Epilepsy

25^th June 2026

Drug-resistant epilepsy (DRE) affects approximately one-third of all patients with epilepsy globally and is a leading reason patients seek medical cannabinoids as an adjunctive treatment option.

Common forms of drug-resistant epilepsy include Dravet syndrome, Lennox-Gastaut syndrome, West syndrome, and cortical malformation-related epilepsy, among others.

For individuals living with difficult-to-control seizures, ongoing seizure burden significantly impacts safety, independence, employment, education, and quality of life. Medical cannabinoids, particularly CBD-dominant formulations, have demonstrated significant potential as an adjunctive treatment option in selected patients with DRE.

How Cannabinoids Can Help

Epilepsy has one of the most studied areas among neurological conditions for cannabinoids therapy, particularly for drug-resistant cases [1]. CBD has shown beneficial anticonvulsant properties through effects on ion channels, neurotransmitter systems and neuroinflammation [2]. For selected DRE patients, cannabinoid therapy represents a meaningful therapeutic advance.

Proposed Mechanisms of Action

Ion Channel Modulation

CBD may modulate voltage-gated sodium and calcium channels, reducing excessive neuronal excitability and seizure generation [2].

GABA Enhancement

CBD may enhance GABAergic signalling, which normally inhibits neural activity and prevents seizures [2].

Serotonin (5-HT1A) Receptor Interaction

In preclinical studies, CBD has been shown to interact with serotoninc (5-HT1A) receptors, which may contribute to its neurological effects and may play a role in modulating seizure susceptibility [1].

Anti-inflammatory Effects

CBD may reduce neuroinflammation, which contributes to seizure generation in some epilepsy syndromes [1].

Endocannabinoid System Modulation

CBD may indirectly influence endocannabinoid signalling, which regulates neuronal excitability [2].

Common Conditions Related to Drug-Resistant Epilepsy

• Sleep Disturbances: Poor sleep quality is both a consequence of seizures and a seizure trigger, creating a difficult cycle.
• Anxiety and Depression: Emotional challenges are common secondary to seizure burden and lifestyle restrictions.
• Cognitive Difficulties: Memory, concentration and learning challenges may result from seizures, medications or underlying neurological dysfunction.
• Injury Risk: Frequent seizures increase risks of falls, head injuries, status epilepticus and SUDEP (Sudden Unexpected Nocturnal Death in Epilepsy).
• Social Challenges: Restrictions on driving, employment and activities impact independence and quality of life.

Conventional Treatments

• Multiple Anti-Seizure Medications (ASMs): Patients typically trial several medications in combination, but approximately one-third of patients remain uncontrolled.
• Ketogenic Diet: A specialised diet that can reduce seizures in some patients, but compliance may be difficult to maintain and long-term effects require monitoring.
• Surgical Interventions: Epilepsy surgery may be considered for focal seizures with identifiable lesions.
• Neurostimulation Therapies: Vagus nerve stimulation and other devices provide additional options for some patients.
• Lifestyle Management: Sleep optimisation, stress management and trigger avoidance provide important support.

Cannabinoids and Symptom Management: Clinical Evidence

Seizure Reduction in Drug-Resistant Epilepsy

A landmark 2018 randomised controlled trial published in The New England Journal of Medicine [3] demonstrated that purified CBD reduced seizure frequency by approximately 50% in patients with Dravet syndrome (a severe, treatment-resistant form of epilepsy) compared to placebo. This study provided the first major evidence base for CBD in paediatric DRE.

A 2016 open-label study in The Lancet Neurology [4] examined CBD in a broader population of DRE patients and found that participants of the study achieved approximately a 50% reduction in seizure frequency compared to their baseline.

A systematic review in Frontiers in Neurology [5] (2020) concluded that CBD demonstrates meaningful seizure reduction in selected DRE populations, particularly in treatment-resistant epilepsy syndromes where conventional medications have failed.

Sleep and Seizure Control

Improving sleep through cannabinoid therapy may provide indirect seizure management benefits [6]. Seizure reduction itself typically improves sleep quality and reduces daytime fatigue, which further supports neurological stability and quality of life.

Quality of Life and Caregiver Well-being

Beyond seizure reduction, clinical observations indicate that DRE patients receiving CBD report substantial improvements in anxiety, mood, sleep and overall quality of life. For families of DRE patients, reduced seizure burden significantly alleviates caregiver stress and improves family functioning.

Benefits of Cannabinoids

• Novel Mechanism of Action: CBD works through different pathways compared to conventional ASMs. Therefore, potentially offering benefit to patients who have failed multiple traditional medications.
• Improved Tolerability: CBD generally has a favourable side effect profile compared to conventional ASMs, which often cause sedation, cognitive impairment, ataxia or behavioral changes.
• Adjunctive Symptom Support: Beyond seizure reduction, CBD may also support co-occurring challenges such as anxiety, sleep difficulties, and mood symptoms that are not directly addressed by conventional anti-seizure medications.
• Regulatory Approval: FDA-approved purified CBD (Epidiolex) demonstrates regulatory recognition of its efficacy and safety profile for DRE.

Side effects of CBD

CBD is generally well-tolerated, with most adverse effects being mild to moderate. These may include diarrhoea, nausea, appetite changes, somnolence, and fatigue. Elevations in liver enzymes may occur, particularly when used with valproate or other medications metablised by the liver. Serious adverse effects are rare. Baseline and periodic liver function monitoring is recommended, especially in patients with hepatic impairment or those receiving hepatoxic medications.

Drug Interactions

CBD may interact with other medications, and some medications may also affect CBD levels in the body. These interactions can occur through shared liver enzyme pathways, including CYP3A4 and CYP2C9. As a result, levels of either CBD or certain medications may increase or decrease, which may affect therapeutic response and the risk of side effects. This may be particularly relevant for certain cardiovascular, psychiatric, and anticonvulsant medications. The extent of interaction varies depending on the specific medication, cannabinoid formulation, and individual patient metabolism.

Conclusion

For individuals with drug-resistant epilepsy who continue to experience significant seizure burden despite conventional treatment, CBD-based medical cannabinoids represents an evidence-supported adjunctive therapeutic option. Purified, pharmaceutical-grade CBD formulations offer meaningful seizure reduction and quality-of-life improvements while operating within regulatory frameworks. By ensuring specialist neurological oversight with the prescribing physician and structured outcome monitoring, AKOS BIO can responsibly provide DRE patients access to cannabinoid therapies as part of a comprehensive epilepsy management plan.

How to Access AKOS BIO Cannabinoid Therapy

If you are interested in exploring cannabinoid-based treatment as part of your therapeutic plan, discuss this option with your treating healthcare provider. They can help determine whether cannabinoid therapy may be be appropriate for your individual circumstances.

Alternatively, if you would like to explore AKOS BIO’s pharmaceutical-grade cannabinoid products, you can book a consultation with an independent prescribing healthcare practitioner via the AKOS BIO website.

AKOS BIO provides pharmaceutical-grade cannabinoid products and educational resources to support patients and healthcare professionals. Prescribing decisions are made independently by qualified healthcare practitioners.

In South Africa, AKOS BIO doctors will apply for your Section 21 licence (SAHPRA) on your behalf if medical cannabis is appropriate for your condition. The permit is valid for six months and can be renewed if treatment is effective.

For more information or to book a consultation:

Website: [www.akos-bio.com](https://www.akos-bio.com)

WhatsApp: 066 269 1108

References

[1] Pesántez Ríos, G., Perucca, E., Striano, P., Caraballo, R., Pesántez Ríos, X., Pascual-Pascual, S. I., & Pesántez Cuesta, G. (2026). Epilepsy, neuroinflammation and cannabidiol: What do we know thus far? Frontiers in Pharmacology, 16, 1749260. https://doi.org/10.3389/fphar.2025.1749260

[2] Silvestro, S., Mammana, S., Cavalli, E., Bramanti, P., & Mazzon, E. (2019). Use of Cannabidiol in the Treatment of Epilepsy: Efficacy and Security in Clinical Trials. Molecules, 24(8), 1459. https://doi.org/10.3390/molecules24081459

[3] Devinsky, O., Patel, A. D., Cross, J. H., et al. (2018). Effect of cannabidiol on drop seizures in the Lennox-Gastaut syndrome. New England Journal of Medicine, 378(20), 1888-1897. https://doi.org/10.1056/NEJMoa1714631

[4] Devinsky, O., Marsh, E., Friedman, D., et al. (2016). Cannabidiol in patients with treatment-resistant epilepsy: an open-label interventional trial. The Lancet Neurology, 15(3), 270-278. https://doi.org/10.1016/S1474-4422(15)00379-8

[5] Rosenberg, E. C., Tsien, R. W., Whalley, B. J., & Devinsky, O. (2020). Cannabidiol in the treatment of epilepsy: A focused review of evidence and gaps. Frontiers in Neurology, 11, 531939. https://doi.org/10.3389/fneur.2020.531939

[6] Babson, K. A., Sottile, J., & Morabito, D. (2017). Cannabis, Cannabinoids, and Sleep: A Review of the Literature. Current Psychiatry Reports, 19(4), 23. https://doi.org/10.1007/s11920-017-0775-9