Epilepsy

Epilepsy is a chronic neurological condition that causes seizures of different types (e.g. focal, tonic-clonic), which are brief episodes of abnormal electrical activity in the brain. Seizures range from lapses in attention to severe convulsions and loss of consciousness. Epilepsy is sometimes compared or referred to as “an electrical storm inside your head.”

Approximately 1.2% of the US (3.4 million people) suffer from epilepsy in the US. Around 2.9 million adults and 456,000 children had epilepsy as of 2021, according to the CDC. Epilepsy is associated with abnormal electrical activity in the brain, which causes convulsions, loss of consciousness, sensory disturbances, and in some cases, sensitivity to lights, patterns, and sounds.

Medical cannabis, and in particular the cannabinoid cannabinoid (CBD), can be of immense help in helping reduce the frequency and intensity of seizures associated with epilepsy.

Epilepsy Causes

Epilepsy is thought to have a genetic component and runs in families. However, there are instances when epilepsy may be a result of a traumatic brain injury (TBI), or brain damage from an illness. In many cases, there is no clear cause for epilepsy.

Epilepsy Symptoms & Health Effects

Common signs and symptoms of epilepsy include:

• Losing awareness of the things around you.
• Long, unconscious, blank staring into space.
• Becoming stiff.
• Migraines.
• Panic attacks.
• A “rising” feeling in the tummy, unusual smells or tastes, and a tingling feeling in your arms or leg, or other similar strange sensations.
• Collapsing, fainting, or falling forwards or backwards, depending on the type of seizure.
• Losing consciousness.
• Uncontrollable jerking and shaking, called a “fit” or a “seizure”.

There are many different types of epilepsy, some of which are more difficult to control than others. Temporal lobe seizures, a category of focal seizures, are the most common type of epilepsy.

Some of the most difficult forms of epilepsy to treat include:

• Developmental and epileptic encephalopathy (DEE)
• Rasmussen’s encephalitis
• Early onset epilepsy
• Lennox-Gastaut syndrome (LGS)
• Dravet syndrome (DS)

There are many anti-epileptic drugs (AEDs) available, but they do not always work. Indeed, drug-resistant epilepsy is quite common, thought to affect about one-third (33%) of adults and up to one-quarter (20-25%) of children.

Other challenges in managing epilepsy include side effects of the condition, such as mood disorders (including anxiety and depression), insomnia, chronic pain from injuries during seizures or surgery complications, gut problems (including IBS), and the side effects of medications (e.g. “brain fog”, dizziness).

Epilepsy Diagnosis

A person will be diagnosed with epilepsy, usually by a neurologist, if they have had more than one seizure. A neurologist will also ask the following to determine the type, frequency, and severity of the seizures:

• When you had the seizure.
• What you were doing when it happened.
• How you felt before, during and afterwards.
• How often these seizures happen.

The most common test for epilepsy is an electroencephalogram (EEG), which tests for brain activity. Other brain imaging tests and scans may be used to check for any brain abnormalities or damage.

Epilepsy Prognosis

With treatment, many of those with epilepsy can live a completely or mostly seizure-free life. Those with epilepsy of unknown cause live a close-to-normal life expectancy. Those with inherited epilepsy may live up to 10 years fewer than the general population.

Epilepsy Treatments

There are several ways epilepsy is managed. These include:

• Anti-epileptic drugs (AEDs) are the primary treatment: These are often benzodiazepine-based and have sedative effects. Commonly prescribed benzodiazepines include diazepam and lorazepam.
• A low-carbohydrate, high-fat (ketogenic) diet
• Inserting a small electrical device inside the body to help control seizures
• Surgery to remove the small part of the brain causing seizures

First-Line Treatments

AEDs are typically the first treatment recommended for epilepsy.  Common AEDs include carbamazepine, lamotrigine, levetiracetam, oxcarbazepine, sodium valproate, and topiramate. They usually belong to benzodiazepine, but some belong to non-benzodiazepine anticonvulsant drug classes.

Other Treatments

Other types of drugs may be prescribed if benzodiazepine-based AEDs do not work. One such drug is phenytoin (PHT), brand name Dilantin. In some rare instances, surgery may be recommended.

Adjunctive Therapy & Alternative Treatments

Some evidence suggests that a ketogenic diet may be useful for managing the frequency and intensity of epileptic seizures as it reduces levels of the hunger hormone, ghrelin, which is elevated in epileptic patients.

Cannabis for Epilepsy

The idea that marijuana could help reduce the frequency of seizures has been around since the 1970s. Alongside glaucoma, cancer, and multiple sclerosis (MS), epilepsy was one of the first conditions where cannabinoid-based treatments were thought to have therapeutic (in this case, antiseizure) effects.

There is now a considerable body of evidence showing that cannabidiol (CBD) can help reduce the frequency of seizures in people suffering from Dravet syndrome or Lennox-Gastaut syndrome, which are particularly severe and treatment-resistant forms of childhood epilepsy. We now have the Schedule V CBD-based Epidiolex available for prescription in the U.S., which has been shown to be effective in reducing seizures in those with Lennox-Gastaut syndrome or Dravet syndrome.

Phytocannabinoids (plant cannabinoids) other than CBD that display anti-seizure and other potentially therapeutic properties include:

• Cannabidivarin (CBDV or CBDv) = has displayed antiseizure and anticonvulsant properties 
• Cannabidiolic acid (CBDA or CBDa) = may combine with CBD to increase its antiseizure properties
• Tetrahydrocannabidiolic acid (THCA or THCa) = reduces pain and inflammation, and may also have antiseizure properties
• Cannabichromene (CBC) = CBC has effects that may help protect against any inflammation and brain damage caused by seizures
• Cannabigerol (CBG) = also has antioxidant and neuroprotective properties
• Cannabinol (CBN) = has sedative effects that can aid sleep

The following terpenes have relaxing and pain-relieving properties that may help provide relief from some of the side effects of seizures, such as insomnia and chronic pain:

• Linalool
• Myrcene
• Beta-caryophyllene

One of the other reasons why CBD may help is because many people with epilepsy find the drugs (benzodiazepines in particular) ineffective or find the side effects intolerable. Cytochrome P450 (CYP450), CYP2C9, CYP3A, CYP2C19, and CYP2D6 are all enzymes responsible for the metabolism of many anti-epileptic drugs (AEDs), such as Clobazam.

Many of those with epilepsy have mutations in the genes that code for these enzymes, meaning that the anti-epileptic drugs (AEDs) they are being given are not effective and can even be harmful. It is not unusual for epileptic patients to have to try several different types of benzodiazepine before they find an effective one.

Artisanal CBD products are generally best avoided, as their THC content may induce seizures. However, small amounts of THC may be helpful for some for its sedative and analgesic properties. It may also reduce the amount of CBD needed for therapeutic effects such as managing chronic pain and helping overcome addiction to sedatives. Those wishing to avoid THC due to its potential to cause seizures may prefer to utilize THCA instead.

Additional Information for Patients

Although many people live long, full lives with an epilepsy diagnosis, it can still be a difficult condition to manage and can cause significant reductions in one’s quality of life (QoL). Those with severe epilepsy may be regularly hospitalized, have seizures that can cause brain damage, and have a reduced life expectancy.

Several charities in the USA help epilepsy patients including,  Epilepsy Foundation, CURE Epilepsy, and Epilepsy Alliance America.

Epilepsy FAQs

What types of seizures are there?

There are different types of seizures associated with epilepsy. These are:

• Tonic: Where the muscles become stiff and unmovable.
• Atonic: A sudden, unexpected loss of muscle strength or tone.
• Myoclonic: Movements become short, lightning-quick, and jerky.
• Clonic: Periods of rhythmic shaking or jerking movements.
• Focal: Where a seizure occurs in one part of the brain, but can move across to other parts.
• Absence seizure: Blanking out or staring into space.

Are seizures associated with any other conditions?

Yes, other than epilepsy, seizures can occur in conditions like:

• Abnormal levels of sodium or glucose in the blood
• Autism spectrum disorder (ASD), although many may be diagnosed with epilepsy or another seizure disorder
• Brain infection, including meningitis and encephalitis
• Brain injury that occurs to a baby during labor or childbirth
• Brain problems that occur before birth (congenital brain defects)
• Brain tumor (a rare cause)
• Electric shock
• Fever (particularly in young children)
• Head injury
• Heart disease
• Heat illness (heat intolerance)
• High fever
• Hydrocephalus
• Phenylketonuria (PKU), which can cause seizures in infants
• Poisoning
• Stroke
• Toxemia of pregnancy
• Toxin buildup in the body due to liver or kidney failure
• Use of some types of recreational drugs, such as angel dust (PCP), cocaine, and amphetamines
• Very high blood pressure (malignant hypertension)
• Venomous bites and stings (such as a snake bite)
• Withdrawal from alcohol or certain medicines after using it for a long time

Are there any activities epileptics should avoid?

Those who are prone to uncontrolled seizures should ideally avoid activities such as scuba diving, rock climbing, skydiving, hang gliding, and mountain climbing. Restrictions may also be placed on activities such as driving or operating machinery.

Related Articles

Using Cannabis for a Child with Epilepsy

How CBD Can Help Treat Epilepsy

Lennox-Gastaut Syndrome

Dravet Syndrome

What is Epidiolex?

CBD and the Brain: The Impact of Cannabidiol on Brain Health

Seizures and Seizure Disorders

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