Seizures

Seizures are sudden, uncontrolled electrical disturbances in the brain that can result in changes in behaviour, movements, feelings, or consciousness.

They are symptoms of various neurological conditions, most commonly epilepsy, but may also arise due to brain injuries, infections, or metabolic disorders. The severity and impact of seizures can vary greatly, significantly affecting a patient’s quality of life.

Common Conditions Related to Seizures

Seizures are associated with a range of underlying conditions, including:

Epilepsy: A neurological disorder characterised by recurrent seizures, epilepsy is the most common condition linked to seizures and affects individuals of all ages.
Lennox-Gastaut Syndrome (LGS): A severe form of epilepsy that typically begins in childhood and involves multiple types of seizures.
Dravet Syndrome: A rare genetic epileptic disorder that starts in infancy, leading to frequent and prolonged seizures.
Traumatic Brain Injury (TBI): Brain injuries can result in seizures, sometimes progressing to post-traumatic epilepsy.
Stroke: Brain damage caused by a stroke can lead to seizures, particularly in older adults.
Fever (Febrile Seizures): High fevers can trigger seizures, especially in children.
Cerebral Palsy: Neurological conditions associated with cerebral palsy can lead to seizures in some cases.

Conventional Treatments for Seizures

Seizure management typically relies on anticonvulsant medications that aim to stabilise brain activity and prevent the abnormal electrical impulses that cause seizures. Common treatment approaches include:

Antiepileptic Drugs (AEDs):

The cornerstone of seizure treatment, AEDs are tailored to the type of seizure and condition. Examples include:

Valproate (Depakote): Used for a broad spectrum of seizure types.
Carbamazepine (Tegretol) and Phenytoin (Dilantin): Commonly prescribed for partial seizures.
Lamotrigine (Lamictal) and Levetiracetam (Keppra): Effective for generalised and partial seizures.
Topiramate (Topamax) and Clonazepam: Frequently used for treatment-resistant epilepsies like Lennox-Gastaut syndrome.

Benzodiazepines:

Drugs such as Diazepam and Lorazepam are used for acute seizure management, especially during status epilepticus (a prolonged seizure).

Steroid Therapy:

Certain severe epileptic conditions, such as infantile spasms, are treated with steroids like Prednisolone or ACTH (adrenocorticotropic hormone).

While AEDs are effective for many, their use is often associated with significant side effects, including dizziness, fatigue, cognitive impairment, and behavioural changes. Approximately 30% of epilepsy patients are refractory or resistant to these treatments, highlighting the need for alternative options.

How Cannabis Can Help

Medical cannabis, particularly cannabidiol (CBD), has garnered attention as a potential treatment for refractory epilepsy and other seizure-related disorders. CBD is a non-psychoactive cannabinoid that interacts with the body’s endocannabinoid system (ECS), which plays a key role in regulating neuronal excitability and reducing seizures.

Cannabinoids and Seizure Management: Clinical Evidence

Lennox-Gastaut Syndrome (LGS)

A landmark 2017 study published in The New England Journal of Medicine evaluated the efficacy of Epidiolex (a purified CBD extract) in patients with Lennox-Gastaut Syndrome. The trial demonstrated a 43.9% reduction in seizure frequency compared to a placebo, with manageable side effects such as sleepiness and diarrhoea.
A follow-up study in 2018 confirmed Epidiolex’s effectiveness in reducing seizures in children with LGS who had not responded to conventional treatments.

Dravet Syndrome

Another groundbreaking 2017 study, also published in The New England Journal of Medicine, focused on CBD in children with Dravet Syndrome, a rare and severe epilepsy. The results showed a 39% reduction in seizure frequency, with some patients achieving seizure freedom for the first time.
Epidiolex was approved by the US FDA in 2018 specifically for treating Dravet Syndrome and Lennox-Gastaut Syndrome, based on strong clinical evidence.

Refractory Epilepsy

A 2018 study in Epilepsia reviewed 92 patients with refractory epilepsy treated with CBD-enriched cannabis extracts. Patients experienced a 54% reduction in seizure frequency, even when traditional AEDs had failed.
Another systematic review published in Frontiers in Neurology (2018) reported that CBD reduced seizure frequency by an average of 50% in patients with treatment-resistant epilepsy.

Epilepsy in General

A 2016 study in Seizure: European Journal of Epilepsy found that cannabis-based therapies significantly reduced seizure frequency in 10 out of 12 epilepsy patients, with improvements in quality of life metrics.
A 2019 retrospective study in Epilepsy & Behavior reported that CBD as an adjunct to conventional AEDs improved seizure control, with some patients achieving complete seizure remission.

Mechanisms of Action

Cannabis, particularly CBD, modulates seizure activity by interacting with the ECS and GPR55 receptors in the brain. Key mechanisms include:

Regulating Excitatory and Inhibitory Signals: CBD helps maintain the balance between excitatory and inhibitory neurotransmission, reducing the likelihood of abnormal electrical activity that leads to seizures.
Reducing Brain Inflammation: CBD has anti-inflammatory properties that reduce excitotoxicity, a key factor in seizure activity.
Modulating the ECS: While CBD does not bind directly to CB1 and CB2 receptors, it indirectly enhances ECS signalling, promoting neuronal stability.
THC and Anticonvulsant Effects: In smaller doses, THC may also exhibit anticonvulsant properties, though its psychoactive effects make CBD the preferred option for most patients.

Advantages Over Conventional Treatments

Cannabis-based therapies, particularly CBD-dominant formulations like Epidiolex, offer several advantages over traditional treatments:

Better Tolerability: While AEDs often cause side effects like cognitive impairment, fatigue, and mood changes, CBD has a more favourable side effect profile, with mild drowsiness or gastrointestinal discomfort being the most common.
Effectiveness in Refractory Cases: CBD provides hope for patients with drug-resistant epilepsy, reducing seizures where other treatments have failed.
Non-Psychoactive: Unlike THC, CBD does not produce psychoactive effects, making it a safer option for children and those seeking cognitive clarity.

Conclusion

Medical cannabis, particularly CBD, has emerged as a promising treatment for seizure disorders, especially in patients with refractory epilepsy or conditions like Lennox-Gastaut Syndrome and Dravet Syndrome. Supported by robust clinical evidence, cannabis-based therapies offer a new pathway for reducing seizure frequency and improving quality of life for individuals who do not respond to conventional medications.

By ensuring access to well-regulated cannabis-based treatments, healthcare providers can offer patients and their families a safer and potentially more effective alternative to traditional anticonvulsants, addressing a critical need in seizure management.