Cannabis for Epilepsy: CBD as an alternative anti-epileptic?

For a long time, cannabis was only considered an intoxicant. In recent years, however, it has been shown that cannabis, in the right combination and dosage, can also be used to alleviate illnesses or side effects.

The topic of cannabis in epilepsy is also taken up here. What is particularly interesting for doctors is the possibility of limiting the frequency of seizures caused by cannabis in epilepsy.

If you would like to find out more about these options, CBDonline.hk has created a comprehensive guide about CBD and Epilepsy in the following article to help you learn more.

The essentials in brief

• Since 2017, it has been possible in Hong Kong to use medical cannabis for the treatment of various diseases. However, it can only be used if other therapies do not work or do not achieve the desired effect.
• A US study has shown that the cannabis derivative cannabidiol was able to reduce the number of epileptic seizures in some study participants. However, the study was conducted without a comparison group using placebo drugs.
• It should be noted that studies and tests also show side effects that can occur when treating epilepsy with cannabis. Above all, increased sleepiness and loss of appetite were named here.

Definition: what is medical cannabis?

There are differences in cannabis. It is therefore clearly stated that the flowers can only be used in epilepsy if it is medicinal cannabis.

The medicinal cannabis flowers are issued by prescription. The cannabis flowers have a different nominal CBD and THC content. Medical cannabis contains different nominal contents of the named active substances.

The THC content starts at 1% and can reach up to 22%, depending on the flowers. The CBD content starts at 0.05% and can go up to 10%.

In order to better understand where the difference lies between THC and CBD, there is the following overview:

THC	CBD
Also often referred to simply as cannabis	Known as “cannabidiol”
Connection to CB1 receptors	Connection to CB1 and CB2 receptors
Influences perception	Does not affect the perception
Triggering of depression possible	Mood-enhancing effect, does not reduce intoxication caused by THC
Can reduce the ability to concentrate	Can have a relaxing effect on the body
medical cannabis	medical cannabis

What is the legal situation in Hong Kong?

On March 1, 2017, there was a “change in narcotics law and other regulations”, which also related to medical cannabis, among other things.

Since then, it has been available for prescription and, if the doctor sees a basis, can be used for various diseases.

Cannabis extracts and cannabis flowers can be prescribed. The prescription is based on a narcotic drug prescription.

So far, there are no special qualifications that the doctor who issues the prescription must have. Before the law was changed, there was a procedure that patients had to go through.

In this procedure, it was necessary to apply for a so-called exception permit through the Federal Opium Agency of the Federal Institute for Drugs and Medical Devices.

This made it possible to acquire standardized cannabis extract preparations and use them in self-therapy.

The law does not provide clear indications

You may find it interesting to know that there are no clear indications in the law as to the indications for which medicinal cannabis can be prescribed.

A prescription is therefore possible for various indications. In principle, it is necessary for the doctor to provide information on why further therapies cannot be used.

In order to be able to have the costs covered by the health insurance company, it is particularly important to be able to prove that other therapies have already been tried for epilepsy, but have not been able to achieve the desired success.

But even if therapies are still open that have not yet been used, reimbursement of costs may be possible in rare cases.

Background: What you should know about cannabis for epilepsy

Is there any experience with CBD in epilepsy?

There has been some experience of using CBD for epilepsy. Studies have shown that the active ingredient can primarily reduce seizures.

For this, studies were carried out with animals and also with affected people.

An anticonvulsant effect was shown in these tests. “Convulsive” is used when it comes to a convulsive attack.

When a drug has an anticonvulsant effect, it combats the seizures. These studies also found that taking cannabis could reduce the potential for damage to the brain during a seizure.

Animal experiments have also shown that cannabinoids can be able to reduce and end seizures much more quickly.

This is attributed to the ability of the active ingredient to restore the overactive synapses to normal.

Are there any studies on cannabis in epilepsy?

There are now some studies looking into the effects of cannabis on epilepsy. For example, a meta-analysis was carried out by Brazilian researchers.

This refers to several clinical studies that focused on refractory epilepsy as the basis for treatment with CBD.

The analysis was carried out with a test. Patients were given a dose ranging from 1 to 50 g/kg of cannabis, depending on the severity of their illness. The duration of treatment ranged from three months to 12 months.

Patients have reported an improvement in the number of seizures in two-thirds.

A study was also carried out in Canada. Here it was found that the anticonvulsant properties can be attributed to both THC and CBD.

There was also the recommendation that cannabis oils can be used for seizures that show resistance to drugs.

The evaluation made it clear that a reduction in the number of seizures could be recorded.

What interactions and side effects are there?

In the context of research on cannabis in epilepsy, the question of possible side effects or interactions with other drugs is interesting.

There are initial research results from the University of Alabama. The researchers found that the side effects are manageable and that cannabis is quite well tolerated.

Diarrhea and an increased need for sleep are particularly common. Interactions with clobazam have also been noted.

There were also interactions with topiramate and rufinamide. If you are taking any of the medications, you should speak to your doctor about possible interactions.

What to do with epilepsy: Use cannabis for seizure disorders

Which strain of cannabis for epilepsy?

For the treatment of epilepsy, it is recommended to take medication that contains a proportion of THC and CBD.

Again and again, recommendations are made that refer to using only CBD products. Basically, it is important to speak to your doctor about therapy.

He can estimate which drugs can be used in which dosage. The advice to use cannabis oil against epilepsy occurs again and again.

In principle, it is possible to administer medical cannabis in different ways.

If you prefer to take oil, you can talk to your doctor about the possibilities he sees in this context. Ingestion in the form of a spray is also widespread.

How does cannabis therapy work for epilepsy?

How cannabis therapy is used for epilepsy depends, among other things, on the form of the disease. The effect of reducing seizures is particularly well known.

Cannabis cannot cure the disease. However, it may be able to significantly reduce the amount of seizures. Here, however, it depends on which active ingredients are included.

Above all, CBD is said to be very effective. Due to the specific compound, it does not have a psychoactive effect and therefore has fewer side effects than THC.

It is mainly used as an anticonvulsant. THC is said to have a potentiating effect on epilepsy drugs.

The treatment of epilepsy with cannabis is rarely used as the sole therapy. However, it may be possible that complementary therapy can be used for your treatment.

Research has shown that cannabinoids may be able to increase the effects of some drugs used for epilepsy. These include, for example:

• Diazepam
• Carbamazepine
• Topiramate
• Gabapentin
• Valproic acid

Can side effects occur?

Before taking cannabis for epilepsy, it must first be checked how the benefits and side effects interact.

Studies have shown that 94% of participants who received a high dose were likely to experience side effects. In participants with a lower dose, 84% of participants were affected.

However, participants who received a placebo also showed side effects. At least 72% of the participants were affected here. The likelihood of side effects occurring is therefore relatively high.

On the other hand, the side effects themselves are considered manageable. Above all, there is an increased loss of appetite and an increased need for sleep.

Nevertheless, the side effects can limit patients and limit their daily routine. Therefore, an extensive educational discussion is particularly important here.

Is there a cannabis prescription for epilepsy?

If cannabis is to be used in epilepsy, the question naturally arises whether you need a prescription for it.

The information on the legal situation in Hong Kong mentioned above is one of the most important foundations for this. You can only use cannabis for epilepsy if you can get a prescription.

The use of cannabis in epilepsy has been possible in Hong Kong since 2017. Medicines with the active ingredient could also be used beforehand.

For this it is necessary that you contact your doctor. He can prescribe you medicinal cannabis. For this, however, it is necessary that the doctor knows your previous therapeutic path.

The health insurance company only covers the costs if there is a very clear indication that the doctor must determine.

It is also important that the therapy is tailored to your form of the disease. Therefore, if you want to use cannabis to treat epilepsy, you should consult your doctor.

Do joints also help against epilepsy?

How cannabis is absorbed is basically irrelevant at first. Depending on the amount of medicinal cannabis, it can in principle also be smoked. However, there are several problems here:

• Dosing is difficult.
• There is no telling how well your body is absorbing the cannabis.
• Consumption over a joint is legally prohibited in Hong Kong.

The doctor does not prescribe the medical cannabis for you to smoke. The therapy is based on ingestion in the form of tablets, powder or oil.

This is related to the form of therapy. If you get yourself cannabis to reduce the signs of epilepsy, you are violating the Narcotics Act.

The risk of incorrect dosing should also not be underestimated. There are reports that patients with epilepsy have shown an increased risk of seizures after using a joint.

Can children take cannabis with epilepsy?

Epilepsy can also affect children. Depending on the severity and frequency of the seizures, treatment with cannabis may be considered.

The seizures in epilepsy can damage the brain. The use of medicinal hemp can both reduce the frequency of seizures and protect the brain from damage.

The use of cannabis in epilepsy in children and adolescents is not prohibited but is viewed with caution.

This is related because the impact of cannabis on brain development in children and adolescents can have a negative impact.

In the United States, for example, cannabis is used in Colorado and many other states to treat children and adolescents.

A check of the medical records shows that the seizures could be reduced by around 50% in every fourth patient.

Treatment with CBD has shown good results here. CBD is the active ingredient from cannabis that does not induce intoxication. Its use in children can therefore be justifiable.

Conclusion

The use of cannabis for epilepsy has been a form of therapy that can be used for several years. The legal regulations with regard to the allocation of prescriptions for medical cannabis were changed in 2017.

Still, it is not that easy to get a prescription. Therapy with cannabis can usually only be started if other therapies do not work.

Cannabis cannot cure epilepsy; as current studies show. Still, it may be able to reduce the number of seizures and minimize or prevent lasting damage to the brain.

If you would like to take advantage of therapy, you can contact your doctor directly.