Seizure patients trying medical cannabis need to know how much CBD for epilepsy treatment.
When the story of Charlotte’s Web (a CBD-rich strain of cannabis) went viral, it became difficult for the world to ignore the potential for the cannabis plant in the treatment of intractable epilepsy. Since the story of CBD for epilepsy broke in 2012, there are now hundreds of results on PubMed for cannabis and epilepsy. But what do we know about dosage? How much CBD for epilepsy is effective?
A New Systematic Review and Meta-analysis on CBD
In 2020, the Journal of Epilepsy & Behavior is set to publish a review, “Efficacy and adverse event profile of cannabidiol and medicinal cannabis for treatment-resistant epilepsy: Systematic review and meta-analysis.”1)Reis, R. D. C., Almeida, K. J., Lopes, L. D. S., Mendes, C. M. D. M., & Bor-Seng-Shu, E. (2020). Efficacy and adverse event profile of cannabidiol and medicinal cannabis for treatment-resistant epilepsy: Systematic review and meta-analysis. Epilepsy & Behavior, 102, 106635. doi: 10.1016/j.yebeh.2019.106635
The review pulls over two hundred individual studies. The authors then whittled this down to only twenty after excluding those which didn’t meet the criteria for inclusion. Out of the twenty studies, nineteen were looking at cases of childhood epilepsy.
The goal of this meta-analysis was to find out just how useful cannabis and cannabis medicine was for the treatment of drug-resistant epilepsy. The authors also wanted to systematically look for adverse events.
CBD Treatments Considered Effective
Once collected and analyzed, the review came to a few key conclusions. First, “CBD treatments were effective compared with placebo, regardless of the dose administered.” Second, many of the studies assessed under this meta-analysis relied on treatments containing a minimal level of THC.
When it came to adverse events, the review pulled several common threads from the body of literature. The most commonly-reported side effects were drowsiness, appetite loss, weight loss, and diarrhea. These are typical side effects of CBD treatment. Pharmaceuticals used in the treatment of epilepsy also cause these symptoms. The authors of the review also added that adverse events were more prevalent over the short term than during long term treatment with CBD.
Based on their analysis, the authors behind this study determined that “CBD treatment for epilepsy is effective in reducing the frequency of seizures.” They also found evidence for efficacy of THC and CBN (cannabivarin). However, they found that keeping THC reduced adverse side effects on children.
How Do Cannabinoids Work?
Before tackling the pertinent question of “how much CBD for epilepsy?”, it might first be relevant to understand why cannabinoids like CBD are so useful. According to a paper published in the Journal of Epilepsy Research (2017), called “Cannabinoids in the Treatment of Epilepsy: Hard Evidence at Last?” researchers now understand that the endocannabinoid system undergoes alterations in various types of epilepsy. Furthermore, “external modulation of these systems can prevent or modulate seizure activity.”2)Perucca E. (2017). Cannabinoids in the Treatment of Epilepsy: Hard Evidence at Last?. Journal of epilepsy research, 7(2), 61–76. https://doi.org/10.14581/jer.17012
Scientists discovered several dramatic changes in the endocannabinoid systems of patients with epilepsy. These included lower levels of naturally occurring endocannabinoids and downregulation of CB1 receptors. The suggestion is that epilepsy seems to change the endocannabinoid environment. It does this, in theory, by reducing the ability of the human body to self-regulate the imbalance.
Cannabinoids seem to modulate this imbalance. The three most valuable options for intractable epilepsy are CBD, THC, and CBN. Each cannabinoid works in unique ways within the endocannabinoid system, but these therapeutic properties are still not completely clear.
Researchers hypothesize that CBD does not have a true affinity to either of the two cannabinoid receptors (CB1 and CB2). So, its anti-seizure characteristics occur through other mechanisms of actions. Some suggestions include working with G-protein-coupled receptors, ion channels, 7-transmembrane receptors, and other non-endocannabinoid sites of action.
How Much CBD for Epilepsy?
The media often talks about CBD as a miracle cure for cases of severe childhood epilepsy. Although cannabinoids are naturally occurring, and the plant has a comparatively good safety profile, it is always wise to work with a physician to determine usefulness and dose. The guidance of a healthcare professional is invaluable for chronic conditions. This is also true for those incorporating CBD into a holistic treatment plan.
Still, patients need to arm themselves with information when speaking with a professional. For example, how much CBD for epilepsy does the research use?
Within the meta-analysis detailed above, effective solutions consisted of either pure CBD or a ratio of CBD to THC. Common ratios included 20:1 or 50:1 of CBD to THC. The addition of low-levels of THC may help reduce the reported adverse reactions of weight loss. Most of the studies followed a slow and steady titration from low daily doses to a maximum of 50 mg of cannabinoids per kilogram per day.
CBD Rich, THC Low Treatment
In a study published in the American Neurological Association (2018), twenty participants received a high-CBD, low THC daily dose over twenty weeks to treat Dravet Syndrome (a rare form of epilepsy). In the nineteen participants who completed the trial, there was a seventy percent reduction in “median motor seizure” activity. Quality of life was also statistically improved. In this trial, the “mean dose achieved was 13.3 mg/kg/day of CBD (range 7–16 mg/kg/day) and 0.27 mg/kg/day of THC (range 0.14–0.32 mg/kg/day).”3)McCoy, B., Wang, L., Zak, M., Al-Mehmadi, S., Kabir, N., Alhadid, K., McDonald, K., Zhang, G., Sharma, R., Whitney, R., Sinopoli, K., & Snead, O. C., 3rd (2018). A prospective open-label trial of a CBD/THC cannabis oil in dravet syndrome. Annals of clinical and translational neurology, 5(9), 1077–1088. https://doi.org/10.1002/acn3.621
The essential takeaway into “how much CBD for epilepsy is effective?” is the importance of slow and steady titration. Starting low and increasing every few days is the best way to achieve maximum therapeutic value, while minimizing adverse side effects.
The Research on CBD for Epilepsy Speaks for Itself
There are now at least twenty well-controlled clinical trials of cannabinoids for the treatment of drug-resistant epilepsy. As the forthcoming meta-analysis indicates, cannabinoids are safe and have a comparatively low side-effect profile.
When it comes to how much CBD for epilepsy is safe and effective, patients should still work with a healthcare practitioner to determine the proper dose. These patients also need to be closely monitored for upticks in seizure activity. So far, it seems as if pure CBD, as well as combinations of CBD with THC, are incredibly useful. Additionally, several studies indicate that for patients that become habituated to CBD, cycling with THC may improve seizure outcomes.
For those suffering with epilepsy, these cannabinoid compounds are improving quality of life and reducing the frequency of seizures.
References [ + ]
|1.||↑||Reis, R. D. C., Almeida, K. J., Lopes, L. D. S., Mendes, C. M. D. M., & Bor-Seng-Shu, E. (2020). Efficacy and adverse event profile of cannabidiol and medicinal cannabis for treatment-resistant epilepsy: Systematic review and meta-analysis. Epilepsy & Behavior, 102, 106635. doi: 10.1016/j.yebeh.2019.106635|
|2.||↑||Perucca E. (2017). Cannabinoids in the Treatment of Epilepsy: Hard Evidence at Last?. Journal of epilepsy research, 7(2), 61–76. https://doi.org/10.14581/jer.17012|
|3.||↑||McCoy, B., Wang, L., Zak, M., Al-Mehmadi, S., Kabir, N., Alhadid, K., McDonald, K., Zhang, G., Sharma, R., Whitney, R., Sinopoli, K., & Snead, O. C., 3rd (2018). A prospective open-label trial of a CBD/THC cannabis oil in dravet syndrome. Annals of clinical and translational neurology, 5(9), 1077–1088. https://doi.org/10.1002/acn3.621|