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As of 2019, evidence from high-quality randomized control trials suggest that cannabidiol (CBD) probably reduces seizures among children with drug-resistant epilepsy. Under the currently limited evidence-based literature, these findings should be by primarily restricted to CBD and not extrapolated to all cannabis-based products. With that being said, some of the major medicinal benefits of cannabinoids stem from their ability to be powerful neuroprotectants, antioxidants and anti-inflammatory agents.

Many case reports have illustrated the potential of THCA, the precursor of THC, to be clinically useful in seizure prevention. This type of promising anecdotal evidence needs to urgently drive more research into examining minor cannabinoids like THCA and the synergistic effects of cannabinoids and terpenoids in whole plant products.

In comparison to almost all other medications, cannabis has a superior safety profile, especially considering there has been no reports of a toxic dose of cannabis in humans in the over 10,000 years of its recorded use. Not only does cannabis have inherent safety features, CBD in particular, appears to have a very broad and safe effective dosing range for epileptic patients. It is important to still be aware of possible drug to drug interactions affecting the efficacy and/or side effects of other medications. Please consult with the primary physician before incorporating cannabis into a medical regimen.

Human Clinical Studies and Systematic Reviews

Cannabinoids in the Treatment of Epilepsy: Hard Evidence at Last? (2017)
  •  “For the first time, there is now class 1 evidence that adjunctive use of CBD improves seizure control in patients with specific epilepsy syndromes”
The current status of artisanal cannabis for the treatment of epilepsy in the United States. (2017)
  • “Cannabinoids appear to have a broad safe and effective dosing range in patients with epilepsy”
Cannabis in the Management and Treatment of Seizures and Epilepsy: A Scientific Review (2014)
  • “The seizures in one 11-year-old girl with highly drug-resistant Lennox-Gastaut syndrome were lessened in both intensity and frequency. Awareness, postural tone and speaking ability also improved to a degree that allowed for the reduction of barbiturate dosage…”

  • “… coadministration of 50 mg/kg Δ9-THC (p.o.) with CBD plus cannabinol (CBN; both 50 mg/kg po; doses separately shown to have no effect upon MES seizures) led to a highly significant (P <0.02) anticonvulsant effect.”

  • …the consistently anti- and not pro-convulsant effects of CBD (compared with Δ9-THC), combined with the indication that its effects arise via mechanisms that are discrete from conventional anticonvulsants, support potential clinical utility of CBD…”

  • “More recent results employing CBDV, CBD’s naturally occurring propyl derivative, suggest that it may be more efficacious than CBD, although a direct side-by-side comparison is required to definitively answer this question…”

Trial of cannabidiol for drug-resistant seizures in the Dravet syndrome. (2017)
  • “This randomized, controlled trial showed that cannabidiol [CBD] resulted in a greater reduction in convulsive-seizure frequency than placebo among children and young adults with drug-resistant Dravet syndrome.”
Cannabidiol in patients with seizures associated with Lennox-Gastaut syndrome (GWPCARE4): a randomised, double-blind, placebo-controlled phase 3 trial. (2018)
  • “Add-on cannabidiol is efficacious for the treatment of patients with drop seizures associated with Lennox-Gastaut syndrome and is generally well tolerated.”
Cannabidiol (CBD) reduces convulsive seizure frequency in Dravet Syndrome: results of a multi-centered, randomized, controlled study (GWPCARE1). (2016)
  • “This phase 3 study of CBD in the adjunctive treatment of drug-resistant epilepsy in children with Dravet syndrome supports open-label study reports and provides Class 1 evidence of the efficacy and tolerability of CBD in this population.”
Cannabinoids and Epilepsy. (2015)
  • “These studies suggest that CBD avoids the psychoactive effects of the endocannabinoid system to provide a well-tolerated, promising therapeutic for the treatment of seizures…”
Chronic administration of cannabidiol to healthy volunteers and epileptic patients. (1980)
  • “All patients and volunteers tolerated CBD very well and no signs of toxicity or serious side effects were detected on examination. 4 of the 8 CBD subjects remained almost free of convulsive crises throughout the experiment and 3 other patients demonstrated partial improvement in their clinical condition. CBD was ineffective in 1 patient.”
Interactions between cannabidiol and commonly used antiepileptic drugs.
  • “…our study showed that CBD has a clinically and statistically significant interaction with clobazam and its active metabolite N‐desmethylclobazam, resulting in increased sedation in adult participants.”
  • “Because CBD continues to be studied as a potential anticonvulsant, clinicians and researchers alike should be aware of significant changes in serum levels of clobazam/desmethylclobazam, eslicarbazepine, rufinamide, topiramate, and zonisamide.”
The use of cannabidiol for seizure management in patients with brain tumor-related epilepsy. (2016)
  • “These data suggest that CBD may be safe and effective in some patients with brain tumor-related epilepsy.
Report of a parent survey of CBD-enriched cannabis use in pediatric treatment-resistant epilepsy.(2013)
  • “Sixteen (84%) of the 19 parents reported a reduction in their child’s seizure frequency while taking cannabidiol-enriched cannabis. Of these, two (11%) reported complete seizure freedom, eight (42%) reported a greater than 80% reduction in seizure frequency, and six (32%) reported a 25-60% seizure reduction. Other beneficial effects included increased alertness, better mood and improved sleep. Side effects included drowsiness and fatigue.”

Animal Studies

Cannabidiol displays antiepileptiform and antiseizure properties in vitro and in vivo. (2010)
Cannabinoids control spasticity and tremor in a multiple sclerosis model
  • “These data provide compelling evidence that CB receptors are involved in the control of spasticity in an environment of existing neurological damage, and that exogenous agonism may be beneficial.”
Cannabidiol exerts anti-convulsant effects in animal models of temporal lobe and partial seizures. (2012)
  • “We propose that CBD exerts a cumulative anti-convulsant effect; this may be achieved by a poly-pharmacological profile, with CBD simultaneously modulating a number of endogenous systems to attenuate and/or prevent epileptic neuronal hyperexcitability. Importantly, despite numerous potential targets, CBD has an excellent side-effect profile.”

Additional Educational Resources 

News from the American Epilepsy Society Annual Meeting: Cannabidiol Research Offers Hope for Seizure Disorders. (2017)
Dr. Bonnie Goldstein Interview on Cannabis Therapeutics (Video).
  • Physician Bonnie Goldstein speaks on her clinical experience as the medical director of CannaCenters where she educates patients and their family members on the use of cannabis therapy. She sees many pediatric patients with autism and epilepsy and speaks of her dosing strategies and how to perceive cannabis as medicine.
  • “And I really believe that the reason – one of the reasons that CBD is so helpful, not only because CBD, cannabidiol the compound, itself actually works to help balance some of the messages being transmitted in the brain and lessen the firing that causes the seizures, but also the anti-inflammatory effect. One of the other parts is the neuroprotective effect of cannabidiol. And remember, in a developing brain seizures are damaging. And so, having that neuroprotective property is extraordinarily important.” – Dr. Goldstein
CBD for children with Dravet’s and intractable seizures (Video).
  • Learn from the incredible stories of two pediatric cannabis patients that found success using cannabis-based medicine.
Project CBD: Cannabis & Epilepsy Resource.
  • An additional list of resources from scientific studies to relevant articles and videos
Epilepsy Foundation: Medical Marijuana and Epilepsy.