PART II: Cannabis for Pediatric Epilepsy

March 18, 2017

Izaiah is a young patient of Dr. Goldstein.

I have found excellent results using CBD-rich medicine for children who have intractable epilepsy. Most of these patients have tried numerous antiepileptic medications without success and have the devastating consequences of ongoing seizures. The burden of this difficult disorder and subsequent negative impact on quality of life has triggered a parent-led movement advocating use of CBD-rich cannabis.

Scientists have responded with a focus on research into how the endocannabinoid system may be a target of treatment for these patients. There is scientific evidence that people with epilepsy may have an endocannabinoid deficiency, leading to overexcitation of the flow of neurotransmitters in the brain, which leads to abnormal firing of the brain cells. Evidence also points to significant neuroinflammation in the seizuring brain. The way that CBD works to reduce and stop seizures is being researched and so far, this is what we know: CBD enhances the brain’s own endocannabinoid levels, enhancing the endocannabinoid system; CBD modulates the flow of calcium and potassium in neurons, thereby stabilizing these cells, and CBD works as an antiinflammatory, blocking formation of pro-inflammatory compounds and reducing toxic substances, resulting in a brain that is less inflamed. As you can see, CBD, with its multiple mechanisms of action, acts at multiple targets in the brain. This is why we think it works well for epilepsy. Since CBD does not activate the cannabinoid receptor the way THC does, it does not cause tolerance, and as it is not psychoactive, it is an ideal compound for pediatric patients.

Izaiah about 6-7 months after starting cannabis oil treatments.

A number of surveys of parents who are using CBD-rich cannabis oil to treat intractable epilepsy in their children report that over 75% have seen a reduction of seizures with little to no side effects, and approximately 15% report seizure freedom. In my practice, approximately 75% of patients had a 25% or greater reduction of seizures after three months of treatment. Approximately 38% of patients had greater than 75% reduction of seizures and 12% became seizure-free. Ten percent of patients discontinued use due to no effect. Approximately 16% did not see seizure reduction but saw reduced severity or duration of seizures. Beneficial side effects reported by parents included better sleep, more alertness, better mood, better appetite, improved focus and memory, more energy for therapy and play, and less emergency room visits and hospitalizations. One particular little boy came to my office on four seizure medications still having frequent seizures and experiencing many negative side effects. He was one of five children, and his mother said that life was terribly difficult because of his illness. She told me that all she wanted was to be able to take her kids to the park, which was something they hadn’t been able to do since his seizures had become so frequent. After two months on cannabis oil, I received a text message from his mother asking “Guess where we are? At the park!” This boy has been on oil for over two years with significant seizure reduction and a life-changing improvement in his (and his family’s) quality of life.

In most cases, the oil is administered under the tongue, swallowed by mouth, or given through a gastrostomy tube. I insist that my patients use laboratory tested solvent- and pesticide-free cannabis oil. Adjustments in dosing and the CBD:THC ratio are often required after periods of observation, and sometimes different strains of CBD-rich cannabis must be tried before seeing a clinical response.

“Cannabis for Pediatric Epilepsy” is the second installment of a five-part series on Children and Cannabis Medicine.

Part 1: Cannabis Medicine in Practice

Part 2: Cannabis for Pediatric Epilepsy

Part 3: Cannabis for Pediatric Autism

Part 4: Cannabis for Pediatric Cancer

References:

Hampson AJ, Grimaldi M, Axelrod J, and Wink D (1998) Cannabidiol and (-)delta9-tetrahydrocannabinol are neuroprotective antioxidants. Proc Natl Acad Sci USA 95: 8268-8273 (CBD reduces glutamate and has antioxidant effects)

Vezzani A. Inflammation and epilepsy. Epilepsy Curr. 2005 Jan-Feb;5(1):1-6.

Lozovaya N, Min R, Tsintsadze V, Burnashev N. Dual modulation of CNS voltage-gated calcium channels by cannabinoids: Focus on CB1 receptor-independent effects. Cell Calcium. 2009 Sep;46(3):154-62

Izzo AA, Borrelli F, Capasso R, Di Marzo V, Mechoulam R. Non-psychotropic plant cannabinoids: new therapeutic opportunities from an ancient herb. Trends Pharmacol Sci. 2009 Oct;30(10):515-27.

De Petrocellis L, Ligresti A, Moriello AS, Allarà M, Bisogno T, Petrosino S, Stott CG, Di Marzo V. Effects of cannabinoids and cannabinoid-enriched Cannabis extracts on TRP channels and endocannabinoid metabolic enzymes. Br J Pharmacol. 2011 Aug;163(7):1479-94.

Mechoulam R. Plant cannabinoids: a neglected pharmacological treasure trove. Br J Pharmacol. 2005 December; 146(7): 913–915.

Originally published on Marijuana.com