Introduction to Epilepsy
What is epilepsy?
Epilepsy is the fourth most common neurological condition after Alzheimer’s, stroke and migraines. Epilepsy affects more than 50 million people worldwide in all age groups, ethnic groups and socioeconomic demographics.
In the United States, 3 million adults and nearly half a million children live with epilepsy, according to the Center for Diseases Control and Prevention, and it’s estimated that 1 in 26 Americans will develop epilepsy in their lifetime. The National Institute of Health estimated the occurrence of epilepsy in the general population at 7.1 per 1,000.
Symptomatic or secondary epilepsy is caused by stroke; head injury; brain tumors; brain damage from prenatal or perinatal injuries; brain infections such as meningitis, encephalitis and neurocysticercosis; and certain genetic syndromes.
Epileptic seizures are caused by excessive electrical discharges in a group of brain cells. Neurons that generate electrical and chemical signals to produce human thoughts, feelings and actions fire faster than normal — as many as 500 times a second — triggering seizures that affect body function and behavior.
Recurrent seizures can vary from brief episodes of involuntary movement involving part or all of the body to severe and prolonged convulsions, sometimes accompanied by breathing problems, rapid eye blinking, confusion, loss of consciousness and loss of control of bowel or bladder functions. Seizures can vary in frequency from less than one per year to several per day.
Seizures can be triggered by stress, hypoglycemia, strobe lights and high fever in young children. Seizures can lead to injury or death, especially if they occur while people are driving vehicles or performing manual labor.
The Centers for Disease Control and Prevention estimates the direct and indirect annual cost of epilepsy in the United States is $15.5 billion.
Who’s most affected by epilepsy?
While any person of any age can develop epilepsy at any time, the brain disorder most commonly affects adults over age 55, a demographic that’s more susceptible to secondary epilepsy factors such as Alzheimer’s, stroke and brain tumors.
Children are most commonly diagnosed with epilepsy in their first year of life due to factors such as low birth weight, trauma during birth or loss of oxygen during birth.
Life-expectancy reduction can be up to two years in people with idiopathic epilepsy and up to 10 years in people with symptomatic epilepsy.
For people with symptomatic epilepsy, the higher mortality risk is related to the underlying cause of the epilepsy rather than disorder itself. Deaths directly related to epilepsy include Sudden Unexplained Death in Epilepsy (the unexpected death of a seemingly healthy person with epilepsy, where no cause of death can been found); consequences of seizures (eg: accidents, drowning and aspiration pneumonia); drug toxicity; and suicide. Epilepsy was listed as the underlying cause of death for more than 40 percent of all deaths in the United States with any mention of epilepsy in 2014.
Men have have higher epilepsy mortality rates than women. People age 85 and older have the highest epilepsy-related mortality rate of any age group.
How can cannabis help improve/relieve/reduce the occurrence and symptoms of epilepsy?
Historically regarded for its anticonvulsant properties, cannabis has been used for centuries to treat seizures — recorded first in 4000 BC by Chinese medicinal practitioners and hailed as an epilepsy therapy in the 1800s by British surgeon William O’Shaughnessy, who praised cannabis for its “alleviation of pain in most, a remarkable increase of appetite in all, unequivocal aphrodisia and great mental cheerfulness.” From the mid-19th century until political and social conditions changed in 1941, the U.S. Pharmacopeia listed cannabis tincture as a treatment for pediatric epilepsy.
Today, mounting research suggests that medicinal cannabis reduces the incidence and severity of seizures while relieving physical and behavioral effects in epilepsy patients who have not been adequately treated by traditional drugs or who suffer from intractable forms of seizures.
A recent study published by the New England Journal of Medicine provided more evidence of the effectiveness of CBD as a potential treatment for children with epilepsy. The double-blind clinical trial found that seizures in children suffering from Dravet syndrome, a rare and severe form of epilepsy that typically starts during infancy, decreased, on average, 39 percent after patients took Epidiolex, a liquid CBD medication created by British company GW Pharmaceuticals.
In a 2014 study, GW Pharmaceuticals reported more than 50 percent of children and adults suffering from Dravet syndrome and Lennox-Gastaut syndrome, another rare and severe form of epilepsy, experienced reductions in seizure frequency while taking Epidiolex, which is not yet approved for use in the United States.
The most high-profile case of a person using cannabis to treat epilepsy is that of Charlotte Figi, a 6-year-old from Colorado whose seizures dropped from up to 300 per day to fewer than four per month after she began ingesting a non-psychoactive, cannabidiol-rich cannabis extract.
How does cannabis integrate with/complement traditional epilepsy therapies?
There is no medical cure for epilepsy and no drug can prevent the underlying causes of the brain disorder. The majority of people who suffer from epilepsy can control seizures with prescription medications. Approximately 30 percent of all epilepsy patients do not respond to multiple medications.
While surgery, nerve-stimulating implants and specialized diets offer mixed therapeutic results, most epilepsy patients are prescribed one or more of nearly two dozen anticonvulsant pharmaceuticals developed in the past 20 years. The percentage of patients with medically intractable seizures has not changed significantly despite new anti-seizure medications.
In addition to its anticonvulsant properties, cannabis contains other therapeutic benefits that researchers believe help relieve negative side effects of anti-seizure pharmaceuticals, including headaches, nausea, depression, irritability and sleep disturbances.
What are effective consumption methods for epilepsy?
Pharmaceutical anticonvulsants are administered in several forms: pills, capsules, syrups and suppositories. Cannabis may be consumed in those forms too, but cannabis extracts (raw or decarboxylated cannabis oil suspended in plant or vegetable oil) and liquid preparations such as syrups are most commonly administered orally or sublingually.
What are effective dosages and ratios for epilepsy?
Everyone’s endocannabinoid system is unique. No single strain, product, dose or ratio is right for everyone or for any single condition.
In human and animal epilepsy trials, researchers have heeded the advice given to all consumers of cannabis products: Start low and go slow — from as little as 5 mg of CBD per day per kilogram of body weight. While GW Pharmaceuticals recommends a maximum dose of 25 mg of Epidiolex per day per kilogram of body weight, doses of non-pharmaceutical cannabis extracts used in trials and by home-administered patients like young Charlotte Figi are as high as 300 mg of CBD once per day.
Extensive clinical trials conducted outside the United States have shown that a 1:1 CBD:THC ratio can effectively relieve neuropathic pain. In the case of epilepsy, higher CBD:THC ratios demonstrate efficacy in reducing the incidence and severity of seizures while relieving their physical and behavioral effects. Charlotte’s Web cannabis extract, for example, has tested up to 20:<0.5 CBD:THC.