What is Epilepsy
Epilepsy is a neurological disorder in which the normal patterns of brain activity becomes disturbed, causing strange sensations, emotions, and behavior. It can also cause seizures, convulsions, muscle spasms, and loss of consciousness. Cases of epilepsy can range from benign to life-threatening, and anyone can develop it—epilepsy affects people of all ages, sexes, races, and ethnicities.
Typically, at least two unprovoked seizures are required before an epilepsy diagnosis. Because epilepsy is caused by abnormal brain and neuron activity, seizures can affect any process that the brain coordinates. Seizure symptoms can vary greatly depending on the type of seizure that is had.
Symptoms of epilepsy
The two broadest categories of seizures are focal seizures or partial seizures that are caused by abnormal activity in just one area of the brain, or generalized seizures that involve all areas of the brain. Each of these has its own etiology and symptomology.
Focal seizures without loss of consciousness – These seizures can alter someone’s emotions or senses—causing differences in the way things look, smell, taste, feel, or sound—as well as spontaneous sensory symptoms such as tingling, dizziness, or flashing lights. This type of seizure can also cause muscle spasms or involuntary jerking of a body part or limb.
Focal seizures with impaired awareness – These seizures can cause either a change or total loss of consciousness or awareness. Someone experiencing this type of focal seizure may be unable to respond to their environment, stare into space for a period of time, or perform repetitive movements, such as hand rubbing, chewing, swallowing, or walking in circles.
Absence seizures – These cause the person seizing to stare into space and make subtle body movements example eye blinking, lip-smacking, etc. They can also cause a brief loss of awareness and occur most commonly in children.
Tonic seizures – Causes the stiffening of muscles—most often in the back, arms, and legs—and may result in the person seizing to fall to the ground.
Atonic seizures – Causes a complete loss of muscle control—often resulting in the person seizing to suddenly collapse or fall to the ground.
Clonic seizures – Causes repeated or rhythmic muscle jerking—usually in the neck, face, and arms.
Myoclonic seizures – Causes sudden jerks or twitches of the arms and legs.
Tonic-clonic seizures – The most extreme type of epileptic seizure. Can cause an abrupt loss of consciousness, muscle stiffening, body shaking, tongue biting, or a loss of bladder control.
Epilepsy Medications & Treatment
While there is no cure for epilepsy, there are treatment options with treatment mainly focussing symptom management and seizure control. Once a diagnosis is made, it is recommended to start treatment as soon as possible.
The most common therapeutic intervention for epilepsy is anti-epileptic drugs (AEDs), also called anti-seizure or anti-convulsive drugs. Different medicines tend to work better with certain kinds of seizures when compared to others and if one treatment fails, another maybe work better.
AEDs work by changing the levels of certain chemicals, helping to reduce the frequency and severity of seizure activity. However, they cannot stop seizures from happening all together and they cannot cure epilepsy.
There are several types of AEDs including sodium valproate, carbamazepine, lamotrigine, levetiracetam, oxcarbazepine, ethosuximide, and topiramate. Although AEDs are effective in helping control seizures in about 70% of people, they are not without side-effects. These include drowsiness, irritability, nausea, stomach upset or discomfort, headaches, tremors, swollen gums, and rashes.
In cases where AEDs are not effective and when it is medically a viable option, epilepsy surgery may be recommended. This involves surgery that removes the area of the brain causing seizures and often results in seizure activity stopping completely.
Dietary changes can also help, especially in children. This involves going on a ketogenic diet high in fats and low in carbohydrates and protein. It is thought that this diet may make seizures less likely by changing the levels of chemicals in the brain in a similar way as AEDs do.
There are also other therapies available that work by changing the electrical signals in the brain. Vagus nerve stimulations (VNS) is when a small electrical device similar to a pacemaker is placed under the skin of the chest and attached to a wire that goes under the skin and connects to the vagus nerve in the neck. Similar to VNS is deep brain stimulation (DBS) which is similar but the connected wires run directly into the brain.
CBD for Epilepsy
Research & Scientific Evidence
Cannabidiol (CBD) for epilepsy has been extensively researched for the past several years, with Dravet syndrome (DS) and Lennox-Gastaut syndrome (LGS) which are two forms of epilepsy, being the 1st and only FDA-approved use of CBD.
In a review from 2016 published in Epilepsy and Behavior, researchers summarized the findings of a collaboration between a group of clinical investigators and GW Pharmaceuticals developed to explore the use of CBD in patients with childhood-onset treatment-resistant epilepsy (TRE).
They reviewed findings from several surveys, case studies, case series, and placebo-controlled trials, including an open-label interventional trial of CBD in patients with TRE, a state-sponsored CBD treatment program, and Epidiolex placebo-controlled clinical trials.
They concluded that sound scientific evidence exists that suggests that CBD is a viable, safe, and well-tolerated treatment option for epileptic conditions in addition to effectively reducing convulsive seizures and drop seizures. In addition, open-label studies with CBD support its efficacy in a broader range of seizure syndromes including TRE, DS, LGS, Tuberous Sclerosis Complex (TSC), Febrile Infection-Related Epilepsy Syndrome (FIRES), and focal epilepsy.
In an open-label clinical study from 2017 and published in Epilepsia, researchers surveyed pediatric patients that were being treated with CBD to evaluate seizure frequency as well as their quality of life before and after 12 weeks of receiving treatment.
In addition to baseline AEDs, pediatric patients received 2 – 5 mg of CBD per kg per day (mg/kg/day), divided into two dosages. This was gradually increased until intolerance or a maximum dose of 50 mg/kg/day over 12 weeks. Quality of Life in Childhood Epilepsy (QOLCE) scores and monthly motor seizure frequencies were assessed during the initial 4-week baseline and again after the 12-week treatment period.
They observed improvements in caregiver‐reported QOL in children and young adults with severe, childhood-onset epilepsy, including energy/fatigue, memory, other cognitive functions, control/helplessness, social interactions, and behavior, as well as improvements in general QOL sub-scores. They also found a ≥50% reduction in mean monthly motor seizures from baseline, therefore showing that not only is CBD effective in reducing symptomology but also the overall quality of life.
Building on previous studies that evaluated CBD in TRE patients, this 2019 clinical trial published in the journal CNS drugs evaluated the pharmacokinetics and safety of CBD in pediatric patients with treatment-resistant epilepsy.
Pediatric patients (aged 1 to ≤ 17 years) with treatment-resistant epilepsy were divided into three experimental groups, receiving a daily dose of 5, 10, or 20 mg/kg/day of orally administered CBD respectively as an add-on to their current AED regimen. Dosages were increased to twice daily doses totaling 10 mg/kg/day (group 1), 20 mg/kg/day (group 2), or 40 mg/kg/day (group 3).
Although individual results varied, they found that in addition to CBD being effective in controlling the frequency of seizures resulting from children and adults suffering from epilepsy, it is also has a positive safety profile. Their data showed that overall, CBD can be considered as safe at all doses they examined with only mild dose-related side-effects such as diarrhea, flatulence, somnolence, and psychomotor hyperactivity, usually only in patients also taking clobazam. This could be due to concomitant administration of clobazam resulting in an increase in CBD exposure.
The media is full of stories about children who have effectively treated their epilepsy with high-quality CBD oil. Arguably the most well-known of these is probably Charlotte Figi, but there are many others as well, including Billy Caldwell and Alfie Dingle from the UK. In addition, many adults are also reporting that CBD can help reduce and control seizure activity as can be evidenced from the many testimonials, social media comments, and product reviews.
Testimonials of patients taking CBD for epilepsy
CBD as a complementary treatment
There is a lot of evidence for CBD as being an effective treatment option for epilepsy, especially in patients suffering from DS, LGS, and TRE. However, much of the research on CBD for epilepsy also involves using it as an add-on to the patients’ current AED regime, hinting that CBD could be more effective as a complementary treatment to AED drugs.
However, CBD can also help in other ways such as reducing the side effects of AEDs. For instance, CBD has been shown to help stabilize mood, helping reduce the irritability that is often associated with many AEDs. Similarly, stomach discomfort and nausea is often reported as a side effect of anti-seizure medications, and can also be relieved by CBD.
A reasonable amount of research from animal studies and clinical trials indicate CBD has the potential to be a safe, effective treatment option for both children and adults suffering from epilepsy. However, the number of patients using prescription CBD is relatively small, while the studies are generally limited in duration and scope, preventing definitive conclusions from being drawn. Always consult a medical practitioner before using CBD for epilepsy as it can interact negatively with other medications. In addition, your physician can monitor dosage, symptom severity, and other clinical parameters to ensure that your CBD treatment is both safe and effective.