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Seizures/seizure disorders

Cannabis for Seizures/seizure disorders

a girl lying comforted by her mother

Seizure disorders encompass a range of conditions characterized by sudden, uncontrolled electrical disturbances in the brain. While epilepsy is the most well-known seizure disorder, other conditions such as hydrocephalus, seizures associated with autism spectrum disorder (ASD), cerebral palsy, febrile seizures (seizures due to fever), and those resulting from brain diseases or injuries also fall under this category.

These disorders can severely impact quality of life (QoL), and conventional treatments may not always provide adequate relief. Increasingly, medical cannabis has emerged as a potential therapeutic option for managing seizures and associated symptoms in diverse patient populations. As of 2022, approximately 3 million adults and 0.5 million children in the U.S. live with a seizure disorder.

Medical cannabis, and particularly cannabidiol (CBD), can help reduce the frequency and intensity of seizures, particularly those associated with Dravet syndrome (DS), Lennox-Gastaut syndrome (LGS), and tuberous sclerosis complex (TSC). The FDA has approved the Cannabis sativa-extracted prescription medication, Epidiolex, which is a highly purified form of CBD tincture.

Causes of seizures

Seizures can result from a variety of underlying conditions, including:

  • Epilepsy: A neurological disorder causing recurrent seizures
  • Hydrocephalus: Abnormal buildup of cerebrospinal fluid in the brain, leading to increased intracranial pressure
  • Autism spectrum disorder (ASD): Seizures are a common comorbidity in individuals with ASD
  • Cerebral palsy: Neurological damage that can trigger seizures and spasticity
  • Febrile seizures: Seizures triggered by high fevers, particularly in children
  • Brain injuries or diseases: Traumatic brain injury (TBI), infections, degenerative diseases, or tumors can disrupt normal brain function and cause seizures

Seizure symptoms & health effects

Seizure symptoms can vary based on the type of seizure and the affected brain regions. Common symptoms include:

  • Sudden jerking or twitching movements
  • Loss of consciousness or awareness
  • Staring spells or unresponsiveness
  • Temporary confusion
  • Muscle stiffness or limpness
  • Emotional changes, such as fear, anxiety, or deja vu

In addition to physical symptoms, seizures can lead to significant health effects, including:

  • Injury during seizures (such as falls or head trauma)
  • Cognitive impairments and memory problems
  • Developmental delays, particularly in children
  • Social and emotional challenges

Diagnosing seizures

Diagnosing seizures involves a thorough clinical evaluation, consideration of the patient’s medical history, and diagnostic testing. Key steps include:

  • Neurological examination: Assessing brain and nervous system function
  • Electroencephalogram (EEG): Measuring electrical activity in the brain to identify abnormal patterns
  • Imaging tests: MRI or CT scans can detect structural abnormalities, tumors, or injuries in the brain
  • Blood tests: Checking for infections, electrolyte imbalances, or metabolic issues
  • Medical history: Understanding triggers, family history, and prior medical conditions

result of brain CT scan

Seizure disorder prognosis

The prognosis for seizure disorders depends on the underlying cause, seizure type, and treatment effectiveness. While some individuals may experience freedom from seizures with appropriate management, others may face chronic and recurrent episodes. Early diagnosis and comprehensive treatment can significantly improve outcomes, reduce seizure frequency, and enhance quality of life.

Treating seizures

Treating seizures usually involves some form of medication, although lifestyle changes can help manage seizures. In some instances, surgery may be required.

First-line treatments

The first line of treatment for most seizure disorders includes:

  • Antiepileptic drugs (AEDs): Medications that control seizures by stabilizing electrical activity in the brain
  • Lifestyle modifications: Identifying and avoiding seizure triggers, such as stress, lack of sleep, or certain lights and sounds
  • Ketogenic diet: A high-fat, low-carbohydrate diet shown to reduce seizures, particularly in children

Other treatments

For individuals who do not respond to first-line therapies, additional options include:

  • Surgical interventions: Procedures to remove or disconnect the seizure focus in the brain
  • Vagus nerve stimulation (VNS): Implanting a device that sends electrical pulses to the brain to reduce seizures
  • Responsive neurostimulation (RNS): A device that monitors brain activity and delivers targeted stimulation to prevent seizures

Adjunctive therapy & alternative treatments

Adjunctive therapies can be used in combination with conventional treatments to enhance seizure control:

  • Physical therapy: Improving motor function and reducing spasticity in cases like cerebral palsy
  • Behavioral therapy: Addressing emotional and cognitive challenges associated with seizure disorders
  • Complementary approaches: Mindfulness, yoga, and acupuncture may help reduce seizure triggers like stress and anxiety

Cannabis for seizure disorders

Medical cannabis has emerged as a promising adjunctive therapy for managing seizures. The two primary compounds in cannabis—cannabidiol (CBD) and tetrahydrocannabinol (THC)—interact with the endocannabinoid system (ECS), which regulates brain activity and neural balance.

  • CBD: Known for its anticonvulsant properties, CBD has been shown to reduce seizure frequency, particularly in conditions like Dravet syndrome and Lennox-Gastaut syndrome. The FDA-approved drug Epidiolex is a CBD-based medication for these types of epilepsies. CBD may also reduce the need for benzodiazepines (sedatives), which are often prescribed for seizures.
  • THC: While psychoactive, THC may also provide anticonvulsant effects in carefully dosed formulations. However, THC may induce seizures in some, so doses must be kept extremely low (less than 2 mg daily). THCA – the acidic precursor to THC that does not cause psychoactive effects – has anti-inflammatory and potential anticonvulsant properties that enhance the efficacy of CBD.
  • Mechanisms of action: CBD modulates GABAergic transmission, reduces neuroinflammation, and regulates neuronal excitability
  • Terpenes:Myrcene, linalool, and beta-caryophyllene have anticonvulsant, anti-inflammatory, and anti-anxiety (anxiolytic) properties that can help manage seizures and their side effects
  • Flavonoids:Flavonoids in cannabis, like quercetin, have displayed antiseizure and antioxidant properties that can help reduce inflammation and seizure frequency

cannabis tinctures

Additional information for patients

Patients and caregivers considering medical cannabis for seizure disorders should:

  • Consult healthcare providers: Medical supervision is essential to avoid interactions with antiepileptic drugs (AEDs)
  • Understand delivery methods: Options include oils, tinctures, capsules, and sublingual sprays. Sublingual administration is often preferred for its rapid onset.
  • Monitor side effects: CBD is generally well-tolerated, but THC may cause psychoactive effects and increase the likelihood of seizures, especially in children
  • Follow local laws: Medical cannabis regulations vary by region, impacting access and treatment options

Seizures FAQs

Can medical cannabis stop seizures completely?

While medical cannabis, particularly CBD, can reduce seizure frequency and severity for many individuals, it does not guarantee complete seizure control. Results vary based on the individual and the underlying cause.

Is CBD safe for children with seizure disorders?

CBD has been shown to be generally safe for pediatric patients, particularly when used under medical supervision. The FDA-approved Epidiolex is specifically indicated for children with severe forms of epilepsy.

What are the side effects of medical cannabis for seizures?

Common side effects include fatigue, changes in appetite, diarrhea, and, in the case of THC, psychoactive effects like dizziness or euphoria.

How long does it take for CBD to reduce seizures?

The onset of effects varies, but patients may notice improvements within a few weeks of consistent use.

Can cannabis interact with antiepileptic drugs (AEDs)?

Yes, medical cannabis can interact with AEDs, potentially altering their effectiveness. Patients should work closely with their healthcare providers to monitor for side effects or adjustments in dosage.

Are there alternatives to medical cannabis for treating seizures?

Yes, treatments like antiepileptic drugs, ketogenic diets, and surgical options remain the standard therapies. Medical cannabis is typically used as an adjunctive therapy when first-line treatments are insufficient.

Is medical cannabis legal for seizure treatment?

Legality varies by country and state. Patients should check local laws to determine access and eligibility for medical cannabis treatments.

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