Cannabis for epilepsy

In Germany, epileptic seizures without an obvious trigger occur in about one in 100 individuals. If occasional seizures are included, an estimated ten out of 100 persons experience at least one seizure in the course of their lives¹. Depending on the severity of the disease, affected individuals are considerably restricted in their everyday lives. In addition, antiepileptic drugs are not effective for all sufferers. When all treatment options have been exhausted, cannabidiol (CBD) could be an alternative option.

Epilepsy is a neurological disease and belongs to the functional disorders of the brain². Characteristic of the disease are epileptic seizures, in which neurons (nerve cells) in the brain suddenly emit uncontrolled impulses. The severity of an epileptic seizure can vary. While some patients only experience a slight twitching in the muscles, others suffer an uncontrolled seizure of the entire body¹.

The medical profession refers to epilepsy when the following conditions are present, as defined by the International League Against Epilepsy^3,4.

• At least two epileptic seizures occur within 24 hours that seem to come out of nowhere (non-provoked seizures). Only in the rare forms of epilepsy are the triggers (e.g., light stimuli or sounds) known.
• A non-provoked seizure occurs and there is a high probability that further seizures will occur.
• Specific forms of epilepsy or a syndrome are present, such as Lennox-Gastaut syndrome or Dravet syndrome.
• Medical cannabis, particularly the cannabinoid cannabidiol (CBD), has the potential to reduce seizure frequency according to several studies and may improve the quality of life of those affected^5,6.

Criteria for prescribing medical cannabis

The Cannabis as Medicine Act⁷ allows physicians of all specialties (except dentists and veterinarians) to prescribe cannabis as medicine on a narcotic prescription under certain conditions.

These conditions include the presence of a serious disease that is classified as refractory to treatment, for which no standard therapy is available, or for which the side effects of standard therapy are unacceptable. According to medical assessment, there must also be a chance that the symptoms will improve with medical cannabis.

Epilepsy: What are the causes?

In many cases, no cause or explanation for the occurrence of epilepsy seizures can be found. According to recent research, the receptors for the nerve messengers are genetically altered in many patients, which can promote the development of epilepsy³.

In some patients, structural changes in the brain can be found by imaging techniques or an underlying disease can be considered as a trigger. These diseases include, for example, a brain tumor, a stroke or encephalitis.

Epilepsy: Symptoms

A basic distinction is made between two main groups of seizures^3,7:

• Generalized seizure, in which the entire brain is involved.
• Focal seizures, affecting single areas or one hemisphere of the brain.

Generalized seizures may present as follows^3,7:

• Tonic: The entire body tenses and may even turn bluish.
• Clonic: There are coarse twitches in the body or individual muscle groups. Here, there is a risk of affected persons losing consciousness or biting their tongue.
• Tonic-clonic (grand mal): The tonic seizure is followed by a clonic seizure. Usually the entire body convulses and twitches, and sufferers lose consciousness.
• Atonic: Muscle tension suddenly subsides in one part of the body. For example, the legs may suddenly buckle away or unconsciousness may occur.
• Myoclonic: Here, individual muscle groups twitch very quickly.
• Absences: affected persons suddenly suffer short pauses in consciousness.
  

The symptoms triggered by a focal seizure depend on the area of the brain in which it occurs. A distinction is made here between sensory, motor and visual seizures. It is quite possible that epileptics have altered perception during a seizure and, for example, see, hear and smell differently. Anxiety, dizziness and hallucinations³ are also possible.

Usually, a seizure does not last long. However, if the epileptic seizure lasts longer than five minutes, doctors refer to it as "status epilepticus". Note: Status epilepticus is an emergency and an ambulance with an emergency doctor should be called immediately⁷.

Diagnosis of epilepsy

In addition to the medical history, neurological examinations are performed. Since affected persons often cannot remember a seizure, interviewing relatives can be very helpful in the diagnosis.

In addition, further examinations may be required to rule out certain diseases and confirm the diagnosis⁷:

• Laboratory tests
• Electroencephalography (EEG)
• Imaging procedures such as computed tomography (CT) and magnetic resonance imaging (MRI).
• CSF or lumbar puncture (taking a sample from the cerebrospinal fluid).
• Epilepsy: treatment and therapy

Treatment of epilepsy is not always necessary. It is often sufficient if affected persons avoid the triggers known to them (e.g. flickering lights or computer games) and pay attention to their general health^4,6. In most cases, further seizures can already be avoided in this way.

If there is a high risk of further seizures of unexplained cause, or if an epilepsy syndrome is present, drug treatment is recommended. Especially if patients find the seizures very distressing. However, physicians should carefully weigh the benefits and risks of therapy³.

So-called anticonvulsants (antiepileptic drugs) are used. These are designed to inhibit the excessive activity of nerve cells in the brain. The aim is to use the drugs to reduce the frequency of seizures. If one drug does not show sufficient effect, several agents can also be combined. However, such combined therapies must be carefully considered and monitored³.

Side effects of antiepileptic drugs

Especially at the beginning of drug therapy, numerous side effects may occur, such as^7,8,9:

• Headache
• Dizziness
• Drowsiness
• Fatigue
• Blurred vision or double vision
• Gastrointestinal discomfort
• Nausea and vomiting

In addition, antiepileptic drugs can affect numerous processes in the body. Plus, the drugs can interact with other medications, making extensive medical consultation especially important⁴.

The negative consequences of side effects can also significantly affect the lives of patients' relatives and friends.¹⁰.

Information on other treatment options

If the frequency of seizures does not decrease with medication, the following interventions may be an alternative treatment option for a severe clinical picture^1,3:

• Epilepsy surgery: a focal epileptic seizure occurs in a specific area of the brain. If this can be identified, it can be surgically removed under certain conditions.

• Stimulation procedures: Vagus nerve stimulation involves implanting a pacemaker under the skin in the chest area that delivers electrical impulses. This is intended to inhibit the overactivity of the nerve cells.

Medical cannabis for epilepsy

The components of the cannabis plant have been used for centuries to treat various symptoms and diseases. For several years now, scientific interest in the wide-ranging effects of cannabinoids has been on the rise. Medical cannabis already has a firm place in pain treatment as well as in palliative medicine^11,12.

The topic of cannabis in epilepsy is also attracting more and more attention from researchers. Initial animal studies provided evidence years ago that cannabinoids such as tetrahydrocannabinol (THC) and cannabidiol (CBD) may have anticonvulsant effects⁵. Over time, CBD in particular was found to have therapeutic potential to reduce the frequency of seizures¹³.

Studies on CBD for epilepsy

The spectrum of action of CBD for the treatment of refractory epilepsy has been the most studied scientifically⁶. In one review, researchers assessed and summarized the results of more than 40 studies¹⁴. These involved children and adults who suffered from a severe form of epilepsy. In summary, the researchers stated that CBD was able to reduce the frequency of an epileptic seizure significantly more than a placebo (dummy drug).

Another study also states that as adjunctive therapy, the additional administration of CBD may be an effective long-term treatment option for Lennox-Gastaut and Dravet syndromes^15,16. However, the mechanisms underlying CBD's anticonvulsant properties have not yet been definitively elucidated.

CBD and antiepileptic drugs

Isolated studies exist that have investigated the concomitant use of CBD and clobazam. Clobazam belongs to the group of benzodiazepines that can be used to treat states of agitation, tension, and anxiety, as well as seizure disorders such as epilepsy.

In a review, researchers summarized the results of placebo-controlled studies. Compared to placebo, the frequency of epileptic seizures decreased when CBD and clobazam were taken simultaneously¹⁷.

Another study found similar results. Here, CBD was studied as a potential adjunctive treatment for children with refractory epilepsy. A total of 25 children participated, 13 of whom received clobazam. Nine of the children who received clobazam and CBD were less likely to have an epileptic seizure¹⁸.

How can Canify help?

Canify Clinics is here to help you get closer to your goals: We want to help you regain your quality of life. To do this, it is important to keep bureaucratic hurdles low and to adapt appointments and tasks to your everyday life. This means that the symptoms of your disease must not prevent you from taking care of your health. To make your path to medical cannabis easier, Canify Clinics works on the principle of telemedicine.

After you register on our portal without any obligation, our doctors* will review your records and contact you in a timely manner to discuss the next steps. If treatment with medical cannabis is an option for you, an appointment with one of our cooperating physicians will follow. The follow-up appointments can take place in the comfort of your own home, and you can discuss everything important with your doctor via video chat. Only once a calendar year do you have to attend an appointment – we will be happy to help you prepare for this.

FAQ

Does epilepsy need to be treated?

If an epileptic seizure occurs, it should definitely be clarified by a doctor. If the diagnosis of epilepsy is confirmed, treatment is not absolutely necessary in all cases. If there is a risk that epileptic seizures will occur more frequently, epilepsy medications (antiepileptic drugs) cannot combat the cause, but in the best case they can prevent a seizure or reduce the frequency of seizures.

Does CBD have an anticonvulsant effect on epilepsy?

Cannabidiol (CBD) has the potential to be anticonvulsant and reduce seizure frequency in epileptic seizures - studies have shown this in severe, treatment-resistant epilepsies. However, the exact mechanisms are unclear, and further investigation, particularly clinical placebo-controlled trials, is needed.

Disclaimer and legal information

This article is for information purposes only and does not replace medical advice from a doctor. The content is not intended to motivate self-diagnosis or self-treatment, nor to induce independent changes in medical treatment. Canify Clinics does not make any recommendations or promote any diagnostic methods or treatments. If you wish to change your treatment, this should always be discussed with a doctor. Furthermore, Canify Clinics cannot guarantee the accuracy, timeliness and balance of the content. Therefore, neither the authors of the texts nor Canify Clinics accept any liability for damages resulting from the independent use of the information described here.

References

1. Epilepsy | Gesundheitsinformation.de.

2. Epilepsien - Neurologienetz.

3. Epilepsie: Definition, Formen, Auslöser, Therapie - NetDoktor.de.

4. Fisher, R. S. et al. Standards und Leitlinien Operationale Klassifikation der Anfallsformen durch die Internationale Liga gegen Epilepsie: Positionspapier der ILAE-Klassifikations-und Terminologiekommission. Zeitschrift für Epileptologie 31, 272–281 (2018).

5. Gaston, T. E. & Szaflarski, J. P. Cannabis for the Treatment of Epilepsy: an Update. Curr Neurol Neurosci Rep 18, (2018).

6. Golub, V. & Reddy, D. S. Cannabidiol Therapy for Refractory Epilepsy and Seizure Disorders. Adv Exp Med Biol 1264, 93–110 (2021).

7. Fragen und Antworten zum Gesetz ‘Cannabis als Medizin’ - Bundesgesundheitsministerium.

8. Perucca, P., Carter, J., Vahle, V. & Gilliam, F. G. Adverse antiepileptic drug effects: toward a clinically and neurobiologically relevant taxonomy. Neurology 72, 1223–1229 (2009).

9. de Kinderen, R. J. A. et al. Side-effects of antiepileptic drugs: The economic burden. Seizure 23, 184–190 (2014).

10. Luoni, C. et al. Determinants of health-related quality of life in pharmacoresistant epilepsy: results from a large multicenter study of consecutively enrolled patients using validated quantitative assessments. Epilepsia 52, 2181–2191 (2011).

11. Doppen, M. et al. Cannabis in Palliative Care: A Systematic Review of Current Evidence. J Pain Symptom Manage (2022) doi:10.1016/J.JPAINSYMMAN.2022.06.002.

12. Baron, E. P. Medicinal Properties of Cannabinoids, Terpenes, and Flavonoids in Cannabis, and Benefits in Migraine, Headache, and Pain: An Update on Current Evidence and Cannabis Science. Headache 58, 1139–1186 (2018).

13. Devinsky, O. et al. Cannabidiol: pharmacology and potential therapeutic role in epilepsy and other neuropsychiatric disorders. Epilepsia 55, 791–802 (2014).

14. Lattanzi, S. et al. Highly Purified Cannabidiol for Epilepsy Treatment: A Systematic Review of Epileptic Conditions Beyond Dravet Syndrome and Lennox-Gastaut Syndrome. CNS Drugs 35, 265–281 (2021).

15. Laux, L. C. et al. Long-term safety and efficacy of cannabidiol in children and adults with treatment resistant Lennox-Gastaut syndrome or Dravet syndrome: Expanded access program results. Epilepsy Res 154, 13–20 (2019).

16. Gaston, T. E. & Friedman, D. Pharmacology of cannabinoids in the treatment of epilepsy. Epilepsy Behav 70, 313–318 (2017).

17. Lattanzi, S. et al. Cannabidiol efficacy and clobazam status: A systematic review and meta-analysis. Epilepsia 61, 1090–1098 (2020).

18. Geffrey, A. L., Pollack, S. F., Bruno, P. L. & Thiele, E. A. Drug–drug interaction between clobazam and cannabidiol in children with refractory epilepsy. Epilepsia 56, 1246–1251 (2015).