Introduction

What is epilepsy?

Epilepsy, a chronic noncommunicable disease, affects around 50 million people globally. Individuals with epilepsy experience recurrent seizures. A seizure is a brief episode of involuntary movement which can involve part of the body or the entire body. Seizures are a result of excess electrical discharges in a group of brain cells. Different areas of the brain may be the site of these electrical discharges. The frequency of seizures may also vary; those with epilepsy may experience seizures less than once a year or several times a day. One seizure is not evidence of epilepsy; up to 10% of people globally have one seizure during their lifetime on average. Epilepsy is defined as two or more unprovoked seizures. Epilepsy is one of the oldest recognised conditions, with evidence of epileptic individuals dating back to 4000 BCE. Social stigma has been attached to epilepsy for centuries, and this stigma is still evident in many countries today, which can impact the quality of life for epileptics and their families.¹

When medications don’t work

Sometimes, seizures are not controlled with commonly used epilepsy medications. A number of terms are used to describe drug-resistant epilepsy, such as uncontrolled, intractable, and refractory. But how often does drug-resistant epilepsy occur? Studies have found that drug-resistant epilepsy develops in about one-third of adults and 20-25% of children.² There can be many factors contributing to suboptimal treatment of seizures: 

• Using the wrong medication - Most seizure medications are useful against a number of different seizure types. However, some medications are not useful; for example, Carbamezepine is good for treating focal seizures but not absence and myoclonic seizures²
• Incorrect doses of medicine - response to seizure medication varies widely. Too high of a dosage may lead to side effects, and too low may lead to seizures²
• Polypharmacy and toxicity - The use of multiple medications (polypharmacy) to treat the same condition may lead to drug interactions that limit how well the drug works or increase the side effects of another drug²

If epilepsy seems to be drug resistant, it is important to be seen by an epilepsy specialist to evaluate why and to explore alternative treatment options. 

Why CBD is an option to consider

Cannabidiol (CBD) has been approved as an anti-seizure medication for three drug-resistant epilepsy syndromes in children and adults. Researchers do not yet understand how CBD affects the brain, as it acts on both neuronal and non-neuronal targets. The main target is considered to be the endocannabinoid system (ECS), which regulates diverse functions through its receptors. Multiple studies have confirmed the use of medical cannabinoids and clinical improvement in patients with epilepsy.³

What is CBD, and how does it work?

CBD in simple terms

Cannabis is part of something called the Cannabaceae plant family. THC and CBD are two compounds in cannabis that we call cannabinoids. THC is notoriously known to induce multiple psychoactive effects; on the other hand, CBD does not.³

How CBD may help with epilepsy

The ECS regulates functions through its receptors, including neuronal excitability, pain, inflammation, and glial cell homeostasis.³ Researchers have found that CBD blocks signals carried by a molecule found in brain cells called neurons called lysophosphatidylinositol (LPI). Researchers think LPI amplifies nerve signals normally but can be hijacked in individuals with epilepsy to promote seizures.⁴

Research on CBD and epilepsy in children

What studies say

Researchers found that in children and adults with Dravet syndrome, CBD resulted in a reduction of convulsive-seizure frequency compared to patients in a placebo group. However, CBD was associated with adverse events such as the elevation of liver-enzyme levels. More research is needed to determine the long-term efficacy and safety of CBD for epilepsy.⁵ 

FDA approval of CBD for epilepsy 

In 2018, the first CBD medication Epidiolex, was approved by the FDA for patients two years of age and older with Dravet syndrome or Lennox-Gastaut syndrome. Epidiolex, a plant-derived CBD product with THC extracted, was initially a Schedule 5 controlled substance and has since been descheduled. Despite this product being approved and regulated, CBD products are available, but restrictions in some countries unfortunately foster controversy around the use of products that are marketed as CBD oil.⁶

Is CBD safe for kids?

The most commonly reported side effects in a number of studies on the use of CBD in the treatment of epilepsy were tiredness, diarrhoea and changes in appetite and weight.⁷ However, as this is a fairly new treatment, there are some things we do not yet know. 

Despite the availability of CBD products for children and the numerous therapeutic claims, there are few rigorous studies to inform dosing, safety, and efficacy of medicinal CBD in paediatric clinical practice. This emphasises the importance of working with your doctor or health care provider when considering CBD as an alternative treatment in drug-resistant CBD.⁸ 

What parents should know before trying CBD

Finding high-quality products

The quality of over-the-counter CBD products in the UK can be below par, particularly when it comes to CBD content. Only 38% of products were within 10% of the advertised CBD content. There is also an issue with the presence of controlled substances within these products; for example, THC and cannabinol, as well as other controlled substances, were detected in 55% of over-the-counter CBD products.⁹

Understanding legal considerations

In the UK, the use of medical cannabis and cannabis products was legalised in 2018. Despite this, in 2020, only 12 NHS prescriptions and fewer than 60 prescriptions in total were approved. This does not reflect the results of a patient survey by the Centre for Medical Cannabis that found 1.4 million people use illegal cannabis for medical problems. This highlights the importance of speaking to your doctor or health care provider about the appropriate way to acquire medicinal cannabis products like CBD.¹⁰

Conclusion

Although controversial, the use of cannabis derived products for medicinal purposes grows more popular each year. Research into the benefits of cannabis derived products for various medical issues, including drug-resistant epilepsy, continues. While the debate regarding whether cannabis products should be used for medicinal or recreational purposes continues amongst the general population, special considerations need to be made for paediatric use. The lack of research in paediatric medicine means caution should be taken when using these products for your child. Despite the benefits of CBD in treating drug-resistant epilepsy in children, more research is needed to fully understand the efficacy of CBD in children, as well as long-term studies to assess neurocognitive development in children using CBD long-term.¹¹

Summary 

Epilepsy is a chronic condition which causes repeated seizures that may vary in frequency and severity. Epilepsy is diagnosed when an individual has two or more unprovoked seizures. Despite its long history, epilepsy often carries social stigma, affecting the quality of life for patients. For some, traditional epilepsy medication fails to control seizures.

Drug-resistant epilepsy affects around one-third of adults and 20-25% of children with the condition. While the exact mechanism remains to be elucidated, it is believed to work by affecting the ECS, which helps to regulate various bodily functions. Multiple studies support the benefits of CBD for certain types of epilepsy. CBD is one of the many compounds found in cannabis. Unlike THC, CBD is not psychoactive however, it may block certain brain signals linked to seizures. 

Studies indicate that CBD can reduce seizure frequency in children with drug-resistant epilepsy, though side effects have been reported. Epidiolex and regulated CBD medications are specifically used for epilepsy in pediatric patients. While side effects such as tiredness and appetite changes have been commonly observed, CBD’s long-term safety in children requires more research.

Due to these unknowns, working closely with a healthcare professional is advised. Due to inconsistencies in over-the-counter CBD products, including incorrect CBD content and the presence of controlled substances, finding high-quality CBD products is essential. Additionally, while medical cannabis was legalised in the UK in 2018, few prescriptions through the NHS have been approved.