Conventional treatments fail to work for roughly 30 percent of people with epilepsy, according to the Epilepsy Foundation. And as more states pass legislation allowing patients to access the non-psychoactive cannabis extract cannabidiol (CBD) for the treatment of seizure conditions, many patients and families of patients with intractable epilepsy are curious to know how the risks and benefits of CBD stack up against those of traditional epilepsy drugs.
Most experts agree that more research is needed to gain a comprehensive understanding of the risks and benefits associated with CBD for epilepsy treatment. However, accumulating anecdotal evidence and early clinical trials do provide a solid basis for beginning to assess the effects of CBD treatments versus those of traditional epilepsy treatments.
Risks and Benefits of CBD for Epilepsy
Due to federal law, which considers cannabis and extracts like cannabidiol (CBD) Schedule I substances with no legitimate medical use, it has been difficult for US researchers to conduct large-scale studies on the efficacy of CBD for epilepsy. However, there is tremendous anecdotal evidence and a growing body of scientific research that indicates cannabis can be helpful in controlling seizures, particularly for patients with difficult-to-control conditions like Lennox-Gastaut syndrome and Dravet syndrome.
One recent study funded by the biopharmaceutical company GW Pharmaceuticals released promising findings in May 2017 from a rigorous double-blind placebo-controlled CBD trial involving children and young adults who suffer from the severe form of epilepsy called Dravet syndrome.
Study participants who received CBD treatments showed dramatic reduction in the frequency of their seizures when compared to patients who received placebo. Over the course of the 14 week clinical trial, patients receiving CBD experienced a median of 5.9 seizures (down from 12.4), while patients receiving placebo experienced a median of 14.1 seizures (down from 14.9).
“This study clearly establishes cannabidiol as an effective anti-seizure drug for this disorder and this age group,” Orrin Devinsky, principal investigator and director of the Comprehensive Epilepsy Center at New York University Langone Medical Center, told Scientific American. “It certainly deserves to be studied in other types of epilepsy.”
Despite evidence indicating CBD may be a promising treatment for intractable and hard-to-treat epilepsy conditions, marijuana is not without side effects. Open-labeled studies on CBD have shown patients may experience side effects such as sleepiness, diarrhea, fatigue, and decreased appetite.
The majority of side effects associated with CBD treatments were described as mild or moderate, and they went away. The most serious adverse affect possibly associated with CBD treatments is status epilepticus, when a person has long or repeated seizures, although this is very rare.
It’s also important to know that CBD appears to have interactions with some epilepsy medications. Like many medicines, marijuana is broken down in a person’s liver, and some drug-to-drug interactions may pose health risks.
According to the Epilepsy Foundation, valproic acid (VPA), a commonly used anti-seizure medication, may interact with CBD and increase the risk of liver issues. Additionally, clobazam (Onfi) appears to interact with CBD in some patients, and may be the cause of tiredness that is reported by some people simultaneously taking CBD and Onfi. More research is needed to fully understand these drug interactions however.
Risks and Benefits of Traditional Epilepsy Treatments
Antiepileptic drugs (AEDs) are the go-to form of treatment for people with epilepsy-related seizure conditions. Due to their legal prescription status under federal law, these drugs have been more rigorously studied and far more widely utilized than CBD thus far. That means doctors have a pretty solid understanding of the risks and benefits associated with these medications.
The Epilepsy Foundation reports that the majority of epilepsy patients (up to 70 percent) respond well to AEDs and may be able to completely control their seizures using these standard pharmaceutical treatments.
There are more than 20 prescription AEDs available today, according to the National Institute of Neurological Disorders and Stroke. Treatment options depend on a patient’s age, lifestyle, type(s) of seizures, frequency of seizures and other factors.
Depending on which medication, or combination of medications, a patient uses, potential risks and side effects will vary. Fatigue is one of the most commonly reported adverse effects across all AED options, and this was also a common side effect reported for CBD treatments. However, most AEDs are accompanied by a longer list of potential adverse effects than CBD treatment is – some of which, such as liver toxicity, can be potentially very dangerous.
Studies also show a slightly elevated risk of suicidality among patients taking AEDs, according to a 2008 FDA Alert, which covered findings of nearly 44,000 people who had recently participated in clinical trials of AEDs for the treatment of medical conditions, including epilepsy. According to the Alert, 3.5 out of 1,000 people taking AEDs showed suicidality, compared to 1 out of 1,000 patients taking placebo who reported suicidality.
CBD or AEDs?
The question of whether CBD or AEDs will work best in treating an epilepsy patient’s seizures is ultimately a decision that needs to be carefully discussed and determined under a physician’s care.
Both CBD and AED treatments often require a process of trial and error to find the most effective strain or pharmaceutical treatment option for an individual patient.
Most people with epilepsy can control their seizures using standard AEDs, experiencing tolerable minimal to moderate side effects. But for the approximately 30 percent of patients who don’t respond well to AEDs, CBD may be a promising alternative treatment option.