Marijuana for Epilepsy
Use of marijuana for epilepsy has been going on for millennia, but scientifically controlled trials of the practice have only recently been pursued in earnest. A new report presented at the American Academy of Neurology’s annual meeting in Washington, DC, as well as some other recent research, shed some light on advances in this area.
The latest research involved 213 children and young adults who had severe types of epilepsy and who had not responded to other treatments. Of the more than 15 epilepsy syndromes, some individuals in the study suffered from Dravet and Lennox-Gastaut syndromes, two of the less common forms and both of which are difficult to treat.
In the study, the patients were treated with liquid cannabidiol (CBD) once daily. Cannabidiol is an extract of marijuana (cannabis) that does not have the psychoactive or “stoning” effect associated with THC (tetrahydrocannabinol).
Medicinal marijuana products used for epilepsy patients are typically either CBD alone or high in CBD and low in THC. Currently, there is a move to grow CBD-rich strains of marijuana for the medicinal market.
This study was mainly designed to explore the tolerability, safety, and possible effectiveness of the medication. By the end of at least 12 weeks of treatment, here’s what the authors found concerning the 137 patients who completed the trial:
- A 54 percent overall reduction in number of seizures
- A 53 percent decline in convulsive seizures among the 23 patients who had Dravet syndrome
- A 55 percent decline in atonic seizures among the 11 people with Lennox-Gastaut syndrome
- Side effects included drowsiness (21% of participants), diarrhea (17%), tiredness (17%), and decreased appetite (16%)
It should be noted that this study was small and did not involve a placebo. One of the study’s authors, Dr. Orrin Devinsky, of New York University Langone Comprehensive Epilepsy Center, pointed out that larger, double-blind, placebo-controlled studies of marijuana use for epilepsy are needed and that such trials of CBD in specific epilepsy groups are being planned.
Another new epilepsy and marijuana study
Another new study of the impact of marijuana on epilepsy in children has just been published in Epilepsy Behavior. At Children’s Hospital Colorado, University of Colorado, 75 children and adolescents who were not responding to therapy were treated with oral cannabis extracts.
Various types of epilepsy were represented in the study, including absence seizures, focal seizures, generalized tonic-clonic seizures, myoclonic seizures, epileptic spasms, Doose syndrome, Dravet syndrome, and Lennox-Gastaut syndrome.
In this retrospective study, parents reported the following results concerning treatment:
- 57 percent had improvement in seizure control
- 33 percent had a better than 50 percent reduction in seizures
- Response rate varied depending on the epilepsy syndrome: 23% for Dravet, 88.9% for Lennox-Gastaut, and 0% for Doose
- In addition to better seizure control, the parents also noted improvements in behavior, alertness, language, and motor skills
- Side effects were noted in 44 percent of patients, including an increase in seizures (13%) and fatigue (12%).
According to Kevin Chapman, MD, a senior investigator in the study, the reviewers also found that patient response was three times higher among individuals whose families had just moved to Colorado (to take advantage of the medical marijuana availability) when compared with established Colorado residents. This suggests a parental bias in the reports of treatment response.
A review of other published papers on the use of marijuana for epilepsy reveals a clear need for randomized, well-controlled clinical trials before marijuana can be more readily used for treatment of this disease, especially in children. Currently there are at least two trials underway: a multi-center, open-label trial sponsored by Georgia Regents University, and another focusing on Dravet syndrome, sponsored by the University of Colorado, Denver.
American Academy of Neurology news release
Press CA et al. Parental reporting of response to oral cannabis extracts for treatment of refractory epilepsy. Epilepsy Behavior 2015 Apr 2; 45:49-52