How CBD Helps With Seizures
CBD has been gaining interest as a potential treatment for the medical condition.
In a 2014 study published in Epilepsy and Behavior, CBD reduced the frequency of seizures among patients dealing with treatment-resistant epilepsy(1).
Treatment-resistant epilepsy is associated with a low quality of life (QOL)(2). It was suggested that CBD may improve patients’ QOL through effective seizure control(3).
Seizures are bursts of uncontrolled electrical activity between neurons (brain cells) that cause temporary abnormalities in movements, behaviors, consciousness, or sensations. Meanwhile, epilepsy occurs when an individual has recurring seizures(4).
The two types of seizures are focal and generalized seizures. Focal or partial seizures start with an electrical discharge in one area of the brain, while generalized seizures can spread to both sides of the brain(5).
The ECS regulates various functions in the body, including immune response, pain sensation, mood, memory processing, metabolism, appetite, anxiety, and sleep.
CB1 and CB2 are the two main types of receptors of the ECS. Each receptor has specific roles and is located in different parts of the body.
CB1 receptors are prevalently expressed in the central nervous system, including the brain. These receptors are also found in the liver, lungs, retina, gastrointestinal and urinary tracts, and reproductive organs(6).
CB1 receptors’ activation in the body has been linked to neuroprotective responses(7).
This mechanism suggests that cannabinoids with a high affinity for CB1 receptors, like CBD, may help prevent and treat neurodegenerative conditions(8).
Cannabinoids are naturally occurring compounds that may come from the cannabis plant.
Meanwhile, CB2 receptors are mainly situated on the immune system’s cells and their associated structures. When activated, these receptors stimulate a response that reduces pain, fights inflammation, and minimizes tissue damage.
The blocking of GPR55 receptors and the reabsorption of adenosine in the brain have been suggested to play a vital role in CBD’s anti-seizure activity(10).
Adenosine is a neurotransmitter that may stop seizures and convulsions(11). A 2017 study in the Neuropharmacology journal noted that the therapeutic increase of adenosine prevents epileptic seizures(12).
GPR55 (G protein-coupled receptor) is a type of protein found in the brain. A study found that the function of GPR55 receptors was enhanced by epilepsy that made seizures worse(13).
However, CBD remained adequately potent in epileptic brains, which suggests the anticonvulsant properties of CBD. These anticonvulsant characteristics may be related in part to CBD-mediated modulation of the ECS(14).
The modulation is done through inhibiting anandamide degradation or decline, resulting in reduced excess brain activity(15).
Anandamide is an endocannabinoid (cannabinoids produced within the body) that acts as a neurotransmitter and regulates emotional behavior.
Research noted that endocannabinoids are released by bursts of action potentials, such as seizures or events resembling spikes(16).
Benefits of Using CBD for Seizures
Studies indicated CBD’s antiepileptic efficacy in acute and chronic seizure rodent models. However, the exact mechanisms of action remain unclear(17).
In various animal studies, pure CBD used on partial and generalized epilepsy models showed anticonvulsant effects(18). These studies were conducted on mice, rats, and gerbils.
Meanwhile, open-label studies and small randomized controlled trials of purified CBD in humans with treatment-resistant epilepsy demonstrated mixed results(19).
A study in the New England Journal of Medicine indicated that CBD use resulted in a significant reduction in convulsive-seizure frequency than placebo among people with Dravet syndrome(20).
Dravet syndrome is one of the types of epilepsy syndromes that begins in infancy or early childhood. This condition is characterized by frequent or prolonged seizures(21).
Many of these clinical trials used a product that combines a one-to-one ratio of CBD and tetrahydrocannabinol (THC), a compound with known psychoactive effects.
The results of the 2017 study were promising. On average, CBD decreased convulsive seizures from nearly 13 seizures to about six seizures per month(22).
Meanwhile, the average change with the placebo was from 15 to about 14 seizures per month. A minority of about 5% of patients became seizure-free.
In another randomized, double-blind, placebo-controlled trial in 2018, researchers investigated CBD’s efficacy on the treatment-resistant Lennox-Gastaut syndrome (LGS).
Findings stated that CBD proved efficacious in treating patients (aged 2 to 55 years old) with drop seizures associated with LGS(23).
Drop seizures, also known as atonic seizures or drop attacks, are characterized by a sudden loss of muscle strength. This type of seizure causes an individual to fall to the ground(24).
In a 2018 study, the high-dose CBD group experienced an average reduction in the drop-seizure frequency of nearly 42% during the treatment period.
Meanwhile, the low-dose CBD group experienced about 37% reduction while only 17% in the placebo group reported drop seizure reduction.
The researchers also suggested that CBD is generally well-tolerated. However, 74 out of 86 patients reported adverse effects, such as drowsiness, fever, decreased appetite, diarrhea, and vomiting.
The studies on CBD as an additional anticonvulsant in patients with LGS and Dravet syndrome contributed to the decision regarding Epidiolex’s approval.
Epidiolex is a pharmaceutical-grade purified CBD approved by the US Food and Drug Administration (FDA) as an evidence-based remedy for treatment-resistant epileptic syndromes(25).
CBD Dosage and Delivery Methods for Seizures
CBD dosage for seizures may depend on several factors, such as the patient’s age, seizure type, cause of seizure or epilepsy, and other medications currently taken(27).
You may start with small amounts of CBD at first, then gradually increase the dosing if there are no adverse effects. Get medical advice from your physician to determine the right CBD dosage for seizures.
Meanwhile, the recommended Epidiolex dosages for seizures associated with Dravet or Lennox-Gastaut syndrome are the following(29):
- Starting dosage: 2.5mg CBD per kilogram of the body weight by mouth twice daily
- Maintenance dosage: 5mg CBD per kilogram of the body weight by mouth twice daily
- Maximum maintenance dosage: 10mg CBD per kilogram of the body weight by mouth twice daily
Methods of Delivery
Oral administration is recommended for people with seizures, especially those with Dravet and Lennox-Gastaut syndrome. Epidiolex is an oral solution that involves placing the liquid in the mouth(30).
According to a review published in the International Journal of Pharmacy and Pharmaceutical Sciences, most substances administered sublingually achieve peak blood levels (the drug’s highest level of concentration in the bloodstream) within 10 to 15 minutes, which is faster than oral ingestion(31).
Additionally, the sublingual method is an efficient way to take CBD oil. Studies report that the sublingual form has a bioavailability of 13% to 19% and 35%(32).
Bioavailability is known as the rate and degree at which the body absorbs a drug.
CBD-infused topicals may also be used in massage therapies. However, this method provides limited absorption through the skin(33).
The Epilepsy Society in the United Kingdom stated that complementary therapies, like massages and herbal remedies, may reduce stress, promote well–being, and be used with any antiepileptic drugs taken by an individual(34).
The use of vape should be done with caution, especially for patients with seizures. Experts believe that vaping may cause lung problems due to allergic or immune reactions and chemical irritation to various substances in the inhaled vapors(37).
CBD vs. Other Treatment Options for Seizures
Prescribed medications and surgical techniques may control seizures in 70% of individuals with epilepsy–seizure disorders. However, there is no available treatment of seizures in some forms of epilepsy(38).
These self-management strategies may help epilepsy patients control their seizures better and improve their overall health(39):
- Getting seven to eight hours of sleep.
- Keeping a well-balanced diet and maintaining a healthy weight.
- Finding outlets to relieve stress and seeking professional help for mental health issues.
Multiple studies highlighted CBD’s potential therapeutic properties that may help with these self-management techniques for seizures.
A 2017 study noted that CBD may induce restful sleep and hold promise in the treatment of insomnia(40).
Full-spectrum CBD derived from hemp contains omega-3 fatty acids. A study observed that administering supplements with omega-3 and omega-6 fatty acids resulted in reduced seizures in patients with refractory epilepsy(41).
Another study indicated that CBD had anti-anxiety and antiepileptic effects on the brain that may help with anxiety and depression(42).
Risks and Side Effects of CBD for Seizures
The World Health Organization (WHO) indicated that CBD is generally safe to use(43). However, the possible side effects of CBD may include nausea, dry mouth, fatigue, diarrhea, changes in weight or appetite, and gastrointestinal problems(44).
The FDA-approved CBD drug for epilepsy, Epidiolex, may also come with mild or severe side effects. Some of the adverse reactions to Epidiolex include malaise (feeling of weakness), skin rash, insomnia, and viral or fungal infections(45).
In clinical studies, liver damage occurred in people who took Epidiolex. It was noted that between 8% and 25% of people had high levels of liver enzymes(46).
Studies also showed that CBD may interact with certain seizure medications, including clobazam (Sympazan and Onfi), diazepam (Diastat and Valium), valproate or valproic acid, and phenytoin (Dilantin and Phenytek)(47).
Data suggested that CBD may reduce the effects of the said medications and increase some side effects(48).
How to Choose the Best CBD Oil for Seizures
Full-spectrum CBD contains all nutrients from the Cannabis sativa plant, including trace amounts of THC, terpenes, fatty acids, flavonoids, and essential oils. The combination of these compounds synergizes to create an entourage effect.
This phenomenon occurs when all components work together to achieve more than the sum of what the same components could achieve individually(49). The entourage effect is believed to enhance CBD’s health benefits(50).
You should also know the differences between hempseed oil and hemp oil. Hempseed oil is obtained from hemp seeds and may have little to no THC content, while hemp oil is extracted from the oil of the hemp plant.
The following factors may help you find high-quality, reliable, and safe CBD products:
- Choose quality products made from non-GMO, organic hemp, and manufactured by legitimate CBD brands.
- Some CBD companies grow their hemp or source it from licensed hemp producers. The most common sources of hemp are Colorado and Oregon.
- Know the method of extraction used in the CBD product. According to a study, the FDA recognizes supercritical CO2 extraction as a safe process in pharmaceutical manufacturing(51).
- The standard carrier oils used in CBD oil include hemp seed oil, MCT (medium-chain triglycerides), and extra-virgin olive oil.
- CBD oil products should be tested by an accredited third-party laboratory. Companies should provide the results on their website to ensure the absence of pesticides, heavy metals, bacteria, and residual solvents.
- See if the third-party lab results match the CBD company’s claims about the potency of its products.
- You may also look for certification codes in CBD products. These codes determine if the product is screened and approved by the authorities.
- Get advice from a healthcare professional regarding the proper dosage and recommended form of CBD to use for your condition.
- Research on the brand and read customer reviews when buying from an online store.
- If you are buying from a dispensary or local retailer, make sure that the store is authorized by the government to sell CBD products.
- Know the laws regarding CBD in the state where you will purchase and use it.
Legality of CBD
Industrial hemp is removed as a Schedule I drug from the Controlled Substances Act. Drugs under this category have no acceptable medical use and have a high potential for abuse(53).
The Farm Bill of 2018 also lifted federal restrictions surrounding CBD to allow the cultivation, manufacture, and sale of CBD products. However, state laws may vary regarding CBD with high THC content(54).
Individuals are required to follow the requirements outlined in a state’s medical marijuana program.
Qualifying patients may purchase and use medical cannabis if they have an official diagnosis and recommendation from their physician(55).