Sep 19, 2016 9:15 AM

Study Review: How Can Cannabis Treat Epilepsy?

Modern medicine can replace a faulty heart, liver, or kidney. It can sew on a finger or even a whole hand. It can regrow skin in a Petri dish. But the brain's abnormalities remain a secret to it.

About three million people in the U.S. (one percent of the population) have epilepsy, and almost a third of them has epilepsy with uncontrolled seizures that cannot be cured with medication. That is more people than with multiple sclerosis or Parkinson's disease.

What Is Epilepsy?

Epilepsy is a chronic disorder characterized by a tendency for recurrent, unprovoked twitching of the arms and legs, or seizures.

In most cases, the causes of epilepsy are unknown, though researchers believe people may develop epilepsy as the result of brain injury, tumors, stroke, birth defects, infections of the brain (like meningitis), or certain genetic mutations. Epileptic seizures are the result of excessive and abnormal nerve cells activity in the cortex of the brain.

There are six main types of seizures, most common of which are convulsive. The outward effect varies from uncontrolled jerking movement to a momentary loss of awareness (absence seizure). Not all seizures involve convulsions—some people with epilepsy can seem vacant, wander around or be confused. Usually, a seizure lasts a few seconds. However, some patients can experience a five-minute epileptic seizure. Often people do not remember what occurs during this time—there is a typical period of confusion called the postictal period that lasts from three to fifteen minutes. They may also feel tired and have headaches, difficulty with speech, and abnormal behavioral. Nearly 10 percent of patients have psychosis after a seizure. And tens of thousands of people die every day from status epilepticus, a seizure that is greater than five minutes and requires medical help.

The disease can start at any age, but most patients are either under 20 or over 65 years old. The diagnosis of epilepsy is typically made when a person has at least two unprovoked seizures occurring more than 24 hours apart or was diagnosed with an epilepsy syndrome.

Drug Treatments for Epilepsy

There are dozens of anti-seizure drugs on the market, most of which have been approved in the past twenty years: Carbatrol, Tegretol, Neurontin, Trileptal, Lyrica, Topamax, Depakote and Depakene, and many others. They cannot cure the condition. They only reduce the seizures but still are often not very effective. A million epileptics in the United States have drug-resistant seizures, and doctors report that at least a quarter of those patients are children.

Anti-epileptics (AEDs) can have troublesome side effects, from mild ones, like mood changes and sleepiness, to severe ones, like liver toxicity and suppression of the bone marrow. When used during pregnancy, they can cause birth defects. Valproate (valproiс acid) may cause stomach and intestinal problems; Tegretol and Carbatrol sometimes lead to osteoporosis and decrease in white blood cells; barbiturates like Primidone and Phenobarbital were reported to cause memory problems; Gabapentin and Pregabalin are not recommended for the use of children because kids often experience hyperactivity and aggressive behavior while using these medications.

Surgery, Deep Brain Stimulation therapy, ketogenic diet, and alternative medication can be an option for some patients with epilepsy. For example, surgery could be a viable treatment option to remove the parts of the brain that cause seizures.

For years, people with epilepsy have turned to medical cannabis to treat their debilitating condition, crediting the drug with dramatically reducing seizure activity. Finally, a few groundbreaking clinical trials seem to provide some scientific evidence to back the potential therapeutic use of marijuana in the treatment of epilepsy.

Cannabis Reduces Seizures

A small but growing body of studies provides evidence that marijuana may be an effective anticonvulsant, especially for patients who have a treatment-resistant form of the disease.

A 2004 study conducted by Polish scientists showed that THC enhanced the effectiveness of current anti-seizure drugs. A synthetic form of THC called WIN 55,212-2 increased the ability of three common epilepsy drugs—Clonazepam, Valproate, and Phenobarbital—to ease seizures in animal models of treatment-resistant epilepsy. The researchers did not find side effects of this epilepsy treatment. Moreover, it could even reduce the side effects of the drugs since patients would require lower doses of the chemical medication.

At the same time, a few studies involving THC reported conflicting results, most pointed to insufficient evidence to draw conclusions about the issue. A 2014 review by the American Academy of Neurology on the efficacy of medical marijuana in several neurological conditions concluded that “oral cannabinoids are of unknown efficacy” in the symptoms of epilepsy and added that there was “risk of serious adverse psychopathologic effects.”

Cannabis Is Helpful for Children

As many as a third of all children with epilepsy in the United States do not receive sufficient help from the existing drugs, according to GW Pharmaceuticals. So, parents are increasingly turning to marijuana.

In 2013, the U.S. Food and Drug Administration granted several medical organizations permission to use an experimental drug derived from marijuana, Epidiolex, and gave it “orphan drug” status providing a producing company with full marketing rights for seven years. The drug is a liquid containing pure cannabidiol, the component of marijuana knows as CBD that does not provide the high effect. This was the first drug that contains the cannabis derivative CBD to receive the green light from the FDA in the country.

A study on Epidiolex was presented last year at the American Academy of Neurology's 67th Annual Meeting. The trial involved treating patients with severe form of epilepsy with Epidiolex for 12 weeks. The results showed that the administration of Epidiolex decreased seizure frequency by more than half in all treated patients and by 63% in patients with Dravet syndrome (a rare form of epilepsy). About 9% of total treated participants and 16% of the Dravet syndrome patients became seizure-free.

Epidiolex is expected to be more expensive than some of the medical marijuana products available on the market. The price is likely to vary from $2,500 to $5,000 a month. But analysts say it might be covered by insurance, unlike other drugs.

UK-based GW Pharmaceuticals, a company that makes Epidiolex, also offers Sativex containing equal parts of CBD and THC. This is a drug derived from cannabis that treats stiffness and muscle spasms in multiple sclerosis patients in Canada and Europe. However, the drug is not available in the United States except for trials.

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