It is estimated that 50 million people around the world suffer from epilepsy and more than 3.4 million of those patients are in the United States. Although some forms of epilepsy are rare, if we take all different types of epilepsy together this disease is more common than autism, multiple sclerosis, cerebral palsy and Parkinson’s disease combined.
According to data from the WHO, the majority of patients affected by epilepsy live in low or middle income countries, and 70% of them could live seizure-free if they were diagnosed and received the appropriate treatment. But what about those patients who are treatment-resistant or don’t have access to the appropriate medication?
When thinking about epilepsy and seizures, many questions come to mind: what is epilepsy? Are epilepsy and seizures the same? What are seizures caused by? What causes epilepsy? Is epilepsy hereditary? Can epilepsy go away? How can medical cannabis help treat epilepsy and seizures? Do epilepsy and seizures qualify for the Texas’ Compassionate Use Program? We’ve got all these answers and more below.
The short answer is NO, they are similar but not exactly the same. Although epilepsy is the most common seizure disorder, not all patients who experience seizures suffer from epilepsy.
Let’s start with the basics: What are seizures and what are seizures caused by? Seizures are bursts of uncontrolled electrical activity between neurons in the brain that result in temporary abnormalities in behavior, feelings, levels of consciousness, muscle movement and muscle tone. Most seizures last between 30 seconds and two minutes, and seizures lasting 5 minutes or more must be treated as a medical emergency as they can potentially cause brain damage.
The causes for seizures are varied and include brain injury from stroke or head injury, genetic predisposition, high blood sugar, brain tumors, illnesses or infections affecting the brain (like meningitis,) neurodegenerative diseases such as dementia or autism, high fevers or psychological factors. Sometimes the causes are unknown.
When seizures present as isolated events and are caused by psychological factors rather than physiological factors, they are known as Psychogenic Nonepileptic Seizures (PNES) and are usually the result of a traumatic event. When correctly diagnosed, these can be effectively treated with cognitive behavioral therapy and serotonin reuptake inhibitors. Unfortunately they are sometimes misdiagnosed as epileptic seizures, patients receive inadequate treatment since the main cause (the trauma) is not addressed and often traditional treatment with medication is insufficient to curb the attacks.
What is epilepsy? Epilepsy is the most common neurological disorder and it presents as recurrent and unprovoked seizures in individuals of all ages. Patients who have 2 or more seizures in less than 24 hours are likely to be diagnosed with epilepsy after thorough examination. As mentioned before, when looking at what causes epilepsy the answer lies in different types of brain damage from illness or injury, dementia, autism, genetic predisposition, tumors or stroke and sometimes it’s not possible to know the cause.
Patients can identify different triggers for their epileptic seizures and design a treatment plan along with their doctor. What triggers seizures? Some common triggers are poor sleep, alcohol, drugs, illness, fever, specific foods or unbalanced diet, stress and hormonal changes (to name just a few.) Treatment options include anti-seizure medicine (such as Epidiolex,) diet therapy, surgery or electrical stimulation.
Can epilepsy go away? Yes, it has been reported that for 6 out of 10 patients, provided they receive the appropriate treatment and respond well to it, epilepsy can go away as the seizures diminish in number and intensity until they eventually completely disappear, making a huge impact in the patient’s quality of life. This is great news for patients who respond well to treatment, but what about those who are treatment-resistant or those who experience intolerable side effects derived from traditional medication? For those patients who haven’t been able to control epileptic seizures with or can’t tolerate the undesirable side effects of traditional medication, medical cannabis can be the answer they have been looking for.
In a nutshell, the cannabinoid CBD present in the marijuana plant is the key to understanding how medical marijuana helps not only treat seizures but also prevent them all together. CBD has the ability to bind with receptors in the human body’s endocannabinoid system positively affecting diverse signaling systems that might be hijacked by disease and impact the balance of excitatory and inhibitory signals which is key for normal brain function.
To better understand the process, let’s take a quick look at how seizures are produced: neurons in the brain fire electrical pulses that release neurotransmitters that encourage the next cell to either fire more excitement signals or to inhibit the continuation of that excitement signaling process. Excess firing promotes the occurrence of seizures, that’s why maintaining a balance between the two types of signals is essential for a normal brain function.
A recent study conducted by researchers from NYU’s Grossman School of Medicine identified a neurotransmitter called lysophosphatidylinositol (LPI) as being a key player in the occurrence of seizures. This molecule is in charge of connecting to endocannabinoid system receptors such as GPR55 receptors and amplify nerve signals as a regular function but when affected by disease, it not only amplifies nerve signals promoting excitement but also blocks inhibiting signals that prevent seizures, therefore creating a seizure-promoting loop. CBD can block the signals carried by LPI, effectively breaking the seizure-promoting loop and giving the nervous system a better chance to maintain a balance between exciting and inhibiting signals. By doing so, CBD in medical cannabis can help reduce the frequency of seizures and even help them disappear for good, which is a game changer for the patient’s quality of life.
For centuries cannabis has been used as a treatment alternative for numerous illnesses such as epilepsy around the world, but there was no legal access to medical cannabis in the US until recent years.
Specifically for epilepsy, the use of medical marijuana was officially authorized by the US government as a treatment option with the approval by the FDA of Epidiolex (a CBD based medicine) in 2018. Although this was great news, Epidiolex’ approval was limited to the treatment of 2 rare types of epilepsy (Dravet Syndrome and Lennox-Gastaut Syndrome,) leaving all other epilepsy patients behind. Fortunately for them, many states have included epilepsy and other seizure disorders on the list of qualifying conditions for their medical cannabis programs at the state level, giving hope to those patients who were deprived of opportunities in the past.
The Texas’ Compassionate Use Program (TCUP) was initially adopted in 2015 with intractable epilepsy patients in mind (particularly children who had no other medication alternatives.) Actually, this was the only qualifying condition for access to the program at the time. Since then, the TCUP has been extended to cover a much wider list of conditions (including all forms of epilepsy and other seizure disorders) and it’s expected to continue to evolve and expand to grant access to more Texan patients of all ages.
So the answer is YES, not only do patients suffering from epilepsy and other seizure disorders have access to medical marijuana legally in Texas, they were among the precursors and the reason for the program to be created in the first place.
It is important to note that not all marijuanas are created equal. Although CBD is present in the marijuana plant and in most forms of marijuana, patients should consult with a doctor when including cannabis in their course of treatment. Buying weed from the street or CBD oil at a supermarket or specialty store can hamper the chances for success and bring unforeseen complications. It is always best to consult with an authorized healthcare provider who can customize a treatment plan that adjusts to the patient’s age, health condition and ongoing treatment plan, selecting a compound with the most effective strains and doses and preventing any negative interactions with other medications the patient might be consuming. Also, only medical cannabis sold at authorized dispensaries has guaranteed quality, purity and transparency in terms of the exact components that go into the product (which cannot necessarily be said for over-the-counter products.)
If you or a loved one suffer from epilepsy or other seizure disorder and are wondering what the steps are to access medical cannabis as your next treatment option, you can find information here or you can contact us with this and any other questions and we’ll be happy to guide you.