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13 min read
Sam North
With International Epilepsy Day just passing us by (on the 12th of February), we decided to take a look back at how medical cannabis treatment has added to epilepsy treatment options, the role epilepsy played in essentially forcing medical cannabis to become a legal reality here in the UK, and a look forward to what the future may hold for medical cannabis and epilepsy treatment in the UK.
International Epilepsy Day is much more than simply a day to raise awareness for the almost 630,000 people living with epilepsy in the UK (and the estimated 50 million globally). It's a day to promote understanding and support for individuals living with epilepsy on an international scale, and to celebrate progress and milestones in treatment and care.
One such milestone for UK epilepsy sufferers is the legal access that they are now afforded to medical cannabis.
Epilepsy is a neurological disorder characterised by recurrent seizures, which are sudden abnormal bursts of electrical activity in the brain. It is a complex, heterogeneous condition - meaning there are many differing types of epilepsy, all with their own varying causes and symptoms.
No two individuals' experiences with epilepsy are exactly the same, which is why personalised treatment plans are not only recommended but absolutely essential.
Epilepsy comes in many forms, and its symptoms can range from mild to severe. Some people may experience auras or warning signs before a seizure occurs, while others may have no indication at all. Seizure types can also vary, including:
Epilepsy is a condition where people often need anticonvulsant meds to control seizures. But here's the thing: more than 30% of patients don't respond well to traditional treatments and still have seizures. That's why drug regulators in countries like Canada, the UK, the US, Europe, and Australia have given the green light to administering CBD alongside existing antiepileptic meds.
The impact that this often debilitating condition can have on epilepsy patients is far-reaching, affecting not only their physical health but also their mental and emotional well-being. It can impact daily activities, relationships, and the overall quality of life of both sufferers and their loved ones.
The endocannabinoid system, or the ECS, is the largest neurotransmitter system in the human body, with researchers now theorising that it plays the role of 'master regulator' for the body's other neurotransmitter systems.
The ECS is made up of cannabinoid receptors (CB1 and CB2), endocannabinoids (cannabinoids produced naturally within the body) that interact with these receptors, and enzymes that both synthesise and then degrade the endocannabinoids.
One study, titled "The Interplay between the Endocannabinoid System, Epilepsy and Cannabinoids", showed that epilepsy has been associated with ECS dysfunction and, in particular, neuroinflammation.
Cannabis also produces cannabinoids (called phytocannabinoids). Just like our own endocannabinoids, these phytocannabinoids also have the ability to interact with the ECS (among other systems in the body). The two phytocannabinoids most researched for their medical applications are tetrahydrocannabinol (THC) and cannabidiol (CBD).
CBD has shown to be particularly promising in reducing the frequency and severity of seizures, leading to widespread interest in its potential for epilepsy management. THC may also have anticonvulsant effects, but its psychoactive properties make it less attractive as a treatment option. CBD is totally non-psychoactive, making it a more viable option for patients.
While it may not be as potent of an anticonvulsant as CBD, THC has demonstrated a wide range of therapeutic effects that can enhance the overall quality of life for individuals with epilepsy. Notably, research indicates that THC offers neuroprotective properties, alleviates inflammation and pain, enhances sleep quality, and even exhibits some antidepressant and antianxiety characteristics.
Epilepsy was the catalyst for the medical cannabis revolution in the UK.
After a series of high-profile cases of children with severe epilepsy being denied access to medical cannabis treatment despite its proven effectiveness, with some being forced to travel abroad to access it, the UK government finally began discussing the possibility of legalising medical cannabis.
The impact of grass root advocacy and the tireless work of patient groups and families with epileptic children really can't be overstated here. Without their efforts, it's difficult to imagine that we would be where we are today and that patients suffering from not just epilepsy, but a range of conditions, would have access to medical cannabis products.
After months of parliamentary debate and petitioning, just two medical cannabis for epilepsy products were originally approved by the NHS, one of which was specifically designed to help reduce epileptic seizures - Epidyolex.
In November 2018, medical cannabis was, to the surprise of many, legalised in the UK. But it came with some major restrictions.
Only specialist doctors are allowed to prescribe it, and less than 1% of eligible patients can receive a prescription through the NHS, and the financial assistance that the NHS affords. Right now, the NHS currently only covers the cost of cannabis-based medical prescriptions (CBMPs) prescriptions for three specific health issues: epilepsy, multiple sclerosis (MS), and chemotherapy-induced nausea and vomiting.
It gets even more complicated, as only two rare forms of epilepsy, Lennox-Gastaut syndrome and Dravet syndrome, are eligible for NHS treatment with medical cannabis. There are other avenues that patients with different forms of epilepsy (and a wide range of unrelated health issues) can take to access medical cannabis products, such as private clinics like Releaf.
There is also a certain amount of optimism in the medical cannabis community that these NHS restrictions and limitations will change as medical cannabis becomes more widely accepted and understood.
But, as it stands, the overwhelming majority of CBMP prescriptions come through private clinics.
At this point, it is important to point out that medical cannabis shouldn't be seen as a cure-all for epilepsy or any other condition. And, while it has shown promising results in managing seizures and improving the quality of life for many patients, it may not work for everyone. The National Institute of Clinical Excellence (NICE) has called for research proposals to increase our knowledge in this area because, for many conditions, medical cannabis has not been fully tested in comparative randomised controlled trials in large numbers of patients.
Above, we briefly mentioned one study looking at CBD's anti-seizure effects, but there is a wealth of evidence to suggest that medical cannabis can have far-reaching therapeutic benefits for epilepsy patients. Let's dig into some of the other research and see what patients who have taken medical cannabis for epilepsy have to say.
"Long‐term safety and treatment effects of cannabidiol in children and adults with treatment‐resistant epilepsies", a paper from 2018, is a great starting point. This literature survey explores previous studies on the application of CBD in the management of epilepsy. The results show clearly just how effective CBD can be in reducing seizures in patients suffering from various types of epilepsy, including Lennox‐Gastaut syndrome, Dravet syndrome, febrile infection related epilepsy syndromes, and others.
CBD treatment reduced the average monthly convulsive seizures by 51% and total seizures by 48% at 12 weeks, and these reductions continued through to the end of the study after 96 weeks. Only 11% of participants reported no seizure control effects at all.
An earlier study that was not included in the 2018 paper came to similar conclusions. The results show that:
"CBD-enriched extracts have shown promise in improving seizure control in patients with specific epilepsy syndromes. However, further research is needed to determine the direct action of CBD and its potential interactions with other medications."
That last sentence is important.
There is still a lot we don't know about medical cannabis, and it's not as simple as replacing traditional medication with CBD or another cannabinoid. But the progress that has been made so far is encouraging, and with medical cannabis slowly becoming a legal reality not just here but globally, the access that researchers are afforded to this plant will only increase, and with it, our understanding of its potential.
When it comes to epilepsy patients who have their lives changed by medical cannabis treatment, we can't overlook the case of Billy Caldwell. Billy's mother, Charlotte, made the decision to seek out medical cannabis treatment for her son after his multiple daily seizures became unbearable. After travelling to the US and seeing positive results from CBD oil, and then to Canada to continue treatment, they returned to the UK and were immediately met with resistance from both immigration officers at the airport and the Home Office.
The CBD oil that Billy had been prescribed in Canada was confiscated at the border, leading to a highly publicised legal battle to have it returned. Billy's life-threatening seizures unfortunately reappeared within a few days of his medication being seized at the border, but after much public pressure and media attention, the Home Office issued a special licence for Billy to receive his CBD oil treatment. In the last three years, Billy Caldwell has suffered none of the devastating seizures that once needed life-saving medical intervention.
This is just one of many stories that highlight the very real and positive impact of medical cannabis treatment for patients with epilepsy. As more research is conducted and understanding grows, we hope to see more patients like Billy have access to the life-changing treatment they need.
Can we predict the future?
Of course not, but we can make some informed estimations based on current trends and research.
As medical cannabis continues to gain acceptance globally, an exponential number of clinical trials are being conducted to explore the potential of cannabinoids in treating a range of health conditions. While epilepsy has been one of the most researched areas so far, there are still many avenues that researchers are exploring.
One of the more recent studies, from just last year, provided new insights into the mechanisms by which medical cannabis can reduce seizures in patients with epilepsy, stating:
"CBD's mechanisms of action in epilepsy include modulation of the endocannabinoid system, regulation of neurotransmitter release, and reduction of neuroinflammation."
With this ever-growing body of research, there is hope for even more effective, personalised cannabinoid therapies and tailored treatment plans for epilepsy in the future.
Yes, currently, only certain types of medical cannabis are legal for prescription in treating epilepsy through the NHS in the UK. Specialists working with private medical cannabis clinics can prescribe more options, as they have legal access to a larger range of products.
It's important to consult with a medical professional before starting any new treatment.
As mentioned earlier, more research is needed to fully understand the potential interactions between medical cannabis and other medications. As cannabis is processed by the liver when taken orally, it does have the potential to interact with other medications metabolised by the same enzymes.
That depends on what you are prescribed. Most CBMPs prescribed for epilepsy are CBD-based, which is totally non-psychoactive. However, some CBMPs may contain small amounts of THC, which may cause mild psychoactive effects in some individuals.
Again, it's important to consult with a specialist doctor who is experienced in prescribing CBMPs for epilepsy and discuss any concerns before starting treatment.
International Epilepsy Day is an important reminder of the ongoing struggles faced by those living with epilepsy and their families, as well as the constant need for research and innovation in treatment options. As we continue to learn more about the potential of medical cannabis, it's clear that this plant has a potentially crucial role to play in improving the lives of epilepsy patients.
But while progress has been made, there is still much work to be done regarding legal access here in the UK, and further research globally. It's important for us to continue advocating for the recognition and acceptance of medical cannabis as a viable treatment option for epilepsy and other health conditions. Together, we can make a difference in improving the quality of life for those living with epilepsy.
Releaf understands the importance of medical cannabis in treating various medical conditions. With our tailored monthly packages, specialist consultations for medical cannabis, and a unique medical cannabis card for protection, you can access the treatment you require without worrying about the stigma.
It is important to seek medical advice before starting any new treatments. The patient advisors at Releaf are available to provide expert advice and support. Alternatively, click here to book a consultation with one of our specialist doctors.
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Am I eligible?Sam North, a seasoned writer with over five years' experience and expertise in medicinal cannabis, brings clarity to complex concepts, focusing on education and informed use.
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