Does CBD Help Epilepsy?

About 1% of Americans live with some form of epilepsy, a chronic neurological disorder characterized by recurrent, unprovoked seizures. Epilepsy can result from stroke, Alzheimer’s disease, traumatic brain injury, or something else. For about 60% of cases, however, there is no clear cause.

Epilepsy disrupts all aspects of a person’s daily life. When a seizure strikes, the violent shaking can put the individual at very serious risk, depending on what they’re doing at the time. Individuals with epilepsy are also more prone to suffer from migraines, sleep issues, and depression and anxiety disorders.

Typically, epilepsy is treated with antiepileptic drugs (AEDs). Unfortunately, as many as 20% to 40% of people with epilepsy have drug-resistant epilepsy. For these individuals, AEDs simply aren’t effective, or the side effects are so severe as to make taking the medication prohibitive.

As a result, many seek out alternative treatments to help manage their epilepsy. One promising option is cannabidiol, or CBD oil. Due to its interaction with the endocannabinoid system, CBD can relieve a variety of the symptoms associated with epilepsy—without inducing a “stoned” feeling like THC. In fact, CBD has been so successful at alleviating seizures, that the first and only FDA-approved drug containing CBD is prescribed to treat severe forms of epilepsy.

Is CBD the Same as Medical Marijuana?

Before we get into how CBD can treat epilepsy, it’s helpful to understand what CBD is in the first place, and how it differs from medical marijuana.

Because they both hail from the cannabis plant, it’s common for people to confuse CBD with THC, the primary psychoactive ingredient in marijuana. Both CBD and THC are cannabinoids. But there are over 100 cannabinoids in the cannabis plant, and they have different properties.

THC is most popularly known for creating the “high” of marijuana. Marijuana is a strain of cannabis that contains higher amounts of THC. Besides its psychoactive effects, THC provides a number of health benefits that are useful for medical marijuana patients, such as pain relief, appetite stimulation, and nausea suppression.

CBD, on other hand, comes from hemp. This strain of cannabis is legal nationwide, since it contains high amounts of non-psychoactive CBD and very low amounts of THC. As a result, hemp products—and any CBD oils sourced from hemp—do not produce a “high.” While CBD will not get you high, it can create a general feeling of relaxation. As a natural anti-inflammatory and analgesic, CBD provides several other benefits, such as relief for migraines, pain, anxiety, and more.

Most pertinent for people with epilepsy, CBD appears to have superior anticonvulsant effects than THC:

thc vs cbd for epilepsy

CBD has also been shown to relieve other symptoms associated with epilepsy, such as migraines, inflammation, and sleep problems. CBD does all this without the less desirable aspects of THC. With CBD, patients don’t have to worry about getting high, or whether it’s legal where they live (CBD is legal throughout the United States).

Does CBD Help with Epilepsy?

In June 2018, the FDA approved the first drug containing CBD. This oral solution, called Epidiolex, contains 99% pure CBD and is prescribed to treat severe forms of epilepsy—specifically, Dravet syndrome and Lennox-Gastaut syndrome. Both of these begin during childhood. Because the seizures associated with these syndromes are so frequent and severe, they often result in delayed or poor development of the child’s language and motor skills, ability to connect with others, and intellectual aptitude.

Before approving the drug, the FDA held three randomized, double-blind, placebo-controlled clinical trials with a total of 516 patients who had either syndrome. When taken along with other medications, Epidiolex significantly reduced the participant’s frequency of seizures when compared with the placebo group. Moreover, the CBD also improved other related symptoms for the participants, such as sleep.

Currently, Epidiolex is only approved to treat these two types of epilepsy. However, a growing body of research indicates Epidiolex and CBD can be helpful in relieving other forms of epilepsy.

For example, in 2015, researchers provided Epidiolex to 214 patients of varying ages (from 1 to 30 years) in 11 epilepsy centers across the country. All of the patients had severe, childhood-onset forms of epilepsy which were resistant to treatment, including Dravet syndrome and Lennox-Gastaut syndrome. The researchers wanted to evaluate both the overall safety of the drug among treatment-resistant epilepsy, as well as the optimal dose, so they gradually increased the dose for patients from 2-5 mg/kg per day to 25-50 mg/kg per day. Overall, by the end of the 12-week treatment period, the monthly frequency of seizures decreased by 36.5%.

The Long-term Treatment Potential of CBD for Epilepsy

Individuals with treatment-resistant epilepsy tend to experience a “honeymoon” when they transition to a new therapy, meaning that over time, they eventually become resistant to that, too. In late 2018, researchers observed that this may occur with CBD treatment as well.

In the study of nearly 100 patients aged 1 to 37, about one-third of participants developed a tolerance to the CBD. The tolerance occurred on average about 7 months after they began the regimen, at which point they needed to increase the dose to maintain efficacy. When the dose was increased, nearly half of the patients achieved their previous response level. While it’s disappointing that the response was not maintained for all participants, the researchers reinforced that it was a “key finding” that for two-thirds of participants, the CBD remained effective on a long-term basis.

However, in an earlier study from 2015, researchers found that CBD treatment held significant, sustained effects over a period of 2 years. 132 child and adult patients were included in the study, and their seizures over a 2-week period reduced on average from 144 to 52. The participants were using 20 to 30 mg/kg per day doses of Epidiolex.

While the long-term potential of CBD still has to be evaluated, these studies go to show that CBD has a history of significantly alleviating both the severity and frequency of seizures for many individuals with treatment-resistant epilepsy.

How Does CBD Oil Stop Seizures?

The research suggests CBD has an ability to limit seizures due to its interaction with the body’s endocannabinoid system.

The endocannabinoid system works to maintain biological functions in a state of optimal functioning, from appetite and body temperature to sleep and motor control. To do this, the endocannabinoid system communicates with various bodily systems by way of cannabinoid receptors located throughout the central and peripheral nervous systems. Endocannabinoids (which are produced by the body as part of the endocannabinoid system) bind to these receptors as needed to reset a healthy equilibrium. After they’ve done their work, enzymes break down the endocannabinoids, preventing them from overcorrecting.

As a cannabinoid, CBD has a similar structure to that of the endocannabinoids produced internally by your body. As a result, when you ingest CBD, it’s also able to bind to cannabinoid receptors, even though it comes from a plant.

Scientists believe seizures stem from abnormal electrical activity in the brain, such as that caused by inflammation or overexcited neurons. For individuals with epilepsy, CBD primarily interacts with CB1 cannabinoid receptors in the brain. This interaction may improve the overall functioning of the person’s endocannabinoid system, leading to a reduction in seizures.

Scientists still do not understand exactly how this works, but they’ve made the following observations which may contribute to CBD’s ability to reduce seizures:

  • The release of endocannabinoids has a neuroprotective function, lowering the risk of seizure-induced neurotoxicity. When an individual ingests CBD, they introduce more cannabinoids into their system, potentially aiding a poorly functioning endocannabinoid system.
  • The endocannabinoid system also serves a modulatory function. Neuroexcitation may trigger seizures. A properly functioning endocannabinoid system, aided by the ingestion of CBD, may prevent that excitation from happening.
  • In addition to being an anticonvulsant, CBD is also an anti-inflammatory. Seizures may also be caused or worsened by brain inflammation. By reducing neuroinflammation, CBD may reduce the frequency of seizures or their severity.

Is It Safe to Take CBD for Epilepsy?

For healthy people, CBD is experienced with little to no side effects. However, CBD can produce side effects when combined with other medications. Since individuals with epilepsy are often taking other drugs, they should use caution and always consult a doctor before taking CBD.

With the Epidiolex clinical trials, for instance, the most common side effects were tiredness, diarrhea, and upset stomach, although some people in the placebo group reported these as well. Generally, though, the drug was well-tolerated among participants. More severe side effects included sedation, lethargy, decreased appetite, insomnia, and liver injury.

This last one is the most concerning, as liver injury can cause complications for individuals who are already taking AEDs, since the drugs are metabolized by the same group of enzymes as CBD. Specifically, some individuals who took valproic acid (VPA), a common anti-seizure drug, experienced up to a 300% increase in their liver enzyme levels above normal. However, the study authors noted that for most Epidiolex patients, the liver injury they experienced was mild and only cause for concern in that it increased the risk of more severe injury in the future.

This is why it’s important to consult with your doctor before using CBD, particularly if you are taking AEDs. They can advise you as to how to adjust your dosage of CBD or AED (and the times of day you take your dose) to avoid adverse interactions.

How to Use CBD to Treat Epilepsy

Epidiolex is an oral solution, although individuals using CBD to treat epilepsy may also take it in the following forms:

  • Vape oils, which are inhaled through a vaporizer or vape pen. Many prefer vape oils because they find the act of inhalation soothing, and they prefer the flavoring of vape oils over CBD’s natural earthiness.
  • Sublingual tinctures, which are administered via a dropper under the tongue (sublingually). Studies show that sublingual tinctures provide the highest, most consistent blood absorption rates of CBD.
  • Capsules, which are swallowed orally like any other pill. These can be an easy way to remember to take CBD and avoid any natural hemp taste.

The only drug containing CBD that has been officially approved by the FDA is Epidiolex. While CBD is widely available online and in many health and wellness stores, the CBD industry on the whole remains unregulated. This leaves room for less scrupulous manufacturers to make claims as to the quality or amount of CBD in their products, which may or may not be true.

Because CBD can interact with AEDs and other medication, it is important to consult with a doctor—ideally one trained in cannabis medicine—before starting any CBD regimen. Since they know your medical history, they are best positioned to advise you on what type of CBD you can use, whether they’ll need to adjust your other medication to avoid side effects, and the optimal starting dose.

Before starting CBD, we also recommend learning about the experience of others by asking questions in online forums like the Epilepsy Foundation Community Forums, and the CBD and Epilepsy subreddits.

Additional Resources

You can learn more about CBD at the links below.