CBD and epilepsy: a real alternative to antiepileptics?

Particularly prevalent in children, but sometimes persisting into adulthood only to worsen again with age, epilepsy affects more than 50 million people worldwide. In France, 5% of the population is or will one day be affected by epilepsy, which brings the number of French epileptics to around 600 people, half of whom are under the age of 20.

The problem ? Current treatments are powerless against many forms of epilepsy, and when they work, their side effects can prove heavy. CBD then represents an interesting avenue of treatment., which has already proven itself.

CBD and epilepsy: yes, it can work!

We will come back in detail in a moment to what epilepsy is, the limits of current treatments and the opportunities offered by CBD. However, it is important not to keep the suspense any longer on the interest of CBD in the context of this disease.

1. Epilepsy is one of the few diseases for which there are already recognized treatments cannabis-based (with the multiple sclerosis and neuropathic pain).
2. Epidiolex, a CBD oral solution, received a favorable opinion on reimbursement by the High Authority of Health (HAS).
3. This CBD drug can legally be used in France in the treatment of epileptic seizures related to Lennox-Gastaut syndrome or Dravet syndrome, in patients two years of age and older.

Now that we have established the interest of looking at CBD in the context of epilepsy, let's dig into the subject in depth!

Epilepsy: nearly 50 different syndromes

During an epileptic seizure, the electrical activity of the brain panics, in some cases leading to convulsions and loss of consciousness.

Epilepsy is a chronic disease which results in more or less frequent seizures. There are different types of epileptic seizures:

• Partial seizures, which affects only one area of ​​the brain and results in different symptoms depending on the part of the brain involved (motor or behavioral disorders for example).
• Generalized crises, which affect the entire brain. In the best case, there is an absence with loss of consciousness for a few seconds to a few minutes. It is a common form in children. During more serious seizures, called tonic-clonic seizures, the patient suffers from convulsions, muscle contraction et usually totally loses consciousness.

Known for a long time (we find traces of it since the Middle Ages), epilepsy is still a poorly understood disease. It must be said that there are nearly 50 epileptic syndromes, that seizures come in various forms and that the factors involved are numerous (genetics, brain damage, infectious disease, malformation, head trauma, alcoholism, among others).

So much so that, although treatments exist, they are sometimes insufficient.

Effective treatments ... but not for everyone

For at least a quarter of epileptics, existing treatments are not effective

There are treatments for epilepsy. However, they have limitations and are not suitable for all patients. Thereby, for 25 to 30% of patients, anti-epileptic drugs are not effective enough to reduce or stop seizures. We then speak ofrefractory epilepsy, which requires a real need to develop alternative therapeutic solutions.

For the 70 to 75% of epileptic patients in whom antiepileptics work, all is not rosy either. So even for them there is no therapeutic approach capable of completely curing them. Treatments are in fact limited in the best of cases to suppressing seizures, if not to reducing or attenuating them. Not to mention that they can induce side effects.

Many side effects

There are very many antiepileptics, belonging to different families of drugs and more or less adapted according to the type of epilepsy and / or the profile of the patient. In some cases, however, they are accompanied by sometimes serious side effects. Notably :

• Drug interactions, particularly with contraceptives which may lose effectiveness on contact,
• Weight gain,
• Tired,
• Mood swings,
• Loss of attention,
• Disruption of the sleep cycle,
• Difficulty breathing,
• Rashes,
• Birth defects during the pregnancy.

Even though new antiepileptics frequently come onto the market and reduce the side effects incurred, finding more effective alternatives remains a priority.

CBD as a new avenue of treatment

Thanks to its action on the endocannabinoid system (SEC, or ECS in English), CBD is a potential treatment against epilepsy

We now know it well: cannabidiol acts on the human body by activating the receptors of our endocannabinoid system, itself having a direct influence on our nervous and immune systems. It is mainly thanks to this that it has soothing, anxiolytic, anti-inflammatory effects or helps to regulate our sleep cycle. So many properties that have led scientists to study its action in patients with epilepsy.

The results, extracted from several studies, were conclusive to say the least:

• 43% of epilepsy patients taking CBD experienced halving their seizures (27% on placebo).
• 42% reduction in atonic seizures (vs. 17% on placebo).
• CBD also works on epilepsy in children.
• A dose of 20 milligrams of CBD per kilo per day increases the chances of success.

In return, side effects of CBD mild to moderate (mainly diarrhea and drowsiness) were noted in around a quarter of patients, apparently related to high doses of cannabidiol concerned.

In addition to CBD, a first encouraging study [in English] also evokes the interest of cannabidivarin, or CBDV, another non-psychoactive cannabinoid (without high or addictive effect) which shows conclusive effects in the treatment of epilepsy in rats.

Authorities in favor of cannabinoid-based treatment for epilepsy

For once, the case of CBD and epilepsy is, with the multiple sclerosis, without a doubt the exception that proves the rule. France, a stronghold against cannabis derivatives in Europe, has allowed prescription since December 2018 and from the age of two years.Epidiolex, a drug containing CBD marketed by the same pharmaceutical group that already produces Sativex (GW Pharmaceuticals). Its main asset? To succeed in reducing the severe and too often refractory infantile epileptic seizures associated with Dravet syndrome and Lennox-Gastaut syndrome.

The first large-scale clinical trials (3000 patients) carried out in France by 2023 also plan to focus more specifically on theuse of medical cannabis in epilepsy. If the treatments exist, they are in fact not yet actually used. The near future should therefore, if the results are conclusive, allow a better use of CBD in the context of epilepsy.

Cannabidiol and epilepsy: beware of self-medication

Thus, CBD represents a therapeutic progress real for patients who suffer from seizure disorders and do not respond positively to conventional treatments. The proof with the authorization of Epidyolex in France, despite the obvious reluctance of successive governments in the face of cannabis derivatives. However, cannabis treatments are used by experienced medical teams, who know how to dose it precisely, in specific situations and for patients with special needs. Recognizing the effectiveness of CBD should therefore not be taken as an incentive to consume it for all epileptics.

CBD oil can certainly contribute to decrease the intensity and/or frequency of seizures. If you suffer from epilepsy, it is still essential to talk to your doctor about your willingness to take cannabidiol. Not only will he be able to advise you on the potential interest of the cannabinoid in your particular case, but he will also be able to help you determine the dose and frequency of intake most appropriate to your situation.

Last element to take into account, cannabinoids can influence the effects of other treatments (especially the action of antidepressant drugs, but not only). Again, consulting a specialist is the best way to avoid Drugs interactions.

The specialists of the modern cannabis market undoubtedly have a role to play for a better overall understanding of cannabis and its opportunities. It is therefore important to move forward together, in collaboration with the medical sphere.

To conclude: what you can really expect from CBD to treat epilepsy

• Primarily for patients suffering from Dravet syndrome or Lennox-Gastaut syndrome.
• In priority for those and those for whom the drug treatments do not work or not well.
• Up to 50% reduction in seizures in patients taking CBD (comparable to the results of most AEDs on the market today).
• Mild to moderate side effects in about a quarter of patients (diarrhea, drowsiness, loss of appetite).
• In combination with certain treatments, risk of drug interactions (increased or altered effects of drug treatment).