cbd oil for simple partial seizures

THE BEAST

CBD is a component of the cannabis plant that is used to relieve stress and anxiety . It is known for its anti-seizure properties. It is not psychoactive, and does not produce a ‘high’ in its users, unlike another popular cannabis component, Tetrahydrocannabinol (THC).

CBD Oil is an effective and legitimate way to treat seizures.

Studies have suggested that teens and children who have epilepsy and were treated with pharmaceutical Cannabidiol (CBD) products, experienced enhanced seizure control than those treated with artisanal CBD.

Pharmaceutical CBD products do not contain THC, while artisanal CBD does.

A CBD drug Epidiolex has been approved by the Food and Drugs Administration (FDA) to treat the two most severe forms of epilepsy, Lennox-Gastaut syndrome and Dravet syndrome. People who suffer from these disorders often do not respond to convention medications that are used to treat epilepsy.

CBD Derived from Hemp

Hemp is a variety of the Cannabis Sativa plant. Hemp was originally grown for the fibrous materials that are found in its seeds and stalks. It has been traditionally used to manufacture items such as upholstery, clothing fibre, and other household items.

Hemp plant is abundantly rich in CBD , and contains much lower concentrations of THC than the cannabis plant. Cannabinoids that are extracted from hemp plants, including CBD, were up until recently considered as marijuana, and were classified as Schedule I substances.

According to the Drug Enforcement Agency (DEA) , the substances that constitute Schedule I have no accepted medical usage and have high potential for being abused.

After the enactment of the Farm Bill in 2018, hemp and CBD derived from hemp are no longer classified as Schedule I substances. Instead, they are recognized as an agricultural commodity. Thus, CBD derived from hemp is not illegal at the federal level of the USA, however some states still demm it as illegal. So before purchasing any CBD product make sure to check your state laws.

What are Complex Partial Seizures?

A Complex Partial Seizure is a type of seizure that starts out in a single area of our brain. It is also known as a focal onset impaired awareness seizure or a focal impaired awareness seizure. More often than not, the seizure starts in the temporal lobe of the brain.

It most commonly affects people who have epilepsy. A complex partial seizure also affects people with cerebral palsy.

The seizures are characterised by uncontrolled movement of limbs and other parts of the body. The seizures last for a short duration, during which the person experiencing the seizures is unaware of their surroundings.

The person experiencing the seizure may also lose consciousness for a brief duration of time. People who have been diagnosed with epilepsy often experience this type of seizure.

Symptoms of Complex Partial Seizures

A Complex Partial Seizure can have several symptoms associated with it. However, it is not necessary that all symptoms are visible during each and every seizure. Complex Partial Seizures usually only last for a few minutes.

Seizures that begin in the frontal lobe of the brain generally last shorter than the ones that start in the temporal lobe area.

Symptoms often appear abruptly, and they person experiencing them may not even realise that they have just had a seizure. The symptoms include:

  • Being unable to recollect the seizure after it ends
  • Being unable to respond during the seizure
  • Being partially or wholly unaware of their surroundings
  • Being confused when the seizure ends
  • Hallucinations
  • Say words repetitively
  • Scream, laugh, or cry uncontrollably
  • Daydreaming
  • Trying to hurt themselves

What Causes Complex Partial Seizures?

While Complex Partial Seizures are usually a consequence of epilepsy, they can be caused by several other factors. Some of these include:

  • Anxiety and Depression
  • Autism
  • Damage caused prior to birth
  • Extreme stress
  • Neurofibromatosis
  • Neurologic conditions
  • Other medical conditions related to the brain
  • Psychological distress or trauma

What Triggers the Complex Partial Seizures?

A Complex Partial Seizure usually occurs without warning, and can happen at any given time. Sometimes the person can first experience an aura, which is a simple partial seizure. It acts as a warning that a bigger seizure is on its way.

Some additional factors that can trigger a seizure include:

  • Flashing Lights
  • High Fever
  • Low Blood Sugar
  • Reactions to certain medications

Treatments for Complex Partial Seizures

There are several types of treatments available to manage Complex Partial Seizures. Some of the common ones are:

  • Antiepileptic Drugs
  • Tiagabine hydrochloride (Gabitril), a new antiepileptic drug that shows significant promise in several trials
  • Stimulation of the Vagus nerve
  • Responsive Neurostimulation
  • Surgery
  • Dietary changes

Health Conditions Associated with Complex Partial Seizures

A Complex Partial Seizure can be experienced by anyone. However, people who have certain medical conditions makes them predisposed to these seizures. These conditions include:

  • Brain Injury
  • Cerebral Palsy
  • Epilepsy
  • Infection in the brain
  • Some heart conditions
  • Stroke
  • Tumours

People who are afflicted with these conditions may have higher chances of experiencing Complex Partial Seizures.

Are Antiepileptic Drugs Effective?

Conventionally, the preferred choice of treatment for seizures and epilepsy are antiepileptic drugs. While these drugs are effective, they are also riddled with several side effects. These side effects include:

  • Drowsiness
  • Fatigue
  • Nausea
  • Vomiting
  • Sleep Disorders
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Moreover, studies have found that up to thirty percent of people who have epilepsy do not respond to antiepileptic drugs. As the success rate of antiepileptic drugs is not very high, researchers have started to explore more natural and efficient methods of treatment.

CBD to Treat Complex Partial Seizures

A meta-analysis published in the Journal of Neurology, Neurosurgery and Psychiatry studied the effects of CBD in treating epilepsy. It suggested that CBD could aid in reducing and even stopping seizures altogether.

Researchers from various institutions studied the results of the analysis. Most of the studies that were a part of the meta-analysis involved children with the average age of 16 years.

The team observed that CBD reduces seizures along with improving the quality of life of patients suffering from seizures and epilepsy. They also noted a significant drop in the frequency of the seizures in over half of the participants of the studies.

The research team also found that almost forty eight percent of the people who participated in the studies experienced a reduction in the frequency of their seizures by over fifty percent.

The evidence suggests that CBD has tremendous potential to be a natural and effective treatment to manage and reduce seizures.

Epidiolex is a pharmaceutical drug that contains CBD, and has been approved by the FDA to treat two severe forms of childhood epilepsy. However, currently the drug is prescribed to treat only Lennox-Gastaut syndrome and Dravet syndrome.

If you are looking to treat other kinds of seizures, including Complex Partial Seizures, there are several other CBD infused products available in the market like CBDistellery’s CBD oil , that is made with organically grown hemp and can be used to treat your condition.

Conclusion

To sum up, there is sufficient evidence that suggests that CBD products can be beneficial in treating and managing seizures and epilepsy, including Complex Partial Seizures. To choose the best course of treatment for yourself, it is recommended that you consult your doctor and get an accurate diagnosis of your condition. Only after you are diagnosed by a qualified medical practitioner, you should start to look for treatment options.

CBD has proven to be an effective and a natural treatment to several ailments, especially epilepsy. It may successfully aid in relieving the symptoms of Complex Partial Seizures.

Could Cannabidiol be a Treatment Option for Intractable Childhood and Adolescent Epilepsy?

Epilepsy is an important disease that affects brain function, particularly in those under 3 years old. Uncontrolled seizures can affect cognitive function and quality of life. For these reasons, many trials have been conducted to investigate treatments for pediatric epilepsy. Currently, many antiepileptic drugs are available for the treatment of epilepsy, but cases of intractable epilepsy continue to exist. In the past, cannabis has been tested as a potential treatment of intractable epilepsy. Since 2013, 10 epilepsy centers in America have conducted research regarding the efficacy of cannabis to treat epilepsy. Cannabis has many components, including cannabidiol (CBD) and Δ 9 -tetrahydrocannabinol (THC). THC has psychoactive properties exerted through its binding of the cannabinoid receptor (CBR) whereas CBD is a CBR antagonist. The inhibition of epilepsy by CBD may therefore be caused by various mechanisms, although the detailed mechanisms of CBD actions have not yet been well defined. In most studies, trial doses of CBD were 2–5 mg/kg/day. Several such studies have shown that CBD does have efficacy for treatment of epilepsy. Reported adverse effects of CBD were mostly mild, including drowsiness, diarrhea, and decreased appetite. Severe adverse reactions requiring treatment, such as status epilepticus, have also been reported but it is not clear that this is related to CBD. Furthermore, many previous studies have been limited by an open-label or survey design. In future, double-blind, controlled trials are required and the use of CBD to treat other neurological problems should also be investigated.

Introduction

Epilepsy impacts the brain, and is associated with cognitive dysfunction and behavior disorder, which can affect quality of life, especially during the developmental period.1–3 Early onset epilepsy, particularly in those less than 3 years old, and uncontrolled seizures are associated with poor cognitive function later in life.4

Currently, more than 20 different antiepileptic drugs (AED) exist for the treatment of epilepsy. However, 30% of patients with epilepsy continue to have seizures.5–7 Many new medications have been approved in the past two decades, but these have not reduced the proportion of patients with intractable epilepsy.5 Recently, cannabis has attracted attention as a potential treatment of epilepsy.7 Cannabis was used to treat epilepsy in Sumeria as early as 1800 BCE.7,8 In the late 19th century, English neurologists also used cannabis for the treatment of epilepsy.9–11 More recently, some states in America have approved medical marijuana for the treatment of epilepsy. Moreover, since 2013, the effects of cannabidiol (CBD) in the treatment of epilepsy have been studied at 10 epilepsy centers using Epidiolex, a purified cannabis containing 99% CBD and less than 0.10% tetrahydrocannabinol (THC). (GW Pharmaceuticals, Sativex, London, UK).

Cannabis contains more than 545 distinct compounds, the most abundant of which are cannabinoids.12 The most important neuro-active components of cannabis are CBD and Δ 9 -THC. THC binds to G-protein-coupled cell membrane receptors, including the cannabinoid receptor type 1 (CB1R), which is found primarily in the brain, but is also present in peripheral tissues, and the cannabinoid receptor type 2 (CB2R), which is located mainly in immune and hematopoietic cells. THC binds CB1R in inhibitory gamma-aminobutyric acid-ergic and excitatory glutamatergic neurons.13,14 These interactions are the pathways by which cannabis exerts its psychoactive function. However, CBD is an antagonist to CB1R and CB2R.15 Some animal studies show that CB1R antagonists can reduce the threshold of seizures.16 This suggests that CBD has another mechanism by which it can control seizures. Indeed, CBD acts via multiple mechanisms ( Fig. 1 ).7,14,15 These include effects on transient receptor potential ation channels at a low level,17 and antagonistic functions at G-protein-coupled receptor 55, by which it can decrease presynaptic glutamate release.18 However, the mechanisms underlying the anti-epileptic effects of CBD are not well defined.

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Cannbidiol mechanism and structure. CB1R, cannabinoid receptor type 1; CB2R, cannabinoid receptor type 2; GPR 55, G-protein-coupled receptor 55; TRPV1–4, transient receptor potential cation channel subfamily V 1–4;TRPVM8, transient receptor potential cation channel subfamily M 8; 5HT3AR, 5-hydroxytryptophan type 3A receptor.

CBD is metabolized by the liver, and it can inhibit cytochrome P (CYP) 450, especially CYP 2C and CYP 3A, which aids metabolism of several AED.19,20 Therefore, if a patient with epilepsy takes CBD with an enzyme-inducing AED, such as carbamazepine or phenytoin, the AED can reduce serum CBD levels. Whereas, if the patient takes clobazam (CLB) with CBD, CBD can raise the serum level of nor-oclobazam, the active metabolite of CLB.21 The half-life of CBD in humans is estimated to be between 18 and 32 hours.22

Here, we review recent trials that have investigated the use of CBD as a treatment for epilepsy and highlight key issues for future research.

Trial dosages of CBD

In many studies, CBD was added to a baseline AED at an initial dose of 2–5 mg/kg/day divided into two doses. CBD was up-titrated by 2–5 mg/kg once a week until intolerance or to reach a maximal dose of 25 mg/kg/day. Some studies increased the does to 50 mg/kg/day, as allowed by the US Food and Drug Administration. The average of dose of CBD was 200–300 mg/day.7

Clinical trials of CBD to treat epilepsy

Some U.S. states now allow the use of cannabis for medical treatment. Many patients with epilepsy have wanted to try cannabis as a treatment even though preclinical and clinical evidence is limited. As mentioned above, several clinical studies have investigated CBD after the late 19th century. Recent studies have shown an effect of CBD in treating epilepsy ( Table 1 ). They suggest that CBD can reduce the frequency of seizures, reducing monthly frequency in most types of seizures. Many studies have included a significant number of patients with Dravet syndrome (DS) and Lennox-Gastaut syndrome (LGS), and have observed reduced seizures as an effect of CBD.

Table 1

Study in cannabidiol in the treatment of epilepsy

Study Age (year) Dose Group (n) Results Reference
Retrospective, parent survey in pediatric refractory epilepsy 6–13 19 Complete seizer freedom: 2 patients
More than 80% reduction in seizure frequency: 8 patients
25–60% seizure reduction in seizure frequency: 6 patients
Porter and Jacobson33
Retrospective, 12- month trial for refractory epilepsy in tuberous sclerosis complex 3–29 Maximum dose of 50 mg/kg/day 18 The 50% responder rates were 50 % after 12 months. Hess et al.25
Retrospective, open label, 12- week trial in refractory epilepsy 1–22.2 Maximum dose of 25 or 50 mg/kg/day 162 More than 50% reduction in seizure frequency: 51 patients
More than 70% reduction in seizure frequency: 30 patients
More than 90% in seizure frequency: 11 patients.
Devinsky et al.23

Between 2014 and 2015, Devinsky et al.23 conducted a prospective, open-label, and expanded trial at 11 epilepsy centers in America. They enrolled 214 patients in the study, of which 137 (64%) were included in an efficacy analysis group and 162 (76%) were included in a safety analysis group. They observed enrolled patients for 12 weeks. This study reported a decrease of 34.6% in the median change of total seizures after 12 weeks’ treatment with CBD. It also showed a decrease of 55% in focal seizures and 54.3% in atonic seizures. They observed a decrease of 36.5% and 16% in tonic seizures and tonic-clonic seizures, respectively. Overall, the median monthly frequency of motor seizures decreased by 47%.

This open-label trial enrolled a large portion of patients with DS (n = 32) or LGS (n = 30). In the case of DS, 16 patients (50%) showed a reduction in motor seizures of more than 50%, and one patient (3%) was free from motor seizures during the 12 weeks of treatment. They reported a median change of −69.2% in monthly tonic seizures (n = 6) and a median change of −46.7% in monthly tonic-clonic seizures (n = 29). Non-motor-focal seizures (n = 10) were observed to show a median reduction of 83.3%. Among patients with LGS (n = 30), 11 (37%) showed a decrease in seizures of more than 50%, but none were seizure free during treatment. The percentage change in monthly seizures for all seizure types was −35.5%. The median change for atonic seizures (n = 14) was −68.8%. In patients with tonic seizures (n = 21), there was a median reduction of 44.0%. However, there was no change in tonic-clonic seizures (n = 16).

Infantile spasm (IS) is another epileptic encephalopathy in need of an effective treatment. In 2014, Hussain et al. conducted a survey about CBD exposure,24 which included patients with IS and LGS. Although this study had several limitations, it supported the possibility that CBD could effectively treat IS and LGS.

Hess et al. studied the efficacy of CBD for refractory epilepsy in tuberous sclerosis complex (TSC).25 They enrolled 18 patients with epilepsy and TSC between 2014 and 2015, and treated them for 6–12 months with CBD. In total, 14 patients (77%) had a mutation, half of whom had a TSC1 mutation and the other half of whom had a TSC2 mutation. At baseline, 72% of patients had shown one or more type of seizure.25 In this study, the median total weekly seizure frequency reduced by 32% after 2 months and 55% after 6 months. At study completion after 12 months of treatment, the seizure frequency was decreased to 63%. Regarding the CBD effect on each type of seizure, epileptic spasms and atonic seizures showed the greatest response. The responder rate of tonic-clonic seizures was 66.7% after 3 months’ treatment. The rates of complex partial seizures and complex partial seizures with secondary generalization were 53.8% and 50% after 3 months’ treatment, respectively. This study was limited by a small sample size, as well as an uncontrolled and unblinded design, but suggests a potential effect of CBD in TSC.

Reported adverse effects

In previous studies, the most common adverse effect of CBD was drowsiness. Most reported adverse effects were mild, for example diarrhea, fatigue, and decreased appetite. Nonetheless, some more serious effects, including status epilepticus, have been reported.

Devinsky et al. reported adverse events in 128 (79%) of 162 recruited patients.23 Most of these adverse effects were mild or moderate, and transient. Critical adverse effects considered to be caused by CBD were observed in 20 patients (12%).23 The most common adverse event was somnolence, while status epilepticus was the most severe and required urgent treatment ( Table 2 ). It is interesting that CBD had this severe adverse effect, status epilepticus, because animal studies have not shown any proconvulsant effects of CBD.9,26 Devinsky et al. also reported thrombocytopenia in 5 patients (3%), but there were no clinical changes in white or red blood cells. CBD also did not affect renal function. Ten patients (6%) showed elevated liver enzymes and this elevation was significant in one patient (< 1%). The authors did not find any relationship between status epilepticus and reduced doses of AED or CBD. Four patients stopped CBD treatment before the end of 12 weeks because of a worsening of seizures or poor efficacy.

Epilepsy & Seizures

More than 2 million people in the United States suffer from epilepsy, a neurological condition affecting the nervous system and triggering frequent seizures in patients. Seizures are disruptions in the normal electrical activity of the brain.

Epileptic patients almost always experience seizures, but it is important to note that not all seizures are caused by epilepsy.

Causes

Epilepsy can surface due to a variety of causes. Sometimes there is a genetic predisposition toward it, and sometimes the exact cause may never be established, which is the case for nearly half of those who suffer from it.

Potential causes for seizures in some infants and children include:

  • Brain malformations
  • Lack of oxygen during birth
  • Intracranial hemorrhage
  • Maternal drug use
  • Fever/febrile seizures
  • Brain tumor
  • Infection
  • Head trauma

Diagnosis

To determine if your child has epilepsy or another seizure-related disorder, our staff will review your medical history as well as specific details about any seizures experienced. From new onset seizures to seizures that are difficult to treat, the Epilepsy Program at Child Neurology Consultants of Austin is here to help. Additional testing is commonly required and often includes:

  • Blood tests
  • CT or MRI scans

Treatment

There are several medications available to help control seizures. Your child may need to try out a few different types to see which is most effective. If seizure medication does not work, there are alternative treatments including surgery, brain stimulation, cannabidiol oil (CBD oil), as well as dietary and behavioral therapies. We will work with you to determine the best possible option for your child.

Other types of seizures we treat include:

  • Absence seizures
  • Atonic seizures
  • Clonic seizures
  • Myoclonic seizures
  • Tonic seizures
  • Simple partial/complex partial seizures
  • Refractory seizures

Resources

Website Resources

Tips/Handouts

Pediatric Neurologist in Central Austin, Cedar Park and South Austin

Child Neurology Consultants of Austin has several board-certified, fellowship-trained pediatric neurologists who can evaluate your child’s seizures, including epilepsy, and guide their treatment. To schedule an appointment, call us at (512) 494-4000, or book an appointment online. We look forward to serving you at one of our three convenient locations in Central Austin, Cedar Park, or South Austin.

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