Medical cannabis for the control of epilepsy and seizures

Epilepsy is a surprisingly common neurological condition (affecting roughly 1 in 23 UK residents) that is characterised by abnormal brain activity. It presents with various symptoms, including unexpected seizures, headaches, and impaired cognition and communication. There are numerous types of epilepsy, each with its own unique set of symptoms.

While many types of epilepsy involve seizures accompanied by loss of consciousness and physical manifestations like twitching and convulsions, others may allow the person to remain conscious or semi-conscious while experiencing abnormal sensory perceptions.

Epilepsy can manifest in childhood or later in life following a head injury, illness, or for unknown reasons. Each case of epilepsy is unique, making it a complex condition to understand and manage.

Currently, there are more than twenty-five pharmaceutical medication options available for epileptics to manage their symptoms. However, some patients experience severe side effects from these medications, and some continue to have breakthrough seizures. Breakthrough seizures occur when a person still experiences significant seizure activity despite being on antiepileptic medication.

In some cases, patients with severe forms of epilepsy have found success in taking cannabis-based medicinal products (CMBPs) to reduce the intensity and frequency of their seizures. Currently, the NHS only prescribes CMBPs for 3 conditions, with two rare types of treatment-resistant epilepsy being on that list. Private clinics, like Releaf, have the ability to prescribe medical cannabis products for a much wider range of health issues.

What is medical cannabis?

The cannabis sativa L. plant has a rich history of recorded medical application reaching back almost five millennia. The earliest records of cannabis as a medicine are from 2732 BC, when the Chinese emperor Shen Nung (often referred to as the "father of Chinese medicine") prescribed it for a variety of conditions, including gout, rheumatism, and malaria.

Today, medical cannabis is the term used to describe pharmaceutical-grade cannabis-based medicinal products (CBMPs) derived from the plant that are intended for medical use. These products come in an immense variety of forms, including dried flower, oils, capsules, extracts, and lotions. Each product offers a different level of active ingredient concentration (known as cannabinoids and terpenes).

Usually, CBMPs are extracted from the plant to create a concentrate that has higher potency and improved bioavailability. The most common cannabinoids in CBMPs are tetrahydrocannabinol (THC) and cannabidiol (CBD).

THC is the cannabinoid responsible for the psychoactive effects of cannabis, while CBD offers zero intoxication to the patient, no matter the dosage size. But both offer some fascinating therapeutic benefits.

Thanks to a rapidly growing body of research, the medical applications of cannabis and its contained compounds are becoming increasingly clear. Research from around the world has shown that CBMPs can be used to effectively treat a number of medical conditions, with epilepsy being one of the first conditions identified as benefiting from medicinal cannabis.

How does medical cannabis actually interact with the body?

The human body has its own endocannabinoid system (ECS), which was only identified in the late 1980s, but is the largest neurotransmitter system in the body. It is responsible for regulating a wide range of bodily functions, including appetite, sleep, pain and inflammation, memory, and mood. Modern-day science is pointing to its overarching role as the body's "master regulator". CBMPs, and the compounds they contain, interact directly with the ECS, providing a therapeutic boost to its naturally occurring endocannabinoids.

When CBMPs are administered, they interact with the cannabinoid receptors found throughout the body and brain. These receptors are part of the ECS network, which allows cannabinoids to bind and activate them – triggering physiological responses and psychological effects. The two ECS receptors are CB1 and CB2, with CB1 receptors being mostly located in the brain and central nervous system, while CB2 receptors are found in peripheral organs, and in high concentrations in immune cells.

THC has been shown to have a strong affinity to CB1 receptors (and a weaker binding action with CB2), while CBD has been shown to have a much higher affinity for CB2 receptors, along with the ability to reduce the enzymatic breakdown of our own endocannabinoids.

Both cannabinoids have also been shown to interact with a range of other receptors, including serotonin, dopamine, vanilloid, opioid, and adenosine.

The result of these interactions is a variety of therapeutic effects, including reduction in inflammation and pain, reduced anxiety and improved mood, better sleep quality, and anticonvulsant properties. This makes CBMPs an attractive option for treating many medical conditions where other treatments have had limited success, and also as a complementary treatment when used alongside conventional pharmaceuticals.

How can medical cannabis help with epilepsy?

Before we venture any further, it is imperative to point out that medical cannabis should never be viewed or advertised as some kind of cure-all for epilepsy. It should instead be seen as a potential supplemental treatment option that may help to reduce seizure activity and improve the overall quality of life of those with epilepsy and other chronic conditions.

With that said, when applied as part of a tailored and managed treatment plan, medical cannabis has been shown to improve the overall control of epileptic seizures. In fact, it is the only non-pharmaceutical treatment option that has been approved by the National Institute for Health and Care Excellence (NICE) in England for two exceedingly rare forms of epilepsy.

Let's look at what the growing body of research has to say.

The anti-seizure effect of medical cannabis

First up, studies have shown that the cannabinoids contained in CBMPs can reduce seizure activity.

This paper from 2018 has a retrospective look at interim results on the safety and efficacy of CBD when administered by 607 patients with ages ranging from 1 to 62 years old. It found that medical cannabis products containing a high concentration of CBD reduced seizure frequency and severity of seizure in a range of epilepsy types.

These results are backed up by "Use of Cannabidiol in the Treatment of Epilepsy: Efficacy and Security in Clinical Trials", a paper published in 2019. The key findings from this study were as follows:

"CBD is a non-psychotropic cannabinoid extracted from Cannabis sativa, which has received scientific interest due to its medical applications. It has shown efficacy as an anti-seizure, antipsychotic, neuroprotective, antidepressant, and anxiolytic compound. The neuroprotective activity of CBD is believed to be linked to its anti-inflammatory and antioxidant properties."

So, as we can see, CBD seems to be an extremely effective anti-seizure treatment when administered in the correct dose and delivery system.

But how about THC?

While CBD has a better anticonvulsant profile in most clinical trials and is largely devoid of psychoactive effects and abuse potential, THC may also offer some anti-seizure benefits, but there is simply not enough research to draw definitive conclusions about its effectiveness. .

Does that mean that THC is totally devoid of medicinal and therapeutic benefits for epilepsy sufferers?

Not, not at all…

The secondary therapeutic effects of medical cannabis for epileptics

To fully explain just how THC may be beneficial for a range of secondary symptoms of epilepsy, we need to discuss what is referred to as the "entourage effect”. This widely accepted theory states that "the active cannabis components work together to amplify therapeutic effects while reducing the psychoactive side effects of THC."

When cannabinoid compounds are administered in their natural form, they contain hundreds of different molecules that interact and work synergistically with one another. This increases their effectiveness considerably when compared to isolated cannabinoids such as CBD or THC extracted from hemp or cannabis plants.

So, what this is saying is that the addition of small levels of THC to a CBD-rich product may have the potential to actually improve the anti-seizure effect.

THC has also been shown to offer a range of therapeutic effects that can help improve the quality of life for people living with epilepsy. For example, studies have shown that THC can offer neuroprotective benefits, reduce inflammation and pain, improve sleep quality, and even has some antidepressant and antianxiety properties.

CBD also shows great promise in reducing inflammation and pain, thus providing relief from a range of symptoms associated with epilepsy and other chronic conditions. The anxiolytic effects of CBD have also been shown to be beneficial for those suffering from anxiety disorders, which can often accompany epileptic seizures.

Along with these finding, a recent study published in the British Journal of Pharmacology found that secondary cannabinoids may be responsible for reducing seizures. In particular, cannadivarinic acid (CBDVA), cannabidivarin (CBDV) and cannabigerovarinic acid (CBGVA), and cannabigerolic acid (CBDa) were associated with antiepileptic effects.

This only further points to the fact that while we already have a good understanding of how cannabis may be beneficial for treating epilepsy, there is still a great deal to learn about the potential benefits of other cannabinoid compounds found in medical cannabis products. With the current wave of medical (and in some countries, recreational) cannabis legalisation, the opportunities presented to researchers have never been greater and we can only hope that further discoveries will be made in the near future.

Are there any side effects related to medical cannabis administration?

Yes, just like all medications, there are potential side effects associated with medical cannabis.

The most common side effects reported following medical cannabis treatment include drowsiness, dizziness, and fatigue. Some people may also experience short-term memory loss, confusion and in very rare cases, psychotic episodes. That being said, these adverse events are typically mild and well tolerated by patients.

How to receive medical cannabis for epilepsy in the UK

We have all been witness to the meteoric rise of 'over-the-counter' CBD products in recent years, however, the vast majority of these options are simply not medical products. The medicinal cannabis sector is subject to far more stringent regulations and as such, any product claiming to be 'medicinal' must fulfil a range of requirements before a doctor can prescribe it.

If you are interested in adding any medicinal cannabis products to your current treatment plan, it is imperative that you seek the guidance, support, and advice of a doctor that is registered, qualified, and experienced in doing so. Not only will they be able to provide you with the correct CBMP for your specific set of epileptic symptoms, but they can also provide the advice needed on dosage frequency and size.

If you have been diagnosed with one of the two rare types of epilepsy, Dravet Syndrome or Lennox-Gastaut Syndrome, and are over the age of 12, you may be eligible for an NHS-funded CBMP prescription. If not, you will have to go down the private clinic route.

For residents of the UK, Releaf will be able to help guide you through this process. We offer a specialist service that includes consultations with experienced doctors and tailored monthly packages for medical cannabis patients.

The wrap up

So, there you have it. As we can see, medical cannabis is becoming increasingly recognised as an effective complementary treatment option for epileptic seizures due to its anti-seizure and neuroprotective properties. While the majority of clinical research has focused on CBD, it's important to remember that the entourage effect of medical cannabis can provide a range of additional therapeutic effects that may prove beneficial in treating epilepsy.

It is anything but a magic bullet for epilepsy, but with the right support from qualified medical professionals, you could see improvements in the quality of your life with a tailored CBMP.

If you are considering adding medicinal cannabis to your epilepsy treatment plan, Releaf is here to help. Releaf understands that embarking on your medical cannabis journey can be intimidating – that’s why we offer tailored monthly packages, specialist consultations for medical cannabis, and our unique medical cannabis card to give you the peace of mind that your treatment is protected, all based on your medical cannabis prescription.