Medical Marjuana To Treat Epilepsy

There’s a lot of talk lately about cannabis and what its properties can do to keep us healthy and happy. People use cannabis-based treatments, including cannabidiol (CBD), for many health conditions, including acute or chronic nausea, eating disorders, chronic pain, appetite stimulation, and anxiety.¹ ²

People often use “medical marijuana” with broad and varied meanings. While hemp-derived CBD (containing <0.3% THC) is federally legal in the US, other marijuana cultivars are only legal in select states.³

Anecdotal reports of marijuana’s therapeutic ability to treat seizures began centuries ago. However, the legal use of regulated medical cannabis-derived drugs to treat epilepsy is a relatively new development.⁴

In 2018, the pharmaceutical-grade cannabidiol (CBD) brand Epidiolex became the first-ever US Food and Drug Administration (FDA)-approved drug derived from cannabis.⁵

Lennox–Gastaut syndrome and Dravet syndrome are rare syndromes that cause treatment-resistant seizures. Epidiolex is only FDA-approved as a therapeutic add-on for adults and children (ages one and up) with these conditions. It is not a standalone treatment.⁶

Outside of this, it would be dangerous (and possibly illegal, depending on where you live) to swap a prescribed epilepsy medication for marijuana or any of its derivatives without medical guidance. 

Close monitoring from a doctor is crucial because the intensity and frequency of seizures may increase without appropriate and consistent medication dosing.⁷

For optimal outcomes, it’s essential to get support from a qualified medical specialist. They can evaluate whether FDA-approved cannabis-based medication is appropriate and prescribe it if the potential benefits outweigh the risks.

What is medical cannabis?

The Cannabis sativa plant is known by many names but is most commonly called marijuana. When speaking about marijuana, you’re usually referring to the plant's female flowers, as these contain most of the plant's cannabinoids. 

Cannabinoids are naturally occurring chemical compounds the plant produces to help it grow well—resisting heat, sun, and pests.⁸

While more than 80 cannabinoids are present in a marijuana plant, the two with primary medical interest are tetrahydrocannabinol (THC) and cannabidiol (CBD).⁹

THC is the compound responsible for causing feelings of euphoria and happiness, whereas CBD doesn’t produce a high. 

Medical marijuana is a broad term referring to cannabis-based treatments that can ease symptoms of certain medical conditions. 

The FDA has approved treatments based on CBD (Epidiolex) and synthetic THC (Cesamet, Marinol, and Syndros) for specific conditions. 

What do I need to know about hemp?

Hemp is a type of Cannabis sativa with very low CBD and almost non-existent THC levels. This means that hemp can’t be used for recreational drug use, so it’s not regulated the same as strictly THC- or CBD/THC-containing products.

Although marijuana plants can produce CBD, only CBD from hemp plants is federally legal in the US.¹⁰

In 2018, hemp was removed from the Controlled Substances Act. Hemp and hemp-derived CBD are now classified as legal agricultural commodities and are no longer part of the US Drug Enforcement Administration’s list of Schedule I drugs.

Hemp is a versatile, sustainable crop, so people also use it for various non-medicinal purposes, such as food (hemp seeds) and textiles.

Does cannabis help reduce seizures?

Emerging evidence suggests that a cannabis-derived product, specifically a highly purified form of CBD, can help reduce or eliminate seizures, particularly in those with treatment-resistant epilepsy.¹¹

As mentioned earlier, using cannabis as an anti-epileptic is an ancient practice, but formal evaluation of its effectiveness didn’t begin until the 1800s.

The development of cannabis-based medications in the US has been slow due to previously strict federal regulations on the cultivation and processing of Cannabis sativa plants.

The recent easing of American laws — especially the descheduling of hemp — makes it easier to research and regulate cannabis-based medications to ensure their quality and safety.

Does CBD have side effects?

Using cannabis or CBD may produce undesirable effects.¹²

Common documented Epidiolex side effects include: 

• Drowsiness

• Decreased appetite

• Diarrhea

• Mood changes

• Rash or allergic reaction

• Sleep disorders

• Elevated liver enzymes

• Infections, including viral, fungal, and pneumonia  

Cannabis can also cause long-term effects like impaired memory and concentration, a reduced ability to think and make decisions, and sleepiness. 

In trials using Epidiolex to treat Lennox–Gastaut syndrome and Dravet syndrome, commonly reported side effects were drowsiness and fatigue, and some participants still experienced seizures.¹³

A study on 4–10-year-old children with Dravet’s Syndrome found fever was the most common side effect. 

Should I worry about drug interactions?

As cannabis is a plant, many view it as inherently safe and natural. CBD is still a chemical compound. It can interact with other drugs you take or substances naturally found in your bloodstream and tissues. This is partially due to how your liver metabolizes CBD.

Enzymes in your liver break down CBD. These enzymes process many other substances, so if they’re busy with cannabinoids, the circulating blood levels of other drugs may be affected.¹⁴

Some commonly-prescribed drugs known to interact with cannabinoids include: 

• The seizure drug clobazam

• The antifungal ketoconazole

• The anticoagulant warfarin

• The antipsychotic olanzapine¹⁵

CBD can also intensify the sedating properties of alcohol. If you drink alcohol or take medications or supplements, be sure to discuss your usage at your next doctor’s appointment.

If you have Lennox–Gastaut syndrome or Dravet syndrome, speak to your doctor about cannabis-based medications. They’ll give you the full run-down on what drug interactions might apply to your situation. 

Are clinical trials for CBD ongoing?

Research on cannabis-derived CBD to treat seizure-related conditions like Lennox–Gastaut syndrome and Dravet syndrome is ongoing. 

More studies are evaluating the safety and effectiveness of CBD-based medication in various types of seizure disorders. For instance, a phase three clinical trial is investigating Epidiolex’s effectiveness for children with myoclonic-atonic seizures.¹⁶

The lowdown 

Marijuana is distinct from cannabidiol (CBD). In the US, one regulated, FDA-approved drug, Epidiolex, is derived from cannabis. It’s specifically approved as a complementary treatment for Lennox–Gastaut syndrome and Dravet syndrome.

Frequently asked questions

What does the FDA approval of Epidiolex (a CBD oral solution) mean?

Approval by the FDA for the treatment of seizures with Epidiolex, an oral solution of CBD, means that if you have treatment-resistant epilepsy, your doctor may be able to legally prescribe this medication alongside other anti-epileptic drugs you’re taking.

Depending on your body’s response to the medication, the number and severity of your seizures may decrease. 

Epidiolex is FDA-approved, so it’s held to a higher pharmaceutical standard than unregulated CBD products. Like any other FDA-approved prescribed medication, it’s legal to possess.

Should someone with epilepsy use medical cannabis if other medications don’t work?

If you’re experiencing treatment-resistant seizures, you may wish to discuss medical cannabis with your doctor or specialist. 

A growing body of evidence seems to demonstrate that cannabis-based medications can help treat seizures, even where other medications have failed.¹⁷