What is epilepsy?
Epilepsy is a chronic condition of the brain, where a person experiences recurring seizures. It is important to note that it is a neurological disease, not a mental illness, where seizures are induced by brief disturbances to the orderly electrochemical activity of the brain. A diagnosis of epilepsy occurs when a person experiences two unprovoked seizures more than 24 hours apart. Many people can experience seizures once in their life due to a range of other conditions, such as diabetes or other heart conditions. There are also different types of epilepsies where some are age-limited and others are life-long diseases. In 2019-20, around 142,740 people live with active epilepsy, with a gender split of 52 per cent in males and 48 per cent for females. If segmented by age groups, 19,196 youth aged 0-14, 93,987 people between ages 15-64 and 29,557 people over the age of 65 live with epilepsy.
What are the symptoms of epilepsy?
Whilst epilepsy is a long-term condition of the brain, seizures are the symptom and not a disease in itself. These seizures are caused by a sudden surge of electrical activity in the brain, where the usual alternating electrical movements are disrupted, causing them to all fire at once. This results in rapid jerking and stiffening of arms and legs, as well as an alternating state of or complete loss of consciousness. They can also cause changes in sensation and feeling, such as with one’s emotions and behaviour.
Seizures can vary in terms of length, where most last within 2 minutes, however, seizures that endure beyond 5 minutes require an immediate ambulance or medical assistance. There are several types of seizures, where generalised seizures engage the entire brain and affect the whole body or focal seizures which are caused by only part of the brain. Below are the 3 main groups of seizures:
- Focal Onset Seizures – part of the brain
- Generalised Onset Seizures – both sides of the brain
- Unknown Onset Seizures – the beginning of a seizure
Focal Onset Seizures are when the seizure starts in only part of the brain, particularly a group of cells on one side, although has the capacity to spread to other areas of the brain as well. Specifically, Focal Aware Seizures are when the individual is completely awake and aware during the seizure, but cannot respond or properly react to what is happening. Focal Impaired Awareness Seizures involve the person feeling confused as their level of awareness has been distorted.
Generalised Onset Seizures are further divided into various subcategories as they affect both sides of the brain at the same time, with the ability to cause an individual to be less aware or lose consciousness. Generalised Motor Seizures can involve stiffening (tonic) and jerking (clonic), often referred to as tonic-clonic movements. Generalised Non-motor Seizures are when there are temporary changes in awareness levels, staring and other automatic involuntary movements, such as lip-smacking. The common classifications of this seizure group are absence (a brief loss of awareness and staring), tonic-clonic (stiffening and then jerking of limbs) and atonic (sudden loss of muscle tone causing the body to go limp).
Unknown Onset Seizures usually refers to the beginning of a seizure when the type is unknown or isn’t witnessed by anyone. Later on, as more information is acquired about the incident, the unknown onset seizure may be classified as either a focal or generalised seizure.
What causes epilepsy?
There are many causes for epilepsy, yet around half of the people with epilepsy still do not know the true cause of their condition. Generally, seizures occur because something has caused damage to the brain. Some of the known causes of epilepsy are:
- Head injury (such as from a motor vehicle accident, trauma or serious fall)
- Strokes or brain haemorrhages
- Prolonged oxygen deprivation to the brain (may include birth trauma, cardiac arrest, drowning or drug overdose)
- Brain infections and abnormalities (such as meningitis, encephalitis or brain abscess)
- Brain tumours
- Degenerative conditions affecting the brain (for example dementia)
- Genetic factors
When diagnosing epilepsy, doctors will first want to identify where the seizure began in the brain, whether the individual was aware or not, and if it involved movements. They will seek to understand if any symptoms can be recalled prior to the seizure or if there were any warning signs as well. Various tests including blood tests, an EEG (electroencephalogram) and brain scans such as a CT (computerised tomography) scan or MRI (magnetic resonance imaging) may be required.
Traditional treatments for epilepsy
As CBD oil as a treatment for epilepsy is quite new, most people rely on other more common methods for managing the condition. Depending on the person, there are various traditional treatments that can be taken to live easier with epilepsy. Around 60-70 per cent of individuals diagnosed with epilepsy are able to gain control of their seizures with medication. Through the prescription of anti-epileptic drugs (AED), also known as an anti-seizure medication, people may experience less frequent and severe seizures. Doctors will consider a range of factors such as the type of epilepsy, if known, the likelihood of experiencing future seizures, age, gender, general health and lifestyle, as well as other potential side effects, preferences and the cost of medication. The potential side effects caused by common AEDs are:
- Weight gain
- Skin rashes
- Cognitive impairments, such as memory or thinking problems – most AEDs cause this
- Mood disturbances, such as aggression
Other severe side effects may include:
- Suicidal thoughts and behaviours
- Severe rashes
- Inflammation in specific organs, such as your liver
Studies have shown that people living with epilepsy are more susceptible to psychiatric illnesses. The most common mental illness is depression, with a strong link to anti-epileptic drugs. Depression relates to a poorer quality of life and increased suicidal thoughts, especially for those diagnosed with epilepsy, which also has the potential to leave patients worse off, as seizure intensity can increase.
Other alternatives to medication, especially for those 30 per cent of sufferers who are unable to be treated with anti-epileptic medication, is surgical treatment and dieting, as they may help manage their seizures and overall condition.
Vagus Nerve Stimulation (VNS) is a surgical treatment that may be considered for children, specific seizures in adults and for improving the moods of epileptic adults. However, infection rates associated with VNS is relatively higher in children than adults. This method involves implanting a small medical device that sends little electrical pulses to the vagus nerve in the neck to disperse and reduce the impacts of abnormal seizure behaviour.
Deep brain stimulation (DBS) involves implanting a generator in the chest and electrodes into specific parts of the brain to send electrical pulses between the two, which may help reduce the frequency of seizures. Some studies have proven this to be a positive long-term treatment, reducing at least 69 per cent of seizures in five years after the surgery.
Ketogenic diets as a treatment are reported to be well suited towards children with severe epilepsy, who are resistant to anti-epileptic medication. However, there is less evidence to support the use of ketogenic diets in adults living with epilepsy. This treatment has been proven to provide short to medium advantages for seizure control. Although, an obstacle for using ketogenic diets as an epileptic solution for children is the gastrointestinal side effects, dislike for the diet and potential long-term outcome of decreased diets.
Medicinal CBD for epilepsy
Cannabidiol (CBD) is extracted from Cannabis sativa, a species of the Cannabis plant, and is a cannabinoid with non-psychotropic effects, which means it does not impact a person’s mental state. CBD oil for epilepsy has proven to be highly effective in reducing seizures for certain epilepsies and is neuroprotective, as it preserves brain structure and function. The search for safe compounds with neuroprotective properties has been of great importance to researchers as they can also protect against many neurodegenerative diseases, such as Parkinson’s or Alzheimer’s. Additionally, CBD has become increasingly popular over the past decade as it is a multi-target drug that has many benefits, such as being an antidepressant, anti-anxiety, antipsychotic and anti-inflammatory.
Over the past decades, many clinical trials using CBD for epilepsy treatments have been conducted to examine the potential effects of cannabidiol to manage the disease. Research and tests have demonstrated medicinal CBD’s ability to greatly reduce the frequency of convulsive seizures (tonic-clonic and atonic seizures), which are commonly seen in Lennox-Gastaut syndrome, a severe form of epilepsy, and in Dravet syndrome, which is a drug-resistant form of epilepsy.
Research published by NCBI in 2017 saw the largest study of CBD as an anti-seizure remedy for epilepsy. The open trial was conducted for exactly a year in January 2014, that first enrolled 214 patients across 11 epilepsy centres in the USA, who were aged between 1-30 years old, with severe, drug-resistant epilepsy. Participants were given a 99 per cent pure CBD oil-based liquid, with a daily dosage of 2-5 mg/kg depending on their intolerance level, up to a maximum of 25 mg/kg. This study sought to analyse the safety and tolerability of CBD, by assessing the number of average motor seizures per months, after a 12-week follow up period. A subset of 137 patients who achieved the 12-week follow-up period was analysed to prove the effectiveness of CBD, where a median 35 per cent of the group experienced a decrease in total seizures, especially with 42 people seeing a reduction in focal seizures and 32 people encountering a drop in motor seizures. Exactly 9 participants experienced no seizures in the last 4 weeks of the follow-up period. Additionally, whilst 51 per cent of patients were on clobazam, an antiepileptic medication, they also experienced a 50 per cent reduction in motor seizures. Although, they were also more likely to encounter other adverse side effects such as extreme drowsiness and fatigue. A 43 per cent median decrease in all seizures was observed in the 32 patients with Dravet syndrome and also a median reduction of 35 per cent in all seizures for the 30 patients with Lennox-Gastaut syndrome. Both convulsive and atonic seizures fell greatly for Lennox-Gastaut syndrome patients.
Another study where 607 patients were enrolled for a median treatment time of 48 weeks experienced positive outcomes, with reductions in seizures. The average age of participants was 13 years old, ranging from around 5 months to 62 years. After prescribing a median dosage of 25 mg/kg of medicinal CBD, monthly convulsive seizures decreased by 51 per cent, with total seizures rates also reducing by 48 per cent after just 12 weeks. Of the patients who experienced convulsive seizures, 52 per cent of them had seizure reductions of 50 per cent or more, 31 per cent of patients felt a reduction of 75 per cent or more, and 11 per cent became free of convulsive seizures after 12 weeks of treatment with medicinal CBD.
Does CBD help with epilepsy?
There are many types of epilepsy syndromes and seizures, all of which can have various causes or factors that can impact an individual’s treatment and quality of life. Whilst people have experienced favourable outcomes from using traditional treatments to manage their condition, there are still many who are resistant to the effects of common methods such as anti-epileptic drugs. A 2019 survey of 978 adult epilepsy patients in Australia found that over half experienced one or more mental illnesses, such as depression or anxiety. It also revealed that seizure medication had caused 89 per cent of respondents’ sleep problems, memory complications and gastrointestinal issues that each lead to a lower quality of life. Medicinal CBD has displayed beneficial results for treating epilepsy, along with many of the other side effects induced by most medications. CBD’s properties to rectify anxiety, changing moods, inflammation, trauma-related conditions, unwanted psychotropic effects and neuroprotective abilities, provide immense value to individuals living with epilepsy.
Despite the impressive findings and value of CBD for patients living with epilepsy, more research and clinical testing are also needed to prove its effectiveness for more severe forms of epilepsy. Based on more recent medical research over the past decade, there has been more evidence to support the benefits of CBD oil as a treatment for certain epilepsies. In 2018, Australia’s Federal Government eased restrictions surrounding medicinal CBD and also passed legislation, legalising the growth of cannabis for medicinal purposes. States and Territories now have their own regulations surrounding the use of legal use of medicinal cannabis. The medicinal cannabis industry continues to expand in Australia, more parliamentarians are starting to recognise its utility and how CBD oil benefits the community.