Epilepsy is a debilitating family of diseases defined by recurring seizures. It’s also one of the most common neurological disorders in the world.
This disorder takes a huge toll. People suffering from epilepsy are often worried about the health and safety risks of uncontrolled seizures and can experience anxiety, sleep disturbances, and strained relationships as a result. And while there are drugs available to help control seizures, many patients experience symptoms that are resistant to treatment.
Cannabidiol or CBD may be a relatively new drug candidate, but it’s attracted a great deal of attention in recent years. One of the most convincing trends that researchers have found is the ability of CBD to reduce seizure frequency.
Let’s explore how CBD may help those with epilepsy get their seizures under control.
What is Epilepsy?
Epilepsy is an umbrella term that doctors use to refer to a family of diseases. The defining feature of epilepsy is frequent and uncontrollable seizures.
Seizures are short term bouts of excessive and abnormal brain activity. There are many different types of seizures and they can manifest in different ways in different people. While some seizures may cause a person to lose balance and awareness while shaking uncontrollably, other types of seizures may look like a person is simply lost in thought.
Epilepsy is one of the most common brain-related disorders. In 2015, nearly 3.4 million Americans suffered from epilepsy. Several conditions that affect the brain can cause epilepsy. Some of the known causes of epilepsy include:
- Brain tumor
- Traumatic brain or head injury
- Loss of oxygen to the brain
- Infection in the brain from parasites (malaria), viruses (influenza, dengue, Zika), or bacteria
- Certain genetic disorders like Down syndrome
- Other neurologic diseases like Alzheimer’s disease
However, for nearly two-thirds of people with epilepsy, the cause is unknown. Additionally, experiencing a single seizure does not necessarily mean that you have epilepsy. Seizures can also be caused by high fevers, low blood sugar, and withdrawal from drugs.
Epilepsy is an incredibly challenging disease. Aside from the primary effects of frequent seizures which can affect a person’s safety and ability to drive and work, those with epilepsy are also more at risk for sleep disturbances, depression, anxiety, and memory and learning problems.
CBD: How it Works
Cannabis produces over 100 different cannabinoids, including the most well-known examples, CBD and THC (tetrahydrocannabinol). Cannabinoid compounds share a similar chemical structure, but they all have a unique effect.
For example, THC is mainly responsible for the “high” associated with cannabis. In contrast, CBD can balance out some of the effects of THC including intoxication, sedation, and increased heart rate while relieving pain, nausea, and anxiety in its own right.
Regardless of their differences, cannabinoids like CBD and THC all work in a similar way. When you ingest cannabis or a cannabis-based product like CBD oil, the cannabinoids take effect by interacting with your body’s endocannabinoid system.
The Endocannabinoid System
The endocannabinoid system is a complex biological signaling system present throughout much of the human body. The system is made up of three main components:
Cannabinoids: these are a diverse class of compounds that have the ability to affect the endocannabinoid system by binding to cannabinoid receptors. They can either come from the cannabis plant (phytocannabinoids), our body (endocannabinoids), or they can be made in a lab (synthetic cannabinoids).
Cannabinoid receptors: these are located on the surface of certain cells throughout the body. Cannabinoid receptors help modulate the activity of the endocannabinoid system in specific areas. Cannabinoids can bind to certain cannabinoid receptors like a key fitting into a lock.
Enzymes: Certain enzymes are responsible for making and breaking down cannabinoids. This helps control the level of cannabinoids in your body and thereby controls the activity of your endocannabinoid system.
Scientists discovered the endocannabinoid system while exploring the effects of cannabis. But this biological system doesn’t exist just so we can get high.
The endocannabinoid system actually plays an important role in maintaining homeostasis or balance in the body by regulating our mood, appetite, temperature, immunity, sleep, and much more.
When cannabis is ingested, phytocannabinoids like CBD enter the bloodstream and the brain. They take effect by mimicking our natural endocannabinoids and essentially hijacking the body’s endocannabinoid system.
How Does CBD Affect Epilepsy?
So far, researchers have found that CBD may be effective for treating symptoms of PTSD, Autism Spectrum Disorder, and anxiety. However, the relationship between epilepsy and CBD is one of the most well-studied. And early studies show promising effects of CBD in treating epilepsy.
Let’s take a look at some of the evidence demonstrating CBD’s ability to treat epilepsy.
Gold Standard Data
We’ve already covered several studies looking at the link between CBD, the endocannabinoid system, and epilepsy. But there’s a wealth of data out there. And even better, much of that data adheres to the “gold standard.”
When it comes to clinical trials, the gold standard represents the most reliable, unbiased type of experimental design called the randomized controlled trial or RCT. In RCTs, researchers carefully select a sample of patients and randomly assign them to a treatment group that receives the drug being studied or a control group that receives a placebo. The researchers don’t know which patients received the actual treatment or the placebo until after the trial is complete.
The RCTs looking at CBD’s effect on seizure frequency in epileptic patients show significantly positive results. In one 2018 RCT study, patients who took 20 mg of CBD per kilogram of body weight experienced a 50% decrease in seizure frequency over baseline. The side effects were relatively minor and included sleepiness, decreased appetite, and diarrhea.
Another 2017 RCT study showed similar results. 20 mg of CBD per kilogram of body weight resulted in a 50% drop in seizure frequency with 5% becoming seizure-free while taking CBD. And other non-RCT studies have shown a similar 50% reduction in seizure frequency.
The FDA Approves CBD
There was so much data supporting the effectiveness of CBD as an anti-seizure agent that it was even approved by the FDA. Greenwich Biosciences (the U.S. subsidiary of GW Pharmaceuticals) developed Epidiolex, a purified cannabis extract oil that contains over 98% CBD.
Researchers used Epidiolex in the two RCT studies mentioned above. In June 2018, the FDA approved Epidiolex for treating Dravet syndrome, a rare genetic form of epilepsy that causes prolonged and frequent seizures, and Lennox-Gastaut syndrome, another rare form of epilepsy that begins in early childhood.
Over the Counter CBD
The FDA approved CBD in the form of Epidiolex for treating specific types of epilepsy disorders. But what if you don’t have one of those disorders and can’t get a prescription?
Luckily CBD is legal to buy without a prescription as a health supplement. In 2018, the U.S. passed a new Farm Bill. The new bill changed existing cannabis laws so that CBD made from low-THC hemp is now legal to produce, sell, and consume in the U.S.
That means CBD is generally legal to buy and consume in all 50 states. But it’s important to note that states can pass their own legislation if they want to ban CBD. Make sure to check your state laws before buying CBD online.
Look for a CBD company that uses high-quality, simple ingredients like American-grown, organic hemp with few additives. The best CBD companies also perform quality testing to ensure you’re getting a product that’s safe and the right potency.
It’s also a good idea to talk to your doctor before adding CBD to your routine.
One of the benefits of CBD is that it has relatively few side effects compared to other prescription medications. While the side effects may be mild, it’s still important to know how CBD can affect you.
The most commonly reported side effects are:
- Decreased appetite
The truth is we don’t know everything about CBD yet and it can potentially interact with other medications to cause additional side effects.
Drug tolerance occurs when a person experiences a reduced response to a drug after using it for an extended period of time. In this case, the researchers defined tolerance as either a response reduction of over 30% or needing to increase the dose by more than 30% to get the same effect.
For the patients who experienced tolerance, the researchers increased their CBD dose. Of these patients, 12 were able to reach their previous response level, but 15 were not.
Unfortunately, this means that, for some, the effects of CBD may be short-lived and CBD will not offer a long term solution for treating epilepsy. However, the majority of patients in the study (two-thirds) did not experience any tolerance. That means CBD may be an effective long-term anti-seizure treatment for most people.
Less is More
Developing a tolerance to CBD is clearly a concern. Therefore, it’s important not to take more CBD than you really need. If you’re trying over the counter CBD for the first time, think carefully about your CBD dosage.
Be conservative at first. Start with a low dose (approximately 10 mg) twice a day. See how you feel and slowly work your way up from there. Your optimal CBD dose will depend on your body weight and unique body chemistry.
Frequent seizures represent a huge burden for people suffering from epilepsy, especially for those who experience treatment-resistant symptoms. However, clinical research shows that CBD can be effective at reducing seizure frequency.