As a general rule, due to both cultural and legal obstacles, the medical cannabis community has always suffered from a lack of research compared to more socially accepted pharmaceuticals. For patients finding cannabis as a successful part of their treatment regimen, this is especially frustrating and a clear case where science is literally behind the times instead of ahead of it as it should be. However, the imbalance between the likelihood of medical benefit and the dearth of research has never been so clear as in the case of controlling hard to treat epileptic seizures with cannabidiol (CBD).
Epilepsy affects roughly three million people in the United States, with around 1/3rd of those having frequent uncontrollable seizures. These seizures constitute a major loss in quality of life, with deleterious effects ranging from physical injuries, mortality from seizure, to social stigma and restrictive lifestyle. Yet worse than these effects are the cognitive and psychiatric disorders that can accompany epilepsy. Especially during early development (youth), epilepsy is often associated with cognitive and behavioral deficits and lower IQ that occur as a result of brain damage during critical, foundation-laying years. As a result, many adults continue to suffer from epilepsy even in cases where seizures are brought under control.
Unfortunately, as noted by the director of Pediatric Epilepsy Research at the University of California, Dr. Maria Cilio, epilepsy frequently displays “pharmacoresistance”. In other words, patients often find themselves frequently switching between medicines, sifting through a large range of chemicals to find something that will actually attenuate their specific conditions. For this reason, Dr. Cilio joins ranks with a growing number of physicians in recommending the increased study of treating epilepsy with CBD, which has shown promise anecdotally.
Although few rodent or clinical studies have been conducted at this point, one strong boost of support has come from a Stanford University survey of parents of epileptic children being treated with CBD. The study securely collected information from parents, accumulating complete medical histories of the children involved. As seen in survey results, “sixteen of 19 parents reported a reduction in their child’s seizure frequency while taking cannabidiol-enriched cannabis”. More than half reported at least an 80% reduction in seizures, with minor side effects, such as drowsiness. Two reported total freedom from seizure, a complete cure, which is astounding bearing in mind that all children involved in the study had a verified diagnosis of epilepsy. Of course, 19 self-reported cases does not constitute hard-boiled proof, and collection of such information is by nature self-selective. The survey was administered to parents currently using cannabidiol-enriched cannabis to attenuate their children’s symptoms, meaning that bias must exist.
Even so, the rigor and results of the study have already caused quite a stir in the medical community. Joseph Sirven from the Mayo Clinic’s Department of Neurology, Division of Epilepsy, recommended last year that the survey be observed by the epilepsy community at large. Of course, many of those in favor of increased experimentation are careful to note that potential pitfalls exist and must be accounted for. The miracle of nature is that a plant can synthesize complex compounds with no laboratory equipment or electricity, simply soil, sun, water, and air. However, unlike a laboratory procedure, the precise amount of chemicals contained in each sample of herbal matter vary. As the article on terpenoids noted, the issue is not quite so simple as quantifying CBD and THC contained in each sample. Parents must be aware that there is risk involved in dosing children with other chemicals from cannabis that often accompany CBD tinctures, pills, oils, and flowers, etc. However, as one parent of a child with epilepsy noted, this is a last resort. When the pharmacopeia has been exhausted without success, and parents are forced to watch their children suffer, the risk of untreated epilepsy is simply greater than the risk of these poorly understood and relatively safe chemicals.
The exact process through which CBD is attenuating seizure onset is the subject of current speculation and not understood on even a basic level. As Cilio notes, “[pathways] may include modulation of equilibrative nucleoside transporter, the orphan G-protein-coupled protein receptor, and the transient receptor potential of melastatin type 8 channel.” Another study, performed by the Shahid Beheshti University of Medical Sciences in Tehran, recently explored the role of CBD-triggered potassium BK channels in anticonvulsant effects. After noticing similar behavior between CBD and paxilline, a potassium BK channel blocker, the group has speculated that this is the function underlying anticonvulsive properties.
At the Cornerstone blog, we tend to error on the side of being overly conservative, reporting only what has been well-documented in peer-reviewed research journals and being careful to note ways in which data could be misinterpreted. We are not simply cheerleaders for cannabis; we are cheerleaders for a future in which all patients can receive the most effective and safe treatment available, which may include cannabis or cannabinoids. In this case, with the lack of numerous studies, we can only speculate what the future will hold for the medical future of CBD and epilepsy. Yet, the anecdotal evidence at this time is so pronounced and striking, it seems almost inevitable that the family of phytocannabinoids, such as CBD, will eventually be adopted into mainstream medicine. In the meantime, we await science to take a more measured, calculated approach to determining how these chemicals affect our bodies as a whole, and in what ways they can be reproduced, concentrated, and standardized effectively.
Maria Roberta Cilio, Elizabeth A. Thiele, and Orrin Devinsky. (2014) The case for assessing cannabidiol in epilepsy. Epilepsia, 55(6):787-790. DOI: 10.1111/epi.12635
Brenda Porter, Catherine Jacobson. (2013) Report of a parent survey of cannabidiol-enriched cannabis use in pediatric treatment-resistant epilepsy. Epilepsy & Behavior 29 (2013) 574-577.
Joseph Sirven. (2013) Editorial: Medical marijuana for epilepsy – Winds of change. Epilepsy & Behavior 29 (2013) 435-436.
Zahra Shirazi-zand, Leila Ahmad-Molaei, Fereshteh Motamedi, and Nima Naderi. (2013) The role of potassium BK channels in anticonvulsant effect of cannabidiol in pentylenetetrazole and maximal electroshock models of seizure in mice. Epilepsy & Behavior 28 (2013) 1-7.