The Wall Street Journal, The New York Times, and Time Magazine have all weighed in on medical marijuana. Even CNN’s Dr. Sanjay Gupta is calling for a revolution to legalize the drug, the site reports.
So far, 23 states and Washington, D.C., have legalized medical marijuana in some form, according to the National Conference of State Legislatures.
Patients and parents desperate to manage severe cases of epilepsy like Dravet syndrome, which is treatment-resistant and involves multiple seizures, have looked to medical marijuana for relief.
But not everyone is fully on board.
“We’ve already had patients come to us and say that the only thing they’ll take is marijuana instead of proven therapy,” says Kathryn Davis, MD, MTR, neurologist and medical director of the Epilepsy Monitoring Unit at the Penn Epilepsy Center. “That’s frightening because we don’t yet have the research to support this decision.”
A Tangled Web
The controversy surrounding the use of medical marijuana for epilepsy is caught up in Charlotte’s web. Not the children’s storybook, but Charlotte Figis, a 5-year-old from Colorado who was given marijuana oil to manage her seizures - and it worked, according to an August 2013 report by CNN.
Medical marijuana for a five-year-old? It’s not what you think. Charlotte was having over 300 seizures a week, each lasting at least 30 minutes, and even the strongest medications weren’t working. Her parents desperately sought relief for her chronic seizures and this provided that relief.
But even after showing success in small clinical trials, medical marijuana may not actually be the magical potion for seizures after all.
“Initially, it was just one child who had a dramatic improvement with medical marijuana, and that received a lot of publicity,” warns Dr. Davis. “The press highlighted this so much on very little scientific data - or no scientific data - and it was all over the news. It’s a very hot topic, but it’s an unstudied topic. Physicians need to carefully advise their patients on the use of medical marijuana. It clearly needs more study and trials are ongoing. As a clinician, I rely on evidence based medicine to treat my patients, and, unfortunately, we don’t yet have solid evidence for medical marijuana in epilepsy.”
The Root Of The Problem
The marijuana plant consists of more than 400 chemicals. But the ones that concern people seeking relief from seizures are: THC, or tetrahydrocannabinol, and CBD, or cannabidiol.
Each of these components has a very specific role.
“THC is the psychoactive component in marijuana that gives the euphoric high feeling,” explains Danielle Becker, MD, MS, neurologist and director of the RNS Program at the Penn Epilepsy Center. “CBD does not cause psychoactive effects, but has shown some positive effects on certain body systems and may help prevent seizures.”
Extracted as an oil from the cannabis plant, highly concentrated CBD—as in 98% CBD to 2% THC- has been proven to manage certain seizures quite well in small clinical trials, says a December 2014 report from the American Epilepsy Society (AES).
But marijuana has inconsistent amounts of these particular cannabinoids, Dr. Becker adds. That is where the controversy lies: at this point the FDA does not regulate how much of each compound is in the marijuana and therefore how much of each compound a person receives is not controlled and what amounts are effective has yet to be established. And even with a greater concentration of CBD to THC, the risks may actually outweigh the benefits.
Medical Marijuana On Trial
Researchers found that one-third of nearly 60 children and adolescents receiving the cannabis extract had a reduction in seizures by 50% or more, according to a December 2014 report from AES.
However, in this same group, nearly 50% also experienced:
- More seizures or new seizures
- Sleeplessness and fatigue
- Developmental decline (including an intubation and a death)
In yet another smaller study, a cannabis extract called Epidiolex was given to 23 patients, who averaged 10 years of age and had severe forms of epilepsy, such as Dravet syndrome and Lennox-Gastaut Syndrome.
Nine of the 23 patients reduced their seizures by more than 50%, states the December 2014 AES report. One-third of the Dravet syndrome patients became seizure-free.
“Medical Marijuana is much less defined in children and contains many different compounds along with THC and CBD in inconsistent concentrations,” explains Dr. Becker. “THC has been associated with possible increase in seizures.”
The truth is that marijuana may not help all types of epilepsy. In fact, it may actually make some types worse, says Dr. Davis. Until a large clinical trial shows that it’s effective for reducing seizures, medical marijuana is not the best answer for seizure control.
However, this doesn’t mean you are out of options.
“Medical marijuana contains different compounds along with THC and CBD in inconsistent concentrations,” explains Dr. Becker. "There are many different formulations and there is a lot to be learned about the various compounds and their effects. Studies are currently being run to determine which concentrations will be most beneficial to patients. Until then caution is advised as some compounds, including THC, have been associated with a possible increase in seizures.”