many individuals dealing with the same health conditions. She had Dravet syndrome, a type of severe epilepsy. At age 5, she had as many as 300 seizures a week.
Charlotte’s case has made the use of cannabis oil from medical marijuana an almost-last option for hopeful families looking to treat their children’s epilepsy.
Through the exhaustive personal research and invaluable assistance from a Colorado-based medical marijuana (medical cannabis) group, called Realm of Caring, Charlotte’s mother started complementary therapy with a high concentration CBD:THC strain of cannabis, now known as Charlotte’s Web(60).
This extract, slowly titrated over weeks and given in conjunction with Charlotte’s existing antiepileptic seizure medications, helped with seizure control.
Sadly, Charlotte died after being hospitalized for a seizure that resulted in a cardiac arrest and respiratory failure. She died on April 7, 2020, at age 13.
Epidiolex No Longer A Controlled Substance
GW Pharmaceuticals announced on April 6, 2020, that it received notice from the U.S. Drug Enforcement Administration (DEA) granting the biopharmaceutical company’s petition to deschedule its cannabis-derived drug, Epidiolex(61).
Cannabis has been a Schedule I drug, which has limited the type and scope of research needed to figure out how best to benefit from its medical use.
Under the U.S. Federal Controlled Substances Act, Schedule I drugs have no currently accepted medical use and a high potential for abuse(62).
This latest confirmation means that Epidiolex is no longer subject to the Controlled Substances Act (CSA).
Epidiolex is the first prescription medicine of highly purified, plant-derived CBD, and the first in a new category of antiepileptic drugs.
“The descheduling of EPIDIOLEX has the potential to further ease patient access to this important therapy for patients living with Lennox-Gastaut Syndrome and Dravet syndrome, two of the most debilitating forms of epilepsy,” says GW Pharmaceuticals in their press release.
COVID-19 and Epilepsy
Currently, there is no substantial scientific evidence to suggest that an individual diagnosed with epilepsy alone is at increased risk of getting the coronavirus disease (COVID-19).
Although the Centers for Disease Control and Prevention (CDC) once considered epilepsy as a condition that may help increase the risk of serious COVID-19 for individuals of any age, the International League Against Epilepsy (ILAE) thinks otherwise(63).
As medical experts continue to learn more about COVID-19 and its impact on health, epilepsy patients are encouraged to consult with a doctor if their current epilepsy treatments or other medical conditions impact their level of risk.
The studies mentioned above showed that CBD might help individuals with epilepsy by potentially reducing convulsive-seizure frequency.
CBD’s anti-anxiety, anti-depressant, anti-stress, sleep-inducing, and appetite-regulating qualities also make it useful in managing epilepsy.
However, studies conducted on CBD and epilepsy are still lacking, and the long-term effects of CBD use remain unknown.
Also, as with the use of any natural chemical compound, there are risks involved in using CBD for seizures.
Consulting with an epilepsy specialist experienced in cannabis use for advice and guidance is the essential first step for parents looking into trying CBD for seizures.
Individuals dealing with any form of epilepsy can explore, together with their doctors, the possible treatment options with CBD to empower them to make informed decisions that weigh both risks and health benefits.
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