CBD in the treatment of Epilepsy

CBD in the treatment of Epilepsy

CBD in the treatment of Epilepsy

Table of contents

Overview of Epilepsy

CBD in the treatment of Epilepsy

  1.   Therapeutic values of CBD for Epilepsy management
  2.   Drug safety and interaction
  3.   Choosing the right dose
  4.   How to use
  5.   Notice about using CBD to treat epilepsy

Conclusion

Reference

Overview of Epilepsy

What is Epilepsy?

Epilepsy is one of the world’s oldest recognized conditions, with written records dating back 4000 BCE. Fear, misunderstanding, discrimination, and social stigma have surrounded epilepsy for centuries. In this section, we provide basic knowledge about epilepsy under the eyes of modern science.

Epilepsy is a neurological disorder in which neurons become abnormally excited resulting in uncontrolled and sudden electrical discharge in the brain. It is characterized by recurrent seizures, which are brief episodes of involuntary movement and sometimes accompanied by loss of awareness. According to the World Health Organization, the condition affects around 50 million worldwide and up to 10% people have one seizure during their lifetime.

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One seizure doesn’t signify epilepsy, epilepsy is diagnosed with two or more 2 unprovoked seizures over 24 hours or one provoked seizure with a high chance of having another episode.

Causes

It isn’t a contagious illness. Although many underlying factors can lead to epilepsy, the exact mechanism of disease is still unknown with about half of patients having no identifiable cause globally. In the other half, the condition is a result of various factors. Example include:

  • Brain damage: It may be a head trauma or stroke that restricts oxygen supply to the brain.
  • Premature birth with low gestation weight
  • Infections such meningitis or encephalitis
  • Family history of seizure
  • Alcohol withdrawal
  • Medications which lower the seizure threshold such as antidepressants, opioids, stimulants, etc.

Signs and symptoms

People with epilepsy tend to have more physical symptoms, as well as higher rates of developing physiological problems, such as anxiety, and depression. In general, the symptoms are categorized into 2 types, including motor and non-motor symptoms


Motor signs

Non-motor signs

Automatic behaviors such as lip smacking or chewing

Loss of muscle tone

An involuntary muscle movement and/or contraction

Muscle stiffening

Sudden and excessive movements

Sweating, salivation

Freezing behavior

Language, thinking, and memory issues

Feeling of numbness, tingling

Anger

Depression

Loss of awareness

Depending on the type of seizure, the patients have particular manifestation, time of onset, status of awareness, and duration of symptoms.

Treatment

Treatment can help prevent seizure recurrence and optimize quality of life. Treatments include:

  • Anti-epileptic drugs (AEDs)
  • Surgery procedure
  • Electrical device application

While some patients need treatment for life, others might be able to stop if your symptoms are managed completely. 

The common drugs contain sodium valproate, carbamazepine, phenytoin, lamotrigine, and levetiracetam. The best type for you will rely on types of epilepsy, characteristics of patients, cost of drug, and the availability. The doctors will prescribe the AED medication based on the mentioned criteria. 

Side effects are very common when starting anti-epileptic drugs. Some may appear soon and you can tolerate it after a few weeks. Common side effects of medication include

GI issues (Diarrhea, nausea, vomiting)

Skin rash - it may be a life-threatening condition and you must contact your physician as soon as possible.

Hair loss

Drowsiness and/or agitation

For people who don’t control seizure with AED medications, brain surgery may be an option to stop the symptoms. In case brain surgery isn’t suitable for you, there are some procedures that could help, namely vagus nerve stimulation, deep brain stimulation.

CBD in the treatment of Epilepsy

Epilepsy may be a therapeutic challenge with one third of patients having persistent seizures despite the growing number of anti-epileptic drugs [1]. In recent years, the scientific community has shown interest in CBD because several studies confirmed its efficacy in the treatment of epileptic seizure, especially in pediatric age. In the next section, we provide an overview of clinical trials which study the use of CBD in patients affected by epilepsy.

Therapeutic values of CBD for Epilepsy management

FDA has approved Epidiolex, which contains purified CBD, for the treatment of seizure with Lennox - Gastaut syndrome, Dravet syndrome or tuberous sclerosis in patients 2 years of age or older. 

Through many well - controlled clinical trials as well as careful review of FDA’s drug approval process, FDA concluded that this drug is quite safe and effective for its indication. This is the first FDA-approved drug that contains substances derived from cannabis and it is also the first drug approved from Dravet syndrome in patients with epilepsy. The effectiveness of Epidiolex was studied in 3 randomized, double-blind, and placebo - controlled  clinical trials with 516 patients suffering from Lennox - Gastaut or Dravet syndrome. When taken along with other medications, it was shown to be effective in reducing the frequency of  seizure when compared with placebo. The most common side effects were sleep disturbance, nausea/vomiting, fatigue, rash which are mild or moderate [2].

A study to investigate efficacy and safety ò CBD á adjunct treatment for seizure associated with  Lennox Gastaut  syndrome in children and  adults

This trial included 171 patients aged between 2 to 55 years of age. They use normal anti-epileptic drugs at stable doses for at least 1 month before administration of oral CBD. The endpoint was frequency of seizure and safety. The participants were divided into 2 groups using CBD at a dose of 20 mg/kg/day for 14 weeks or placebo. After 14 weeks of treatment, the monthly frequency of seizures decreased 43.9% from baseline in the CBD group. When it comes to the number of patients having a reduction of 50% or more in frequency of seizure, the percentage in the CBD-treated group was 44%, while it is 24% in the placebo group [3].

CBD as a new approach for drug-resistant epilepsy in Epilepsy associated with Tuberous Sclerosis Complex

Tuberous sclerosis is a genetic disorder characterized with 85% of patients having epilepsy. 18 of the 56 patients were diagnosed with treatment-resistant epilepsy. The initial dose was 5 mg/kg/day was increased up to 50 mg/kg.day if tolerated. The seizure frequency and response were recorded from the first to 12th month. After 3 month, the total weekly frequency of seizure reduced significantly from 69% to 11%. The response rate remained 50% from the first month to the end of the study. The authors suggested that CBD may be an effective and well-tolerated treatment option for refractory seizure [4].

Drug safety and interaction

We don’t recommend  cannabis or THC-rich compounds  because their effects on seizure is uncertain, and they have psychoactive effects, such as depression, suicide attempt,... In contrast, CBD has a better safety profile with mild-moderate side effects. The most prevalent SEs are reduced appetite, nausea/vomiting, fatigue, and drowsiness. Through various clinical trials, the rate of CBD discontinuation is extremely low at a rate of 3 to 10%.

When taken with carbamazepine or phenytoin, the CBD level was reduced, while CBD increases the level of topiramate when co-administration. Hence, People considering or taking CBD products must always mention their use to their doctor, especially if you are taking other medications or have underlying ailments, such as kidney disease, liver disease, heart failure, or immunocompromised condition. Pharmacists are also a reliable source to help you learn about potential drug interaction with supplements, over-the-counter drugs or prescribed drugs.

Choosing the right dose of CBD

There is no one size fits all dosage for CBD. What’s optimal mainly depends on a range of factors, such as body weight, tolerance, symptoms, metabolism, and so on. These factors can yield unique effects for each CBD consumer. Keep in mind that you should pay close attention to how you feel after each dose. It might not occur immediately, and you should be patient to remember that you’re unlikely to get immediate results. As soon as you experience positive effects, lock in that dose and stick with it.

With oral route, start at a dose of 20 milligrams per day (using twice or three times a day) and increase the dose gradually to achieve desirable effects. Do not increase or decrease your dose more often or longer than recommended. Your condition may not improve faster, your risks of side effects will increase.

With topical CBD products, take sufficient amounts of CBD to apply directly into the skin (2-3 times a day) and start at low dose and increase the dose gradually. You can combine using topical CBD products with oral route for maximizing effects.

The recommended dosage forms are CBD capsule, and CBD oil. As compared to capsule, CBD oil is extremely versatile because it can be taken under the tongue, vaporized, infused in food, or cosmetics.

How to use

Taking capsules is the simplest and most convenient way to use CBD. You only need to swallow the capsule with at least 300 ml of water. The drawbacks of the oral route are low availability and delayed onset of effects.

There are some ways to take CBD oil, and we will provide two most common and effective methods to use CBD in this section.

Firstly, applying CBD sublingually is incredibly easy. CBD oil needs to be put under the tongue and held from 60 to 120 seconds without swallowing to allow adequate time for CBD to diffuse completely across the epithelial cells. The method remains the same when you use CBD oils or tinctures. You must hold the CBD under the tongue since different areas of the mouth might not be permeable enough for diffusion into the bloodstream. Taking CBD sublingually provides fast onset of action and high bioavailability.

Vaping CBD seems to be slightly more difficult than taking CBD sublingually. The first step to vaping properly is to determine how much CBD you consume each time. If you feel unconfident at first,  you should start with the easiest option. Disposable cartridges and pods are the simplest tools for new users. Refillable vape pens are a little bit more advanced but more cost-effective in the long term. It is important to read the instructions carefully before using them.

Notice about using CBD for Epilepsy

How you choose the best CBD products for Epilepsy

Overall, it is vital that your doctor check your improvements, disease progression, side effects, and interaction with food or drugs at regular visits to make sure CBD is working properly.

  • Notice any side effects and tell your doctor right away.
  • Don’t take other medicine (including ETC, OTC medicines, herbal, or vitamin supplements) unless they have been discussed with your doctor.

As regards CBD products, they are made by a company that provides 

  • Third-party test
  • Business certification
  • Certificate of analysis (COA), no contain more than 0.3% THC and pass tests for heavy metals, pesticides, etc.
  • Source of their hemp
  • Product information (Brand, CBD content, ingredients, potency, route of administration, indication, instruction)
  • Customers’ review
  • No subject of FDA warning letter or make any unsupported health claim

If you use CBD by taking it under the tongue or vaping, there are a few things that you should take into account. We will provide details in the following section.

Applying CBD sublingually

Shake well before use

Determine the number of drops in accordance with the dose of CBD consuming each time

Start at a low dose as we recommend above and increase the dose to have the therapeutic effects.

Hold the CBD under the tongue for at least 60 seconds

Accidentally swallowing the CBD oil won’t pose any risks  to your body. However, once you swallow this substance, you no longer take it sublingually. Instead, you are eating it, which means that it has to pass the digestive system and metabolism before your body can utilize it. Although it’s not dangerous, it does mean decreased bioavailability and slower onset of action.

Taking CBD sublingual bypasses the digestive system, there’s no need to  worry about taking it with or without food.

After the necessary time is up, drinking water or eating food won’t interfere with the working of the CBD. At best, you might wait a few minutes prior to drinking water.

Putting a few drops of CBD under the tongue won’t turn your teeth yellow as well as make your breath smell.

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Vaping CBD

Determine your suitable CBD dosage, the number of puffs each time, and types of CBD vape

Read carefully the user manual, especially if you are a new user

Wait 5 – 10 minutes between puffs and observe how CBD affects you

Always start at low dose, and work your way up to the optimal dose

After inhaling, you should check the battery life or clean the vape tank if needed

Conclusion

Research finding potential of CBD to treat epilepsy is ongoing. Currently, CBD is approved to treat epilepsy associated with Lennox - Gastaut syndrome, Dravet syndrome or tuberous sclerosis by FDA. Some studies have found that CBD may also be effective for other types of epilepsy through reducing frequency of seizure and symptoms.

Keeping in mind that if you try using CBD for epilepsy, you should consult with your physicians and they can help you choose the right decision.

Reference

  1. Chen Z, Brodie MJ, Liew D, Kwan P. Treatment outcomes in patients with newly diagnosed epilepsy treated with established and new antiepileptic drugs:a 30-year longitudinal cohort study. JAMA Neurol. (2018) 75:279–86. doi: 10.1001/jamaneurol.2017.3949
  2. https://www.fda.gov/news-events/press-announcements/fda-approves-first-drug-comprised-active-ingredient-derived-marijuana-treat-rare-severe-forms
  3. https://clinicaltrials.gov/ct2/show/NCT02224690
  4. https://pubmed.ncbi.nlm.nih.gov/27696387/










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