Epilepsy can be a frustrating and debilitating disorder, although research is coming out that suggests it could be treatable with medicinal cannabis.

Epilepsy is the fourth-most common neurological disorder in the world, affecting people of all ages - and as many as 250,000 Australians. However, epilepsy is also very treatable with the right combination of medication and changes to one’s lifestyle. Preliminary research suggests medicinal cannabis may also be a solution for some individuals.
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What is Epilepsy?

Epilepsy is a neurological disorder that can cause recurrent seizures. These seizures are actually the result of a sudden uncontrolled rush of electrical or chemical activity in the brain, causing a variety of symptoms such as muscle spasms and loss of consciousness.

However, just because a person experiences these fits does not mean that they are epileptic. Indeed, seizures are, relatively speaking, quite common, and most people will experience one at some point in their lives – whether due to injury, illness, or some other factor. 

These seizures become known as epilepsy when they keep occurring, yearly, weekly, perhaps even daily. A person may only experience them very infrequently, but if their doctor believes they are at risk of experiencing them repeatedly, that is when they may be diagnosed with epilepsy. 

Why does epilepsy occur?

There are many causes of epilepsy, and about half of all individuals who are diagnosed with the disorder will not find out why it has occurred in them.

Based on current medical science, we believe genetics plays a strong role in the onset of epilepsy; a person may simply be born with changes in their DNA that direct brain cell function. It could be an inherited trait from a parent, it could be the result of a mix of inherited traits that combine to cause epilepsy, or it could seem random. We still have a lot to learn about the origins of the disorder.  

Injuries and serious illness can also play a role. Stroke, head trauma, tumours or cysts in the brain and certain infectious diseases (i.e. meningitis) have been known to cause epilepsy. Seizures have also been linked to other conditions, such as Alzheimer’s, autism spectrum disorder and cerebral palsy. 

MRI Brain Scan of head and skull with hand pointing

Types of seizures

Seizures can be classified into two groups, based on a few key factors: the origin point of the brain seizure, the patient’s awareness during said seizure (i.e. are they conscious, aware), and the amount they move during the fit.

General seizure: In a general seizure, the epileptic fit affects cells in both the left and right hemispheres of the brain at once. During this type of episode, the patient may experience muscle twitching and loss of consciousness. General seizures can be broken down into further categories: 

  1. Absence: A sudden loss of awareness, which may look like a person is staring into space or blanking out. The patient’s eyelids may flutter, and the seizure lasts around 10 seconds or less. 
  2. Tonic: A sudden stiffening or tension in the muscles, lasting maybe 20 seconds, typically beginning with a fast, forceful jerk. 
  3. Atonic: The opposite of tonic, where a person’s muscles go limp. Atonic seizures may be called ‘drop seizures’ or ‘drop attacks’, and last around 15 seconds. 
  4. ClonicFits of jerking and twitching that may only last a few seconds, most commonly diagnosed in babies. 
  5. Tonic-clonicA combination of tonic and clonic, previously known as a ‘grand mal’ seizure. The person experiences tonic stiffening and may lose consciousness, falling to the floor. Then they enter a period of clonic jerking for a few minutes. 

 

Focal seizures: Focal seizures start in one part of the brain, impacting function in that specific area. Previously known as partial seizures, focal seizures are generally classified based on a person’s awareness levels, and can cause loss of consciousness. 

Simple focal seizures (aka focal onset aware seizure) can cause changes to sensations such as touch, smell and taste, as well as muscle jerking and other, milder symptoms. A complex partial seizure (aka focal onset impaired awareness) can cause more severe symptoms, such as loss of consciousness, muscle spasms, unresponsiveness and staring blankly. Focal seizures may also spread to the other half of the brain, causing a greater degree of stiffening and twitching, and would at that point become known as a focal to bilateral tonic-clonic seizure. 

Common seizure triggers

  • Bright, flashing lights, strobing, patterns 
  • Stress and anxiety 
  • Lack of sleep 
  • Illness 
  • Low blood sugar 
  • Over-eating or skipping meals 
  • Alcohol, caffeine or drug use 
  • Menstruation 
  • Certain medications (i.e. antidepressants) 

How is epilepsy commonly treated?

Epilepsy is commonly treated through medication, but other changes may also impact the likelihood of experiencing seizures.

Treat options typically include: 

  • Anti-epileptic drugs (AED) to stabilise brain activity 
  • Surgery to remove the cause of the epilepsy 
  • Dietary changes such as the keto diet 
  • Complementary relaxation technique (yoga or meditation) to reduce stress 
for a scientific experiment, a girl is connected with cables to a computer, EEG for research,

Treating epilepsy with medicinal cannabis

Children with epilepsy

A group of Canadian researchers reviewed available scientific literature on treating drug-resistant epilepsy in children, looking for results that told them medicinal cannabis could help with freedom from seizures, reduction in the frequency of seizures, improved quality of sleep, reduced visits to the emergency room, and a few other outcomes. They found a statistically significant reduction in seizure frequency when treating with cannabidiol (a major cannabis compound), and an increase in the number of patients with at least a 50% reduction in seizures. Their conclusion? Evidence suggested cannabidiol “probably” reduces seizures in pediatric patients, with moderate certainty. Source 

 

Dravet syndrome

More Canadian researchers have been looking into Dravet syndrome specifically. They provided an add-on treatment of 100 mg per mL of cannabidiol and 2 mg/ml delta-9 THC (another cannabis compound) to 20 children – looking to see its impact on their therapy, their body’s electrical readings and quality of life. They noted improvements in all three areas, including a median motor seizure reduction of 70.6%, with half of their patients at a rate of 63%. The children also reported improved quality of life and showed a reduction in electrical spikes. Source 

 

Lennox-Gastaut Syndrome 

A paper from the US illustrates the possible efficacy of using cannabidiol as an add-on treatment to AEDs for patients with Lennox-Gastaut syndrome. Patients here (aged two years to 55) were split into three groups, receiving either 20 mg per kg of bodyweight cannabidiol, half that amount or a placebo. So what happened? The authors noted that drop seizures reduced by an average 41.9% in the former group, and 37.2% in the half-dose group. Side effects such as somnolence and loss of appetite were more common in the 20 mg group, showing how doctors may be able to prescribe different dosage sizes to balance reduction in drop seizures with potential side effects. Source 

 

Long-term usage 

This paper, from the Federal University of PiauíBrazi, analysed over 200 scientific studies on medicinal cannabis and epilepsy. After combing through the results, they found “statistically meaningful” results showing that cannabis treatments were more effective at treating epilepsy than placebos, and that adverse effects (aka side effects) were less common over long-term use than short-term. This could support the idea of using cannabis as a supplement for long-term treatment. Source 

Limitations of medicinal cannabis research

At the time of writing, research on medicinal cannabis is in its early stages. In medicine, we like to see a large number of studies conducted over long periods of time (with large numbers of participants) to make definitive statements about the efficacy of certain treatments. As yet, medicinal cannabis has not reached this stage, although there is a significant amount of preliminary research coming out that warrants more large-scale study. Patients should always talk to a health professional for advice on their unique requirements before making any decisions about their treatment options.

Who to talk to next

Wondering where to turn to next? If you’d like to speak with a medical professional who knows the research on medicinal cannabis and can offer you guidance on whether it’s right for your needs, consider booking a digital GP appointment using our telehealth service today.