CBD for Seizure Disorders

One of the most pronounced health benefits of herbal phytocannabinoids such as cannabidiol (CBD) is their ability to assist in the treatment of seizure disorders. The most obvious metric of progress in such treatment is a reduction or elimination of seizure activity in conditions such as epilepsy, Dravet syndrome (DS), and Lennox-Gastaut syndrome (LGS).

Epilepsy is a disease of the central nervous system characterized by abnormal brain activity that causes seizures or “periods of unusual behavior, sensations, and sometimes loss of awareness” (according to the Mayo Clinic). Causes range from genetic influences and infectious disease to head trauma and brain conditions, including malformations and tumors. Prenatal injuries and developmental disorders sometimes lead to seizure disorders (which can also appear in those with autism).

According to the Centers for Disease Control and Prevention, epilepsy afflicts about 3.5 million people in the United States alone, including half a million children. Many forms of the disease are intractable, relegating traditional drugs and therapies ineffective in providing beneficial reductions in seizure activity—forcing patients and wellness practitioners to seek alternative treatment solutions.

Importance of Dosing
Proper dosing (also called titration) is critical for consumers and patients seeking maximum efficacy from CBD products. While tinctures are, in some cases, more straightforward, capsules can result in doses that are unintentionally too strong or too weak. Correct dosing is an exercise in trial-and-error experimentation. Combined with careful journaling and healthcare practitioner oversight, dosing can result in maximum relief and efficacy (in addition to cost savings resulting from reduced product waste).

Dosing, however, extends beyond the volume, or amount, of an herbal extraction or concentrate consumed during a single session. Also of importance is the number of times per day that an extraction is consumed and the duration over which this routine occurs. Some studies have revealed that maximum efficacy results after a week or more of regular, sustained consumption of a supplement such as CBD or cannabigerol (CBG).

“I try to help my patients develop a dosing regimen that they can happily live with in the long term,” said Colleen Kibler, a state-licensed cannabis caregiver in Belgrade, Maine. “I like to speak to the patient several times through the first month to ensure that we are on the right track with dosage,” said Kibler during an exclusive interview with Vegas Cannabis Magazine. She emphasized the subjective efficacy that plagues both patients and their caregivers when attempting to accurately dose cannabinoids such as CBD or CBG. “Each individual has a different set of needs,” stressed Kibler.

Sunil Pai, MD, an Integrative Medicine expert and author of the 2016 book An Inflammation Nation, echoes other medical professionals when he advocates a “start low and go slow” approach to dosing CBD. Pai recommends the following steps to his patients and readers to determine proper individual dosing of wellness products such as CBD tinctures:

1. Maintain a journal to record all daily consumption data, including exact dose and experienced efficacy (or lack thereof).
a) Take note of any environmental factors that might skew results(such as a flu or unusually high anxiety due to environmental stressors).
2. Take 0.25-1.0 dropper sublingually (hold under tongue for one minute) three times daily (after breakfast, lunch, and dinner) and at bedtime.
a) The final bedtime dose can be increased if extra support is needed to treat pain and sleep issues.
b) If consuming capsules, begin with approximately 7.5 mg.
3. Sustain this routine for 7-10 days.
4. Slowly increase the weekly dose until the desired effects are experienced.
5. Continue increasing the dose until:
a) Negative side effects are experienced.
b) Positive efficacy begins to wane.
6. Leveraging the journal, decrease the dose to the previous most-efficacious dose.
7. Sustain this level until efficacy wanes or undesired negative side effects are experienced.

Unfortunately, metabolic changes resulting from aging, injury, seasonal shifts, and environmental stressors may require a recalibration of dose at several points following initial determination.

Research Studies
A variety of recent research studies have illustrated the ability of cannabinoids such as CBD to reduce seizure activity in users, as detailed below.

A 2018 research study entitled “Effect of Cannabidiol on Drop Seizures in the Lennox–Gastaut Syndrome” that was published in The New England Journal of Medicine investigated the effect of CBD on seizure occurrence. This double-blind placebo-controlled human trial—the most rigorous type of scientific investigation possible—involved 225 participants aged two to 55.

The study found that administration of CBD at various dosing levels decreased seizure activity among study participants. “The median percent reduction from baseline in the frequency of drop seizures per 28 days during the treatment period was 41.9% in the 20 mg cannabidiol group, 37.2% in the 10 mg cannabidiol group, and 17.2% in the placebo group,” reported the researchers.

The study noted a reduction in seizure activity of at least a 50% among large portions of each segment of study participants. Of those receiving 20 mg of CBD, nearly 40% achieved a 50% reduction in seizures, while 36% in the 10 mg CBD group did the same (providing more data regarding the importance of proper dosing).

Concluded the researchers, “Among children and adults with Lennox–Gastaut syndrome, the addition of cannabidiol at a dose of 10 mg or 20 mg per kilogram per day to a conventional antiepileptic regimen resulted in greater reductions in the frequency of drop seizures than a placebo.”

A 2017 study entitled “Trial of Cannabidiol for Drug-Resistant Seizures in the Dravet Syndrome” that was published in The New England Journal of Medicine explored the ability of CBD to reduce seizure activity in patients with Dravet syndrome. This double-blind placebo-controlled human trial study involved 120 participants (all children and young adults) with treatment-resistant Dravet syndrome.

The study’s authors reported significant reductions in seizures for the group consuming CBD. “The median frequency of convulsive seizures per month decreased from 12.4 to 5.9 with cannabidiol, as compared with a decrease from 14.9 to 14.1 with placebo.” This represented a reduction in seizure activity of more than 50% when participants used CBD instead of a placebo.

While most study participants experienced a reduction in seizures, 5% of those receiving CBD became seizure free. Interestingly, the study observed all seizure activity reductions for convulsive seizures, but no reduction for the nonconvulsive variety. “The frequency of total seizures of all types was significantly reduced with cannabidiol, but there was no significant reduction in nonconvulsive seizures.”
Concluded the study’s researchers, “Among patients with Dravet syndrome, cannabidiol resulted in a greater reduction in convulsive-seizure frequency than placebo.”

A 2017 study entitled “Cannabinoids in the Treatment of Epilepsy: Hard Evidence at Last?” that was published in the Journal of Epilepsy Research investigated the ability of CBD and other cannabinoids to decrease seizure activity in patients with DS and LGS varieties of epilepsy.

Reported the literature review study, “CBD was found to be superior to placebo in reducing the frequency of convulsive (tonic-clonic, tonic, clonic, and atonic) seizures in patients with Dravet syndrome and the frequency of drop seizures in patients with Lennox-Gastaut syndrome.”

Like many other studies, the researchers found the safety profile of CBD to be consistently acceptable, offering no opportunity for addiction or other common negative side effects encountered with traditional treatments, such as opioids. “CBD is mostly devoid of adverse psychoactive effects and possesses anticonvulsant, analgesic, anti-anxiety, antiemetic, immune-modulating, anti-inflammatory, neuroprotectant, and anti-tumorigenic properties.”

The researchers concluded that their survey of the existing research illustrated the efficacy of CBD for seizure disorders. “For the first time, there is now class 1 evidence that adjunctive use of CBD improves seizure control in patients with specific epilepsy syndromes,” wrote the researchers.

Conclusions
Research is revealing that the wellness molecules called cannabinoids that are produced by hemp and cannabis, including CBD, sometimes exhibit considerable benefits for patients suffering from a wide range of serious diseases. Among these are seizure disorders affecting millions of North Americans.

In addition to its role as an anticonvulsant in reducing seizure activity, current research has demonstrated many other benefits of CBD, including analgesia (pain management), reduced anxiety (therapeutic for Post-traumatic Stress Disorder sufferers), the prevention of nausea and vomiting (helpful for cancer and Crohn’s disease patients undergoing chemotherapy), decreased systemic inflammation (good for those suffering from arthritis and fibromyalgia), and neuroprotection (helpful for some pain patients and those suffering from Alzheimer’s disease and Parkinson’s disease)

Patients who consume CBD on a regular and monitored basis sometimes exhibit considerable improvements (especially when they consume full-spectrum hemp and cannabis products that contain other beneficial cannabinoids). This sometimes includes a significant reduction in the occurrence of seizures and other negative side effects of life-altering diseases. As additional research is conducted, wellness professionals, patients, and consumers are beginning to better understand the ability of phytochemicals from herbs like hemp to deliver significant relief for a range of ailments.