Cbd oil hybrid for epilepsy

CBD for Seizures- Use, Effectiveness, Side Effects, and More

If you have seizures or are the parent of a child who has seizures, then you are probably constantly on the lookout for ways to control seizures with as few side effects as possible. CBD oil is one of the latest things to be touted as a miracle cure for seizures. While its effects are not the miracle cure some people suggest, it is a promising treatment that might be right for you.

What is CBD?

CBD is short for cannabidiol, which is a chemical found in marijuana. It is not the same as tetrahydrocannabinol (THC), the chemical in cannabis that is responsible for the “high” feeling people get from marijuana.

What does CBD do?

Well, people make many claims about what CBD can do. Not all of them have been tested and verified. However, there is support for claims that CBD may help reduce pain and anxiety.

Does CBD help seizures?

The short answer is yes. CBD can help prevent some types of seizures in some people and animals. Clinical trials have demonstrated a significant reduction in seizures for people taking CBD to treat Lennox-Gastaut, Dravet syndrome, or tuberous sclerosis complex. Research in other areas is still in early stages, but there are indications that CBD may help prevent other types of seizure or increase the efficacy of other antiepileptic medications. Early clinical trials suggest that CBD may dramatically reduce seizures in people with CDKL5 deficiency disorder, Aicardi syndrome, Doose syndrome, and Dup15q syndrome. In addition, CBD appeared to retain its efficacy over the length of the clinical trial.

How does CBD help prevent seizures?

That is a wonderful question, but, unfortunately, the research simply is not sufficient to give a definitive answer. What we do know is that bodies contain natural neurotransmitters and receptors known as the endocannabinoid system. CBD is believed to interact with that system, which is believed to influence a range of bodily functions and systems including immune response, appetite, pain, and sleep.

Is CBD approved by the FDA to treat seizures?

Yes, but not all CBD oils and not all types of seizures. Currently, Epidolex, a prescription form of CBD, is approved to treat seizures caused by Lennox-Gastaut, Dravet syndrome, and tuberous sclerosis complex.

Does CBD interact with other seizure medications?

Yes. We know that CBD interacts with brivaracetam, clobazam, eslicarbazepine, stiripentol, rufinamide, topirimate, valproic acid, and zonisamide. It also possible that it interacts with other antiepileptics, and as research continues, we should have a better idea of other possible interactions.

How do I use CBD or CBD oil to treat seizures?

If you have a seizure disorder, you should be seeing a neurologist for treatment. It is very important to discuss whether you should use CBD oil with your neurologist. While it is generally safe to use, there is always a risk of potential drug interactions. In addition, some people actually experience an increase in seizures when they use CBD. Therefore, just like with any antiepileptic drugs, you want to have a professional monitoring your use of CBD.

What is an average clinical use of CBD to treat seizures?

The starting dose for CBD is 2.5 mg/kg of Epidolex, two times a day. A normal maintenance dosage is 5mg/kg twice daily, and the maximum dosage is 10mg/kg twice daily. As with other antiseizure medications, it should be introduced or stopped gradually, as sudden changes can increase seizure activity.

What are the potential side effects of CBD when used to treat seizures?

Whether used alone or with other seizure medications, there are some potential side effects of using CBD to treat seizures. It can lead to an increase in suicidal thoughts or behaviors, sleepiness, drowsiness, diarrhea, and loss of appetite. While most of these side effects are inconvenient, interactions can also cause liver damage.

Can CBD increase my seizures?

This is a tricky question to answer. Anecdotally, it seems clear that some percentage of people will have an increase in the number of seizures in response to using CBD. However, why is not so clear. Research seems to suggest that people who use commercial CBD products are likely to see an increase in seizures, while people using prescription CBD are likely to see a reduction in seizures. The speculation is that commercial products are not pure CBD, but are tainted with THC, which is known to be a potential seizure trigger.

Can I use over-the-counter CBD to treat epilepsy?

The problem with OTC CBD is that it is not regulated by the FDA. This makes it impossible to know what dose you would be getting, if the product is contaminated with impurities, or if it even is CBD. If you want to explore using CBD to treat seizures, talk with your doctor about adding Epidolex, an FDA regulated product that eliminates the specific risks posed by an OTC product, to your treatment plan.

Marijuana for the Treatment of Seizure Disorders

ABSTRACT: Cannabis, the substance more commonly known as marijuana, has gained interest in recent years for its potential use as an antiepileptic agent. The two main components of marijuana are delta-9-tetrahydrocannabinol, which has had mixed effects in epilepsy, and cannabidiol, which has shown more consistent anticonvulsant effects. Data supporting the use of marijuana for this purpose are limited, as the majority of clinical trials were conducted before 1990. There are case reports showing promising results; however, the data are inconsistent and cannot be generalized. The legal issues surrounding marijuana in the United States also may limit the use of this substance as an antiepileptic.

Epilepsy is defined as recurrent and ongoing seizures caused by changes in neuronal firing in the brain. Whereas nonepileptic seizures are not associated with neurophysiological changes, 3% of the population is predisposed to otherwise unprovoked, recurrent epileptic seizures. 1 Current pharmacotherapy for epilepsy aims to restore normal neuronal function and decrease seizure frequency. Prospective, randomized trials estimate that individuals experiencing a first, unprovoked seizure have a 40% to 50% chance of seizure recurrence at 2 years. The risk of recurrence, which diminishes with time, is highest immediately following the first seizure, with 80% to 90% of patients experiencing recurrent seizures within the first 2 years. 2,3 Despite available treatments, about 30% of patients remain resistant to therapy (fail two or more antiepileptics), resulting in poorly controlled and recurring seizures. 4,5 This review discusses the current research on, rationale for, and limitations to the use of marijuana for the treatment of seizure disorders.

Historical Medical Use of Cannabis

The earliest documented use of cannabis (marijuana) occurred in about 2,700 bc in China, where it was used for a variety of medical ailments, including gout, malaria, constipation, menstrual disorders, and absentmindedness. Western medicine adopted the use of cannabis as a common analgesic in the 19th century. 6

Cannabis was available in U.S. pharmacies as an OTC product until the 1937 Marihuana Tax Act limited its accessibility. Subsequently, the passing of the Controlled Substances Act in 1970 gave cannabis a Schedule I classification, making its use illegal. 7 Since 1970, there has been increasing interest in the use of marijuana for its possible antiepileptic properties. 4

Pharmacology

Cannabis sativa and Cannabis indica are two species of the Cannabis genus of flowering plants. Both of these species have a long history of use as an antiepileptic, with sativa strains causing more psychotropic and stimulating effects and indica strains causing more sedation. 6 Compounds contained in the cannabis plant are known as cannabinoids.

Cannabis contains two main components: the psychoactive portion of marijuana known as delta-9-tetrahydrocannabinol (THC) and the nonpsychoactive portion known as cannabidiol (CBD). What makes cannabis an attractive agent for epilepsy is the presence of cannabinoid type 1 receptors in the hippocampus and amygdala, both of which are associated with partial seizures. 8 The THC component of cannabis is a partial agonist at these receptors. 9 Conversely, CBD interacts with other nonendocannabinoid signaling systems, reducing the psychotropic activity of THC while increasing tolerance. 6 Recent trials of CBD have shown more consistent anticonvulsant properties, and this cannabinoid has gained interest as a possible agent for epilepsy. 9,10

There are many potential routes of administration for synthetic CBD, the only non–delta-9-THC phytocannabinoid assessed for its anticonvulsant effects in clinical trials. 6 The most common delivery route is by inhalation, either recreationally or for medicinal purposes. Because of the highly lipophilic nature of CBD and its high volume of distribution, the lungs are an effective route of medication delivery, with rapid distribution into the brain, adipose tissue, and organs. Cannabinoids are extensively metabolized by the liver, predominantly by CYP3A2, CYP3A4, CYP2C8, CYP2C9, and CYP2C19. Owing to significant first-pass metabolism through the liver, CBD is only about 6% bioavailable, thus rendering oral, oral-mucosal, and sublingual routes of delivery less desirable. The transdermal route of administration has also been considered; however, this route may be economically impractical, since special delivery systems are needed to prevent excessive accumulation of CBD in the skin. 11,12

Marijuana as Treatment

Clinical trials examining the efficacy of marijuana for treating epilepsy are limited. One of the earliest was a small randomized, controlled study conducted by Mechoulam in 1970. 13 In this trial, nine patients with treatment-resistant temporal lobe epilepsy received either CBD or placebo for 5 weeks in addition to their current antiepileptic therapy. Two of the four CBD patients were seizure-free at 3-month follow-up, whereas none of the five placebo patients showed improvement. However, this trial was limited by its small sample size and lack of statistical analysis or power calculation. 13

Cunha and colleagues conducted a small randomized, controlled trial involving 15 patients with generalized epilepsy. 14 Seven patients received CBD and eight received matching placebo for 3 to 18 weeks. There were no reported toxicities, and four CBD patients compared with just one placebo patient were seizure-free. This study was limited in that it had no performed power calculation, no statistical analysis, and a small sample size. 14

Although a number of early small, controlled studies demonstrated some efficacy of CBD for epilepsy, more recent studies indicate that CBD has limited or no effect on epilepsy. In one trial, Trembly and Sherman examined the effect of marijuana on uncontrolled epilepsy. 15 No discernible effect was found overall, and there was no statistical analysis of trial outcomes or main effects. A study conducted by Ames and Cridland showed no difference between CBD and placebo. 16 As was the case in previous trials, the study population was small and there were no power calculations. 16

Various case reports have identified adult patients favoring marijuana as antiepileptic treatment, as well as parents who have sought marijuana with CBD content to treat resistant epilepsy in their children. 7,17,18 Some of these reports yield promising information; however, there is no consensus on dosage, formulation, route of administration, or duration of marijuana therapy. Placebo effect and recall bias may be confounding variables. These limited case reports highlight that there is a paucity of safety and efficacy data from randomized, controlled trials to establish the use of marijuana for the treatment of epilepsy. See TABLE 1 for a summary of studies on cannabinoid use as an antiepileptic.

Adverse Effects

Adverse effects of chronic marijuana use include addiction risk, negative effects on brain development, increased risk of certain mental illnesses, motor-vehicle accidents, and various effects on health. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, 9% of individuals who use marijuana may become addicted. In addition, discontinuation of habitual cannabis use may cause withdrawal symptoms such as irritability, insomnia, dysphoria, enhanced cravings, and increased anxiety. 19

Marijuana initiation at a young age may impact brain development, as it can impair neural connectivity in specific areas of the brain, resulting in altered learning, memory, and function. Marijuana use in adolescence could lead to a heightened response to other drugs, paving the way for addictions to other drugs in adulthood.

Consistent marijuana use has been correlated with anxiety and depression; however, a causal relationship has not been established. There may also be a positive association between chronic marijuana smoking and an increased incidence of lung cancer, as well as other pulmonary diseases, through lung airway inflammation, airway resistance, and hyperinflation. 8,19

Heavy and chronic marijuana use may be correlated with the majority of the adverse effects, mostly attributable to the THC component. However, there may also be confounding variables; therefore, causality cannot be established. Future studies involving CBD may result in a different side-effect profile, since multiple small studies of CBD safety in humans have shown adequate tolerance with no significant side effects at dosages up to 1,500 mg per day by mouth or 30 mg IV when used acutely and chronically. 6,20

Current Medical Use

Currently, the FDA has not approved marijuana for any indication. However, 23 states and Washington, DC, have legalized the use of medical marijuana (containing delta-9-THC), and 22 states have approved it for seizure use (TABLE 2). In addition, Massachusetts allows marijuana for “conditions as determined in writing by a qualifying patient’s physician.” 21 Medical marijuana use is licensed in Canada, the Netherlands, and Israel. 9

Future research involving drug products derived from botanical marijuana or synthetic versions and substances that act similarly to marijuana must be approved via an Investigational New Drug Application before human trials can be conducted. In addition, the Drug Enforcement Administration reviews the researcher registration application, and the National Institute of Drug Abuse is responsible for supplying research marijuana for trials. Ultimately, for a drug product to be approved for the U.S. market, the FDA must ensure that it meets necessary quality standards and is safe and efficacious. 22

Conclusion

There is insufficient evidence to form a reliable conclusion regarding the efficacy of marijuana as an antiepileptic agent. Despite case reports demonstrating efficacy in reducing seizure frequency and severity, limited clinical studies have been published on its use for this indication. Additionally, the studies conducted were inadequately powered, lacked complete information, and used small sample sizes. There are few studies of long-term administration of cannabis and its safety profile. Currently, legal restrictions on cannabis make it difficult to conduct large-scale clinical trials, as the FDA has classified marijuana as a Schedule I controlled substance. The utility of marijuana for the therapeutic treatment of epilepsy cannot be determined at this time; more large-scale studies are needed that assess the efficacy and safety of treatment with either high CBD-THC ratio marijuana or isolated CBD compounds.

Marijuana and Seizures: What You Should Know

Cannabis has been the talk of the town everywhere around the world ever since the 2018 farm bill was passed, ensuring its legalization in several states in the US. Ongoing research has been successful in proving marijuana’s potential medicinal benefits. They say the plant has miraculous properties of curing almost every medical or mental health condition that exists. It’s effectively treated insomnia, anxiety, aging skin, inflammation, epileptic seizures, chronic pain, muscle spasms, migraine, period cramps, and even some cancer-related symptoms. However, the data gathered until now is still somewhat insufficient for making big claims in an industry as sensitive as the healthcare sector.

A few more years of trials and testing will likely bring forth better conclusions. Nevertheless, the available evidence is already making people go insane over cannabis. Now, how exactly does marijuana work for medical conditions that involve seizures?

What Science Says

Cannabis plants are packed with more than a hundred cannabinoids in each strain. The most prominent ones are CBD (cannabidiol) and THC (tetrahydrocannabinol). While THC is the one that comes with psychoactive effects, CBD precisely renders relief for medical conditions. Therefore, if you’re consuming CBD with a minute proportion of THC (or no THC at all), it is unlikely that you will experience a “ high.

Since our body is also equipped with an endocannabinoid system (ECS), the chemical compounds in cannabis interact directly with it. The ECS controls various functions inside our body, for example, the central nervous system, immune system, several cardiovascular functions, etc. Marijuana has been used to treat seizures for centuries. The commodity may have found its true fame now, but its glory days date back to ancient times. Many types of medication were introduced in the US during 2018 after the farm bill was passed. Epidiolex is a plant-based oil that came into being around the same time and was recommended particularly for epilepsy patients.

Epidiolex was found to be beneficial for treating seizures in patients with varying conditions and syndromes such as benign tumors, tuberous sclerosis, dravet syndrome, etc. Clinical trials were conducted on a sample of 516 people. Half of them were given Epidiolex, while the other half were given placebos. The end results were surprisingly affirmative. 48% of individuals that were given Epidiolex were found with reduced seizures, while only 24% with the placebo responded with the same. It is yet unclear how exactly cannabis works to treat seizures. However, researchers have brought a few theories to the table. Marijuana might reduce inflammation in the brain cells, or it may tamper with calcium levels. Nonetheless, further research is needed to come up with a better conclusion.

Which Marijuana Strains Are Best For Treating Seizures?

Cannabis strains come in two main variations: Sativa and Indica. Sativa strains are supposed to make you feel energized and invigorated. They also help in improving focus and boost creative thinking abilities. Indica strains, on the other hand, are the complete opposite. They promote relaxation and run you through a tunnel of tranquility. They also help you remain calm and sleep better at night. So which one of the two is supposed to help epileptic patients? Well, both of them. Here are some of the strains that are bound to help.

Charlotte’s Web belongs to the Sativa side of the family and gained widespread public and media attention after it helped a young girl with a rare condition that involves seizures. Thus, it was named after the little girl, Charlotte. Consumers also love this strain for other reasons. Even though it’s a Sativa, it makes you feel relaxed while you’re focused and energized too. While you’re at it, the strain will also make you feel more innovative.

Ringo’s gift is a rare hybrid strain and is popular for possessing a balanced ratio of CBD and THC. Its dominance is on the Indica side as it renders a soothing feeling of serenity over your body. It’s known for treating stressed, anxious, and insomniac individuals precisely. Newly found evidence also regards it to be helpful for seizures.

Sweet and Sour Widow is an Indica dominant strain and is popular for its sweet but pungent onion-like aroma. Since the THC levels are pretty low in this one, it’s best for people who are new to cannabis or those who are avoiding getting a foggy head. This strain makes you feel happier and uplifted. It’s also excellent for relaxation as it’s Indica-dominant.

The Bottom Line

Medical marijuana has taken over the world like an inevitable flood, and it continues to progress. Available data has proved it to be effective for seizures and countless other medical conditions. However, if you’re looking forward to consuming strains or other OTC goods to treat your health difficulties, it’s best to consult with a doctor first.