Share on Pinterest

• Cannabidiol (CBD) has been approved for use in the treatment of two early-onset, intractable forms of epilepsy, Dravet syndrome and Lennox-Gastaut syndrome, since 2018.
• This decision followed clinical trials showing that CBD could reduce the frequency of seizures in people with these conditions.
• Researchers have now conducted a survey of over 500 carers of people with these forms of epilepsy to determine if CBD has an impact on other aspects of the syndromes.

Many jurisdictions have started to reverse the criminalization of cannabis, often in order to make it easier for people with a medical need for drugs derived from the plant to access treatment.

Cannabidiol, also known as CBD, is a compound found in cannabis and hemp and one of over 100 cannabinoids found in the plant.

Cannabidiol is one of the main cannabinoids that can be extracted from cannabis and is a main component of medical cannabis, alongside THC, which is the compound that causes the psychoactive effects, or ‘high’, associated with cannabis use. CBD does not have a psychoactive effect but can still have some medical applications and is considered an active ingredient.

One of those applications is in the treatment of Dravet syndrome, one of the symptoms of which is early-onset epilepsy that does not respond to treatment, and a significant proportion of children with this condition die before the age of 11. Many instances are linked to a genetic mutation.

Another is the treatment of Lennox-Gastaut syndrome, which is also characterized by early-onset intractable epilepsy. People with both have other disabilities that affect their day-to-day lives.

The WHO has noted the efficacy of CBD in treating epilepsy in people with both syndromes, and the FDA approved Epidiolex CBD oral solution for the treatment of seizures associated with these conditions in 2018.

This treatment has gone on to be approved for the same indications in other countries, including the U.K., where it is available on the NHS.

Though clinical trials have demonstrated the efficacy of CBD in reducing epileptic seizures, patients have many other symptoms. Hence, a group of scientists from Northwestern University Feinberg School of Medicine designed a trial to test whether CBD had any effect on non-seizure symptoms people with epilepsy may experience.

They published their results in Epilepsy Research.

85% of people report improvement in symptoms with CBD

As most children and adults with these conditions require caregivers to help them with day-to-day activities, researchers developed an online survey in association with caregivers, healthcare professionals, and epilepsy researchers to gather data on the effect of CBD on non-seizure symptoms. They called it the BEhavior, COgnition, and More with Epidiolex® (BECOME), and it took participants 20 minutes to complete the questionnaire.

As part of the study, 498 participants, ages 1–73, were given Epidiolex®, a 100 mg/mL oral CBD solution, for three months alongside their existing anti-seizure medication. The carers, mainly parents, completed the survey, while researchers compared nonseizure outcomes, including alertness, cognition, and executive function, emotional functioning, language and communication, sleep and physical functioning, during treatment compared to the period before CBD initiation.

The research showed that 85% of respondents reported improvements in at least one area and 93% were planning to continue treatment.

How does CBD reduce epilepsy symptoms?

Dr. Daniel Ganjian, board certified pediatrician at Providence Saint John’s Health Center in Santa Monica, California, who was not involved in the study, told Medical News Today in an email: “CBD may interact with brain systems involved in regulating seizures, potentially reducing their frequency and severity. This could involve influencing how nerve cells communicate and interact.”

In addition to this, CBD is thought to have other effects on the brain and body, too.

“Epilepsy can cause various challenges beyond seizures, like sleep problems, mood swings, and cognitive difficulties. CBD might positively impact these areas by:

• Supporting brain function: By potentially influencing brain systems related to mood, sleep, and cognition.
• Reducing the seizure burden: Lessening the impact of seizures on the brain and body can indirectly improve overall well-being,” Dr Ganjian added.

Dr. Sherry Yafai, a board certified emergency medicine physician at Saint John’s Physician Partners Urgent Care and Adjunct Assistant Professor at Saint John’s Cancer Institute in Santa Monica, California, and cannabis specialist, who was not involved in the research, said the reason that CBD has an effect where some other epilepsy drugs don’t is because CBD targets several receptors at once.

“CBD is being shown to potentially positively impact the brain of epileptic patients because of its neuroprotective effects on multiple receptor pathways. CBD uniquely targets multiple receptors in the brain, including the Cannabinoid Receptors CB1/CB2, GABA-A receptors, FAAH inhibition, 5-HT-1A, TRPV1/TRPV2, and GPR55,” she said.

“All of these CBD targets have been seen to be involved in seizure activity to some degree. Of these targets, TRPV1 and FAAH inhibition are directly involved in increasing the amount of circulating endocannabinoids (anandamide and 2AG), which have been found to protect against seizures in animal models,” she continued.

CBD’s effects on other neurological conditions

Dr. Yafai said these results reflected the findings of some other studies on the impact of CBD on neurological conditions.

“Symptomatically, what the authors have identified in this article as a potential benefit of CBD on non-seizure related outcomes is the positive effect of the endocannabinoid (eCB) system globally in the brain. The global neuronal effect of the eCB system involvement is responsible for the regulation of cognition, language, and emotional behaviors,” she explained.

“Parallel positive results to this study are being seen in other studies involving other neurologic disorders such as autism and dementia. In autism, outcomes such as improved cognition, increased social interaction, and improved behavioral effects with the use of CBD are also being seen.”
— Dr. Sherry Yafai

“We are starting to see a slew of data, studies, and research funding focused on the use of CBD for multiple different diagnoses, with this same common thread: the global improvement in well-being, as well as treatment,” she added.

CBD may be a good addition to epilepsy treatment

There were some limitations to the study. While the authors outlined that they had developed the questionnaire due to an FDA-recognized lack of appropriate surveys for caregivers for patients with epileptic encephalopathies on non-seizure outcomes, the nature of the conditions being researched meant that the data gathered was potentially subjective.

“This research is based on caregivers’ reports, not direct measurements of brain activity or objective medical data. Further research is needed to fully understand how CBD works in the brain and its long-term effects,” Dr. Ganjian said.

“CBD can interact with other medications, so it’s crucial to consult a healthcare professional before using it, especially for children. CBD is not a cure for epilepsy and should be used as part of a comprehensive treatment plan.”
— Dr. Daniel Ganjian