Medical Marijuana and Pediatric Epilepsy

Cannabis for Children With Epilepsy

Research has shown that cannabis may help ease severe epilepsy in children and may help where other therapies have failed. British scientists discovered that medical marijuana reduced epileptic seizures in children by 90% while also reducing the need for traditional medications.

Epilepsy in Children Overview

Approximately 3.4 million people in the United States have epilepsy. Of these 3.4 million individuals, 470,000 are children.

Epilepsy often has no known cause but is sometimes believed to be triggered by:

• Stroke
• Brain tumor
• Traumatic Brain Injury
• An infection in the central nervous system (CNS)

Types

There are several different types of childhood epilepsy, but the ones that cannabis has shown the most promise in treating are:

• Dravet syndrome
• Lennox-Gastaut syndrome

Both Dravet and Lennox-Gastaut are severe forms of epilepsy characterized by frequent, violent seizures. In 2018, the Food and Drug Administration (FDA) approved Epidiolex as the first natural cannabis-derived medication to treat Dravet and Lennox-Gastaut syndromes. The FDA approval was groundbreaking, as up until 2018, only synthetically derived cannabis medications (i.e., Dronabinol for people with cancer) had been approved.

Traditional Treatments

Traditional treatments for epilepsy include the following:

• Seizure-reducing prescription medications like valproic acid and Clobazam
• Nutritional therapy
• Vagus nerve stimulation (VNS)
• Brain surgery

Prescription medications for epilepsy usually come with numerous side effects, such as stomach pain, nausea, diarrhea, headache, weight gain, and thinning hair. Some families, frustrated by these limitations, consider other approaches, such as medical marijuana. The benefit of Epidiolex and other cannabis-based treatments is that they usually cause only mild side effects or no side effects at all.

How Medical Marijuana Helps Seizures and Epilepsy in Kids

Cannabis and CBD may help some children with epilepsy, especially treatment-resistant epilepsy. CBD’s efficacy derives from the distinct differences between CBD and THC (delta-9-tetrahydrocannabinol).

THC typically affects several of the body’s endocannabinoid receptors and impacts our sense of pain, anxiety levels, and memory, as well as affecting perception, learning, and motor control. CBD, however, does not interact in the same way with our body as THC and does not interact with CB1 or CB2 receptors in the same way. When taken together, CBD can even dampen many of the effects THC has on the user or elongate THC’s effects at the same time as blunting them.

Multiple factors go into current theories for why CBD and medical marijuana effectively reduce the severity of intractable childhood seizure conditions. The experts aren’t precisely sure why CBD reduces convulsions in so many children suffering from chronic seizure conditions. However, Dr. Ben-Zeev of Sheba Medical Center in Israel is certain that:

1. A Facebook group of 150 parents reported an 84% reduction in seizure frequency after using CBD extracts to treat their children; 11% became seizure-free.
2. In another online survey, 117 parents of children with epilepsy using CBD extract reported 85% responders, with 14% of the children achieving seizure freedom.
3. A survey from Mexico tracked 53 patients aged nine months to 18 years, reporting that 83% of patients experienced improved seizure control, and 16% became seizure-free while using cannabis extract compounds.
4. Based on parental reports and a medical chart review, one-third of 75 children and adolescents with Lennox–Gastaut syndrome and Dravet syndrome who received doses of oral cannabis extracts experienced more than a 50% reduction in seizures.
5. A multicenter retrospective study from three epilepsy clinics in Israel treating 74 children for intractable epilepsy found that 52% of patients experienced more than a 50% reduction in seizure frequency.
6. A chart review on the effect of “artisanal” cannabis on 272 pediatric epilepsy patients from Washington and California noted a more than 50% reduction in seizure frequency in 45% of patients, with 10% becoming seizure-free.

It is interesting to note that THC also shows significant anticonvulsant properties, as do many other cannabinoids, psychoactive or non-psychoactive. Two of particular note are the CBD-related cannabidivarin (CBDV) and the acidic form of THC, tetrahydrocannabinolic acid (THCA).

Using Cannabis for Epilepsy in Children

There are several possible cannabis treatment options for children with epilepsy, including prescription medications, CBD products, and medical marijuana strains.

Prescriptions

Currently, Epidiolex is the only FDA-approved cannabis medication for childhood epilepsy. Unlike over-the-counter CBD products, most health insurance companies cover Epidiolex, which is an important benefit for many people as the drug can be very costly out-of-pocket.

Not only can CBD-based medical cannabis treatment be used to treat children and adolescents with intractable epilepsy, but that use has happened for decades already.

In January 2020, the U.S. National Library of Medicine published an article titled “Medical Cannabis for Intractable Epilepsy in Childhood: A Review.” The entry provides an overview of studies conducted during the previous six years into the efficacy of using medical cannabis products to relieve the symptoms of intractable childhood seizure disorders.

The National Library of Medicine author Bruria Ben-Zeev, MD, a specialist in pediatric neurology, notes a long history of study, predating the discovery and isolation of CBD, that documents cannabis used as an epilepsy therapy.

Dr. Ben-Zeev also links Chinese historical records from 2700 BC and Sumerian and Akkadian tablets inscribed in 1800 BC to 19th-century papers published by leading physicians of the day, all extolling the virtues of cannabis as an anticonvulsant.

Frequently Asked Questions

Is medical marijuana okay for kids?

Under proper medical supervision, marijuana may be appropriate as a supplemental treatment for treatment-resistant epilepsy in some children. There are some important considerations regarding the use of any therapy, especially cannabis, in younger patients. Your ReThink-Rx specialist will explain these to you.

How safe is using cannabis to treat epilepsy in kids?

Epidiolex, a cannabis-derived prescription drug, has received FDA approval, which means that it has an acceptable safety profile. The drug is intended to treat severe forms of epilepsy, including Dravet syndrome and Lennox-Gastaut syndrome.

Use of other cannabis products should balance the risks against the benefits, like any other therapy. Adding THC-containing products to the therapeutic plan should balance the effects of sedation, psychotropic effects, and other unwanted effects against the goal of reducing seizure frequency and severity. Always conduct this therapy with the guidance and oversight of all your healthcare providers, especially your neurologist.

The Best Ways to Use Medical Marijuana for Epilepsy

A few good methods of delivery for medical marijuana to children are:

• Edibles: These are a great choice for someone who is inexperienced with cannabis treatments, like your child, for example. You can give them a tasty treat infused with cannabis.
• Tinctures and sprays: These go in your child’s mouth. They’re very versatile and discreet. Your pharmacist will demonstrate how to administer these.

Conclusion

Many patients and their families have turned to medical cannabis to treat pediatric seizure disorders like Dravet Syndrome and Lennox-Gastaut syndrome. At ReThink-Rx, we have helped numerous families gain access to this important therapy with great success. The science regarding these applications is still young but promising. The FDA has approved Epidiolex for childhood seizures. It is the first natural cannabis therapy approved for such an application. Whole-plant medical marijuana contains many cannabinoids, each working with the others to produce their effects in what’s referred to as the entourage effect. Together, the cannabinoids complement and enhance the effects of the others. The details of these interactions are the subject of intense study.

Working with a neurologist who is familiar with medical marijuana is paramount. These specialists are crucial to monitor the effects of the therapy, adjust dosing, and support patients and their families. While medical marijuana specialists offer education and certification for the therapy, the neurologist must actively follow the young patient’s condition in an area that is typically beyond the scope of practice of most other providers.

Seizure control is one of the many indications for medical marijuana. But selecting this therapy for a minor must be taken seriously, as the long-term effects are still being studied. Presently, the American Academy of Pediatrics does not yet endorse this therapy. The pros and cons must be balanced carefully, and the approval for the therapy must be offered on a case-by-case basis.

Dosing and strain choice are important considerations for the therapy, and your medical marijuana specialist and dispensary pharmacist will help you learn and choose wisely. Multiple methods for consumption make administering the therapy more approachable for younger patients. Additional legal and procedural steps are needed to make cannabis therapy available to minors, so choose your medical marijuana specialist carefully to ensure compliance with the laws in your area.

If your child’s neurologist thinks medical cannabis may be an option worth considering, contact the specialists at ReThink-Rx for help. We are happy to discuss your child’s condition and explain more about medical marijuana as an option.